Latest / Straumann® ProTalk / Clinical edition: Dr. Alejandro Lanis on "Invisible" implant aesthetics and FP1 workflows (video version)

Transcript

Clinical edition: Dr. Alejandro Lanis on "Invisible" implant aesthetics and FP1 workflows (video version) · Straumann® ProTalk

• 0:00
  Honestly, I think aesthetics should be a consequence of function.
• 0:04
  Most of the times patients, they want to look good and they
• 0:07
  don't care about functionality.
• 0:08
  But if something looks good and it doesn't function, it doesn't make any sense.
• 0:12
  So it needs to function, look good, but also if we could say look invisible.
• 0:17
  It should not highlight and say, "Oh, I have something here."
• 0:19
  Yeah.
• 0:19
  That's exactly my point.
• 0:20
  But I don't want you to be walking in the street and someone to come and
• 0:23
  say, "Hey, you did something." no.
• 0:25
  It has to be something natural.
• 0:26
  "Hey, you did something in your hair.
• 0:28
  Something looks better.
• 0:30
  Something looks different.
• 0:31
  I can see that you look good and better, but I don't know what it is." Yeah.
• 0:50
  Alejandro Lanis.
• 0:52
  Ale for the ones that are your friend.
• 0:54
  What an honor to have you at Straumann ProTalk Clinical.
• 0:56
  Thanks for coming all the way from Chile to join us.
• 0:59
  Thank you very much for having me.
• 1:01
  What a pleasure.
• 1:03
  I would like to start with the fundamentals.
• 1:06
  implant dentistry, especially more dedicated to aesthetics in implant
• 1:10
  dentistry, have moved long ways.
• 1:12
  We shifted from functionality back in the '80s, where surfaces
• 1:16
  and material was the gold rush.
• 1:18
  Now we already take as a given.
• 1:20
  We know things work.
• 1:22
  People want to function, but they also want to look good.
• 1:25
  If we have to shift the definition of success to the standards of today,
• 1:29
  how can we define it in aesthetics?
• 1:34
  This is a very good question because, honestly, I think aesthetics should
• 1:39
  be a consequence of function.
• 1:41
  Most of the times patients, they want to look good, and they don't
• 1:45
  care about functionality, but if something looks good and it doesn't
• 1:49
  function- it doesn't make any sense.
• 1:51
  So I always talk to the patients.
• 1:53
  I say, "Look, this is gonna look good, but it has to work properly." Now, talking
• 1:58
  about aesthetics, I think, a- at least from the way I, learn, aesthetics is
• 2:04
  not something that looks, strange into your mouth, even when it looks good.
• 2:09
  It has to look natural and integrate to your face, to your smile, to
• 2:15
  your, to the shade of the rest of your teeth that you have.
• 2:18
  if you're doing a full arch, it l- it has to adapt to your face and smile,
• 2:23
  so that's why we are working that much with, face analysis with photography,
• 2:29
  with Smilecloud and all these tools that we have today that help us a lot
• 2:32
  to integrate the smile and the teeth of the patient into a more complex, thing.
• 2:39
  So it needs to function, look good, but also if we could say look invisible.
• 2:45
  It should not highlight and say, "Oh, I have something here."
• 2:47
  Yeah.
• 2:48
  That's exactly my point.
• 2:49
  So when my patients come to my office and they say, "Look, I want to improve
• 2:53
  my smile or my teeth or, the shade," I say, "Look, my, my idea here is that of
• 3:01
  course we are gonna improve or inc- or increase your satisfaction in terms of
• 3:05
  your smile, but I don't want you to be walking in the street and some- someone
• 3:09
  to come and say, 'Hey, you did something.'
• 3:11
  No.
• 3:12
  It has to be something natural.
• 3:13
  'Hey, you did something in your hair.
• 3:16
  Something looks better.
• 3:17
  So- something looks different.
• 3:18
  I can see that you look good and better, but I don't know what it is.'"
• 3:22
  Yeah.
• 3:22
  And I think that- Good point … yeah.
• 3:23
  And I think that's the main goal of aesthetic dentistry.
• 3:28
  Lanis, and I know you've been investing a lot of time improving your full
• 3:33
  arch treatments more towards the FP1.
• 3:37
  Which it's a completely different ballgame.
• 3:40
  When we're talking about full arch, for example, in FP3, and I
• 3:43
  don't mean in any way that FP3s are easy, because they're not.
• 3:47
  No.
• 3:48
  However, when y- when it comes to reaching good aesthetic outcome, FP1
• 3:53
  represents honestly, the highest level of complexity because as you mentioned,
• 3:59
  aesthetic, it needs to disappear in the mouth, it needs to be harmonious,
• 4:05
  aesthetically pleasing, and functioning.
• 4:09
  Now, when we talk about a full arch You extrapolate this to many teeth at once.
• 4:16
  You have to worry about many factors, speaker, smile line, papilla design,
• 4:22
  and on and how can we define the fundamentals of aesthetic, a successful
• 4:28
  aesthetic outcome in FP1 as well,
• 4:32
  as you said, I think the FP1, that is a term that was described by Carmish
• 4:37
  several years ago, it's probably the most complex treatment, when you
• 4:44
  are talking about full arches, okay?
• 4:46
  and for that, I think the planning phase, and the first, the diagnostic phase is
• 4:50
  es- essential, and then the planning has to be very, accurate because moving
• 4:58
  the implant in one millimeter distal or mesial can compromise your papilla or not,
• 5:04
  can compromise the aesthetic result, can compromise the w- the, what the patient
• 5:09
  is gonna show when smiling, smile line, lip movement, facial analysis, mimics.
• 5:15
  Everything is important.
• 5:18
  and that's why the whole c- case analysis in here, it's a
• 5:24
  cornerstone of, the whole, treatment.
• 5:27
  Without a good planning, it's impossible to get to, the
• 5:30
  result that you're expecting.
• 5:32
  That's why digital planning for me, it's a mandatory thing in these type of cases.
• 5:37
  I couldn't go freehand in any case.
• 5:41
  You could or could not?
• 5:42
  Could not.
• 5:43
  Yeah.
• 5:43
  No.
• 5:44
  I think it's a, it's a risk that I don't need to take, and we have the
• 5:48
  tools available to do everything in a very precise way just by transferring
• 5:53
  everything that you have in the computer to the patient's mouth in advance.
• 5:58
  that's why, we simulate all the s- the surgical procedures before
• 6:02
  in a safe and virtual environment.
• 6:07
  but you're right.
• 6:08
  it's a complex situation.
• 6:10
  and, but I like it.
• 6:12
  I like it because,
• 6:15
  you need, I'm not talking about skills or dental skills.
• 6:19
  I need, it's a combination between knowledge and also
• 6:23
  skills and, taste and good eye.
• 6:27
  There are so many details that you need to take in consideration, and of
• 6:30
  course, I have learned all of these things by other people like Eric
• 6:34
  van Dooren, like Florin Cofar, Wael Att, David Norre, all these friends
• 6:41
  that they are masters in this field.
• 6:45
  and I have learned h- sometimes maybe just by moving the implant a little bit upper,
• 6:52
  and hide a little bit certain areas, it's gonna change the whole picture.
• 6:56
  So I think these type of treatments are made by details, and that's why
• 7:01
  it's so important all this clinical analysis before touching the patient.
• 7:06
  I like how you describe it.
• 7:08
  and when we talk about… you've been recently, involved
• 7:13
  in the academic setting-
• 7:15
  first in Chile, then in the US, in Harvard, and you've dealt
• 7:20
  with a whole lot of colleagues in many different skill sets.
• 7:24
  Yeah.
• 7:24
  And we talk about consistency and reproducibility in such a
• 7:29
  demanding type of indication.
• 7:31
  What do you think is still lacking that we can do it more consistent?
• 7:36
  Is it in the planning?
• 7:37
  Is it in the, a better understanding of the prosthetic resolution so
• 7:42
  you know where you wanna get, so you back plan all of this till you
• 7:46
  get there, like a GPS, for example?
• 7:50
  what are the roadblocks that you see?
• 7:53
  I think in here, as I said before, diagnosis is a word
• 7:57
  that we don't use much today.
• 8:00
  We skip directly to planning, and we need to understand a little bit what is
• 8:03
  h- why the patient got to the situation where he is right- he or she is right now.
• 8:09
  And then the planning phase, considering the, face of the patient as an im-
• 8:18
  as an important role of our treatments, something that wasn't
• 8:19
  happening maybe 20 years ago.
• 8:20
  We were m- we were focused on functionality and not of, on this
• 8:25
  integration of this prosthetic structure into the patient's mouth.
• 8:31
  face, sorry.
• 8:33
  and the other thing I believe is important is it's very difficult for
• 8:37
  me to separate the surgical aspect of implant dentistry from the restorative
• 8:43
  as- aspect of implant dentistry because both things are linked together.
• 8:46
  One affects the other.
• 8:48
  so if you are a surgeon, for example, and you are gonna do the surgical
• 8:53
  part of the treatment, and you don't know anything about the future
• 8:57
  restoration of the patient, then there is a lack of information that
• 9:00
  is gonna affect the overall result.
• 9:03
  If you are working only in the restorative part and the implants are placed
• 9:07
  anywhere, then of course you are gonna have problems restoring those cases.
• 9:11
  But if you work with, as a part of a team, where you have good communication,
• 9:17
  and you, let, the surgeon know exactly where you want to, your implants because
• 9:22
  of a restorative purpose, of course the things are gonna work better.
• 9:27
  The opposite, if you are the restorative dentist, then… Or the
• 9:30
  surgeon, you need, you wanna know what the other one is expecting.
• 9:35
  So in my case, I do both things, and that's why I think it's easier for my,
• 9:38
  for me to deliver these type of cases.
• 9:40
  But if not, digital technologies are the best tool available to communicate
• 9:45
  in real time, even with someone that is in a different country or a different
• 9:49
  continent, but you are both talking the same language, and preparing the case
• 9:54
  together, something that is very important to have in this particular treatment.
• 9:59
  Yeah.
• 10:00
  So if I hear you well- Two, two streams need to be in place in order
• 10:07
  to reach consistently good results.
• 10:09
  If you are a single practitioner and you predominantly focus on
• 10:13
  surgeon, on surgery, you need to improve the restorative,
• 10:19
  execution and planning, right?
• 10:21
  So they're complementary.
• 10:22
  Or work in a multidisciplinary environment where you- Yeah
• 10:25
  can work in real time together, and that's how probably will be
• 10:29
  the best way to move forward.
• 10:32
  Exactly.
• 10:33
  In fact, even for example, for the selection of the abutments, I'm going
• 10:37
  into a very technical topic now, but we, know now, and, this is something
• 10:41
  that we have published and others like the team from Ronnie Yang in Zurich,
• 10:47
  Franz Strauss and others, they have already published and demonstrated that
• 10:51
  the selection of the abutment influence the result or the aesthetic result
• 10:55
  because you can remodel the bone or the sur- the tissues around the implant
• 10:59
  just by compressing those tissues by the selection of the wrong abutment.
• 11:04
  And we were used to select the abutments after the implants were already placed.
• 11:09
  Today, we select the abutments during our surgical planning, and
• 11:13
  that's why using these digital sy- technologies are so nice, because
• 11:17
  they give you the opportunity to prepare everything in advance.
• 11:20
  Yeah.
• 11:20
  Se- and play with this abutment and select the, proper one and measure the
• 11:24
  spaces, because when you're working or, preparing for an FP1, every
• 11:31
  s- every millimeter is important-
• 11:33
  Right
• 11:33
  in every single direction of the space.
• 11:35
  And I learned this from Florine.
• 11:37
  We were working on… This is, al- almost anecdotic, but we were working on a case
• 11:42
  in Romania, and he told me, "Me- look, in here, I think you made a mistake
• 11:46
  because if you measure from this platform to this platform, you're gonna see that
• 11:50
  instead of two millimeters, you have 2.2."
• 11:54
  And when we were checking on the case later, I realized that we lost that
• 11:59
  papilla because of this minor mistake.
• 12:02
  Wow.
• 12:02
  So you can see that in this situation, every single detail is important.
• 12:06
  It is.
• 12:07
  And you touch a very good point.
• 12:08
  With the digital technologies today, Ale- I was gonna say Launis, but you,
• 12:13
  I know you already, pierced my ears.
• 12:18
  I see, high-performance sports like FP1, FP1, F1 Formula 1, or
• 12:26
  even, commercial pilots, they rehearse tremendously on simulator.
• 12:32
  With digital technology, we have an unique opportunity today to
• 12:36
  rehearse in many different ways.
• 12:38
  We don't see the impact immediately, but we can anticipate if a
• 12:42
  certain gingival height, if the distances are properly selected,
• 12:47
  which we didn't have in the past.
• 12:50
  it bugs me to think that colleagues are still not embracing this and
• 12:55
  moving forward with the, I think you- … upgrading their skills
• 12:59
  … you used a, very good example, pilots, okay?
• 13:04
  they prepare a lot in simulators.
• 13:06
  It doesn't mean that they can have a complication during the flight.
• 13:10
  Of course, for us it's the same.
• 13:11
  You can prepare everything in advance and c- you can still have a
• 13:14
  complication, but the good thing is that you're gonna know how to deal
• 13:16
  with this complication in advance, too.
• 13:20
  dig- digital technology, digital planning, surgical planning in a computer
• 13:23
  is gonna give you that opportunity to play in advance and to prepare
• 13:28
  everything before you touch the patient.
• 13:29
  And in my case, and this is what I do in my practice, is I talk to
• 13:34
  the patient once I have already gathered all the information.
• 13:37
  We have a coffee together, and I say, "Look, this is my computer.
• 13:41
  This is your case.
• 13:43
  This is your surgery.
• 13:44
  I already did your surgery in the computer.
• 13:46
  What I have to do now is to transfer this inf- this surgical planning to
• 13:51
  your mouth through a surgical template."
• 13:53
  If I go… If I'm gonna do it guided.
• 13:56
  If I'm gonna do navigation, maybe it's a little bit different,
• 13:59
  but I already prepare and did your surgery in the computer.
• 14:04
  So this is the safest way to have everything prepared in
• 14:08
  advance because I already did it.
• 14:10
  I know what can happen.
• 14:12
  I have my plan A, B, C, but this is your surgery.
• 14:16
  So they a- they also feel part of the treatment, and of course, they
• 14:20
  feel s- maybe safer in terms of the amount of information that they manage
• 14:26
  before going to the dental chair and start, and I start working with them.
• 14:32
  So I believe it's super, super important in modern implant dentistry to have access
• 14:37
  to these things, and if you are not doing it yet, I really recommend you to start
• 14:43
  because it's gonna change the way you treat your patients and the amount of
• 14:47
  information that you can manage before.
• 14:50
  Yeah.
• 14:51
  I'm with you on this.
• 14:53
  Lenny is- Ale.
• 14:59
  If I had a problem, I tell everybody honestly, I would go to Chile because
• 15:04
  I, I really the way you work, and the quality and the standard of your work.
• 15:08
  And if, speaking of pilot and simulating, I would like to pick your brain.
• 15:12
  The learning's approach, right?
• 15:14
  Let's assume I have a… Let's not put you on a spot.
• 15:18
  Not a low, not a high, but a mid smile line, and I have already
• 15:24
  lost a few teeth left and right, and I have a terminal dentition.
• 15:29
  And I come to your office, and I ask your help.
• 15:32
  Let's assume I'm, about to become a full arch patient.
• 15:37
  And there's an option that I can- we can go either FP1 or FP2 compensated-
• 15:43
  or FP3.
• 15:44
  If I have to reduce bone- if my smile line.
• 15:47
  How would you walk me through your workflow?
• 15:49
  What is the learnings approach from very
• 15:52
  first step?
• 15:55
  so this is the way- We have time.
• 15:58
  No, So this is the way- Take- … I, work, and it doesn't mean that it's
• 16:01
  the right way to do it, but it's the w- the, way I like to do it.
• 16:06
  the first appointment with the patient is always about gathering information, okay?
• 16:11
  It's about, knowing the patient, know their, h- his or her expectations,
• 16:20
  previous stories, et cetera, the medical history, whatever.
• 16:25
  And then, I do an examination, internal scanners.
• 16:29
  I try to get all the information that is gonna be useful for my analysis.
• 16:35
  I take, I have a small setting for photography, so I take portrait photos.
• 16:40
  Sometimes I take videos just to s- analyze a little bit how the
• 16:44
  lips move when patient is talking.
• 16:46
  Because if you talk to a patient with a, with p- a problem in, in, in his
• 16:51
  or her mouth and you ask for a smile, probably they're not gonna smile well
• 16:54
  because they feel ashamed sometimes.
• 16:58
  so I, if you record a video, at some point, because technically a video is
• 17:03
  a s- a set of photograph it's in time.
• 17:05
  So you can stop, the video at, certain point and see the full smile, and
• 17:10
  then you can see if you are gonna see some things or this transition
• 17:13
  between the future, structure with their, own tissues, et cetera.
• 17:19
  Once I have everything together, I get together with the patient
• 17:24
  again in a different appointment.
• 17:26
  I already have prepared everything to show to the patient, and also I have done
• 17:29
  my own analysis, diagnosis, my treatment planning, and I have all the information
• 17:36
  to give to the patient to understand what I, what is my plan or what I want to do.
• 17:41
  and then depending on their situation, we can, choose between different options.
• 17:48
  I always try, if possible, to keep with the FP1.
• 17:54
  I think I don't like to remove bone.
• 17:56
  I don't think, I don't think it's a good idea to remove bone unless
• 18:01
  you have specific indications.
• 18:03
  One, you have a knife-edge ridge that where you cannot place the implants in
• 18:08
  at the proper depth, or you can level all the implants at the same, depth too.
• 18:15
  So in those situations, maybe it's a right indication.
• 18:18
  Transition.
• 18:18
  Then transition line.
• 18:20
  High smile line where you're gonna see the transition between the
• 18:24
  structure o- and the, prosthetic structure and the patient's tissues.
• 18:29
  And third, and it's very rare when you have a class III with a Kelly
• 18:34
  syndrome, and you need to remove a little bit of the lower, the, anterior
• 18:39
  part of the lower jaw or the mandible.
• 18:42
  but in the re- the rest, this concept of prosthetic space that I
• 18:46
  need to create prosthetic space, if the patient had teeth before, the
• 18:51
  prosthetic space is already there.
• 18:54
  This concept of prosthetic space, was, created or published when materials
• 19:02
  needed more thickness because of the-
• 19:05
  Resistance
• 19:05
  resistance, et cetera.
• 19:07
  But with the materials that we are working today, you don't need this 20 millimeters
• 19:12
  of space to create a very stiff bar.
• 19:15
  We can do something very small, and if the patient had teeth before, and the
• 19:20
  central incisor measures in average 10 millimeters, and you have already those 10
• 19:25
  millimeters or 12, you have enough space to use an, FP1 modality of treatment.
• 19:33
  Now, in the case that you were describing, where maybe in the posterior sides you
• 19:37
  are gonna have more space, you can create a combination between an FP2 and an
• 19:42
  FP1, or but going back to the, to your question, I prefer or try not to remove
• 19:49
  bone, because once you have removed bone, reconstruct that bone is very difficult.
• 19:55
  and there is a trend to just chop the bone down.
• 20:00
  Remove two centimeters bone and then place implants to give an FP3 to the patient
• 20:06
  that maybe needed just a periodontal treatment and maybe a couple of implants.
• 20:11
  and this is something that I believe it's, it's n- a little bit neglected
• 20:15
  be- because once you have removed all this tissue, let's suppose that
• 20:19
  you have a complication, you're not gonna have any tools to…
• 20:23
  Unless you are gonna place zygomatic implants-
• 20:25
  Yeah
• 20:26
  … or a remote anchorage.
• 20:27
  You don't have too many solutions to deal with this complication.
• 20:31
  So I, that's why I try to keep the bone as possible.
• 20:36
  And, for the surgical part in terms of implant positioning
• 20:40
  from there, so you, show
• 20:44
  Where you wanna get, right?
• 20:45
  To the patient.
• 20:46
  Let's assume now the patient said, "Let's go for it." What's next?
• 20:53
  of course, you are preparing everything with the, your
• 20:56
  surgical templates, et cetera.
• 20:58
  Once the planning is ready, you need to transfer this information from
• 21:01
  the computer to the patient's mouth, and here's where you have to be very
• 21:05
  precise because as, I was saying before, if you are working with an
• 21:09
  FP1 approach, moving or having the implant one millimeter distal or mesial
• 21:14
  can change completely the result.
• 21:17
  so you have to be very precise.
• 21:20
  Something that I learned from these people that I told you before is you have to
• 21:26
  expect that after the extraction of these remaining teeth, there are gonna be some
• 21:31
  type of, resorption or bone remodeling.
• 21:35
  This is some- something that is gonna happen always because of the loss
• 21:38
  of vascularity to the vandal bone.
• 21:42
  so to compensate this situation, what we like to do is to place
• 21:46
  the implants a little bit deeper and a little bit palatal if w- I'm
• 21:50
  talking about the maxilla because in that way, you are gonna, preparing
• 21:56
  advance to contract to this potential resorption that is gonna happen anyway.
• 22:01
  Of course, if you use a grafting material in the gap between the implant and the
• 22:06
  buccal bone wall, or you use a soft tissue grafting or other techniques, you are
• 22:10
  gonna help to, to this, to prevent this situation, but it's gonna happen anyway.
• 22:17
  So implant positioning, positioning for these situations, it's a
• 22:21
  little bit different than where you place your implant for an FP3, for
• 22:25
  example, where- I see … you are gonna cover everything with the same
• 22:30
  structure, prosthetic structure.
• 22:31
  It doesn't matter if the implant is in the midline or not, you
• 22:34
  can play with statics anyway.
• 22:36
  Yeah.
• 22:37
  and if you have a good technician, it's not a big deal.
• 22:40
  But papillas and the integration of these pontics into the soft tissue-
• 22:45
  is something difficult to do.
• 22:48
  And for that, I always recommend the same.
• 22:50
  You need volume of tissues.
• 22:53
  You need good management with the pontics to give enough pressure
• 22:58
  and space- and to know this, how to play with this balance- to create
• 23:02
  these papillas, and you need time.
• 23:07
  Time, because you cannot rush biology.
• 23:11
  It has its own times, and if you rush, you're not gonna get the
• 23:15
  result that you're expecting for.
• 23:16
  I see.
• 23:18
  So if I have to take one year with the patient or two years, it's
• 23:22
  part of the deal a- and this is the sacrifice to get that result.
• 23:27
  You always need to give something, to you take and you give, and-
• 23:31
  Yeah
• 23:32
  … this is the way I see it.
• 23:34
  Lenis, I, Ale I like very much how you contextualize first in the beginning in
• 23:42
  the, in the sense that, the indication you're aiming to is an FP1, but it's
• 23:50
  perfectly fine to blend if a f- if certain sites are not optimal, dimension-wise-
• 23:57
  to make it with artificial gingiva there is not gonna make less of an FP1, but
• 24:03
  it's gonna be a much better of a overall aesthetically pleasing treatment if
• 24:08
  you blend a bit with FP1 purely dentate
• 24:12
  with- Yeah.
• 24:12
  You're right.
• 24:13
  So the thing here is, everything is, it's, talked first with the
• 24:20
  patient, of course, because always you c- you have other options.
• 24:23
  You can graft in the posterior sites, but it's always, difficult.
• 24:27
  You don't have too much, area to support your grafting.
• 24:32
  So it's not that simple.
• 24:34
  You can do it, but it's not that simple.
• 24:36
  Sometimes you can manage everything with just soft tissue grafting, and then
• 24:39
  you can create these pontics and manage everything with an FP2 type of structure,
• 24:44
  and everything g- is gonna look good.
• 24:46
  Now, yeah, if I'm gonna do a combination between an FP1 and F- an FP2 or 3 in
• 24:52
  the posterior area, and everything's gonna look good, and the patient's
• 24:56
  gonna be happy, and it function, and it's cleanable- Yeah … I
• 25:00
  don't see any problem with it.
• 25:03
  unless you want to show this in a huge stage where you want to talk about FP1
• 25:08
  and how good you are as a clinician.
• 25:10
  But from a patient perspective-
• 25:14
  Yeah
• 25:14
  … for him, an FP1 and FP3 is, are just acronyms.
• 25:19
  Yeah.
• 25:19
  They don't mean anything.
• 25:20
  They don't know.
• 25:21
  Yeah.
• 25:21
  And it's important to always have this transparent and honest
• 25:24
  conversation- Yeah … about where you
• 25:25
  wanna get.
• 25:25
  But that's the thing.
• 25:26
  Y- I talked with them before because everything that you do
• 25:29
  in a, everything that you explain in a- in advance is just a,
• 25:35
  an explanation or an indication of what you're gonna do.
• 25:39
  Everything that you explain after is an excuse.
• 25:42
  Yeah.
• 25:42
  So you have to be careful because patients sometimes their expectations
• 25:46
  are super high, and you forget to say something in advance knowing that
• 25:50
  it's gonna happen, and then they say, "Look, doctor, but what happened in
• 25:53
  here that this part of my mou- of my restoration is different than the one…"
• 25:58
  And then you have to explain, and then it sounds like an excuse.
• 26:01
  So if you are transparent and you… But this is simple because you ha- you are
• 26:05
  watching everything in screen in advance.
• 26:08
  Yeah.
• 26:08
  So it's very difficult not to see these type of things.
• 26:12
  It's not because I'm a, I'm an astronaut.
• 26:14
  It's because it's super simple.
• 26:15
  It's in the com- computer.
• 26:17
  It's in the screen of the computer.
• 26:21
  Ali, you mentioned the such
• 26:25
  a precision level as you mentioned the discussion with, Florin Cofar about
• 26:30
  2.2- two millimeter, and how important is the precise implant positioning?
• 26:37
  You mentioned also, just shortly back about in, let's
• 26:44
  continue on this topic quickly.
• 26:45
  On FP1, your implant positioning will also be different because you will
• 26:49
  like to anticipate, you will like to have more biology- less metal.
• 26:53
  You, you- voluntarily want to give some space-
• 26:56
  maintain volume.
• 26:58
  So how critical precise implant positioning is in order to reach
• 27:04
  everything that you wanna do after, and how do you get there?
• 27:06
  Is it guided surgery?
• 27:08
  In an FP1?
• 27:09
  In everything.
• 27:10
  So
• 27:12
  I like to be the precise as possible in, in every type of treatment that I do.
• 27:17
  but there are certain situations where 3D implant positioning is
• 27:24
  very important.
• 27:25
  ' Cause you mentioned 0.2.
• 27:27
  Yeah.
• 27:28
  Yeah.
• 27:28
  From two to 2.2- Yeah, makes already a big difference in the papilla.
• 27:32
  Yeah.
• 27:32
  So FP1 guided will play a big role.
• 27:36
  I think it's, with based on the tools that we have today, not doing it guided, it's,
• 27:44
  it's a mis- I don't see any reason not to.
• 27:48
  you're just gonna… I'm not saying that you cannot.
• 27:51
  Of course you can, and I know people that they're super skilled, and they are gonna
• 27:56
  be able to do it without any problem.
• 27:58
  But n- for normal humans like me, like myself, why I'm gonna take
• 28:02
  this risk if I have the tools just to transfer everything in the more
• 28:07
  or less exactly the same position?
• 28:09
  It's not 100% precise.
• 28:11
  We know this because of research, but it's very close
• 28:17
  to that, precision, to the 100%.
• 28:20
  And,
• 28:22
  Yeah.
• 28:23
  I, don't see any reason
• 28:26
  not
• 28:26
  to, take this opportunity.
• 28:28
  Ale, I like how you phrase it because look, I'm a big fan of your work,
• 28:33
  and yet you have no, no shame of saying that regardless of how good
• 28:40
  you are, you, trust guided surgery.
• 28:44
  It doesn't make you less of a surgeon because of that.
• 28:47
  I Because we sometimes hear this ego conversation of- oh, I brag myself
• 28:51
  of being a good surgeon.
• 28:53
  let me tell you so- this is also, almost anecdotic.
• 28:58
  I was in a meeting several years ago, and there was a very famous doctor, talking
• 29:03
  about, implant placement, and s- he said something that, I never forg- I forgot.
• 29:09
  he said something like, "Today all my implants are flapless." So when you
• 29:15
  say, when you… Or he said something like, "I always go flapless now." When
• 29:21
  you say, or when you use the always or, the never, there's always something
• 29:26
  stra- always something strange.
• 29:29
  Because today we know that flapless implant surgery has its own indications.
• 29:34
  And very, and they're, I would say, limited.
• 29:36
  So today I, raise more flaps than maybe 10 years ago because I know
• 29:44
  the importance of s- the soft tissue- Soft tissue … around the implants.
• 29:46
  Yeah.
• 29:48
  with, guided surgery, the same.
• 29:51
  I'm not saying that you cannot do it.
• 29:54
  of course you can do freehand surgery, but evidence shows that when you are
• 30:00
  doing your procedures fully guided, you are more precise than even when
• 30:04
  you're doing your osteotomies guided and freehand implant placement.
• 30:07
  So even in that situation, you are more precise when you are
• 30:10
  doing a fully guided approach.
• 30:12
  So why to take this risk?
• 30:14
  Yeah.
• 30:15
  and of course, between surgeons, they say, "Look, if I place all my implants freehand
• 30:19
  because I'm a great surgeon, This is like going to, y- if you go to, to do, to have
• 30:26
  surgery on your knee, what do you prefer?
• 30:28
  Someone who says, "Look, I'm the great s- the greatest surgeon in the world because
• 30:32
  I'm gonna open a huge flap, and I'm gonna do everything by hand," or someone
• 30:36
  that says, "Look, I'm gonna take or get advantage of all the technology available,
• 30:40
  and I'm gonna use a robo- a, a robotic arm that is gonna be very, non-invasive"?
• 30:46
  What is your, choice?
• 30:48
  The second one.
• 30:49
  For us, it's the same.
• 30:49
  No-brainer.
• 30:51
  For us, it's exactly the same, at least the way I, see it.
• 30:55
  Maybe I'm wrong, but this is the way I see it, and it,
• 30:58
  for me, it works.
• 31:00
  Speaking of the advancements, we have this block that is called, and
• 31:05
  I know you're very scientifically oriented, it's not what we think.
• 31:10
  Partially is.
• 31:11
  But it's of what we know, right?
• 31:14
  It's not what we think.
• 31:14
  It's what we know, evidence-based and literature, what's on
• 31:18
  the table at the moment.
• 31:19
  And if there's one piece of evidence that you say, this opened my eyes to
• 31:24
  the way I work today," or, "This changed the way I do things," sp- in the context
• 31:31
  of aesthetic outcome in full-arch treatments, what would be this one that
• 31:37
  impacted Lanis that you say, "I think the dental community should know"?
• 31:40
  f- at first, Ale, what I, have happened to me is that the more I do,
• 31:47
  the less I think I know, and this is something that comes with experience.
• 31:50
  I'm not that old, but I have been working for a while now in this field.
• 31:57
  and that's why all these details, get more important because you can see that
• 32:03
  there are certain things that for some reason they're not working the way you
• 32:06
  want, and you cannot find the solution.
• 32:08
  Then you talk to a friend or a colleague with more experience, and
• 32:10
  then you understand a little bit more.
• 32:11
  Yeah.
• 32:12
  And talking about a specific article or philosophy or something
• 32:17
  that changed a little bit the way I'm working, I would say that
• 32:23
  when I got involved with the ITI-
• 32:26
  you know that I'm very involved with ITI.
• 32:29
  it's like a m- a family for me.
• 32:32
  their philosophy and the way they were, the way they're,
• 32:37
  they were showing how to document things, all these strict analysis of every, of all
• 32:42
  the cases before touching the patient, in some way it changed the way I was working.
• 32:49
  And then I came up with one of the treatment guides.
• 32:53
  I, I don't remember the number right now.
• 32:55
  I think it's number four, about full arches and full mouth reconstruction.
• 33:00
  and then I realized how important are all these details before going to the surgery.
• 33:07
  the spaces between implants, the space or the, type of abutment that
• 33:11
  you are going to use in this specific situation, intermaxillary relationship,
• 33:16
  the skeletal class, all these things that sometimes we don't take care of-
• 33:24
  Right
• 33:24
  are super important to have a predictable result.
• 33:28
  so yeah, I, if I have to define a specific m- I wouldn't say a moment, but a specific
• 33:34
  thing that changed the way I'm working, w- would probably my relationship with ITI.
• 33:41
  The relationship plus also the treatment
• 33:43
  guides Yeah, the treatment guide and all their publications, yeah
• 33:46
  And it's funny that you mention, the treatment guide number four.
• 33:52
  w- we have to check if it's
• 33:54
  number four
• 33:55
  Maybe it's not four, but I think it's number four.
• 33:56
  But it's still, it goes many years back and still very relevant.
• 34:01
  I remember this treatment guide very well talking about implant
• 34:04
  distribution, segmentation, and all the selections that is still, textbook
• 34:11
  Follow, you have nothing to regret.
• 34:14
  Exactly.
• 34:15
  A- and the good thing about, this
• 34:17
  specific, book is that it's still ongoing.
• 34:23
  actually, we are writing the treatment guide 16 that is called The Virtual
• 34:27
  Patient, and hopefully it's gonna get released at, by the end of the year.
• 34:32
  and I know that the 17 is coming, 18, so it's not only about what was
• 34:37
  happening at that time, it's how to…
• 34:40
  Because the last year, the 15 was published, and it
• 34:43
  was also about full arches.
• 34:44
  Correct.
• 34:45
  That's what I was gonna,
• 34:46
  but using the new technology that wasn't available at that time.
• 34:49
  So they are refreshing and updating all these topics that are still, the
• 34:53
  concept is still the same, but the way to get to that result is different.
• 34:58
  Yeah.
• 34:58
  And this is the nice thing about it.
• 35:00
  It's evolving with the field.
• 35:02
  Yeah.
• 35:03
  And I, think this is unbelievable,
• 35:05
  yeah.
• 35:05
  Evolving without losing the basic fundamentals-
• 35:08
  Exactly … that we should respect.
• 35:09
  Yeah, because dentistry is, still dentistry.
• 35:12
  The way we are dealing with it is different.
• 35:14
  My dad was a dentist, but the way I'm doing things today is completely different
• 35:18
  to what he was doing 20 years ago.
• 35:21
  It's a different field in terms of the execution of things, but
• 35:27
  the concept, biology, physiology, and anatomy are exactly the same.
• 35:33
  Yeah.
• 35:34
  Leniz, I would like to shift… I keep k- You,
• 35:37
  can call me whatever you want.
• 35:38
  I'll get there by the last question.
• 35:40
  Ale, shift gears a little bit.
• 35:44
  Dental photography.
• 35:45
  Honestly, once again, I, cannot stress enough how much of a fan I am because your
• 35:50
  photography skills is really pristine.
• 35:53
  You take meticulous care of your photography, your clinical
• 35:58
  photography documentation.
• 36:00
  And this inspires a lot in many ways.
• 36:03
  First, to step up our game in terms of photography, and also to see the steps in
• 36:10
  between your treatments and how you plan, how you execute, how you follow them up.
• 36:15
  Clinical documentation inspire us to also wanna do better clinically
• 36:20
  as well, so thank you for that.
• 36:22
  No,
• 36:22
  thank you for your
• 36:23
  comment.
• 36:24
  And in that sense- Do you think clinical photography will change if people upgrade
• 36:33
  their clinical skills, will change the way they also plan things and get to
• 36:38
  their results, or just a nice to have?
• 36:41
  Because today, if I continue, I don't want to hijack your question, but I see
• 36:46
  each time more how much information you gather, better input, better output.
• 36:52
  Of course.
• 36:53
  And how do you see the dental photography element within clinical practice today?
• 36:58
  It's not a nice to have, right?
• 37:00
  For m- for me it's a must, okay?
• 37:04
  And
• 37:04
  not because I like to, share my photos in social media.
• 37:10
  It's not about that.
• 37:11
  It's because- macro photography gives you information that
• 37:17
  the eye cannot see right away.
• 37:20
  So what I do is if I have doubts or I want to analyze something, I go to my computer,
• 37:25
  I enlarge the f- the picture that I took before, and I can see things that my
• 37:31
  eye cannot see, even with loops, okay?
• 37:33
  Because, and I c- I can enlarge it whatever I want.
• 37:36
  And sometimes you're paying attention to so many moving parts,
• 37:38
  right?
• 37:38
  yeah.
• 37:39
  You are doing surgery, there are so many things happening at the same time
• 37:42
  that th- then the photo's gonna give you that information or that piece
• 37:46
  of information that maybe is missing.
• 37:49
  but also from a diagnosis, diagnostic standpoint, or also from, a planning
• 37:53
  standpoint, it's gonna give you a lot of information to manage and plan your case.
• 38:00
  there are people that, they… Because if you go to my office, you're gonna see
• 38:04
  that I have a bunch of cameras and stuff.
• 38:06
  It's because al- I also like it.
• 38:09
  but they say, why do you have all of this?" and it's because I have a camera
• 38:12
  for internal photos, I have a camera for surgery, I have a cam- because
• 38:15
  I like to have the setting ready and not to start changing and playing
• 38:19
  with the setting during the procedure.
• 38:20
  I see.
• 38:21
  So I have different cameras for different things- Interesting … and purposes.
• 38:23
  But this is, Okay … I'm a little bit crazy too, maybe.
• 38:29
  but honestly, and this is, something that I learned from another doctor
• 38:34
  who taught me a little bit how to take photos, and then I was just watching him
• 38:38
  working and I, l- I learned by myself.
• 38:41
  I think photography w- was one of the things that changed completely the way
• 38:45
  I was working, because I was taking in consideration details that I wasn't
• 38:51
  taking into consideration before.
• 38:53
  So everything changed from that specific point.
• 38:56
  And then I started to like it because I could see that my photos
• 38:59
  were improving and, my photos at the beginning were terrible, like
• 39:04
  everyone's when, they are starting.
• 39:07
  Yeah.
• 39:08
  and I couldn't say that they are perfect now.
• 39:10
  They're… I, and also I take 200 photos and I select two.
• 39:14
  That's the, beauty of the photography too.
• 39:16
  You can just choose.
• 39:18
  Yeah, digital, especially digital.
• 39:18
  Yeah, you can pick the one that you like.
• 39:21
  but they help a lot to improve the way you work.
• 39:25
  they, they also work to transfer or to communicate with others.
• 39:32
  when I'm lecturing, when I'm, trying to explain something to a patient, when
• 39:37
  I'm talking with the lab technician- Yeah … and I want him to see
• 39:40
  something specific, I, think it's a very good way to communicate things.
• 39:45
  And people say an image, it's worth more than-
• 39:49
  S-
• 39:49
  thousand words … speaks more
• 39:50
  than a thousand words.
• 39:51
  Yeah.
• 39:51
  This is exactly the reason I work with photography, and also because I like it.
• 39:56
  Yeah.
• 39:57
  It's amazing how, it's, it's something that it grows in us, right?
• 40:02
  The dental photography.
• 40:04
  And, I like how you phrased it in a sense that we start improving
• 40:08
  and improving because- Any picture is better than no picture.
• 40:13
  But sometimes we see pictures that look like a crime scene, right?
• 40:18
  It's a, you would have, especially the surgical ones too, it's not just like
• 40:22
  a photojournalism that th- something is happening and, you're just observing.
• 40:28
  You have to really take proper care of that so you can refer back to that
• 40:32
  picture and have a sense of what you did.
• 40:35
  Otherwise, it's so much information that not necessarily
• 40:38
  what you wanna get out of it.
• 40:40
  Yeah.
• 40:40
  Yeah.
• 40:40
  Yeah.
• 40:41
  You're right.
• 40:43
  You're, completely right.
• 40:45
  and I always talk to my, when I'm doing surgery to this person who's helping
• 40:51
  me, the doctor or as- my assistant.
• 40:54
  When you are taking photos and then you are gonna show these photos to an
• 40:59
  audience, for example, if I'm gonna have to lecture or, in an article.
• 41:03
  When you're working and everything is full of blood, it looks
• 41:06
  like you are a dirty surgeon.
• 41:08
  Yeah.
• 41:09
  So I prefer just to clean everything.
• 41:11
  It doesn't mean that my sur- my surgeries you, are not gonna find blood.
• 41:14
  Of course, all the patients are bleeding.
• 41:16
  They are alive.
• 41:17
  But as soon as I know that I'm gonna take a photo, I clean everything.
• 41:20
  I prepare the setting, and then I take the photo.
• 41:22
  Yeah.
• 41:23
  Because of respect for the audience, also because you want to highlight
• 41:26
  certain details that if they're covered by blood, it's impossible.
• 41:30
  Yeah.
• 41:30
  so there is a, preparation.
• 41:32
  It's not automatic, of course.
• 41:34
  It takes some time, but then your team is already trained.
• 41:37
  They know what to do.
• 41:39
  So I said, "Photo." I take the camera.
• 41:41
  Boom.
• 41:42
  Yeah.
• 41:42
  Done.
• 41:43
  Very fast because I cannot stay for hours with the patient
• 41:46
  when, while I'm doing surgery.
• 41:48
  Yeah, I agree with you completely.
• 41:50
  Honestly, the quality of your photo documentation is equally proportional
• 41:56
  of the quality of your work.
• 42:00
  Thank you.
• 42:01
  Thank you.
• 42:01
  Thank you
• 42:04
  Ale, there's a section that we call Experience Taught Me This.
• 42:08
  Today, you work at the highest level in terms restorative speaking, surgically
• 42:14
  speaking, but you haven't always been to this level of performance.
• 42:19
  There was a learning curve- No … and a very long one, in which you stumbled,
• 42:23
  I'm sure, upon many circumstances and situations that you say, "Oh, boy,
• 42:28
  I wish I knew then what I know now.
• 42:30
  I wish I had the resources then w- that I have now." Can you remember of
• 42:35
  a situation that it was like it still haunts you? Not haunts you, let's not
• 42:38
  put it that way, that you say, this one particular case, I wish I could
• 42:43
  go back there again and redo it"?
• 42:45
  Can you remember one that-
• 42:46
  Oh … that
• 42:47
  it was a big learning?
• 42:47
  I, know I have several, but-
• 42:51
  I think that, today I'm, Of course, this is about the experience, but I'm
• 42:56
  more cautious than what I was before.
• 43:00
  And if I could go back, there are certain cases that maybe I move forward
• 43:05
  with a, for example, an immediate implant placement, where I think today
• 43:09
  I could go with a different approach.
• 43:11
  I would go with a delayed implant place- or a, early implant placement.
• 43:16
  when you are young and you don't know much or less, yeah, you scare
• 43:21
  less, and then you take these risks because n- not because you're a risky
• 43:26
  person, it's because you don't know.
• 43:28
  And now that I can see those results, or maybe I had to intervene again to
• 43:33
  solve some issues, I could have done it in a different way, maybe be- being more
• 43:39
  cautious of what I was doing at that time.
• 43:42
  And we like to… when I heard something sometimes, it's we like to
• 43:48
  do all the miracles at the same time.
• 43:50
  Yeah.
• 43:51
  Today, I know that's a very difficult thing to do.
• 43:53
  I prefer, if possible, of course, you can do it, but if I'm gonna take some
• 43:57
  risk just by doing everything at the same time, I prefer to go step by step
• 44:00
  because you are always gonna have m- another opportunity to improve the case.
• 44:06
  But if you do everything at once, then you don't have too many
• 44:09
  chances to improve it anymore.
• 44:11
  So I prefer to go in a more cautious way.
• 44:14
  And the other thing, and this is something that I was sharing my, with my
• 44:18
  residents when I was working in Boston Always give time for the tissue to heal.
• 44:24
  If you rush, then you're not gonna get what you're expecting.
• 44:28
  And at that time, I remember some of, my residents… I don't know if we
• 44:32
  have time, but at that time- No, we're good … some of my residents were
• 44:34
  asking me, "Hey, doctor, can I take the impression, the definitive impression?
• 44:38
  Because I think we're ready to move forward with the definitive…" Because
• 44:40
  of course, they needed to graduate.
• 44:42
  Yeah.
• 44:43
  and I was keep saying, "Let's wait.
• 44:46
  Let's give this patient one more month or maybe two weeks.
• 44:49
  Let's see what happens with these p- these papillas.
• 44:51
  Maybe they're gonna go down a little bit more.
• 44:53
  Let's give s- more space." And they were frustrated because they didn't know if
• 44:58
  they were, going to be able to graduate.
• 45:00
  And I said, "Look, guys, I'm the one who's gonna sign for your graduation.
• 45:03
  Don't worry about that. But let's try to deliver the best treatment as
• 45:07
  possible, and for that we need time."
• 45:09
  Yeah.
• 45:10
  And then, yeah, at the end they realized that I was right.
• 45:14
  and they graduated anyway.
• 45:18
  but if you rush, biology is gonna react.
• 45:22
  And that's why we need to give the proper time for the tissues to heal, to
• 45:28
  relocate, to mature, mature, yeah, until we, we get what we're expecting for.
• 45:35
  I like how you phrased this, Ale, because look, there are so many… The, benefits
• 45:41
  of immediate solutions are vast, right?
• 45:44
  There we can, preserve certain, certain structures.
• 45:48
  We can, influence the healing pattern over certain, papillas- contours.
• 45:55
  However, we should never forget that if an implant also integrate, doesn't mean we
• 46:00
  have soft tissue maturation, and that can backfire towards the final restoration.
• 46:05
  Exactly.
• 46:06
  Exactly.
• 46:06
  Exactly.
• 46:07
  So we, at le- look, the way I see it is if you are gonna go with an immediate
• 46:12
  implant placement, something that is, it's very trendy again, and I think
• 46:17
  it's something that is very beneficial for the patient in certain situations.
• 46:21
  But the main purpose of doing an immediate implant placement is to preserve the
• 46:27
  preexisting emergence profile of the tooth that was in there before the extraction.
• 46:32
  So if you're gonna do an extraction, and you're gonna place an implant,
• 46:34
  and you don't have any, purpose of loading that implant- Yeah … or at
• 46:38
  least placing a customized healing abutment, what is the main r- the, what
• 46:44
  is the reason or the purpose to do it?
• 46:46
  You are just taking a risk.
• 46:48
  If that's the situation, you don't have any plan to load that implant right away,
• 46:52
  then maybe the best option is to wait until the soft tissue is healed, and
• 46:56
  you go with an early implant placement that has been described for more than
• 47:00
  30 years, where Danny Buser has All these, papers and publications about that
• 47:07
  specific protocol that is probably w- the most well-described protocol in- Yeah
• 47:12
  implant dentistry, and you know that you're gonna go safe.
• 47:16
  But f- from the other side, if your plan is to preserve that structure
• 47:21
  and to preserve that profile, then the indica- if the indication is the right
• 47:25
  one in terms- Yeah … of the anatomy of the site, yeah, of course, it's a
• 47:29
  beneficial situation for the patient.
• 47:31
  Yeah.
• 47:32
  But then you need to ba- put in the balance what do you wanna achieve, and
• 47:37
  how is the pa- the condition of the patient, if it's appro- appropriate
• 47:40
  case for this specific indication.
• 47:44
  No, I agree completely.
• 47:46
  As long as the indication is on the table, that's a viable and, the right
• 47:51
  solution to go, but we should not cut corners just for the sake of speed.
• 47:56
  This is
• 47:57
  the,
• 47:57
  same thing that I was saying before.
• 47:59
  If you hear something, hear someone… Sorry, someone saying, "I always
• 48:03
  place immediate implants," this always- … is when I start doubting.
• 48:10
  It is trouble.
• 48:11
  Everything has its own indication.
• 48:12
  Biomaterials, they have their own indication.
• 48:15
  Type of implants, they have their own indication.
• 48:18
  That's why we call it personalized, in, in personalized dentistry
• 48:21
  or personalized medicine.
• 48:22
  Today, we have the tools to prepare or to tailor every single treatment
• 48:27
  for, every specific patient.
• 48:30
  We have that tools, and we have the information.
• 48:32
  We just need to manage it and diagnose, plan, and
• 48:36
  execute.
• 48:39
  Ale, we are already, as we said about the pilot, cabin crew prepare for landing.
• 48:45
  We're starting to descend.
• 48:47
  If we now start going not in a dreamer mode, because I could say,
• 48:52
  for example, artificial reality… artificial intelligence is already
• 48:55
  a reali- a reality, and we have so many things coming our way.
• 49:01
  If we're talking about, implant aesthetics, can you anticipate looking
• 49:09
  from… You're very involved with research, with the latest technologies.
• 49:13
  Can you anticipate what clinicians should be paying attention to or
• 49:17
  get prepared skill-wise to confront, not to confront, but to be walking
• 49:23
  hand-in-hand with the new advancements in the next five, 10 years?
• 49:27
  this is a difficult question because it's very difficult to predict the future.
• 49:31
  But what I think is gonna happen, is, technologies are evolving so fast.
• 49:37
  J- just imagine what was happening, I don't know, 20 years ago
• 49:41
  with the iPhone and the type of cell phones that we have today.
• 49:45
  Yeah.
• 49:47
  probably technology in our field is gonna evolve even faster.
• 49:51
  This is an exponential growth.
• 49:54
  so probably what I think is AI is gonna be an im- very important
• 49:59
  part of the diagnostic, diagnosis and also from the planning phase.
• 50:03
  we're, I think we are not gonna need to do our, all the planning ourselves.
• 50:07
  I think you're gonna just click one button, and then you're gonna
• 50:10
  approve or change or do a, like a fine-tuning of the planning.
• 50:15
  Validate.
• 50:15
  Validate, because that's the thing.
• 50:17
  We are w- the software always gonna need a validation from a professional.
• 50:23
  That's a value that we have or we are gonna keep having, luckily.
• 50:30
  so I think it's gonna be an important, factor, or tool that
• 50:35
  we are gonna get, in our planning.
• 50:38
  And then of course, the way we are gonna execute things is gonna be different.
• 50:41
  I think navigation, that is, is something that is already happening.
• 50:45
  Then robotic surgery is gonna, it's gonna come.
• 50:48
  This is something that is in- inevitable.
• 50:49
  It's gonna happen.
• 50:51
  And maybe we are gonna work remotely later, and we are gonna have a…
• 50:54
  In my, in the way I see it in the future, and maybe I'm a little bit crazy, but
• 50:59
  I see people in their houses, with a center with, several robots, and you
• 51:06
  are gonna be just Working from home.
• 51:10
  Maybe hopefully in the pool having a beer and just touching certain things, and the
• 51:16
  robot is gonna be doing it, everything.
• 51:19
  I think this is gonna happen.
• 51:20
  I don't know when.
• 51:21
  Yeah.
• 51:22
  but I think that's the future.
• 51:23
  It's an integration between robots, artificial intelligence,
• 51:27
  and all the knowledge that we have that is not gonna change.
• 51:30
  Knowledge is exactly- The same … the same in terms of the concepts.
• 51:33
  Dentistry is gonna still go- being dentistry.
• 51:35
  The way we're gonna face these treatments is gonna be different.
• 51:39
  Yeah.
• 51:39
  What we see around us seems to be pointing to that direction.
• 51:44
  Exactly.
• 51:45
  Let's see what happens.
• 51:47
  Alejandro, it was an honor.
• 51:51
  Once again, I cannot stress how much of a fan I am, and I can only thank
• 51:56
  you very much and to the dental community that is watching us.
• 52:00
  Where can they find most, can th- they find you and learn from you and le-
• 52:06
  see all of the work you've been doing privately with ITI, research, lectures?
• 52:12
  fir- first-
• 52:12
  The camera is yours
• 52:13
  … first, thank you very much for having me here.
• 52:15
  It's, it's my pleasure.
• 52:17
  It's my honor.
• 52:17
  The Straumann is, like my, house too.
• 52:21
  I, I, every time that I come, they treat me so well.
• 52:25
  and if you want to find me or to see what I'm doing, of course, I'm based in Chile.
• 52:30
  I have my own practice.
• 52:31
  But, we are doing certain courses or several courses once in a while.
• 52:36
  I'm very involved with the ITI.
• 52:38
  We're gonna launch the new, ITI Treatment Guide very soon with
• 52:42
  Vincent Fehmer and Ali Murat Cocat.
• 52:44
  Nice.
• 52:47
  we are gonna be soon in Istanbul for the annual conference.
• 52:51
  Next year we have the ITI World Symposium in Milan, so I think
• 52:56
  we are gonna see each other soon.
• 52:58
  And let's keep in touch.
• 53:00
  This is-
• 53:00
  Can they connect to you with social media?
• 53:02
  Yeah.
• 53:02
  My… I have an Instagram account that is only for professional stuff.
• 53:07
  That is Ale, A-L-E, Ale … underscore… No, it's doctor, dr.ale_lanis.
• 53:17
  We're gonna leave
• 53:18
  the- Yeah … the account listed below.
• 53:19
  It's in here now.
• 53:20
  Yeah.
• 53:22
  No, but thank you very much for everything, and it's,
• 53:24
  it has been a pleasure.
• 53:25
  Ale, thanks again.
• 53:29
  And to all of you watching us, if you liked this episode, give it a If
• 53:33
  you didn't like, give it a dislike.
• 53:35
  And honestly, we would love to learn if we're doing things right or wrong.
• 53:39
  Please comment.
• 53:40
  Leave a comment below.
• 53:41
  It doesn't hurt.
• 53:42
  And if you think a friend will benefit from this episode,
• 53:45
  send it to him, send it to her.
• 53:47
  In the end, sharing is caring.
• 53:49
  I would love to see you in the next episode of Straumann ProTalk Clinico.
• 53:53
  Until then, stay safe.
• 53:56
  Bye-bye.