Latest / Straumann® ProTalk / Just because you can doesn't mean you should: Dr. Shakeel Shahdad on clinical judgment in the AI era

Transcript

Just because you can doesn't mean you should: Dr. Shakeel Shahdad on clinical judgment in the AI era · Straumann® ProTalk

0:00
How do you navigate this tension between you knowing basically what
0:03
could be done, but then also really putting the patient in the center and
0:07
doing what's right for the patient?
0:09
This is probably the most difficult thing to navigate.
0:12
Biggest courageous thing in judgment in clinical dentistry is to know I can
0:16
do it, it's possible to do it, but it's not the right thing for this patient.
0:20
No matter how digital, no matter how automated dentistry is
0:24
gonna become, it will always be dependent on the human judgment.
0:28
And that principle, we just can't break away from that.
0:46
So welcome to Straumann ProTalk.
0:47
Welcome to The Pulse of Dentistry.
0:50
My name is George Raeber, and today I'm very honored and pleased
0:53
to welcome Professor Shakeel Shahdad here with us, in Basel.
0:56
Welcome, Shakeel.
0:58
Thank you very much, George.
0:59
It is a great pleasure to be here and what an honor.
1:02
Thank you.
1:03
So Shakeel works at the intersection of many different disciplines: restorative
1:08
dentistry, implantology, periodontics, but he's also very versed in digital.
1:13
He's working at university, he's working in a private practice in a
1:16
hospital, and a conversation with him will allow us to have a very holistic
1:21
view at the state of dentistry today.
1:25
And today's dentistry is becoming faster, more digital, substituting some of
1:30
clinicians' decision potentially with AI.
1:34
But we believe that, managing technology is maybe not the most
1:37
complex topic to be done right now.
1:40
It is about clinical judgment.
1:42
So what to do, what not to do, and when to do the things.
1:47
And this is exactly what we would like to dive into today with you, Shakeel.
1:50
So we would like to start with actually learning about your
1:53
journey, how you built your judgment.
1:56
Then we will look at how important and indispensable good clinical judgment
2:00
is for complex restorative cases.
2:04
And then last but not least, we would also like to dive into the topic of education,
2:08
so educating good clinical judgment for the generation to come, which will
2:13
definitely be active in an era where there is even more digital tools available.
2:19
So stay tuned.
2:20
We will learn something today.
2:23
Now to start, Shakeel, who are you in just one minute?
2:31
At heart I am a restorative dentist, and as a restorative dentist, I
2:37
like looking at the bigger picture.
2:40
And I think the, and, this desire to constantly learn, that has been
2:46
a great, my whole life journey has been about learning things.
2:51
my passion, is to help patients with complex multidisciplinary
2:56
needs, rehabilitation, is to help youngsters develop that
3:01
judgment- that you talked about.
3:04
and, along the way, if, as a teacher, as a trainer, if you can leave your legacy
3:10
with the next generation, that's a task fulfilled really and that's who I am.
3:18
So let's dive a little bit into your quite interesting journey, your life journey,
3:23
and also your professional journey.
3:25
So you've, actually been from, very different places.
3:29
I think, you started in, in Kashmir, then you went further south in, in
3:34
India before you, came to, to Europe, I think to, to Belfast first, then
3:40
further, stations in, the UK, so Swansea.
3:43
Then you went to Dubai.
3:44
Yes.
3:45
Came back to Newcastle, and finally ended up in, in London, now
3:48
having, let's say, a dual role in hospital but also at university,
3:53
plus you have a private practice.
3:56
Now to me, this life journey is not just about, different geographical points.
4:00
It's really about seeing very different cultures, probably also very different
4:04
patient needs and patient pools- Yeah
4:07
and patient expectations.
4:09
What I would wonder is, which of those transitions have shaped you most and, why?
4:18
it's, a pretty tricky question to answer because there isn't a
4:21
simple answer to that question.
4:24
like you, summed up, it's been a long journey.
4:28
I s- I was born in Kashmir, spent my, early years in Kashmir till the age of
4:33
18 and, sitting here in Switzerland, Kashmir, we, we call it the heaven and
4:39
earth or the Switzerland of the East.
4:41
Yeah.
4:43
so I was born around nature, the mountains, the lakes, the natural
4:48
beauty and stuff, and, you would relate to that sitting here in Switzerland,
4:54
with these things with, the mountains.
4:57
They teach you something.
4:58
They teach you humility.
4:59
They teach you- Exactly
5:00
patience.
5:01
They teach you there's a scale,
5:03
Insignificance
5:04
… and significance, right?
5:06
and then, getting my, dental education in India was a big change for me as well
5:12
in terms of moving from a climate which is very similar to Swiss climate into,
5:19
first time experiencing heats of 40, 45 degrees is it had- It's a big difference,
5:25
yeah.
5:25
Exactly.
5:26
Massive difference.
5:27
A body shock, shall we say.
5:31
moving to Belfast was something, a, big change for me in terms of,
5:39
learning belfast in 1995 was just coming out of their own troubles-
5:44
that we had in Kashmir as well.
5:46
So resilience was something that, that comes to mind.
5:50
But I think what I learned most in Belfast was, and that happened literally within
5:55
the first week of me, attending the dental school there, was my perception
6:00
of learning changed what I mean by that, back home there is a very hierarchical
6:06
system, and suddenly I realized the relationship between the teacher and the
6:12
student was in- completely different.
6:14
Was different.
6:15
The barriers came down.
6:16
And suddenly when you have that sort of environment where there are no, barriers
6:23
between a teacher and a student, the learning environment becomes completely
6:27
different, enriching, very nourishing.
6:30
And that's what I I try my best to emulate that since then because
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I've experienced both a hierarchical system where you gotta be very
6:41
careful what you say to the teacher.
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What you say.
6:43
Yeah.
6:45
And, a system where, nothing is too stupid.
6:49
Because then you can express yourself.
6:52
You learn, yeah.
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you open up, there are no boundaries to learning, and I think that's a
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wonderful environment to learn in.
7:01
Dubai was a, When I went to Dubai, I thought, "This is it. I've, done enough."
7:07
You're going to stay there.
7:08
I bargai- I've got more than I had bargained for in the UK." And then,
7:11
very quickly I realized this is not me.
7:15
this is not where I want my life to be.
7:16
This is not where I want my career to be.
7:18
But what it did give me was time to reflect, which is quite important
7:22
in life, and time to focus on what I really wanted to do.
7:26
I, missed those, complex, multidisciplinary patients.
7:33
I missed that interaction amongst colleagues and experts in the field.
7:38
So that's when I said, "No, I gotta go back." And that was
7:41
like being on the crossroads.
7:44
it was a time when I had to take, either carry on that route and regret maybe
7:50
10, 15 years later, or take a really risky decision and decide to go back.
7:54
And I'm really glad I did that, because I don't think I could have
7:59
had a, more fulfilling, career, professional career and personal car-
8:05
personal life if I hadn't done that.
8:07
So it was certainly a moment which allowed me to, see things clearly.
8:13
And then I came back to UK and entered into the formal training in Newcastle.
8:18
And then the big pivotal moment for me was my, when I took my position in, in,
8:23
in, London, and I've been there now since twenty, twenty-one years, and it's opened
8:27
up, different avenues, different doors.
8:31
and, I couldn't be happier.
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Very beautiful and strong story.
8:36
Also this, experience of seeing different ways to teach and also having the chance
8:42
to do mistakes versus, a very hierarchical system- Yeah, that probably is,
8:48
handicapping learning quite, quite a bit.
8:51
How about the differences in, dental treatments that, you were seeing?
8:56
So you were at university in India, then you came to Europe, then Dubai.
9:01
Was there any moment where you really said, "Okay, now
9:03
I see dentistry different"?
9:07
I think again, I would say this was, primarily th- being in
9:12
restorative dentistry, when you start looking at dentistry beyond
9:18
being a procedure, yeah, right?
9:20
y- it's, not just the procedures that we carry out, but
9:24
it's, the holistic approach.
9:26
And, the changes we can make to patients' lives is what really makes
9:30
dentistry- What drives everything.
9:31
What drives everything.
9:33
so that was the pivotal moment.
9:36
dentistry, when I qualified way back in 1992, dentistry in, in India
9:43
was very different at that time.
9:45
we had a-- we got a lot of experience, hands-on experience.
9:49
the theoretical knowledge was there, and we used to read
9:53
American textbooks and stuff.
9:54
So when I came to Belfast, my theoretical knowledge was solid.
9:59
A super
9:59
level,
9:59
yeah.
9:59
Yeah.
10:00
but there was a lot of the stuff that I had read in the
10:02
books but hadn't really seen it.
10:04
And-
10:04
So because there was no access to those kind of,
10:06
treatments or- Exactly.
10:07
And coming to Belfast was the opposite.
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I immediately started seeing all those things, all those procedures,
10:14
all those techniques, all those materials, instruments, and stuff.
10:18
But on the other hand, the, my, the fellow students there, they were amazed
10:24
at the theoretical knowledge I had.
10:26
So it was like I brought the theoretical- It was a good combination for that.
10:28
It was a great combination.
10:29
Okay.
10:29
I brought the theoretical knowledge with less of the clinical exposure, whereas
10:33
they had the clinical exposure but were weaker on the theoretical knowledge.
10:36
It was interesting.
10:37
It was really fascinating.
10:39
And I think the, other thing that really changed, in terms of when you're saying,
10:46
if I focus very specifically on implant dentistry, one of the key moments
10:51
in my own career, which is, which I always say was the watershed moment
10:55
in m- how I have practiced implant dentistry since, was, before I joined,
11:03
finished my training, before joining, London, I came to Bern for a month.
11:10
And in 2005.
11:11
and, implant dentistry was still particularly implant dentistry and
11:17
aesthetic zone and stuff was, y- was, a lot of the stuff we were
11:21
doing, we were doing it without realizing what the consequences really
11:25
are and why things are happening.
11:27
There was very little understanding at that time.
11:29
And spending a month with, at, Bern, particularly, with Professor Buser
11:36
and Professor Von Arx, was when I actually experienced the, tissue
11:42
level implant for the first time.
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And up, up until that stage, my training was around the bone level
11:50
design implants, particularly the Brånemark implants and stuff.
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So tissue level implant, for us in the hospital system in the UK
11:57
was a very distant implant, and it was always looked at But having a
12:03
very, different, concept, wasn't it?
12:07
Spending that month with Danny changed a lot.
12:11
understanding of really, nuances of implant dentistry and, learning
12:19
the GBR from the best, and working with him and Tom was just
12:27
A, pivotal moment in my career because that really triggered that complete change
12:32
in my approach to implant dentistry.
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So I always tell Danny, I say, "Danny, I owe you a lot because that, that w-
12:38
very brief encounter w- had a massive impact on my whole career and how I have
12:45
progressed in implant dentistry." The funny thing is that, when I went back
12:50
to, London and started my, my, my post there, and, I had to make a, a choice
12:59
within the department which was already functioning in terms of the selection
13:03
of implant system that I would use.
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so to cut the long story short, I was left with very few choices and, then, Straumann
13:13
propped up in that choice as well.
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I said, "That, I'm happy with that." And they were looking at me thinking,
13:18
"What's wrong with this guy?" Why?
13:20
I said, "Listen, absolutely fine with Straumann.
13:22
That's what we're gonna go with." And because I was brought in to
13:25
set up the post-graduate program.
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In 2005, you only had tissue level implant.
13:30
Yeah?
13:31
Yeah.
13:32
So I was quite happy with- It was
13:33
another two years before bone
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level came out … it was like in 2006 I got the limited market
13:37
release on the bone level and stuff.
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So I started my journey with tissue level, and soon after that, the,
13:45
world started to move away from tissue level into bone level.
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So I was then fighting against the tide.
13:53
Yeah?
13:53
Because I haven't left tissue level.
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I still place tissue level in aesthetic zone, and we've always done.
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I did a little bit f- a little bit of dipping my fingers and toes back into bone
14:03
level design, and then I looked back at my cases, I thought, "Hang on a second.
14:07
I'm-- We're getting much better results with our tissue level.
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Why am I moving back to bone level?" So the last 20 years, it's more or less been,
14:17
I've, at times have felt isolated Because I felt like I'm going against the grain.
14:23
And to convince my own colleagues at that time that this is the
14:30
way forwards, you know- Was
14:31
very difficult,
14:31
I guess
14:32
it's difficult.
14:32
And you have to prove yourself, especially when you're in a new place.
14:37
You have to prove yourself.
14:38
You have to prove the effectiveness.
14:40
You have to demonstrate, why it's making a difference for them to then
14:45
be able to say, "Yeah, we're with you." And I'm proud that we, never, changed,
14:52
and it's interesting now we're going through the next cycle of- Exactly
14:57
generation four, and everybody is now starting to talk about
15:01
tissue level because we're now seeing long-term implications.
15:05
So yeah, that's, that was a big defining moment.
15:09
Very interesting to, to also see, how these, waves and decades, they sometimes,
15:14
they, there is like a pendulum that-
15:17
Yes
15:17
maybe with acquiring new lo- knowledge, then you also understand better,
15:21
concepts and what fascinates me also in, with your career is that you
15:26
acquired a very broad, set of knowledge.
15:29
So if you look at very successful clinicians over time, they often
15:33
start to specialize in, one particular area and going very deep.
15:37
You choose a, different route somehow.
15:39
And, so you're a restorative dentist, you're an implantologist,
15:44
you're a periodontal, let's say trained, surgeon, so you are in
15:49
endodontics, you are very digital.
15:52
Why did you actually choose those, this integration versus a more,
15:57
let's say, focus on a specific, let's say work in, dentistry?
16:03
Yeah.
16:05
The, UK system is quite unique in that sense.
16:09
So in fact, when I went to U- UK, I, I, did a master's program, and,
16:17
I didn't realize that there was something called as restorative dentistry.
16:20
Because the rest of the world, I was into, there's a perio, there's
16:23
pros, all those mono- what we call the mono specialties in the UK.
16:27
but UK is very unique, that there is those, there are those individual
16:31
programs, but then there is a five-year training program, which is
16:34
an integrated program- restorative dentistry, which brings perio, and
16:38
pros, and endo under one umbrella.
16:39
All together.
16:41
it's about really, rather than small pieces of puzzle, that is the perio,
16:47
the pros, and the endo, it, really- Look
16:49
at
16:49
it holistically … brings the larger picture holistically- Yeah … together
16:52
and, paints a bigger picture.
16:54
And that breadth, how often do you actually see patients who
17:00
come in boxed in a specialty?
17:02
Exactly,
17:03
yeah.
17:03
Yeah.
17:03
It's very rarely.
17:04
Yeah.
17:05
So the oversight, I think, that the restorative as a specialty gives you,
17:10
and this, is quite a trend these days.
17:12
I meet a lot of colleagues around the world who try to specialize in two,
17:15
who try to do prosthodontics and perio or prosthodontics and oral surgery,
17:19
and I think that probably is driven also by implant dentistry made it,
17:24
a, bit, more desirable because you need the knowledge of both.
17:29
so it was very much a UK driven thing, and, with the more comp- the
17:36
more complex the case gets, the more integrated the care needs to be.
17:41
You
17:41
need to think integrated anyhow, so- Yeah … otherwise you cannot solve it.
17:43
and as a
17:45
restorative, dentist in the UK, most of the work that we do
17:50
is around very complex cases.
17:52
it's, people with, hypodontia, anodontia, head and neck cancer, advanced tooth wear
18:00
and, so th- those advanced, big dental traumas and stuff, and they, these sort
18:06
of patients you cannot treat in isolation.
18:09
they need to have the broader overview.
18:11
Now, and it probably from a health economic point of view, if you look at it
18:16
from a health economics, and maybe that was the main driver in the UK at that
18:19
time, for the National Health Service, you're getting three for one in here.
18:26
Yeah.
18:26
Okay.
18:26
Rather than having to recruit or employ three- Three different … different
18:30
specialists … specialties.
18:31
You just extend the training program for three to five, and you
18:34
just have one person who will give you the, dovetail, dovetail, the
18:39
perio approach and endo into it.
18:41
but yeah, it's very much very broad, very holistic, and, it,
18:46
it's, it fits in quite nicely with particularly with implant dentistry.
18:50
And, as implant dentistry became more and more mainstream, I, don't,
18:55
I never look at implant dentistry as-
18:58
Isolated
18:58
… isolated.
18:59
It is, it, essentially is one of the modes of replacing teeth.
19:07
And one of the modes of providing that, the function, the aesthetics,
19:12
the smile for the patient, not just, n-not every patient is
19:16
the right patient, for implants.
19:21
let's stay with this patient perspective for, a second because what, I think is,
19:27
is very important to understand that the patient, as you said, doesn't look
19:31
at the treatment compartmentalized in different specialties, or the patient
19:35
actually wants, the final result and hopes to go through this sequence of
19:39
steps, in a, good way, and then actually is looking forward to, to re-socialize,
19:46
to have the smile that they wish for.
19:48
Now, on the contrary, so in many medical, fields, because of the complexity, we
19:55
start to specialize, and we start to, have specialists for smaller and smaller
20:00
segments of a full treatment chain.
20:02
Now, you somehow are able to provide a much more holistic, let's say,
20:07
treatment to patients, probably also in your, clinic, because you can, go
20:12
through the different specialties, do a lot of, things yourself, implants as
20:15
well as the restorative part, if there is, let's say, endodontics needed.
20:20
so when you look at this difference, your broad training, what does it help to see
20:25
where maybe a more isolated system or group of people wouldn't, would miss?
20:33
I think more important than the execution of treatment is the judgment bit, the,
20:43
assessment and the diagnosis bit, and then being able to, put together the
20:49
prognosis from each aspect to drive and come to that final conclusion-
20:55
for what is right for this patient.
20:57
And I think that is a bigger thing.
21:00
Yeah.
21:00
The, then the execution comes later on.
21:02
You've got to get the diagnosis right- and have a treatment plan right before
21:06
you come to execute the treatment.
21:08
Often what happens is, as you said, we get more and more
21:11
specialized in a certain field.
21:14
So your, identification of the problem, o- is often correct, and, you can deliver
21:21
and optimize the bit of the treatment that you're good at, but you may
21:24
destabilize something else along the way.
21:27
Does that make sense?
21:28
Yeah, it makes sense.
21:29
So-
21:29
Because things, you know-
21:32
One tooth can have three different elements of diseases or problems.
21:37
It can have an endodontic problem, it can have a periodontal problem,
21:40
it can have a prosthodontic problem.
21:41
How does one separate the three?
21:44
It's still the same tooth.
21:45
It's still the same tooth.
21:46
Yeah.
21:46
Yeah.
21:47
Patient, y- and, more complex the problem becomes, more, joined
21:52
up these things need to be.
21:54
So the, broader restorative view, having the surgical or the periodontal and
21:59
the prosthodontic, knowledge really helps you evaluate in terms of what
22:06
is right for this patient rather than what is right for this tooth often.
22:10
So where do you see in, today's dentistry, maybe with the different
22:14
system than the UK has today, also break, a breakdown of this chain of,
22:19
let's say, take the right decision for, let's say that, that patient.
22:23
Where, does it most often happen?
22:26
so first of all, if you're, if you don't have the sort of same system as we
22:30
have in the UK or if you're not dually trained, then you need the right team.
22:36
And in that team, you need those components.
22:39
You need an endodontic input, you need a periodontal input,
22:42
and a prosthodontic input.
22:43
So once you're working in a interdisciplinary team, then
22:48
the most important thing is the trust- between the individuals.
22:53
trust in their judgment and trust in their skill set.
22:58
And if that trust is not there, then things don't work out.
23:00
Things go wrong,
23:01
yeah.
23:02
I work very closely with, because I w- deal with kids and, patients with
23:08
congenitally missing teeth, so I work very closely with, I run a clinic every
23:13
month, full day clinic with my orthodontic and pediatric dental colleagues.
23:16
Sure.
23:16
So we do a multidisciplinary clinic every month.
23:20
we have in fact four a month, and we, see kids from the age of nine, 10,
23:26
11, and we plan them together and they go through their treatment journey,
23:30
and then we, I pick them up later on in life when we need to restore them.
23:35
but what is the most fundamental thing in my team with my orthodontic and
23:40
pediatric colleagues is, trust, that I know that, if we agree on something,
23:45
hey, this is what should be the right…
23:47
And we have some unbelievably… You should come someday.
23:51
the, clinic is my most favorite clinic because the discussions
23:54
we have amongst the trainees and, the team is just fascinating.
23:59
And One thing that I've learned, I always tell my trainees, there is no textbook
24:04
that's gonna teach you what you're gonna learn at this clinic, because
24:07
there isn't a textbook sometimes how to deal with those clinical situations.
24:12
I said, "What you need to be thinking about is out-of-box thinking, yeah?
24:17
come up with some ridiculous ideas which you think, but then let-
24:21
drop it in the team and see And
24:23
let's discuss it.
24:23
Yeah.
24:24
Let's see whether orthodontically that is possible.
24:26
And I always tell my trainees, they sometimes get, get a little bit ahead
24:29
of themselves, say, "Oh, but we can't do this because the orthodontist won't
24:32
be able to move this tooth here."
24:34
I say, are you the orthodontist?" They say, "No." I said- So let's the
24:37
orthodontist, to decide for
24:40
this, yeah you think what is best for you from a prosthetic restorative
24:43
point of view, and then let's put this question to the orthodontist, because
24:47
that's how a team should work, and you build on each other's strengths.
24:51
Excellent.
24:51
So if the trust isn't there-
24:52
Then it doesn't work.
24:53
Yeah.
24:54
Yeah
24:54
… if the competence, and you can't trust their ability and skill to
24:58
deliver that- then of course that
25:00
breaks down.
25:00
Then it will break
25:00
down.
25:00
Yeah.
25:01
Yeah.
25:01
Perfect segue to, let's say, this, next, part of our discussion.
25:06
It's about, clinical judgment in complex, oral rehabilitation cases.
25:10
So you're not only working in clinics, university, and hospital,
25:15
but are also doing a lot of research.
25:17
And with this, you acquired a lot of knowledge on biological principles.
25:21
fascinating studies on, cell, tissue interaction with
25:25
surfaces, immune reactions.
25:28
And, if you combine all of this, I believe that you can really do,
25:32
magic in, some of the patients.
25:34
But there might also be a big gap between what could be done and what
25:38
you might, in an ideal case, want to pursue as a, as a treatment versus
25:42
what's right for that specific patient.
25:45
And, a specific patient comes with a unique bag of maybe historical things,
25:51
be it disease, be it comorbidities, but also, financial means, what can be, done.
25:58
So how do you navigate this tension between, you knowing basically what
26:03
could be done, but then also really putting the patient in the center and
26:07
doing what's right for the patient?
26:11
this is, probably the most difficult thing to navigate and
26:26
restrain is not easy Restrain yourself.
26:26
Yeah.
26:26
Yeah.
26:26
look, we're trained as clinicians.
26:26
We're trained to intervene, and that's a, a subconscious thing.
26:33
knowing when not to treat is the biggest fundamental, biggest courageous thing
26:42
in judgment in clinical dentistry is to know I can do it, it's possible
26:47
to do it- But I will not do it
26:48
but it's not the right thing for this patient.
26:49
Yeah.
26:50
And that takes experience.
26:53
but you also need to be prepared to say no.
26:57
Modern dentistry, we can do anything.
27:00
Yeah, a patient comes in and says, "Oh, I n- need an implant, but I've been
27:03
told I don't have bone." I said, listen, building bone is not a problem today.
27:07
We can build bone anywhere as much as we want." The question isn't about can
27:12
we build bone, the question is about are you the right patient for that?
27:17
And you already li- you know, outlined all these things, whether it's the finances,
27:21
whether it's the patient risk, and all those little factors that come into play.
27:25
And yeah, you're right.
27:26
Patients, they come in with problems.
27:29
They have a lot of baggage with them.
27:31
They don't necessarily come with just the dental problems.
27:34
Exactly.
27:35
There is, these … U- unfortunately, I get to see a lot of failures.
27:43
and that's what happens.
27:44
as, implant dentistry became mainstream and more and more dentists start to place
27:49
implants, I don't get a referral for a simple, "Hey, here's a missing molar.
27:53
Can you place an implant?" Those days are gone.
27:56
They, More than 10 years ago.
27:57
Someone
27:57
else will do that, yeah.
27:58
Now what I get is, aesthetic failures, multiple implant failures, d- dentistry
28:04
done in, medical tourism, dental tourism, and those sort of cases.
28:09
And these are, challenging situations because, patients have already sometimes
28:16
even lost trust in dentists and dentistry.
28:20
And, they've had failures, they've had disappointment.
28:23
They haven't smiled sometimes for years.
28:25
They've been in pain.
28:28
as they s- say, trust is often the first restoration you need to give-
28:33
back to the patient.
28:34
You need to rebuild that trust with those patients.
28:37
So knowing when to say no and knowing when it's not the right,
28:41
even though you, know- You
28:43
could
28:43
do it … you could do it.
28:44
Yeah.
28:44
Yeah.
28:44
Yes, you can place an implant, but knowing that maybe not, if
28:48
not no, but at least not yet.
28:50
Not right now.
28:51
Not right now.
28:52
Yeah.
28:53
And that's the difficult bit.
28:54
And to teach that to the younger clinicians and younger generation
29:00
is an important task that is, our responsibility, to some
29:05
extent, is to teach them that.
29:07
Because it's fast-paced, fast-paced life now.
29:10
Like you said, everything is moving fast, fast.
29:12
And h-
29:12
how do you do it?
29:13
Because, there is such a inclination to action.
29:17
You Now you're, trained, so I can just imagine, a young clinician sees a patient,
29:22
and actually he or she would know what to do because, there was a training.
29:28
But now, you need to restrain yourself.
29:30
How do you teach this?
29:31
Because it also takes a lot of, I would say, confidence to say, yes,
29:36
I maybe could do it, but no, this is not the right patient, and, I'm not,
29:42
maybe I'm disappointing the patient." Yeah.
29:44
And how do I deal with that?
29:47
when I'm teaching in the hospital environment, I, you know- I would always
29:53
try and, I try and instill curiosity in my trainees, and, if they can't see
30:00
it, I'll probe more questions, and I'll try to make them think about the, con-
30:05
consequences and the complications.
30:07
Because if they can see that, then they can step back.
30:10
Often as I say, take a step back and just look at the bigger picture.
30:14
Don't just think s- small-- short term, think longer term.
30:18
Think of the consequences.
30:19
Think what if.
30:21
Yeah.
30:22
because the digital tools, w- every case we do is digitally planning and stuff.
30:28
planning, we may have the tools, but if you don't know how to plan and if you
30:33
don't know what you're planning for-
30:34
Then it's,
30:35
Everything fails.
30:36
Yeah.
30:37
It's
30:37
a bad plan.
30:37
Yeah.
30:37
It's a bad plan, exactly.
30:39
So really, giving space to the young trainees, giving them space and, making
30:46
them think and then helping them, connect the dots, and then gradually that, luckily
30:52
we have them over a five-year period.
30:54
So five years is a long enough period to kind of-
30:56
You can train that muscle
30:58
To, to, to mo-- Exactly.
30:59
Yeah.
30:59
Exactly.
31:00
And that is, what is fascinating is really, and, as I said, to see them, over
31:07
the period of few years and, if they can perform then a, plan, a case, and deliver
31:12
that procedure, which they couldn't have done a year ago or two years ago-
31:17
That's all of a sudden you feel- It's a progression that they're
31:19
doing One feels fulfilled.
31:21
Yeah.
31:22
We're, getting somewhere here, and we, me as a trainer is "Okay,
31:27
we're on the right path. We're moving in the right direction."
31:30
They're on a good way to actually then-
31:32
Yeah
31:32
… decide for themself.
31:33
Yeah.
31:33
So a lot of these procedures are elective, and, how much of the work
31:38
that you have to do with the patient is actually less of a medical work, but
31:43
may- maybe more of a psychological work that actually, to bring across those
31:47
kind of, discussions, maybe that's you came to me with a certain expectation
31:52
of what to be, doing with my, smile.
31:56
But I have to tell you, it's maybe not the right thing for you.
31:58
It's, it's, it's not, let's say a typical discussion that you will
32:03
have on a, knee or hip implant, but probably much more in, in dentistry.
32:08
again, a very difficult decision, right?
32:11
Because often patients come in and s- a lot of the times patients who come to
32:16
me are, have already been to few places.
32:19
So they're either very confused or they're already set in their
32:23
mind what they think they need.
32:26
So- Social media, I saw this picture.
32:26
Exactly.
32:27
This is how
32:27
I want
32:27
to look like.
32:27
Exactly, and I've been to this dentist, he said I can do it in,
32:30
twenty-four hours, everything.
32:32
And it's, then breaking that down, trying to understand in terms of what the
32:37
patient wants and what the patient needs.
32:40
And then to-- if, they're all aligned, it's easy.
32:43
But if it's not aligned, then you need to break it down for the patient
32:45
in terms of-- Because patients will never remember the conversations.
32:49
If some- when things go wrong, they don't remember the conversations you had
32:52
That you actually told them that it's, that's a risk.
32:54
That, that, that's a risk.
32:55
Exactly.
32:58
and more complicated the case, more complicated and complex
33:01
these conversations really become.
33:04
and it's again, it's, being able to sometimes say, "No, let us, take it easy,"
33:12
or, "Let us do it different way because of this." And, my approach is A, and these
33:17
are the benefits and these are the risks.
33:22
these, the psychological element of it, I think it is completely
33:28
underestimated in terms of, one, it's not taught in textbooks.
33:32
It's not nowhere in the curriculums and stuff really much, not enough of it- where
33:36
we talk about, especially patients who had lots of disappointments and failures
33:44
Often the most important thing, the first thing that they need is a listening ear.
33:48
More than jumping in the chair.
33:49
So I, in my, practice, m- my consultation starts on a-
33:54
Like
33:54
this, yeah, on a table
33:54
… outside the dental chair.
33:55
Yeah.
33:56
So we sit and that breaks the ice.
33:59
so just listen to the patients, and that l- that is important so
34:04
they're not in a, being rushed, and we're not feeling rushed.
34:07
The worst thing I see often is, sometimes patients are having their
34:12
CBCTs before they've seen the dentists.
34:15
And you think, "Why would you do that?"
34:18
Yeah?
34:18
Without even fully understanding what the patient needs.
34:21
What they're looking at.
34:21
Yeah.
34:21
What the problems really are.
34:26
and because, we can change, really transform lives of patients, and
34:31
at this, in the same vein, we can make it miserable for them as well.
34:35
And we see this all the time.
34:37
We see patients who had miserable outcomes because things are being rushed.
34:45
you can't fly into one country and have treatment done in 24
34:49
hours, full arch reconstructions, and expect it to be successful.
34:54
Not all of them at least.
34:55
Yeah.
34:56
Because, this, the, success isn't about how well the things look.
35:01
Success is, or a lot of it is what the patient has experienced
35:04
along the way as well.
35:05
Because, the, at, the end of the day, especially with reconstructions and
35:10
stuff, not only do you need to deliver the result, but that patient needs to
35:14
have felt that experience was pleasant.
35:19
I treat very young patients.
35:22
We place implants in patients with anodontia.
35:27
there's never been anything more fulfilling for me seeing an
35:30
11-year-old kid who has no teeth and having full arch reconstruction
35:35
in the mandible at the age of 11.
35:36
Now-
35:37
Wow
35:37
… imagine a child.
35:40
Top dentures is possible.
35:42
I've, made dentures from the age of six, seven for patients, where we had
35:45
to change dentures every year because they're growing and it won't fit.
35:50
Now, the quality of life, these are the kids who, get bullied at school.
35:56
They are a social recluse.
35:58
They know they're different than their colleagues and peers and friends, and,
36:04
has a massive impact on their life.
36:06
On their development.
36:07
On their development.
36:08
On their chances in life.
36:09
And, putting just four implants in the mandible, giving them a fixed, prosthesis
36:15
and see their life transform, there's nothing more gratifying and fulfilling.
36:21
I
36:21
can imagine.
36:21
And that's the sort of impact that we can really have on our patients
36:24
when we do things correctly.
36:26
And you can say, the choice of placing implants at 11
36:32
yes.
36:33
In the mandible, that's what I would do.
36:34
There's no point in making them suffer when that meteorite- Of
36:37
one
36:37
over
36:38
six years or so, yeah
36:39
doesn't make any diff- Yeah In maxilla, a different story.
36:41
Yeah.
36:41
In mandible, we go v- very at the moment, 11, 12 in anodontia, I'll place implants.
36:46
Fascinating.
36:47
And their quality of life, they transform-
36:50
Yeah
36:50
… after that because their worry is gone.
36:52
I can imagine.
36:54
Wow.
36:54
Now let's shift perspective a bit because it's also difficult for young
36:58
clinicians to actually understand, not only, for, patients what they can expect.
37:04
when, we, go to these conferences and then see these, perfect presentations,
37:08
a patient with, severe, complications comes in, and then there's a
37:13
digital planning, there's implant placement, immediate temporization,
37:16
and then the final restoration.
37:17
And for the layman, you can't even, see whether this implant is now,
37:23
an implant or it's a natural teeth.
37:25
That also must be quite attractive and fascinating for young clinicians.
37:30
But in, in your view, what's the biggest misconception that we're probably,
37:35
having in, in, in young or less trained clinicians when they see those kind of
37:38
presentations and believe, "Okay. Wow, this is everything that can be done"?
37:43
yeah.
37:44
Y- you go to congresses and stuff, and it must be very difficult
37:51
being a young clinician today.
37:53
Because the temptation, yep, temptation of, not just going to congresses.
37:59
They don't need to go to congresses to see this.
38:01
They just need to open their phone-
38:03
and get onto one of those social media platforms- Instagram
38:05
and see.
38:06
Exactly, right?
38:08
so to restrain from that and then to have the insight is just so crucial,
38:18
and, to-- the biggest daily misconception is that it is easy, that the digital
38:28
tools are there, they're gonna do the planning for me, and all I've got to
38:32
do is come in and drill for the screw.
38:34
Yeah?
38:35
Without realizing that things don't always go to plan, and if
38:40
you don't know how to manage- The
38:42
complication … the
38:43
complication intraoperatively, you're stuck.
38:47
If you don't know s- when to abort a procedure because it's gonna cause
38:51
more harm than any good, you're stuck.
38:54
So it's, it's the temptation.
38:57
That's the problem is… And, there is plenty of that today,
39:01
the speed, the, photography.
39:05
And sometimes people, the youngsters particularly, don't realize if Professor,
39:13
Buser or Professor Zucchelli or Professor,
39:17
Urban is presenting their really complex stuff, and the young brain often forgets
39:25
that has taken decades of training.
39:27
Decades to get there, to be able to do this, yeah.
39:30
To go on a course for three days, four days, and go to Hungary, Budapest,
39:33
and think that on Monday morning they can do that procedure, and that's the
39:37
problem is the lack of insight sometimes.
39:40
And, that's the worry, and how do we show all of this to the youngsters to
39:46
inspire them to pursue more training rather than, "Here's the stuff.
39:52
You can do this on Monday morning"?
39:54
That's the danger.
39:56
And that's, probably also a temptation that is not easy to, teach, don't fall
40:00
short, because, if you look at those cases and if you're talking about, clinical
40:05
judgment, there are so many steps in between and so many decisions in between
40:09
that you have to take until you get to this final result that, you really need
40:14
to understand step by step what is now the next, let's say decision that I can
40:19
take, and if I take this decision in that direction, if I place this implant
40:24
in this position, what does it mean for the, prosthodontic work, et cetera?
40:28
So I believe it's, as you say, it's a piece of art that needs
40:32
probably decades to develop.
40:35
you're right, and,
40:38
The, experience is important.
40:43
The only problem is that if you don't get the right experience, you're
40:47
re-really reinforcing errors, I often meet people who say they placed
40:51
thousands of implants, but if every, implant is going in the wrong place,
40:55
then that experience is worth nothing.
40:57
Exactly.
40:57
Yeah.
40:58
And, I play a lot of golf, and, to this day, I, i-i-it has
41:04
taught me a lot of humility.
41:06
It's, it, it really does- Sports
41:09
can do this.
41:09
Exactly,
41:10
yeah.
41:10
Oh my God, yeah.
41:12
golf is, everything has to be so precise, very similar to implant dentistry.
41:19
if your putt is a millimeter off, it's not gonna go in.
41:24
and, it's
41:27
you, look at, you, look at the hazards in golf, you think, "You know what?
41:32
I can, I can-
41:33
I can do that
41:33
… I can do that." Yeah.
41:35
And you go for it, and you end up in the hazard.
41:38
And, knowing when to take the aggressive line and when to take, go
41:42
for percentage play- The cautious line,
41:43
yeah
41:45
is, critical thinking.
41:46
It's crucial.
41:47
Yeah.
41:47
Is, crucial.
41:47
Yeah.
41:47
Is critical thinking, right?
41:49
And similar in treatment planning and treatments is, you can very much
41:54
apply, everything in sports can be applied in what we do in dentistry
41:57
or in life really, is knowing when is the right moment to do something.
42:02
And when is the right moment to, not to do something.
42:05
Yeah.
42:06
And to prevent a, an error, a mistake of judgment.
42:10
and to treat and to train, clinicians to do that is, that's why I think, for
42:17
the youngsters particularly, seeking knowledge, learning is important.
42:22
I think the, this is where the, breadth of knowledge becomes important before
42:26
you go into the depth of knowledge.
42:28
you gotta have breadth before you go deeper into
42:30
something.
42:31
Deep.
42:31
Exactly, yeah.
42:32
So perfect segue to the last part where I would like to talk a little bit about,
42:38
the next generation and how to train, good judgment in the next generation
42:43
that is more and more also influenced by digital tools and, digital decision
42:50
support, be it AI or be it, all kinds of, of different, possibilities.
42:55
So you're very active in, in, in teaching at, at university, but
43:00
also you're active in the ITI.
43:02
You mentor a lot, and as we discussed before, a lot of young clinicians,
43:08
and you try to help them actually to, get to this next level.
43:11
And for them, probably it must be quite overwhelming at, at the moment
43:17
to still understand, what do I need to decide and where can I rely on
43:22
certain support systems, AI support systems that tell me, where to place
43:26
an implant, how to design a crown.
43:29
maybe there, there is, there are even tools to, decide whether, is this now a
43:33
simple, a complex and a advanced case.
43:36
So what type of young clinicians do we need to train to be ready for, let's say,
43:41
the next generation, for the next decade?
43:47
look,
43:50
the, digital side of things, it's already quite advanced.
43:54
And yes, there's more to come, and a lot more to come.
43:57
s- stuff that we probably can't even comprehend yet is yet to come.
44:02
but it's al- it's, been there like that.
44:04
But, the conversation we were having earlier, we said, but this, this shift
44:09
currently is pretty significant shift.
44:12
The good thing is that all the youngsters coming in, they're pretty tech-savvy.
44:17
Yeah.
44:17
They have grown up with this.
44:18
They've grown up.
44:19
They're born in this.
44:20
Yeah.
44:20
They've grown up with this.
44:21
So they come with a, basic understanding, a baseline knowledge
44:25
of technology they come with.
44:27
So teaching them the digital side of things is very easy.
44:32
what we need to focus on is how do we b- build that human judgment in them.
44:38
So that actually what we need in the long run is, we've got digital tools.
44:43
Of course, they're gonna get more refined.
44:44
Of course, they're gonna get more better.
44:46
but there needs to be a better integration between the digital-
44:51
and the human judgment, human brain.
44:56
Dentistry remains a profession where we are treating patients.
45:00
I, am yet to meet a patient who wants to be treated by, just wants
45:05
to come into a ro- AI robotic clinic and not meet a human being.
45:10
Yeah.
45:11
The human touch, the empathy, the conversations, the reassurance,
45:15
that's only gonna come when you sit with a human being.
45:19
So it's not gonna take away the, that human touch.
45:24
clinical procedures, is robots gonna take over dentistry?
45:28
I don't see that happening in the foreseeable future- in reality.
45:32
So where those tools are gonna come in is gonna help you plan things, is gonna help
45:37
you in execution of treatment, whether it's your guided surgery- whether it's
45:40
static or dynamic, doesn't really matter.
45:43
But the, us as clinicians are still more or less have to sit
45:48
in the center of all of this.
45:50
And the technology has to sit surrounding us.
45:57
compared to when I was an student, today's students, they're in this
46:03
wonderful place where they can really merge the two together.
46:08
I started my digital journey back in 2007 with the CEREC 2 and the CEREC 3.
46:13
Sure.
46:14
And then the first iTero, when it was- It came out, yeah … with Stra- you guys
46:19
before it became- on its… Yeah, I've literally, we've been pretty, digitally
46:25
advanced at, at, at- From the get-go
46:27
from the get-go.
46:28
Yeah.
46:29
so all my trainees, the infrastructure that we have, both from the implant
46:35
planning point of view, from the lab, from the clinical, scanners and
46:39
stuff, so it's become, it's more or less ingrained in our, in our setup.
46:45
but still, the most important thing, what is gonna be needed for future
46:50
and the coming generations, is how do we instill this human element in it?
46:57
Treat them, t-teach them how to properly treatment plan.
47:02
and, treatment planning isn't one size fits all.
47:05
That's the problem.
47:06
Exactly.
47:07
It is-
47:07
It's very patient specific, yeah
47:08
… tailored.
47:09
Exactly.
47:10
Tailored, customized treatment plan depending on the person
47:13
who's sitting in front of you.
47:15
And when you look at, the, young students that you're seeing today,
47:20
what gives you most optimism, and maybe controversially, what worries you most?
47:25
Because, y- you said they come already tech-savvy.
47:28
Yeah.
47:28
That's probably very positive.
47:29
Yeah.
47:30
But, it's still, AI is its, in its infancy, and it, develops
47:34
very fast, so we're still learning about, where are the limits?
47:38
Can we trust the system?
47:39
To which degree?
47:40
What can be done?
47:41
What cannot be done?
47:42
So there must be both, You seem-
47:44
Yeah,
47:45
quite optimistic, but also some-
47:47
I was at a- … critical … I was at a conference last week, British Society
47:53
of Restorative Dentistry conference, and there was a, radiologist who was, speaking
48:00
on the a- role of AI in imaging today.
48:04
And it was quite an interesting, fascinating,
48:08
lecture because she was showing various AI models that are available
48:12
for diagnosing problems and giving you radiographic reports.
48:17
I can tell you, what is gonna happen over the next, decade is I think
48:22
we're gonna end, there's gonna end up a lot of over-treatment.
48:26
Why is that?
48:27
Because AI is picking up things which we saw with human eyes-
48:32
But we discarded
48:33
… not discarded, but said, "Okay, that doesn't need treatment."
48:36
And what's gonna happen with a lot of the younger generation, not necessarily
48:40
related to generation, but a lot… Because dentistry still is a business.
48:45
Yeah.
48:46
People still have to- And
48:47
what not to do.
48:47
It goes what not to do.
48:49
Yeah.
48:49
Yeah.
48:49
But there may be a- A perception that the AI report is now giving
48:55
me a license to, it's saying, "Oh, it's got a pathology here."
48:59
A pathology we would have said, "Yeah, it's there, but let's look at it in a
49:02
year's time. Let's look at the X-ray taken five years ago. It still was there."
49:06
Not everything that we see in an X-ray needs treating.
49:09
Yeah.
49:10
Whereas the danger now here is that you're gonna start to over-treat patients.
49:14
Now, at the same time, we also had an, had a speaker from the medical
49:19
legal, medical defense union.
49:21
That's what I wanted to go at, exactly.
49:23
Yeah.
49:24
Because-
49:24
So you cannot do nothing if you, see something,
49:28
but also you cannot say that, "Oh, AI told me to do this treatment." Human judgment-
49:35
Human judgment
49:35
is, yeah
49:35
is important because ultimately it's gonna be the clinician- who is still responsible
49:41
for the decisions that we take, and if you look at all the AI, even the
49:45
transcribing softwares that we use, there is a disclaimer at the top, "This is a
49:50
transcription, from AI. you as a clinician need to confirm this is accurate."
49:58
there is also the flip side probably.
50:00
if AI detects something and you're not officially stating, "Okay, I saw
50:05
it and I don't do anything," maybe later on it could be a legal case.
50:09
So I-- it's a difficult, delicate balance that, you know, that we need to find-
50:12
completely agree, but that's where you rely on the team.
50:15
That's where I would then, if there is something that I think, I'm not sure." Not
50:19
sure.
50:19
Yeah.
50:20
I, can see there's something, but does it need treating?
50:22
Well-
50:22
Let's discuss it in
50:23
a group … there's something called as a specialist in, radiology.
50:27
You ask an opinion.
50:29
You say, can you have a look at this X-ray and give me a report?
50:32
What do you think is the diagnosis here?" And then you can make a better judgment.
50:35
Yeah, that's- Very
50:36
interesting perspective.
50:37
And
50:37
so- That's the tea- that's the teamwork.
50:38
That's why we are different specialists, is you don't know everything, and you
50:43
need to rely on people, who are experts in their field to give you their opinion.
50:50
And it also changes our perspective a bit because what, you're basically
50:52
saying is that AI is not just helping us to, make better judgments.
50:58
It might also create more effort to figure out whether the judgment is accurate
51:03
and, you, need to react to basically, if you're asking, you need to react to
51:06
what's coming back in, in, either way.
51:09
Correct.
51:09
And so this could also not only lead to over-treatment, but basically
51:12
also take additional bandwidth- Yeah … of taking the right decision.
51:16
And, it will certainly help you identify things that you may not be able to see.
51:20
Absolutely.
51:22
So it will work both ways, and that's why, we as humans will need
51:26
to continue to be, smart enough to know how best to utilize this tool.
51:31
Yeah.
51:32
So to extend on this, what type of critical thinking do you need to
51:37
install or believe that you need to instill this in, in, in your
51:39
patients to be ready for exactly those conversations that we're just having?
51:44
in patients or-
51:46
No, with, with young dentists.
51:47
Young
51:47
dentists.
51:49
I, I think, y- again, we need to instill curiosity in them.
51:57
ask questions.
51:58
Why?
52:00
why are we doing this?
52:01
why is this thing happening?
52:02
What are the consequences of it?
52:04
And make them believe that, you will make mistakes.
52:10
We all make mistakes.
52:12
as the wise man said, you make mistake, learn from your successes, learn from your
52:18
mistakes, but don't repeat your mistakes.
52:21
because the foolish thing to do is to repeat the mistakes over and
52:24
over again, and that comes from, And the only way you will n- know
52:28
what a mistake is, reflection.
52:30
If you're continuously reflecting, continuously seeking feedback,
52:34
particularly as when you're young, in training, getting feedback, getting
52:38
critical feedback, and using that critical feedback to build positive
52:42
things in yourself is important.
52:46
it's again, like golf.
52:49
Every time I play a great round of golf, I w- I can't wait to go back to play better.
52:53
And the next time I go there and think, "Oh my God, that was a bad
52:55
round." I can relate to this, yeah.
52:58
And but I still can't wait to go back because I wanna fix that bad round.
53:01
And it's the same thing.
53:02
just when we think we know it all That's the day a mistake happens and then you,
53:10
immediately that, that humility comes in
53:13
Needs, needs to set in.
53:14
Exactly
53:14
And you know what is fascinating that this humility is pretty,
53:21
it's, one of those things that, in an inadvertent kind of way, if
53:25
you got the right humility, you're indirectly protecting patients
53:30
Because you're being less egoistic and you're learning from mistakes,
53:34
so somebody's benefiting from that.
53:35
Not only am I as an individual, as a clinician, but the byproduct
53:42
is my patients are getting better because I am not repeating
53:46
mistakes
53:47
yeah.
53:47
And that's a, very beautiful circle to where we started also with you seeing this
53:51
difference between this Indian education system versus then, what you had in, in
53:56
Europe with, a much less hierarchical, let's say, way of teaching, where also
54:01
these kind of mistakes, they are not mistakes but learning opportunities,
54:06
I have absolutely no problem in telling my trainees when they ask me something,
54:11
some question, I'll say, "I don't know.
54:14
Let's go find out."
54:15
Excellent
54:16
and as a teacher, that takes a lot of courage because-
54:21
Yeah, because you're the one that needs to know everything
54:23
Needs to know everything.
54:24
But to be able to say-
54:26
You know what?
54:27
I don't actually know the answer to that." And in fact, you can turn it
54:30
around and say, "Why don't you go find out and then tell me as well?"
54:33
Because then you're making them learn, and then coming back to
54:36
teach you something as well.
54:37
And I think that's the, lifelong learning cycle Learning, yeah
54:41
Because when you think you know everything, you're in trouble
54:44
it's, not a good sign.
54:45
So maybe to conclude this, this section also, in your view, what do we need to
54:52
do, companies like, Straumann, when, we…
54:56
Now, how should we develop the future of dentistry in, a, I would
55:01
say, a, responsible way so that actually this difference between,
55:08
what can be done and what should be done is not overstressed in, in the
55:12
sense that, everything can be done?
55:13
I
55:14
think, I mean- Companies have a huge role to play.
55:19
you have massive reach, more than universities have, more than the
55:23
hospitals have, more than clinicians have, global reach companies like Straumann.
55:28
So what do you need to do is to continue to remain responsible, and I know you're
55:33
doing that, and that, that's why I'm here.
55:35
and, remain responsible.
55:38
The, you've… the developments, of course, you can't stay stagnant.
55:43
You've got to keep on developing and stuff.
55:45
But, mind it that,
55:50
the,
55:53
to try and instill the fact amongst the clinicians around the world
55:56
who are your customers- that, with everything that you provide, there
56:01
is an, there is an onus on education as well, training as well, right?
56:05
And so that has to come from you both.
56:07
You have to provide the evidence, research behind things that you are
56:10
promoting, and you have to provide the education, particularly to, to,
56:15
clinicians who don't have access to institutional education, shall we say.
56:19
And they-- that's the vast majority of the clinicians and dentists around
56:22
the world are the ones in their practices who don't have access except
56:26
when they go for congresses, and how often can they go for congresses?
56:29
So huge role for companies like Straumann and others to, to navigate and safeguard
56:36
both the clinicians and the patients.
56:39
Together with, with institutions like the ITI, where we can actually,
56:43
really do education and help.
56:47
ITI has had a, huge impact on my career, in terms of, the growth of
56:52
ITI over the last, oh, 15 years.
56:56
I think about 26,000, 27,000 members at the moment worldwide.
57:01
there isn't any other, organization or association in dentistry,
57:05
let alone implant dentistry, which has such a global reach.
57:08
Such a global reach, yeah.
57:10
and, ITI has been doing wonderful things from developing evidence,
57:14
consensus statements, and congresses and stuff, and study clubs.
57:18
I run a study club.
57:20
I know.
57:22
in my golf club.
57:23
And often we s- in the summers, we play golf.
57:25
We mix, we play golf in the afternoon and study club in the evening.
57:29
And two of my study clubs are always case discussion.
57:32
And I ask the, my, study club members, they bring cases in, and we have
57:41
Often been in our study club till midnight, would you believe it?
57:45
Yeah, because it's passionate, so- It
57:46
is
57:46
… people are passionate about those,
57:48
I, love- … those cases, yeah … evenings.
57:49
Not the lecture evenings, the study club- when we're discussing case till midnight.
57:54
And nobody wants to leave because it's just such a healthy learning environment.
57:59
We're bouncing, we're bringing cases, learning from each other, discussing
58:02
things, and then because these cases are relevant because somebody's
58:05
brought a case that they want to treat.
58:08
They just, they can treat it, but they just want reassurance.
58:12
Is it the right approach- that I'm choosing?
58:14
Exactly.
58:14
Yeah.
58:16
at the grassroot level, which is what I class the study clubs to be, if
58:21
they're run success- if they're run properly, they can have a massive
58:24
impact in that little community- where you can protect and shield each other.
58:29
Excellent.
58:30
That brings us almost to the end, Shakeel.
58:33
Thanks a lot already for a very fruitful and interesting discussion.
58:37
So I would like to end, the conversation with maybe just
58:40
three takeaways f- from your end.
58:42
So what would be, the one piece of advice you would give to young clinicians that
58:47
want to venture more into complex cases?
58:52
I would say patience
58:57
Take it easy.
59:01
seek knowledge, seek experience.
59:03
Build your experience because complex cases is something that
59:07
requires layers of experience, and it requires patience, right?
59:14
I grew up fly fishing in Kashmir.
59:18
a, an experienced angler won't just come in and wade into
59:23
the water and start fishing.
59:25
You, you come in, you spend the first five, 10 minutes early morning before the
59:28
sun is even up- Observing … to, just to observe- just to see which way the
59:33
water is flowing, where are the, fish, where do you see fish jumping and stuff.
59:39
What sort of, fly to use depends on what sort of ins- what sort
59:43
of insects are flying around and stuff before you start to cast.
59:47
So step back sometimes.
59:49
And be patient.
59:50
Be patient.
59:50
Excellent.
59:51
I think that was the advice I would give youngsters, especially in today's
59:54
day and age, where speed is everything.
59:58
And, same advice goes to Straumann, immediacy, Let's just sometimes
1:00:02
say immediacy when it is right- ,not immediacy for everything.
1:00:06
Excellent.
1:00:07
So what would be then your piece of advice for experienced clinicians?
1:00:11
So what is the one thing they should stay humble about?
1:00:14
We discussed about it before.
1:00:17
a, staying humble.
1:00:18
That's it.
1:00:19
Staying humble.
1:00:19
So that's all it is.
1:00:20
Yeah.
1:00:21
Yeah.
1:00:21
I think staying humble and knowing that every day is gonna teach you
1:00:27
something new, and, just when you think you mastered it all, something
1:00:33
is waiting, surprise is waiting.
1:00:35
So I would say, I, think the, reviewing long term and looking at your patients
1:00:42
after five, 10, 15 years is what really teaches you whether what you did back then
1:00:49
is successful because I don't-- Dentistry is not about short-term fixes and stuff.
1:00:54
Even though, implant dentistry looks immediate, but really what
1:00:58
we want is to play the long game.
1:01:01
and, the most I've learned in my own career is through clinical photography.
1:01:08
I take pictures and photographs of everything I do in my clinics.
1:01:12
And you then can go back
1:01:13
and learn.
1:01:14
Yeah.
1:01:14
And this has taught me a lot, George.
1:01:16
Yeah.
1:01:16
Unbelievable amounts.
1:01:18
There is no- That- … amounts of note-taking or writing which you can
1:01:22
capture- That will substitute for the
1:01:22
picture.
1:01:22
Yeah … a picture.
1:01:24
10 years later, you can compare the two, and it's just like a pi- like a
1:01:27
radiograph, having a clinical picture will give you so much insight- into your own,
1:01:36
interventions and consequences of that.
1:01:38
Excellent advice.
1:01:39
And then lastly, so Is there one principle in dentistry that we should never give
1:01:46
up, even if it becomes more and more digital and we have more and more fancy
1:01:50
toys that maybe substitute for one or the other decision that we have to make?
1:01:57
I would say, I don't think the upda- what you started on is the, human
1:02:04
judgment, and that principle, you just can't break away from that.
1:02:09
No matter how digital, no matter how automated dentistry is gonna become, it
1:02:14
will always be dependent on us making the right decision and then asking our
1:02:20
tools to help us deliver that decision.
1:02:23
Does that make sense?
1:02:24
That makes absolute sense,
1:02:24
yeah.
1:02:25
it has to be a human decision.
1:02:27
It has to be the, pivotal thing that we do, and that is then gonna…
1:02:31
The tools are there to use, the, sh- the digital tools and stuff should,
1:02:40
augment wisdom, not replace it.
1:02:44
Excellent final word.
1:02:45
Thanks a lot, Shakeel, for a very, I would say, inspiring and, conversation
1:02:52
full of learning bits and pieces.
1:02:53
So I really enjoyed it.
1:02:54
Thanks a lot for joining us.
1:02:56
Absolute pleasure, George.
1:02:57
Thank you very much.
1:02:59
I really enjoyed it as well.
1:03:00
Fascinating talk.
1:03:01
Thank you.
1:03:01
So thanks a lot, Shakeel.
1:03:03
To our audience, thanks a lot for actually listening to us.
1:03:07
I hope that you actually enjoyed this, this talk with, Professor Shakeel Shahdad.
1:03:12
And if you found some nuggets that you were interested in, that you would like
1:03:17
to actually, use in your daily practice, please also share this episode because
1:03:20
there might be also others that, would be interested in, this, type of wisdom.
1:03:25
Watch out for the next episodes.
1:03:27
we're of course going to, continue this series, so stay curious,
1:03:31
and we catch you in the next one.
1:03:33
Thank you.