Latest / Straumann® ProTalk / Are we underestimating implant complications? Dr. Frank Schwarz on what dentistry gets wrong

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Are we underestimating implant complications? Dr. Frank Schwarz on what dentistry gets wrong · Straumann® ProTalk

0:00
It doesn't matter how many Instagram followers you have, but
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science, what you put on PubMed, for instance, this is hard work.
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This is super hard work.
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if today you could change worldwide one habit in implant dentistry, which would
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it be and what would be the impact?
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The almost unrestricted usage of CBCT scans.
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We overexpose patients in a way where we don't see a clear clinical benefit.
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I think you have a very high sense of responsibility for,
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let's say, the patient community.
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Dementia correlates with tooth loss.
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So when you reestablish the chewing function by means of
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implants, you even counteract the degeneration of cortical areas.
0:55
Welcome to ProTalk.
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Welcome to the pulse of dentistry.
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Welcome to this episode, where George and myself have the pleasure to welcome
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a guest, a clinician and a scientist actually, that has shaped not only
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our thinking about implant success, but also its limitations and limits.
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very happy to have Professor Frank Schwarz from Frankfurt with us.
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Welcome, Frank.
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Thank you.
1:18
Thank you.
1:19
Good morning, Frank.
1:19
Good morning.
1:20
Good morning.
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Frank, today, we will speak about, of course, the tremendous success
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that implant industry is, but there are limitations as well.
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We will speak about, those limitations.
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we will speak about peri-implantitis.
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This is a reality and it's happening, and we, have to speak about its
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etiology, prevention, diagnosis, therapy, and, with you, we have one
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of the leading experts in the field.
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But you are more than this, than expert in this field.
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We will also speak about, of course, i-innovation and, the
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tension of, let's say, between innovation and clinical reality.
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So very happy to have you, Frank.
2:01
Good morning.
2:03
Frank, first question we always ask is, who is Frank Schwarz in one minute?
2:07
Yeah.
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That's the tricky one.
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be-because to define yourself as a person is, always critical because
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you always see yourself from a different perspective, and usually
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not the way other people look at you.
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So I describe myself as a person who is, fully dedicated
2:29
to details, to professional approaches, to trust, to confidence.
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I'm very much into team working.
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I'm very much supportive for younger people who are striving for, let's
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say, the next steps in their career, and this is what characterizes
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me and what drives me most.
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Yeah.
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as a private person, I'm
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dedicated or fascinated, about aviation, so this is where I spend
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most of my time- Okay … that I have.
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So putting me in the airplane is for me the, best place where I can
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be Because- Okay … this, gives me this, feeling, this sensation
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of, an exceptional environment.
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So I'm f- what is football for you, it's, aviation for me, as I've learned.
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I have unfortunately not the time to spend, with my family because our business
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is really demanding time-wise, as Yeah.
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but all in all, I'm a quite regular, a normal person, yeah?
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And, that's why I, put too much time into my profession, and that's
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what characterizes all of us here.
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Yeah.
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Aviation is actually a very interesting topic- and, that
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I, see a lot of parallels.
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what transfer do you get from, looking at aviation into your professional life?
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i- it's, not linked to, my profession, so I think aviation is something
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that, of course, where you start maybe as, a teenager, yeah, becoming
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a pilot, which was actually my, my, my dream, but it never came true.
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of course it goes, also goes along with what we are doing.
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We are traveling a lot, and this is something that attracts this
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innovation, something that comes, I would say from the outside.
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So this is something that you cannot reach, yeah?
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Because this is something that you don't have in your day-to-day life.
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Yeah?
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It's exceptional.
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And this is something that attracts me.
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Of course, from the perspective of our job, a pilot, they have checklists.
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They, try to avoid errors and failures- and I think they are perfect in this.
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Yeah?
4:58
So the success rate- Yeah … or the survival, let's put it
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that way from our outcomes perspective is exceptionally high.
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Yeah.
5:08
Yeah?
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And the link to peri-implantitis, of course- Yeah … maybe a
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checklist is also something that we should put more into our routine.
5:16
Yeah, exactly.
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Protocols, checklist.
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Yeah, I think there's a lot of, Yeah … actually analogies there.
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Attention to detail.
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Yeah, I think so.
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Absolutely.
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learning.
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Yeah.
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A very meticulous way to learn from mistakes.
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Yes.
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and teamwork, so- Teamwork, right?
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Yeah, Yes.
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Frank, you mentioned soccer.
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in soccer, intensity is, is, Yeah … becoming a big word, to
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play with high intensity, and I see you playing your career … We know
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each other 20 years now, and- Yeah
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you play with a very high intensity and very high quality in many fields.
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You, are a clinician, you are a researcher, you are
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an educator and a speaker.
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you are very active in also associations, in, leading roles in, in associations.
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That also takes time and efforts and, let's say, attention to details.
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What is the bigger purpose for you behi- behind this?
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why do you play this so intensely in, in this completeness?
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Yeah.
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So what should always be the main driver is the academic basis of Dentistry, and
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we will discuss about the term maybe a little bit more in detail because,
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dentistry is, not the way I would put it, so it's more oral medicine.
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but the academic basis is something that is essential.
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So education is always driven by research and the academic basis of,
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medicine, of dentistry is research.
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So that's why the main driver is research, and research is something that is of
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course coming from the institution, but you need research support, you
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need exchange, and that's why the main driver is always research- to
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drive to establish the academic basis.
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Where, do you get your research ideas from?
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Where do you get this inspiration from?
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Yeah, I get it from the industry.
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I get it from the exchange with other people, and also
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from the patient's perspective.
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Yeah?
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The clinical work.
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The clinical work.
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And that's why the translational part is really important.
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So just working in a lab- From my perspective- can never reach the real
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target, the real needs of a patient because you, don't get the feedback.
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Yeah.
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Okay.
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So clinical research is the fundamental basis, but without having the exchange
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with basic research, with basic science, you will of course also not proceed.
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Yeah.
7:51
So at the end you need to- to exchange, to, discuss with
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people from, different fields.
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Or it will remain shallow, Yes … at the end.
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Absolutely.
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Yeah.
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Yeah.
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Yeah.
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how do you balance this with your private life?
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the intensity is high and, and- Yeah … you do with, it was
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nice how you described yourself.
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that's also how we perceive you with, precision and details and
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perfection and doing things right.
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So it takes a lot of time as well.
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How do you balance with your private life?
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Yeah.
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So there is no private life from that perspective, because you
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never, you can never stop, yeah?
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So in these days, a typical, let's say, work days, you, work at the university,
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you have patient service, you have education, you do the research, and
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towards the evening you have meetings in these days with the Zoom meetings.
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So this is actually never ending.
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Yeah.
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So you, have to define, private life in a different way.
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I'm not talking about family life.
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I'm talking about your private life as a person.
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Yeah?
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And our profession, what you do, becomes- part of your private life.
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Otherwise- you couldn't succeed- because the, day has 24 hours.
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It, has 24 hours, yes.
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Absolutely.
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Yeah.
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Yeah.
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Yeah.
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So you're not making basically this, clear distinction because it's your life.
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It's, Yes.
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The work is part of your life and, it's also what, you're probably fascinated by.
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So it's also giving you energy.
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It's not just, Work … draining you, right?
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Yeah.
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this, trend word, this work-life balance.
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So this is something I, think this is, nice and you, can discuss about
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it in, in many different ways.
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But if you say work-life balance means that you work six and a half hours per
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day, and then you make a full stop, and then you enjoy your private life,
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this is something that I could never imagine- that could ever come along
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with the progress, with the career.
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So you have to spend- Many, years- far beyond a six-point
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hour or a seven-hour workday.
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Yeah.
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Absolutely.
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And this can never happen if this what you're doing is not
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part of your, let's say, desire.
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This is not something that you would like to do.
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You will never succeed.
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No, I fully agree.
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I think it's a bit reoccurring topic.
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people, guests we have in the podcast, success is not coming by itself.
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It's not- Yeah.
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You will not have a- It's hard work … a four-day- Yeah … week
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and, have a beautiful clinical career or research career or academic career.
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That's simply not possible.
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Same is true for us, probably.
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Yeah.
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I looked, on your social media profile, as well, w- which you
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have, and we are connected.
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But what, I observe is, Frank, you build and maintain a very science-driven,
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let's say, image as well, and that, that is where I feel you put your
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focus, whereas others are building, huge, let's say, Instagram channel
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and, there is nothing right and wrong.
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Yeah.
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But, I see you, you took a- You think so?
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I--
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Let's, see.
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We have a discussion.
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Oh, yeah.
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But, I, I- It's a good point, Andreas … the question is, it a
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deliberate choice- Yeah … that, you did, and, why did you do it?
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I, give you one example.
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I, was really shocked.
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I will not name any names and not even the society.
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a big conference in my session.
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The chair of the session announced the next speaker, and he said, the
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next, let's welcome the next speaker.
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He is blah, blah, blah, and he has 35,000 followers on Instagram." That
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was the introduction, and I was shocked.
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Because in my mindset- Yeah
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it doesn't matter how many Instagram followers you have.
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In the past, it was this person has so many publications, has reached
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these, let's say, teach goals.
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Yeah.
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He's standing for- Yeah … the topic, whatever.
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But the Instagram profile become all of a sudden- a major part of the
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announcement, and I was reflecting it very heavily, and at the end I was shocked.
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Because Instagram is something that you can influence in different ways,
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but science, what you put on PubMed, for instance- this is hard work.
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This is super hard work.
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And again, going back to the academic basis, this establishes the academic
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basis of dentistry over medicine- Yeah … medicine of each and every discipline.
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Yeah.
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Instagram does not.
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No.
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No, it's not a, it's not a qualification criteria.
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Exactly.
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it's, I- if you have the quality and the content and the depth, it
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might be a channel that will help you to disseminate ideas probably.
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Not in a, very much adapt, but, in a, let's say, more broad way.
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Yeah.
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Yeah.
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But on Insta, you, see it all over the place.
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People are … I'm not against it.
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it's part of the new wave.
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Yeah.
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I think this is important, yeah, for this global outreach, for the communication.
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Super important.
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But it shouldn't come as a first step.
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Absolutely.
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The first step is doing research.
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Yes.
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Spend time, dedicate yourself, find your way.
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Yeah.
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And in the next or the over next step, you put Insta, and
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I think then it makes sense.
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Yeah.
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To, disseminate quality- Yes … and not just- Yes … flip it around.
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Yes.
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Yes.
13:22
Yeah.
13:22
No, I agree.
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Yeah.
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And advertising yourself, promotion of yourself is, I would say,
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it's not the best way to proceed.
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Yeah.
13:31
Yeah, I know.
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Yeah.
13:32
100%. Yeah.
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Yeah, that's a, that's an interesting topic that, probably
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we could spend, more time on.
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Yeah.
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And, maybe later on we have, we have the chance to also discuss a bit there.
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so Frank, now let's, also move a bit into implantology.
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And Andreas, you mentioned before, so implantology in the last, three
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decades has become very successful.
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So also if you compare it to other medical treatments, we have
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high success and survival rates.
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We talk about 95, 98%.
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We have 10, 15, 20 years data, and looks quite promising.
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a lot of patients are actually receiving implant treatment.
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Now, on the other hand, things go wrong, and I think this is where you also
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spent a lot of your career dedicated to, figuring out what can go wrong, and if
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it goes wrong, how can it be treated.
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So- the whole peri implant complications, mucositis, peri-implantitis is a key
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topic of what you're standing for.
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Maybe let's go back to the beginning.
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I would wonder, was there a specific moment where you decided, "Okay, this
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is something I want to dedicate my, let's say my life, my work, theme on"?
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And what was it?
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Was it a specific patient?
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Was it a conversation that you had with, with colleagues?
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How did it come about to really focus that much on, on this topic?
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That's a very good question.
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so I started-- I studied dentistry in the southwestern part of, Germany in
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Homburg, Saar, so it's a quite small town.
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at these days, Tony Scullian was my supervisor, so this is where I got
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to know him as a dental student.
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And w- we had a brainstorming and, he said, peri-implantitis or im-
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infections around the implants becomes more and more popular in, in the
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literature." So we are talking about maybe a handful of publications.
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And I said, "Let's, start it. This is a good topic, so maybe, we, we, should
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establish a basis on, on, on, implants and infections." But the reality was,
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in that small university, in that small city, I have rarely see patients with
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implants because just a few numbers.
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Was not popular yet, yeah.
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It was not popular yet.
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Yeah.
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And I'm talking about the year 1999.
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Yeah.
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So it was the right topic at the wrong place.
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A couple of years later, I lo- moved to Düsseldorf, and
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Düsseldorf was the opposite.
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Many implants, many patients, and all of a sudden we have seen peri-implantitis
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at its best in the clinic.
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So that was the right place to start.
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So the need- to tackle a problem that was apparently a problem
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even in, at this days, 2004.
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Something that, I, often get the question is, how do these two things
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actually come together and make sense?
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Because on one hand, survival rates we have very high, let's say 95, 98.
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On the other hand, if you look at prevalence data of complications,
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it's also quite high, right?
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Depending on publications, 20, 30, 40%.
16:51
So how do you bring this together, and are we systematically
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underestimating the complications that actually can occur with implants?
16:59
Yeah, we have the two worlds.
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We have on the one hand side the clinical reality, what is happening in our
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university, in, in the office next door.
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And what is reported in epidemiologic data.
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So epidemiology always means you have a convenient sample unless you are talking
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about, registries such as in Sweden, you have a well-established registry.
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but even those data are just reflecting the situation in Sweden.
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So it's really super hard to transfer epidemiological
17:30
data to day-to-day practice.
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So that's why when you see a complication rate of peri-implantitis prevalence of
17:39
30% in epidemiological studies, it doesn't mean that you will see it in your office.
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So that means, practically, I would say yes, the tendency
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is always we underestimate the problem, and this is hardly, I
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would say, justified by those data.
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But in essence, I would say the numbers are much higher.
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So now what's the essence of it, Frank?
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So is it, that we have a real problem in implantology, or can we actually maintain
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the status quo- Yeah … and, we do have also treatment options today that
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are, well-suited to, to still be very confident in promoting also implantology?
18:26
Yeah.
18:27
So I think that's the point.
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If you put it that way, peri-implantitis, one-third of implants
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are affected, or let's say 50%.
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You would say 50% of the implants are lost and are big complications, and I
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would say this is definitely not the case.
18:42
Okay.
18:42
Only a very small subset, percentage of those 30 or 50% are really
18:50
hard to treat, hard to manage.
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Most of these can be resolved quite easily and maintained, so even the
18:56
patient will not even notice it.
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Unfortunately, some dentists will also not notice it.
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Also not notice it.
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But, overall, overall, the, projection of, a tsunami of complications is what
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not really matches the, clinical reality.
19:16
So I would say even if you have one-third of implants revealing signs
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of inflammatory reactions, only a subset of these implants are really
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critical- And dangerous … complication related in, your day-to-day practice.
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I'm, sure that you're, seeing some patients, some cases- Yeah … coming
19:36
to you and then you say, "Okay, this could have been avoided."
19:38
Yeah.
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And, if you see those cases, what is the main root cause of these complications?
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Is it more in the planning?
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Is it in the execution, or is it in the maintenance phase of a treatment?
19:50
Yeah.
19:51
All of these components are, critical in the planning phase, of course,
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but the, planning phase is in most of the cases quite well because
20:01
we have now digital planning.
20:02
We have so many tools that facilitates this first step.
20:06
So most of the complications come now in the execution phase when you put
20:11
the implant in, a non-ideal position or the bone is not that, let's say,
20:17
perfect as you would like to have it, so you have a compromisation during
20:22
the execution and the maintenance.
20:25
So this is what many people underestimate.
20:28
It's quite boring, but you have to see your patient many
20:31
times and you have to clean it.
20:32
So for a surgeon, this is something that he doesn't really have on the
20:36
radar and but that makes the difference.
20:38
And even if you don't do it, you have to delegate it.
20:41
You have
20:41
So coming back to your question, it's not necessarily the planning phase, it's
20:46
more the execution and the maintenance.
20:47
And the maintenance, yeah.
20:49
So in, in the last decade, where would you, allocate the biggest
20:53
advancements in terms of, treating peri-implant complications?
20:58
Is it, then in the maintenance phase?
20:59
Have there been better tools developed?
21:02
so where, do you see the biggest advancements, in, in that field?
21:05
Yeah, the biggest advancements are definitely in the definition of risk
21:10
factors so that we know which patient has which profile, that we better understand
21:16
which factors influence the treatment outcome And some of them are still hidden
21:22
factors, so we have just small evidence, but all the immunological parameters.
21:29
So each patient has a fingerprint, an immunological fingerprint.
21:33
And this is something that you can't see by means of a probe or
21:37
by standard tools, so you, need to go into more advanced- Analysis.
21:44
Yeah … analysis.
21:44
and this is, for instance, a cytokine profiling.
21:47
This is something that can be done easily.
21:50
And we have specific cytokines, we have specific cell types that are linked
21:55
to a higher risk profile than others.
21:57
So identifying the patient more from the immunological
22:02
perspective is one advancement.
22:05
And this is something that is established, but can hardly be
22:08
used because the technology is not available in day-to-day practice.
22:13
So it's not always the surgeon who, who to place the implant in the wrong position.
22:19
it's more the immunological component.
22:22
Okay.
22:23
Yeah.
22:24
So do you see the chance that actually those technologies will
22:27
become soon available also for, let's say, general practitioners?
22:31
Because y- they are more complex, and it's not easy accessible today,
22:35
but are they, are there advancements that you see, to actually make this
22:38
more prominent for, general use?
22:42
I hope so.
22:43
this is your job.
22:45
You are the… from the industry side, I think chairside testing
22:49
is something that you can easily establish- for major cytokines such
22:54
as interleukin 6, for instance.
22:56
This can easily be assessed chairside.
22:59
and that would help tremendously to monitor a patient.
23:01
How is the immunological status?
23:03
So that would help tremendously.
23:05
And yes, of course, this can become available within a short period of
23:09
time, but the awareness is important.
23:13
Do, you have the feeling, listening to you, planning treatment, then
23:18
also, let's say, the handling of complications, and in be- in
23:21
between is actually the maintenance.
23:23
Do we underestimate the maintenance phase?
23:27
do you feel it's, clear enough, the guidance is clear enough to
23:31
clinicians out there and to patients, how to do a proper maintenance?
23:36
I think this is well understood.
23:39
This is well described in all the guidelines.
23:42
I think there shouldn't be any lack of knowledge.
23:46
Yeah.
23:46
So this is just the execution.
23:49
How can you implement such a maintenance program in your office
23:52
when you are just placing implants?
23:54
so it's all about the responsibility, who takes the
23:57
responsibility for the maintenance.
24:00
And I think the delegation would be one option, but at the end, that's
24:05
the clear duty of- of a dentist.
24:08
Yeah?
24:08
So he needs to delegate it, or he, has to do it on his own.
24:12
Yeah.
24:13
But from, that perspective, it's more the execution and the diagnosis.
24:19
That leads to the maintenance scheme, yeah?
24:23
And it's not just cleaning.
24:24
It's knowing that this patient is a diabetes patient, is a patient
24:28
with a high immunological risk profile, and this patient needs
24:31
to be handled in a different way.
24:33
Yeah.
24:34
So closer follow-ups.
24:36
What is your opinion on, let's say, at-home monitoring?
24:39
So is this something that we can, put patients in the responsibility or is that
24:45
rather difficult to actually get the, the maintenance done not in a clinic?
24:54
a good example, with my watch, I track my sleep, I track my training, I track
25:00
my stress level over the day, so in the evening and I can easily get access to
25:06
at least 50 parameters- that describe me as a person, how I perform the day.
25:12
Based on data.
25:13
Based on data.
25:15
So it's very simple and easy to monitor- even oral health related parameters with
25:23
all these gadgets, with all these tools.
25:25
I think this step is so simple and small, so- Monitoring at
25:31
home is exactly that domain.
25:35
So in the future, a patient should, get at least some parameters that
25:39
reflect his oral health status.
25:42
Not a bleeding score and not- No … a probing depth of the implant, but- Can you
25:45
please check my - Yeah, but- … partner?
25:48
it should give him at least the awareness that parameters related to the oral
25:53
health status- are- Inflammatory.
25:56
Yes.
25:56
In line or, yeah.
25:57
Or, yes, or are at least in the awareness.
26:00
And I think this is something that can easily be established.
26:04
Very easily.
26:06
Oh, okay.
26:07
Yeah.
26:07
So that would help to, let's say, not just to, avoid, peri-implant diseases,
26:15
but also to generate more the awareness of oral health related quality of life.
26:20
And that's why I started with, at least a short notice on dentistry.
26:26
Is, it's not the appropriate term for what we are doing.
26:31
Yeah, it's oral health, it's oral medicine.
26:35
Yeah.
26:35
L- let's connect the discussion a bit with your activity in the really big,
26:42
associations in implant industry, and I mean in Germany, the DGI- German
26:47
Association of Implantology, the EAO, that, you've been- or, you, have a
26:53
board mandate, ITI, osteology, and congratulations for a great osteology
26:57
congress just recently, Frank.
26:59
So h- how do you see the role of those associations going forward?
27:04
What is their responsibility, nowadays in implant industry to
27:09
help clinicians, moving in the right direction- and to give them kind of
27:14
guidance and navigating them through the, complexity in implant industry?
27:20
education is, important.
27:23
you need to establish, I would say
27:27
a certain ground, a common ground for the surgical skills, for the scientific
27:34
basis on how to properly perform implant dentistry as a practitioner.
27:38
I think this is the obligation of the societies to define a certain standard
27:43
for clinicians this is one domain and I think this is what all these associations
27:49
are actually doing and foundations, they establish standards for patient service
27:55
and for implant industry as a discipline.
28:00
and the second of course, they should ideally, and this is what they also
28:03
do, support research and to provide young people, next generations a
28:07
platform- where they can grow, where they can, become leaders in the field.
28:13
And this is something that you cannot become just based on Instagram.
28:16
You need of course a society, a foundation that gives you certain programs.
28:21
And I think this is such a beauty that we have these associations- and
28:26
foundations in a very positive way.
28:29
Yeah.
28:29
You're also part, I would say almost a standard guest in the consensus
28:33
conferences where you- Yeah … you take, you, you really dive deep
28:38
and, you know- Yeah … you take evidence-based decision and give
28:40
clinicians- Yeah … guidelines at the end what to do- Yeah … what not to do.
28:44
Yeah.
28:44
How, do you see these consensus conferences evolving?
28:47
Because each of the associations has one now.
28:49
There is let's say- Yeah … let's say a tendency to unite,
28:55
these consensus conferences.
28:56
Yeah.
28:56
How do you see this evolving?
28:59
guidelines are terrible because digesting a guideline is, the most terrible
29:06
thing that you can do as a clinician.
29:07
On a Monday morning, you have a 100-pager and you have a real problem in your
29:12
chair and you- And you need to find the right one And you need to find the
29:15
right conclusion, and the conclusion is in many ways, we don't know because
29:19
the evidence is not enough- Yeah
29:20
not sufficient.
29:21
Need to do more research there We cannot, make a clear recommendation.
29:25
And, in other ways you have a recommendation that is likely not what
29:30
the clinician expected to be because his reality is a little bit different.
29:35
So that's why you have to find a sweet spot that a guideline,
29:39
is a very dominant word, right?
29:41
You have to do it that way.
29:44
Yeah, but- we guide you because you can't do it.
29:47
Yeah.
29:47
So this is what the guideline implies, and that's why, if you look at a guideline
29:52
from that perspective, it's terrible.
29:54
But a guideline has also the sweet spot, and the sweet spot is it gives
29:59
you a background on the science, on the evidence, and ideally it gives
30:05
you a clinical advice- that you can follow, that you can understand, and
30:10
that you can implement in your office.
30:12
And that's why this global initiative, this global consensus for clinical
30:16
guidelines had exactly that vision, that focus to be more in the reality, also
30:25
putting the patient into perspective because if you don't ask the patient,
30:30
you can of course not succeed- because the patient needs to be involved.
30:35
And that's this global perspective, the streamlining Of activities of different
30:42
societies, and this GCCG project was- exactly … a, beautiful first step.
30:48
Yeah, good.
30:49
do we miss a, an open evidence type of tool?
30:52
If I listen to you, I wouldn't read through 100 pages.
30:55
No, me neither.
30:56
I would like to have, So but, are we in dentistry missing, an
30:59
open evidence kind of a tool?
31:01
Ah.
31:02
we are … i- in dentistry, our evidence level is quite good.
31:07
So compared to other medical disciplines, we are quite good when it comes
31:12
to high evidence level, studies.
31:16
I think this is where dentistry does a perfect job.
31:20
Yeah?
31:21
But the translation- Okay, yeah … the translation is the important thing.
31:24
Ah, sure.
31:25
Yeah, because for us, we are doing many different steps at our patients.
31:30
So you have step one, step two, step three, step four, and this is what a
31:34
medical doctor not necessarily has.
31:36
He prescribes either the one or the other drug, and the
31:39
guideline tells which way to go.
31:41
But we have to, define 20 different steps- To the end, yeah … just for
31:47
one- Yeah … treatment procedure.
31:48
Yeah.
31:49
So these, technical details that make it so difficult.
31:54
Yeah.
31:54
Yeah.
31:55
Maybe before we move a bit into the field of innovation, Frank, I have a question.
32:00
if today you could change worldwide one habit- in implant dentistry- Yeah … that
32:06
you see and maybe you, think it's, not the right habit, which, would
32:10
it be, and what would be the impact?
32:12
You mean habit?
32:13
A bad habit.
32:14
A bad habit?
32:15
Yeah.
32:15
So what clinicians do or what patients expect?
32:20
I leave it up to you.
32:23
I don't think we, have a bad habit, but one bad habit is, is definitely the, the
32:32
almost unrestricted usage of CBCT scans, so this is something that I- Wow, yeah
32:38
see as a, major fraud because we overexpose patients- in a way where
32:46
we don't see a clear clinical benefit, so this is one threat, and the
32:50
other is, of course, the multiple usage of systemic antibiotics.
32:54
So this is where dentistry massively contributed- to the resistancies that
33:00
we see for many, let's say, clindamycin.
33:03
This is one thing- that is, is hardly driven or mainly
33:07
driven by dental applications.
33:09
So- I remember you saying the, the- Yeah … the contribution of
33:12
dentistry to the radiation doses- Is massive … double digit, right?
33:16
You, can measure it, yeah.
33:18
You can measure it in the meantime.
33:19
Yeah.
33:19
In the past, we were in, in the bubble of the overall exposure,
33:23
dentistry was neg- neglectable.
33:27
But with the introduction of CBCT scans, it, we became A key player
33:32
in the field, and that's why we have to, we, have to rethink.
33:37
So what is for the benefit of the patient and what is not for the benefit?
33:41
And CBCTs are nice- for us, but the patient has- hardly a benefit.
33:49
No, it's a good food for thought.
33:52
Yeah.
33:53
And that's why maybe MRI- Yes.
33:55
In the future could, yeah … in the future, from that perspective, I th-…
33:59
this is the innovation maybe that we will discuss later on, but in essence,
34:05
at least critically thinking about the patient and exposures is important.
34:10
And exposure is also antibiotics.
34:14
Perfect segue to, the innovation topic.
34:16
Yeah.
34:17
so let's also talk a bit about, the future and how you see this, Frank.
34:22
So to start with maybe an example, what is a, recent innovation that
34:26
you, after careful consideration- adapted in your, daily practice?
34:32
So it, it's not a recent innovation, yeah?
34:34
For me it took a quite long time to, to build more on,
34:38
on guided implant placement.
34:41
So for me that was something that made my life harder and more complex
34:48
in the past, but in the meantime, I highly appreciate the comfort of hang-
34:52
having a template, putting the implant.
34:54
So this is not a recent innovation, but the innovation that took a
34:58
quite long time to convince me.
35:00
So you can hardly find an innovation that you bring on the market and say,
35:04
"This is something new," and I'm not an early adapter when it comes to
35:08
clinical, or to devices or technologies.
35:12
I'm a super early adapter for, let's say, for electronics, but not for things
35:18
that are related to my day, daily work because I'm very conservative, because
35:24
I'm not changing the way how I treat and manage cases from today to tomorrow.
35:31
So I'm always spend some time to rethink and to really look for the,
35:39
benefit for me and for the patient.
35:43
Maybe an overlap between electronics and, Yeah … and still dental.
35:46
So wh- what's your opinion on this future possibility of
35:51
dynamic navigation- and robotics?
35:53
Is that- Yeah
35:54
something that you also have already, gained some experience
35:58
and, what's your opinion?
36:00
So the opinion is, I would say this is definitely the future.
36:05
So n- not necessarily for me, but for the next generation of dentists,
36:09
they will have to deal with robotics.
36:13
They have, of course, to be open-minded, but again, this is something that
36:17
works scientifically, so we have many studies, we see it works.
36:23
But will I be able to implement it in the next five to 10 years
36:29
in the routine in my clinic?
36:31
I would say maybe or maybe not.
36:34
Yeah.
36:35
But definitely on the long-term perspective, this
36:37
is a game changer- for sure.
36:41
Yeah.
36:42
So again, it took me about 10 years For the guided surgery,
36:45
yeah … to, build on guided.
36:47
Yeah.
36:47
I'm talking about 50% now.
36:50
50, 60% of my cases.
36:51
Okay.
36:51
Yeah.
36:51
In the past, I was about five.
36:53
Yeah.
36:53
But now, after many years, I'm at 50, 60 and it goes up.
36:59
What has made change your mind?
37:00
So what convinced you basically on, on that principle?
37:03
is it also linked to what we discussed before in terms of, being very conscious
37:08
about the planning and how- Yeah
37:09
to place s- place implants?
37:11
Yeah.
37:12
S- Yeah, there are many components.
37:14
I think, the most relevant is always how easily can you use
37:19
it in your day-to-day- Yeah.
37:21
Exactly.
37:21
Yeah … routine.
37:22
And in the past, for me, I had to do the planning On my own, if
37:28
you don't do the planning on a daily basis, it's really hard.
37:32
And it's why now we have a scheme where we have established workflows.
37:36
It can easily be implemented and of course, if it's easy to reach,
37:41
then I'm of course- get favor of it.
37:44
Yeah.
37:45
So it's always how can you implement the technology in your day-to-day-
37:49
Needs to be- … workflow.
37:51
Interesting It needs to be practical.
37:52
And not, taking too much time.
37:53
Exactly.
37:53
Yeah.
37:54
Yeah.
37:54
It's the same when you are-- you like to eat fruits, yeah, but thinking about
37:59
eating fruits, you have to buy the fruits, you have to cut the fruits.
38:02
Yeah.
38:03
And if there is a buffet and the fruits are- It's much easier … just
38:07
available, you of course you eat the fruits and this is like this or quite
38:11
similar with these technologies.
38:13
They are difficult to implement and if you find a way to implement
38:17
it, of course, it's a deal breaker.
38:20
And I think this is also exactly the way that, dynamic navigation has to,
38:24
go because right now it's still a bit cumbersome for the benefits, but if
38:28
it becomes easy enough to just use it, I think it, it will be a no-brainer
38:33
to actually know where you are.
38:34
Yeah.
38:35
Yeah.
38:36
Yeah.
38:36
Simply speaking.
38:37
So a lot of dental innovations in the, I would say, last decade
38:41
has to do with becoming more immediate in terms of treatment.
38:46
And I think this is also linked to a patient wish.
38:49
So this instant gratification, I would like to have my treatment
38:52
done as- as quickly as possible.
38:54
What's your opinion on this one?
38:56
Do we reach certain biological limits in terms of making treatments
39:01
faster, reducing treatment steps?
39:03
Should we be careful to even push this further or do you
39:06
still see some room to go?
39:09
So I'm very positive about,
39:14
Going beyond the limits.
39:16
So biology has, of course, limitations, but I think with the conservative
39:22
approaches that we have established in the past, we are far, beyond what we can do.
39:29
So immediacy is something that I would say does not pushes the
39:34
limit of the biological system.
39:36
So because if we don't interact, we lose tissues.
39:40
This is what we have seen.
39:41
We get a remodeling, we lose, we have to build it up again.
39:44
So if we are at the level of the biological process, I think
39:49
immediacy is exactly at that level.
39:52
Yeah.
39:52
We place the implant, along with the tooth extraction and
39:56
the bio- biology comes along.
39:58
And I think this is an example where we are lacking confidence because
40:04
many colleagues still think that we are pushing biology, but I think we
40:08
are at the level of the biological process- with these technologies.
40:14
Yeah.
40:15
So you don't have to convince me at all.
40:18
So I'm a big supporter of immediacy, but I know many people have a conservative
40:24
mindset, and conservative doesn't always mean that it's the better side.
40:31
Yeah?
40:32
But it's very positive.
40:32
So immediacy is not too pushy.
40:34
No.
40:35
And this is what we see.
40:36
Of course, this also took a long time- to see that this is not an experimental
40:41
procedure, so it's biologically driven and it's the best possible
40:46
way to support the tissue during the repair and regeneration phase.
40:51
It's very positive to hear.
40:52
I've… I, think we are at the, same level.
40:55
I think it's still not the end of the story.
40:56
So there is so much that we can do, and also we're always surprised by,
41:01
the, biological responses of the body that actually can, help us to- Yeah
41:07
to do much more, and also, being too long without any, for example,
41:12
mechanical stimuli, it has, of course, severe consequences
41:15
also on the tissue maintenance.
41:17
And I think it's good that this is now an established understanding
41:20
of, in implantology as well.
41:22
Of course.
41:23
And this is something from my perspective in dentistry, what many
41:27
people have Too well established.
41:31
So many people th- are acting according to what they think and not to what they know.
41:41
And this is the difference.
41:44
So is this what you think or is this what you know?
41:47
And if you- This is where the research comes in, right?
41:49
Yeah.
41:50
If you think that the conservative way is the better way just
41:53
because it is conservative-
41:55
then it ignores the fact that you don't know that the opposite is the case.
42:01
and knowing is about- Having a proper understanding.
42:04
And this is where dentistry in general is very conservative.
42:08
We are basing our procedures too much on what we think because
42:12
this is how we did it in the past.
42:14
So this disruption is very hard to achieve.
42:17
And you just brought up this immediacy thing, so this is nothing new.
42:22
So this goes back decades.
42:24
So immediacy is nothing new, but now the people are- And it takes a long time
42:29
before- Knowing that- To establishing it though … there are advantages.
42:32
Yeah.
42:32
In the past, they were thinking that this is a bad way to go.
42:36
So knowing and thinking, and again, this is the research
42:39
component that makes a difference.
42:42
I'm still going to ask you about what you think in terms of future.
42:46
Yeah.
42:46
Because we don't know yet.
42:47
Yeah.
42:48
Frank, what's your, view on, let's say, dentistry in a decade from
42:52
now, so in 10 years from now?
42:53
Yeah.
42:54
What are we going to s- have, in that period which we're dreaming about
42:59
today and it might become a reality?
43:02
So I know, and this is not what I think, yeah?
43:05
I know . No, I definitely know that, dentistry becomes more and more part of,
43:14
the medical discipline- because we have now so many, let's say, connections that
43:19
are so essential- for the medical field.
43:23
And of course, you are maybe now a little bit more focusing on technology side.
43:28
Let me just put in- the first step, the biology.
43:32
And, the fact is that oral infections, and we are mainly
43:38
dealing with oral infections, you have name just peri-implantitis,
43:42
we have periodontitis, we have-
43:44
Dental abscesses.
43:45
So we have so many inflammations.
43:47
We have also immuno- related lesions in the oral cavity, and they are all
43:53
drivers for systemic inflammation.
43:56
So this is nothing that we think.
43:57
This is well established.
43:59
So the most recent one is the oral gut-brain axis, so bacteria coming
44:05
from the oral cavity, penetrating into the gut and from the gut to the brain.
44:11
So neuroinflammation, neurodegeneration, these are just some of those links between
44:16
oral medicine and medicine in general.
44:19
So this is something that will definitely, evolve in the future.
44:24
So this gives us more medical relevance, and this is also part of the industry.
44:29
So support this procedure by diagnostics, by tools that helps us to monitor
44:36
inflammation, systemic inflammation, chairside in day-to-day practice.
44:41
So this is one component, and I know that this, is on the way,
44:45
and this will be one of our main future, pillars in the industry.
44:51
So the second is more the technology side, and you, are a major innovator, so you
44:57
have so many innovations in the pipeline.
45:00
And when we think about, let's say, peri-implantitis as a topic, yeah?
45:04
Surface technologies that are maybe more resistant to inflammation, that
45:10
support more the tissue support, decontamination tools, decontamination
45:15
protocols, GalvoSurge, GalvoCare, so all these tools for the future, I think
45:21
they have a high relevance that drive also the implant success even further.
45:28
Yeah?
45:29
So I think oral infections, prevention of infections at the end,
45:35
all modifications of your implant system have one target- to improve
45:43
Success and survival.
45:44
That means you overcome the risk for inflammations.
45:49
So at the end, we have the same sweet spot.
45:53
I think we're dreaming a very similar dream.
45:56
So- Yes.
45:56
Yeah … this, this topic of finally understanding the impact of systemic
46:01
oral infections for, I would say systemic diseases- Yeah … this is
46:07
still under-penetrated, and I think it's not… People know it, and it's not new.
46:11
Yeah.
46:11
And we learned, quite a bit in the last, let's say years, but
46:15
it's not yet common practice.
46:17
So probably this will also have a massive impact on- Yes … the role
46:22
of the dentist in, in, in general health, and, that's probably also a
46:26
slower process to, to establish this.
46:29
And this is where we need your innovation.
46:31
So you, see the way, and you have just to support it by
46:35
technologies, by, by procedures.
46:38
And at the same time, the people are always dedicated to talking about
46:43
aesthetics, pink aesthetic scores.
46:46
I'm always asking, think about the medical component of it." "Think
46:51
about what it means for a patient if you treat an oral inflammatory
46:56
lesion." So this has a medical impact, and you do it on a daily basis.
47:02
So focus on outcome measures, focus on principles that put
47:07
this more in the forefront.
47:09
This is also for a benefit for the patient.
47:12
Yeah.
47:12
Yeah, not, just the aesthetic aspect.
47:14
Yeah … this is of course easier to understand and accessible for
47:16
the patient, and that's probably why it's a, primary driver.
47:20
This really gives me a hard time to see that dentistry has such a
47:24
strong pillar on aesthetics, which is good- but it becomes too strong.
47:29
So biology should be ba- balanced.
47:31
Biology- Yeah, balanced … and the medical component.
47:33
Yeah.
47:34
And putting implants, nobody thinks about what comes when you replace
47:38
a missing tooth, not a tooth, a missing tooth by an implant.
47:42
What is the true function?
47:45
Is it aesthetics?
47:46
Of course.
47:49
But what is more?
47:51
What would you say?
47:52
What is the benefit?
47:53
chewing function.
47:53
Yeah, chewing.
47:54
And then, yeah.
47:55
Speech.
47:56
And biology.
47:56
But chewing.
47:57
What about chewing?
47:58
So what is the main component?
48:01
Nutrition and- Nutrition, of course.
48:04
But there is more.
48:06
What is more?
48:09
There are many studies indicating when you lose teeth, when you lose the masticatory
48:15
function, you have a lack of training of specific areas in the cortex in the brain.
48:22
So you get a degeneration of these areas that have the function to get this
48:27
feedback from the chewing- and from the masticatory function, and they degenerate.
48:34
So when you reestablish the chewing function by means of
48:37
implants, you even counteract the degeneration of cortical areas.
48:44
That means we can keep the function, so dementia correlates also with
48:48
the number of teeth that you lose.
48:51
So restoring teeth by prosthesis or by implants- It's very interesting
48:57
has many more components than just the aesthetics.
49:01
It also has- Obviously mental health also … mental health, exactly.
49:05
So dementia correlates with tooth loss, and also with oral
49:11
infections, as one example.
49:14
This is by far more fascinating- Fascinating topic, yeah.
49:17
… than talking about- Aesthetics … the tooth color and the aesthetics
49:19
and the pink aesthetics course.
49:21
is it the 9, 11 or 12?
49:23
It doesn't matter, but the mental health is also something that is important.
49:27
But the, question, the question it triggers with me, and that's maybe
49:31
for another podcast, but- Yeah.
49:34
… is, then after 40, 50 years of progress in implant dentistry, still from, let's
49:40
say, 100 patients that would benefit from implants, still only 7 to 8% do
49:44
receive an implant, And- Yes … we create this impact that you just
49:49
described in only 7 or 8%, and 92 to 93% of the patients, do, not benefit from-
49:58
Yeah … from what you just described.
50:01
and I think that's just the question- How can we change that?
50:03
… it's still a question that I think we should debate, Yeah
50:07
as a, group as well.
50:07
You just have to put what we have scientifically on the table and say,
50:12
"These are the benefits of restoring the masticatory function of a patient."
50:18
And this is, goes far beyond- It's very powerful … the aesthetics.
50:21
Far beyond.
50:22
Yeah.
50:22
And removing, I would say, chronic, infections.
50:25
Yes, Let's move to the next chapter.
50:29
We, always have also questions from the audience, and we got two this time-
50:32
which we selected, whi- which we liked.
50:34
I start with the first one, which is a nice coaching question actually,
50:39
and I would add something to it.
50:41
The question is, if you were starting your career today, Frank, what
50:46
would you approach differently?
50:48
And what I would add is, based on this, what's your recommendation to
50:52
the next generation of young dentists?
50:58
So I'm not sure whether I would go back to, the decision to,
51:02
proceed with dentistry again.
51:04
So this is, Maybe pilot it.
51:09
not from the perspective of today.
51:12
I would rather go more into the medical field.
51:17
but, still, I think this, link, dentistry and medicine is still worthwhile, so we
51:23
can still, change and improve the way how we, see how we look at dentistry.
51:28
But, I would say the most relevant point that I would change is I would more early
51:38
on focus on, translational research, because at the end, it's really important
51:45
that you understand the clinical need.
51:49
Yeah?
51:51
And you make the link with the experimental work.
51:54
I think this is the sweet spot.
51:56
This is the sweet spot.
51:57
I've spent some years, maybe too much on the experimental side, so
52:02
I'm now more on the clinical side, and I think this is something that
52:07
also attracts many young clinicians.
52:10
You attract them by far more- with clinical procedures
52:13
than with the lab work.
52:14
Yeah.
52:15
Yeah.
52:15
And I think, that defines dentistry in, in the best possible way.
52:20
The possibility to do translational research.
52:22
Okay.
52:23
Good.
52:25
We got the second question, and, I might know a little bit of the answer
52:28
based on our previous discussion.
52:31
So the, question was, for clinicians early in their journey- Yeah
52:34
what should they prioritize first?
52:35
Technical skills- prosthetical understanding, or biological knowledge?
52:40
Yeah.
52:41
It's a no-brainer.
52:43
It's, the biology.
52:44
Yeah.
52:45
Because the biology is the fundamental basis.
52:47
For everything, yeah.
52:48
Yeah.
52:48
You can't fool the biology.
52:50
If you don't follow the rules that the biology definitely
52:53
sets, you will never succeed.
52:55
Yeah.
52:56
You will never succeed.
52:57
So spending some time apart from this translational clinical part
53:02
into basic research is, I would say fundamentally relevant.
53:09
Yeah.
53:10
Very good.
53:11
Good.
53:12
At the end, we also want to give you the opportunity to ask a question to
53:16
Straumann or to, to us, i-if you have one.
53:20
Of course.
53:21
Of course.
53:21
No, first of all, I would like to, appreciate all the
53:26
work that we did so far.
53:27
So this is something that is also, for me, really important to have,
53:32
reliable, trustful collaborations and the collaboration that we
53:36
have had, so it's, outstanding.
53:40
so this of course comes with an obligation, and I would like to
53:44
know what are your next steps?
53:46
So where do you want to drive and to navigate implant industry in the future?
53:57
I would say that's a broad question.
53:59
I can, start, Georg, if you want.
54:00
So I think, us, Georg and myself, driving pretty much the innovation
54:06
agenda that, we have in this company, there are a lot of things in our mind.
54:10
I think one topic, clearly what we see is, to also complete, the treatment
54:17
possibilities in more and more, extreme cases like super severely atrophic cases,
54:23
mandible, maxilla, and to provide also tools so that, more and more patients
54:29
can benefit from this, and we are pushing a bit trying to push the boundaries.
54:33
I think that's, s-certainly one, area, and I would say another area
54:39
is, of course, we always have to work on disrupting ourselves, I think.
54:44
it goes bit back to, Andreas, what you said before with the 7%, penetration rate.
54:49
So h-how can we change that?
54:51
what are the reasons why it is not yet, I would say, further established?
54:58
it's about patient access, it's about education, but it's also
55:01
about, product innovation, workflow innovation that, we want to push.
55:05
And I think we, in our discussion, we already touched upon some of the very
55:10
fascinating topics also for the future.
55:12
So this making sense out of intraoral signals for general health, I think
55:18
that's for us, let's say, a huge, field which we still don't know
55:23
exactly, what role we can play.
55:25
But, we just… sometimes it, it begins with this feeling,
55:28
okay, there, there is something.
55:29
And, we need to go deeper.
55:31
We need to understand better, what are-- what could our contribution
55:34
be actually in that field.
55:36
And it goes exactly in the direction that you mentioned before.
55:39
we see how important oral health is in general.
55:43
And I think we, we do provide a certain set of options to treat oral
55:48
complications, but, what else is there that we need to, let's say, provide?
55:54
And also, how can we- To a certain degree, democratize access to those treatments
56:00
because it's-- that's not done yet.
56:02
And, before we had a, quick discussion on, the different markets on, what's
56:08
happening with-- in, in US market, in the China, market, or in, in underdeveloped
56:12
markets, and what is our role there?
56:14
How can we help actually to, make or provide access for patients to that
56:19
kind of treatment, which of course goes always through the dentists.
56:22
So how can we support the dentists to also use those technologies?
56:27
I think that's what, what's driving us and, Many more things … what
56:30
the future will, bring.
56:31
Yeah.
56:31
Yeah.
56:31
So it's both we have to go deeper and broader- Yeah … and,
56:35
at the same time, yeah.
56:36
Which is very exciting, and it's also exciting to, to collaborate
56:39
with people like you, Frank.
56:41
th-this is also… you said it before, you, get the inspiration
56:45
a lot from your clinical work as well, and it's the same for us.
56:48
We get the inspiration from working with clinicians like you.
56:51
and I think, also conversations like today that are not confidential, but
56:57
others that are confidential are, really fueling our ideas and pipelines.
57:00
Yeah.
57:00
So thanks a lot for many years of partnership, Frank.
57:03
Yeah.
57:03
Thanks.
57:03
So we are thinking in the same direction, right?
57:05
Yeah.
57:06
That's good.
57:06
Yeah.
57:06
Definitely good to know.
57:07
So before we wrap up, Georg, what stood out for you today?
57:12
So first of all, Frank, what stood out for me, what was the central topic that,
57:17
that we discussed is really I think you have a very high sense of responsibility
57:22
for, let's say, the patient community.
57:24
And you drive this in many different ways.
57:27
So I perceive you, and th-that's not just from today, but you-- your, let's
57:33
say, detail-orientedness, your striving for perfection leads to actually
57:39
results that actually can be, used to build one on top of each other.
57:44
And, you do this now since, since many decades, and I think
57:46
this is, very fascinating.
57:48
So this academic basis that you talked about, I believe that also defines
57:52
you on how you work and what you want to achieve because this is the
57:56
foundation and for many others to, to follow on those, steps and build
57:59
on what, what you actually, built.
58:02
The other topic that, I, think is, very central for you is it's not
58:07
about oral health, it's about oral medicine, and it's about general health.
58:11
And also the, question in terms of what would you change, maybe
58:15
you would start in medicine.
58:16
I think that shows a bit how you think in terms of very, I would
58:19
say, connected way of looking at, at disease, at health, at patients.
58:25
And, this was really standing out for me.
58:27
Also, I learned a lot about, restoring or defeating dementia by
58:33
also restoring chewing function.
58:34
Yet another connection that I wasn't aware of.
58:37
And I think that really, is for me a bit,
58:43
a, strong signal of who you are and, the level of detail and
58:47
interest that you're, having.
58:49
Thank you Thanks for the summary.
58:51
I would only add one topic that I always observe also when we talk of- and this is
58:55
your passion also for developing talent in your team- in Frankfurt, and I know how
59:00
important this is for you to, help young clinicians to, to progress and, I think
59:05
it's so important to, to build the future.
59:07
So thanks a lot for being with us, Frank, Thanks a lot.
59:10
Thank you.
59:10
It was my pleasure.
59:11
Exactly.
59:12
And, thanks to the listeners.
59:14
thanks for listening in today.
59:15
I hope this, was an inspiring episode.
59:18
If yes, please recommend it, to a friend, and please always feel free and invited,
59:24
and warmly invited to drop a note and a comment and a question on our Straumann
59:30
Global Instagram channel, and watch out for the next episodes to come around on,
59:35
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59:38
Thanks a lot for listening in.