Latest / Straumann® ProTalk / Clinical edition: The recipe for reliable immediate implants with Dr. France Lambert (video version)

Transcript

Clinical edition: The recipe for reliable immediate implants with Dr. France Lambert (video version) · Straumann® ProTalk

• 0:00
  So basically immediate implant, immediate loading in the aesthetic
• 0:03
  zone is something reliable?
• 0:07
  If the conditions are adequate?
• 0:10
  Favorable?
• 0:11
  Yeah.
• 0:11
  It is a viable option.
• 0:12
  It's just a matter of how to do it.
• 0:14
  It's a little bit like your recipe.
• 0:15
  You need the cooking book and we like to say the ITI treatment
• 0:19
  Guide is a cooking book.
• 0:21
  Whether you're just starting an immediate solutions or already do it
• 0:24
  on a daily basis in your practice.
• 0:26
  This episode is packed with clarity, context, and clinical guidance.
• 0:30
  I had a great discussion on this topic with Professor France Lambert
• 0:34
  from Belgium, who co-authored the ITI Treatment Guide 14 on Immediate Solutions.
• 0:39
  Don't miss it.
• 0:40
  This is Straumann ProTalk Clinical.
• 0:56
  Professor France Lamber, thank you very much for accepting to record
• 1:00
  with us the Straumann ProTalk Clinical on immediate treatment protocols.
• 1:04
  What a privilege to have you with us.
• 1:06
  This is my great pleasure.
• 1:07
  We are going to talk about a topic that is really close to my heart, so I'm
• 1:10
  looking forward to the discussions.
• 1:11
  It's close to my heart as well.
• 1:13
  I can't wait for this conversation.
• 1:15
  Let's start with the what.
• 1:17
  How about that?
• 1:19
  What does an immediate implants
• 1:21
  when it comes to definitions, especially you have recently
• 1:24
  published the ITI treatment guide.
• 1:26
  You have collaborated with it and co-authored together with Adam Hamilton.
• 1:30
  The ITI treatment Guide on Immediate Treatment Protocol.
• 1:33
  If we have to put in context for the newcomers coming out of
• 1:37
  dental school didn't have dental implantology in the curricula.
• 1:41
  You started to get bombarded with all these buzzwords, immediacy,
• 1:44
  immediate treatment protocols.
• 1:46
  How can we contextualize what immediate treatment protocol is?
• 1:50
  Yeah, absolutely.
• 1:51
  Our book, the ITI Treatment guide is about immediate implant and immediate load.
• 1:57
  For partial edentasias, so we have to dissociate an immediate implant,
• 2:02
  which is placing an implant into a fresh socket right after extraction,
• 2:07
  an immediate loading that is placing an immediate restoration.
• 2:13
  The day of the implant placement.
• 2:15
  Yeah.
• 2:15
  And these two can be combined, but they can also be dissociated.
• 2:19
  So you can do an immediate implant without an immediate loading.
• 2:22
  And you can do an immediate loading without an immediate implant.
• 2:25
  Got it.
• 2:25
  So if I get it right, you can optimize anatomical conditions
• 2:29
  to your time of surgery to have it at the day of the surgery.
• 2:32
  Or you can also already provide either provisional or depending
• 2:36
  on how the conditions allowing.
• 2:38
  Even a final crown as I know you have some articles about it.
• 2:42
  Yeah.
• 2:42
  This is not only about the anatomical conditions, but it's also about the need.
• 2:47
  For example, in the aesthetic zone, this is very relevant to have an
• 2:50
  immediate implant, but also an immediate loading for restoring the aesthetic.
• 2:55
  Yeah.
• 2:55
  Directly in the posterior you can discuss that, of course.
• 2:59
  Delivering the final crown.
• 3:01
  The day of the surgery, this is usually not combined to immediate
• 3:05
  implant, and this is a topic that is probably still a bit experimental.
• 3:09
  Yeah, there's not such a consensus about it, right?
• 3:12
  There's some common sense about directions where to go, but we don't have a
• 3:15
  fundamental discussion about this, do we?
• 3:18
  No, I mean it's we like to push the limits.
• 3:21
  Yeah.
• 3:21
  But we also need to have evidence in order to say this is a protocol
• 3:25
  you can use on a daily basis.
• 3:27
  Yeah.
• 3:28
  And what could be mainly if you could outline the main clinical
• 3:32
  indications and contraindications as is stated per in the book
• 3:36
  for Yeah.
• 3:37
  For.
• 3:39
  We want to be reliable.
• 3:40
  If you wanna do an immediate implant, this is a very fast protocol.
• 3:43
  This is, there are lots of benefits and we can also discuss those benefit, but we
• 3:48
  have to do it only if this is reliable, if we can provide the same outcome
• 3:54
  as a conventional protocol or timing.
• 3:57
  So what we need to look at is at the soft tissue conditions first.
• 4:02
  If you are in a site where you have a deep.
• 4:05
  Gingival recession.
• 4:07
  That might not be the good case.
• 4:09
  If you are, for example, in the posterior region and you have no
• 4:13
  keratinized gingival this might also not be the good case for immediate.
• 4:18
  And we look at the cases where we have good quality of the future
• 4:23
  peri-implant mucosa, so quality and quantity and phenotype.
• 4:27
  We also want to have thick phenotype.
• 4:30
  Then to do an immediate implant you need to have a certain bone anchorage.
• 4:35
  So you will look at the CBCT and in the aesthetic zone.
• 4:39
  You need to find anchorage, usually on the apical of palatal
• 4:43
  area in the posterior region.
• 4:45
  That would be more the septum or lateral wall for premolar.
• 4:49
  So you need to evaluate the possibility to stabilize your
• 4:53
  implant without compromising the three dimensional ideal position.
• 4:59
  Ideal position, prosthetically driven, biologically driven.
• 5:03
  That's of course something very important.
• 5:06
  And then we want to look at, other components like the presence of a,
• 5:09
  the facial bone, the, this buccal bone plate, when it's not intact, when you
• 5:14
  have large dehiscences, fenestrations, this might not be the ideal cases.
• 5:21
  And then if I continue the list presence of infection, acute
• 5:24
  infection, very often associated also to these large dehiscences.
• 5:30
  So that's probably not the safe zone.
• 5:32
  To do immediate, you wanna do an immediate implant when you have an intact
• 5:36
  buccal bone wall without infection.
• 5:39
  But, a chronic infection when it's secluded completely in, in the bone
• 5:44
  and when you can properly remove it.
• 5:46
  Yeah.
• 5:46
  You can still place an immediate implant if you're still able to place
• 5:50
  your implant in a proper position.
• 5:51
  So now we know that this is not contraindicated in those
• 5:55
  conditions, for example.
• 5:56
  Yeah.
• 5:58
  So basically it's true that in the book we outline like a risk assessment table
• 6:03
  with, like a checklist to help clinicians in the decision making and, yeah.
• 6:08
  We also have to look, we advise to do a proper digital planning and
• 6:15
  position your implant, now we have all these digital tools and another
• 6:19
  aspect, the last aspect that is very important is to look at the gap you
• 6:24
  have between the implant buccal part.
• 6:27
  And the buccal bone wall.
• 6:29
  And this, I like it to call it the remaining socket the buccal gap.
• 6:33
  It needs to be large enough in order to have a regeneration process there
• 6:38
  where you will place a biomaterial.
• 6:40
  I see.
• 6:40
  And it needs to be at least two millimeters.
• 6:42
  Three is even more.
• 6:44
  But you need this gap in order to do immediate
• 6:46
  implant.
• 6:47
  I like very much how you contextualize.
• 6:50
  I remember many years back when immediate solutions were.
• 6:54
  Giving certain experimental steps.
• 6:57
  It was believed that the implant should fill a socket over time.
• 7:03
  And time is the best educator.
• 7:05
  As Joseph can says, time is your best educator.
• 7:08
  Take it as you want.
• 7:11
  It was proven, not necessarily right.
• 7:14
  We need more, less math or more biology.
• 7:16
  And I like how it evolved and how immediacy also evolved
• 7:20
  to a, not just a clinically.
• 7:23
  Experimental, but really fundamental, scientifically based.
• 7:27
  Now even with the ITI change in the classification now with robust
• 7:31
  amount of evidence supporting, coming together with the changes, but really
• 7:35
  endorsing that this is a safe route.
• 7:37
  Absolutely.
• 7:38
  And it's true that when I started with immediate implant I was trained
• 7:42
  in a group, very progressive and.
• 7:45
  As a very young dentist, I was already doing immediate implant,
• 7:48
  but at that time we did not understand properly the biology.
• 7:52
  We thought the implant would replace the tooth and we were placing these
• 7:55
  large implant into the socket.
• 7:57
  We, we were taught that the closer to the buccal bone the better
• 8:00
  because it would preserve the buccal bone, but we were totally wrong.
• 8:03
  We made our miss.
• 8:04
  Takes and and now we understand biology and we understand exactly what you need
• 8:10
  to be successful with immediate implant.
• 8:12
  Yeah.
• 8:13
  And how do you see it why immediacy today?
• 8:16
  As we said in the beginning, contextualizing this, it's becoming a
• 8:19
  buzzword and it's playing such a pivotal role in implant dentistry, that so much
• 8:24
  of the patient benefit centered benefits.
• 8:26
  How is that coming together?
• 8:28
  What are, what your patients are looking for?
• 8:31
  Tooth.
• 8:31
  They don't want to have pain.
• 8:33
  And if you do multiple surgeries is multi experience of postoperative
• 8:38
  trauma and pain and morbidity.
• 8:40
  Yeah.
• 8:40
  So that's one thing they want to, they, they don't want to come every
• 8:45
  day in your practice or for weeks.
• 8:47
  So they don't necessarily have time.
• 8:49
  Time is money as well.
• 8:51
  So they want fast treatment.
• 8:53
  And if this is in the aesthetic zone, they want also direct
• 8:57
  satisfaction, direct aesthetic.
• 9:00
  They want something if possible, not too expensive.
• 9:05
  And finally, they want results.
• 9:08
  They want something that is that is as reliable as the rest.
• 9:11
  The real benefit of immediacy is definitely you, it's a fast protocol
• 9:16
  with a decreased number of surgeries.
• 9:18
  So if less surgery is also less expensive in principle, 'cause the
• 9:22
  dentist they have to be, of course alert for what they're doing.
• 9:27
  And yeah, direct direct satisfaction.
• 9:29
  So time is definitely a big component.
• 9:33
  And then we also learn from immediate implant, and it's not maybe directly the
• 9:38
  immediate implant, but it's maybe more the direct restoration or anatomical abutment.
• 9:44
  These prosti these component also support the soft tissues
• 9:50
  and when it's combined to.
• 9:52
  An alveolar ridge preservation when it's combined to a socket gap
• 9:56
  filling we understand that all these adjunctive procedures we needed
• 10:00
  implant may also help in the way it's going to heal or in maintaining the
• 10:06
  tissue, so preserving the tissues.
• 10:08
  So there are also definitely a biological benefit of immediate implant when it's
• 10:14
  combined to these adjunctive procedures.
• 10:17
  I like very much how you described, because this last element you touched.
• 10:21
  Preserving gingival architecture that when you let go it's far harder to shape.
• 10:27
  Try to mimic the neighboring tooth together, and if you can just
• 10:30
  start from the day of the surgery trying to preserve not to let that
• 10:33
  go away to then try to reshape it.
• 10:35
  Far more beneficial.
• 10:36
  No.
• 10:36
  We are now definitely in another strategy when it comes to provisionalization.
• 10:42
  We also directly go with the ideal planned design.
• 10:48
  And aesthetic.
• 10:49
  We are not doing the soft tissue conditioning anymore.
• 10:52
  We condition from day zero based on the planning and all the digital tools.
• 10:59
  And the digital planning has also changed tremendously how we do immediacy,
• 11:04
  especially in the aesthetic zone.
• 11:06
  I think we live a golden age as you touched this, because we have.
• 11:10
  Today, so many tools that we can see thoroughly and in big size.
• 11:15
  Three dimensionally.
• 11:17
  All the anatomy that we can think of ahead of time, potential pitfalls that we're
• 11:21
  gonna potentially face during the surgery.
• 11:24
  Then eventually go top down, see how the shape of that abutment will look like.
• 11:28
  Choose different genal heights and then play with this patient in ways
• 11:32
  that you could not do it before.
• 11:34
  And then transferring this to maybe guided surgery.
• 11:38
  Also helping to get a more assertive implant placement to go from point A to
• 11:42
  point B. We're spoiled at the moment.
• 11:44
  Absolutely.
• 11:45
  You can actually.
• 11:46
  Plan everything.
• 11:48
  Not only the implant position, but the prosthetic components you choose
• 11:52
  and and you can even fabricate the original crown prior to the surgery.
• 11:57
  And you have this ready and then you place your implant, you
• 12:00
  place the crown and this is it.
• 12:01
  This is direct
• 12:03
  France.
• 12:04
  I would like to know from you, we touched about the, how we'd like to
• 12:07
  touch about the how, and this is, I would say a bit, innocent question,
• 12:11
  but let's pick one indication, right?
• 12:13
  Let's, as you said, let's take a center incisor.
• 12:15
  What will be France Lambert approach to a center incisor, somebody
• 12:19
  comes to your office, just had an accent fracture that tooth.
• 12:24
  Comes to you now.
• 12:25
  What?
• 12:26
  Yeah, exactly.
• 12:27
  I would like to come back with this risk assessment table.
• 12:29
  I mentioned at the beginning, you're looking clinically checkpoints or
• 12:33
  is the, or the soft tissues, or is the bone environment, does it
• 12:36
  comply with all these characteristic that will address your success?
• 12:42
  And if this is, if this seems safe and reliable, I would.
• 12:47
  Automatically go for immediate because now I really see the benefit
• 12:50
  and we know there is evidence.
• 12:52
  Is there a particular implant shape, for example, that you
• 12:55
  also would like to recommend?
• 12:57
  Yeah, absolutely.
• 12:58
  Of course you would want an implant that has a certain grip.
• 13:01
  Huh?
• 13:01
  A certain yeah.
• 13:03
  Aggressivity to get your primary stability.
• 13:05
  You need a bite.
• 13:07
  Yeah, exactly.
• 13:08
  And we also tend to go with implant that are.
• 13:12
  Narrower because we want to leave the space for this buccal gap.
• 13:16
  So now we know that.
• 13:17
  Now we don't that exactly.
• 13:19
  Now we know
• 13:19
  that.
• 13:20
  And yeah, in the aesthetic zone, definitely a bone level implant
• 13:24
  because you want to be able to customize your trans changeable design.
• 13:28
  We know that transmucosal design is very important.
• 13:31
  We also leave, need to leave the space there for the soft tissues.
• 13:35
  The choice of the Variobase the titanium base is also very important.
• 13:40
  We want to have something that is very slim and narrow to lift
• 13:44
  the space for the living tissue.
• 13:46
  Same concept as for the implant to, leave the space to the bone tissue,
• 13:49
  just in different levels.
• 13:50
  Yeah.
• 13:51
  France, I would like to shift gears for a second.
• 13:54
  I have this session call is not what we think.
• 13:58
  What I think doesn't matter.
• 13:59
  It may help me, but it's not a total truth of the matter.
• 14:03
  So it's not what you think, it's what we know going towards evidence-based.
• 14:08
  And I understand that you, in the preparing for the ITI treatment guide,
• 14:13
  you came across tons of articles that you have to digest in order to prepare.
• 14:18
  And I would like to share for you.
• 14:21
  One article, I remember we discussed this before you, you had some
• 14:26
  conflict of interest there, right?
• 14:27
  Because you, you had some posterior discussions Yeah.
• 14:30
  At some point, and then anterior solution became very close to your heart as well.
• 14:35
  Could you share some of this papers that was really meaningful
• 14:38
  to you that you think the dental community should know about?
• 14:41
  Yeah.
• 14:42
  What was meaningful personally to me was everything the first article
• 14:46
  that relate to the immediacy in the posterior regions, because now we've
• 14:50
  been discussing a lot the anterior.
• 14:51
  Yeah.
• 14:51
  But most of implants are actually placed in the posterior regions, very majority.
• 14:56
  And, icy immediate implants were initially described in the aesthetic zone, to
• 14:59
  replace immediately a failing TT tooth and and combine to immediate loading.
• 15:05
  So this is where they are the most evidence.
• 15:09
  Anterior, but the first articles that describe also extraction,
• 15:13
  immediate implant in the posterior regions, eventually combined to those.
• 15:17
  Because the problem was to really close the gap at some point.
• 15:21
  And now we know that we can also do it in the posterior region, closing the
• 15:26
  gap with, for example, some these custom made abatements that close the sockets.
• 15:31
  We also know that now we can also eventually close it with some.
• 15:35
  Collagen, biomaterials and things like that.
• 15:38
  The anatomical abatement would help in supporting the tissue.
• 15:42
  So I think there are really interest there.
• 15:44
  But I started with immediate implant in the posterior region
• 15:48
  only six, seven years ago.
• 15:50
  While in the aesthetic zone was 20 years ago.
• 15:52
  At the beginning.
• 15:53
  I agree.
• 15:54
  We did not understand everything, but but it is really.
• 15:57
  A game changer because now every time we have a patient that comes into the clinic
• 16:02
  with the tooth still in place and when it correspond to the proper conditions,
• 16:07
  according to the risk assessment table, I would definitely always.
• 16:12
  Consider an immediate implant,
• 16:14
  even poster.
• 16:14
  This
• 16:14
  is, and it's not only the patient gaining time it's also us.
• 16:19
  We are more efficient in, in, in all different dimension.
• 16:22
  Yeah.
• 16:24
  So the initial studies regarding immediacy in the posterior, where
• 16:29
  were of a game changer for me.
• 16:30
  Eyeopener, yeah.
• 16:31
  Eyeopener.
• 16:31
  Yeah.
• 16:32
  And you had this ones in the interior as well that you said you were, you
• 16:36
  say, oh, it was, it goes far back, but I think it's worth also highlighting.
• 16:39
  Yeah.
• 16:40
  NN.
• 16:40
  Now if I have to talk to the community, to the dental community,
• 16:44
  I think some kind of landmark.
• 16:47
  Research that was done recently is everything that relate
• 16:52
  to the Consensus Conference.
• 16:54
  The ITI Consensus conference we had in 2023 about different
• 16:59
  topics, but also about immediacy.
• 17:01
  And for consensus conference, you always prepare some systematic review prior.
• 17:06
  And Adam Hamilton with his collaborators he did a huge work reviewing, the
• 17:12
  selection criteria for immediate implant.
• 17:16
  And this is where we actually realized that everything we were coming up
• 17:21
  in the book was actually backed up.
• 17:24
  By the literature, it was like a kind of a simultaneous work.
• 17:28
  But we came with something really strong.
• 17:30
  And now the consensus conference or the consensus paper says that type
• 17:37
  one a implant placement timing.
• 17:39
  So basically immediate implant, immediate loading in the aesthetic
• 17:43
  zone is something reliable.
• 17:47
  If the conditions are adequate, favorable, yeah.
• 17:51
  So now, because the more conservative we're always saying, yeah, immediate,
• 17:57
  we don't have the evidence and so on.
• 17:59
  So now this is really backed up.
• 18:01
  Yeah.
• 18:01
  And and I think this is now moving and shifting really fast.
• 18:06
  I like it very much because it's come to a point that it's not, if it's a
• 18:10
  viable option, it is a viable option.
• 18:13
  It's just a matter of how to do it.
• 18:15
  The checkpoints, the common sense and respect, the anatomy, the patient, and on.
• 18:21
  Yeah, absolutely.
• 18:22
  Yeah, it's a little bit like a recipe, you need a cooking book and we like to say
• 18:26
  the it treatment guide is a cooking book.
• 18:29
  But yeah and I really hope that with immediacy, I hope I'm convinced that it's
• 18:34
  the indications will probably expand, evidence is continuously building up.
• 18:41
  And also there are, these new technologies, new development,
• 18:44
  new biomaterials and yeah, I'm really curious to see where we
• 18:47
  are in maybe 10 years from now.
• 18:49
  But it makes sense what you just said, that in aesthetic zone has far more.
• 18:54
  Evidence behind because it comes with a lot of emotional appeal behind.
• 18:58
  If you fall, you have an accident, you go to the dentist, you would like this
• 19:01
  to be repaired as quickly as possible.
• 19:04
  So the demand generated the need.
• 19:07
  And the knee generated, the evidence is behind.
• 19:10
  Pretty cool.
• 19:11
  No.
• 19:11
  Yeah, absolutely.
• 19:11
  This is the aesthetic aspect, the the psychological aspect or emotional
• 19:15
  aspect, if you wanna call it like that.
• 19:17
  For the posterior, this is also very relevant.
• 19:20
  Maybe there is not this direct satisfaction, but it
• 19:23
  is a gain of time and cost.
• 19:26
  It is,
• 19:26
  huh?
• 19:26
  To all of us.
• 19:27
  We get out of dental school very excellent, technically, but we're.
• 19:31
  Terrible at managing time.
• 19:34
  Or discussing everything that comes together.
• 19:36
  We're becoming a dentist, becoming a business owner, so time matters.
• 19:40
  Absolutely.
• 19:41
  France.
• 19:41
  I have this other topic experience taught me.
• 19:44
  You came this long journey going from anterior to posterior time.
• 19:48
  Implant has a big, chunky metal piece.
• 19:52
  Something that comes your mind that you say, I wish I had the knowledge
• 19:57
  base and the tools I have now back in it when I had that situation.
• 20:02
  There's something you can check.
• 20:03
  Yeah.
• 20:03
  Absolutely.
• 20:03
  And actually we are we have already somehow addressed it, when I was a
• 20:06
  post-grad student in Perial we were already doing so many needs and I
• 20:10
  was telling you, we were placing this large implants in the socket
• 20:14
  and ah, and I remember we were like, yeah, maybe place your implant as
• 20:17
  close as the buccal bone as possible.
• 20:19
  Can you believe that Now, and yeah.
• 20:21
  We had the, it's agonizing to
• 20:22
  think now.
• 20:24
  No it is yeah, it's great to be, to have progressive ideas and vision, but
• 20:31
  you need to understand the biology.
• 20:32
  And at that time we were really doing immediacy without
• 20:35
  understanding the biology.
• 20:36
  And yeah, if I could redo that, I would've probably tried to.
• 20:43
  Understand more better.
• 20:44
  And some of the very important studies were the studies from
• 20:47
  Maurizio Rojo, this animal preclinical model where they, he studied a lot.
• 20:52
  The dy the dynamic of the socket healing and the bundle bone.
• 20:57
  Yeah.
• 20:57
  And the dimension of.
• 20:58
  The of the socket reducing, especially on the buccal side.
• 21:00
  And then it replicated exactly the same model with placing this
• 21:05
  piece of titanium into the socket.
• 21:06
  And the remodeling process was exactly the same.
• 21:09
  So we know that an immediate implant by itself does not
• 21:13
  prevent the post extraction remodeling, but this is more the.
• 21:17
  The adjunctive therapies like the alveolar ridge preservation,
• 21:20
  you combine to immediate implant that is going to help you.
• 21:23
  And we understand the position is, should be really adjusted according to that.
• 21:27
  And we also understand, the importance of soft tissue grafting
• 21:31
  when it comes to the aesthetic zone.
• 21:33
  In some cases, not in every cases, but in some cases.
• 21:37
  Is it fair to expect that we were back then thinking that
• 21:42
  with a periodontal point of view?
• 21:44
  Thinking implant would just behave the same.
• 21:47
  And that's why we wanted to,
• 21:51
  let's just hold this wall here.
• 21:53
  Just thinking would stay there.
• 21:54
  Let's just and over time with papers like Mauricio, for example, it
• 21:59
  proved literally everybody wrong.
• 22:03
  Which was good.
• 22:03
  Then it triggered actions and research and development to
• 22:07
  look in the other direction.
• 22:08
  And now we we're far better positioned.
• 22:11
  Yeah.
• 22:12
  And yeah, I in.
• 22:14
  I like to show, the outcomes of these implants.
• 22:16
  We placed early 2000 immediate implants where you have those big recessions.
• 22:21
  And yeah, that was aesthetic failures, but we've learned, we learning from mistakes,
• 22:25
  but we should not experiment too much.
• 22:27
  So that's that's why it's really important to to look at the evidence.
• 22:32
  Yes.
• 22:32
  But
• 22:32
  We have it now.
• 22:34
  You mentioned just like in.
• 22:36
  Pilots on an airplane, your Honor, you have all these checkpoints.
• 22:39
  The ITI treatment guide has all these checkpoints.
• 22:43
  Assuming all the checkpoints are in place, is there this one technique that you,
• 22:49
  or one site or one condition that you go home and you have this work smile thing?
• 22:55
  That was a good day.
• 22:56
  I, 'cause we're very crafty people.
• 22:58
  We like to do things and there's this one.
• 23:00
  Situation that you prefer, that when patients come to you, it's
• 23:03
  say, oh, that would be a good one.
• 23:05
  It would be fun to do it.
• 23:07
  Yeah.
• 23:08
  This is a difficult question because I don't think there is like one
• 23:11
  specific thing that is the secret.
• 23:13
  Yeah.
• 23:14
  I think here we're talking about workflows.
• 23:16
  Yeah.
• 23:16
  We talking about each little piece of the puzzle is important for the final outcome.
• 23:23
  But now if I have to pick something that.
• 23:26
  That really changed things.
• 23:28
  A
• 23:28
  workflow, for
• 23:28
  example.
• 23:29
  It's not actually something crafting or a technique.
• 23:32
  I think this is really the tools we have for planning and the visualization
• 23:38
  of the full treatment from day zero.
• 23:41
  And we gained a lot in accuracy.
• 23:43
  And and we have, this we can really.
• 23:50
  We know where we going.
• 23:51
  Yeah.
• 23:51
  And then we followed the path.
• 23:53
  You can plan your, you have your anatomy, you have your aesthetic planning.
• 23:57
  And based on that, you place your implant.
• 24:00
  You look at the prosthetic and then you adjust according to the biology and
• 24:04
  you know where we, where you're going.
• 24:05
  We did not have that before.
• 24:07
  Yeah.
• 24:08
  Even the tomographies, they were quite blurry, Lots of artifacts.
• 24:13
  We cannot see things too well.
• 24:15
  We are really living the golden age of the technologies that we can play with
• 24:20
  to, to, we can even simulate the patient.
• 24:23
  We can print and prototype the patient and even rehearse the surgery otherwise.
• 24:26
  But actually now in those workflow we don't even print anymore.
• 24:32
  You, for example, if we talking immediacy, aesthetic zone, you're not
• 24:35
  doing the planning and you can get your pre fabricated crown without a model.
• 24:40
  Yes.
• 24:41
  So that's fantastic.
• 24:42
  I, that's a reality.
• 24:44
  I see many colleagues already go in model three in many situations.
• 24:48
  Except when you have different occlusal schemes and many implants that you
• 24:51
  really wanna check how things go.
• 24:53
  But normally you're already going moderately to the level
• 24:56
  of precision we're getting, huh?
• 24:57
  Yeah.
• 24:57
  Yeah.
• 24:58
  No the guided surgery as well.
• 25:00
  Whether this is static or know, navigated yeah.
• 25:03
  This is this is exciting development.
• 25:06
  And yeah, it's very exciting to be a dentist in this era, golden age as you.
• 25:10
  We're living in a golden age.
• 25:12
  And see.
• 25:13
  We are living in a golden age, but if you have to look a landscape a few years
• 25:18
  from now, where would you put your coins?
• 25:21
  If you're in Las Vegas, I have to invest in this.
• 25:26
  Where would you, or at least, where would you like us to start looking into
• 25:30
  if we stay in the topic of immediacy, I'm someone that I like
• 25:35
  to challenge and push the limits.
• 25:37
  So I, we have these.
• 25:40
  Conditions where we know this is safe and reliable to do immediate implant,
• 25:44
  but I am sure we can go beyond that.
• 25:48
  And for example but we need to build up the evidence.
• 25:51
  We need to find the ways, we need to find maybe the technologies that are.
• 25:55
  Helping us to do that.
• 25:56
  But maybe when we have even like very minimal quantity of bone,
• 26:00
  we may still be able to place an implant in a proper position.
• 26:04
  In the cases where you have the large buccal defects we may find the
• 26:07
  techniques or the material that would help you to also place in planning
• 26:12
  these less favorable conditions.
• 26:14
  I, I really hope we, we expand the the indications.
• 26:18
  Yeah.
• 26:19
  This is how I see.
• 26:21
  Immediacy for the future.
• 26:23
  And that's very patient-centric.
• 26:24
  I like the direction, very altruistic direction we're going because you're
• 26:29
  saying inquiry and allowing treatments in, I met this very young doctor in
• 26:35
  South Africa and he was working with all this mandibulectomy and cancer
• 26:40
  patients, and he made this his mission in life, giving hope to the hope.
• 26:45
  And you just brought this.
• 26:47
  To widen the options and conditions in which we would have to put the patient
• 26:51
  through so many layers of treatment, so many morbidity, so much cost, all of the
• 26:57
  above, getting from where we are, that is already evidence-based as we have all the
• 27:03
  documentation, all the evidence behind
• 27:07
  going one step further where conditions don't allow that it's still reliable.
• 27:13
  No, you
• 27:15
  the short way.
• 27:16
  Don't allow today.
• 27:17
  No.
• 27:17
  The shortcuts may be, some, may have some benefits some sometimes, but yeah I'm
• 27:22
  not very familiar with with those large conditions, reconstructions and very
• 27:28
  beautiful work they do.
• 27:29
  It's amazing.
• 27:30
  They get bone from the tibia fibula, they already placed the implants.
• 27:35
  And then with the implanting position, then they graft with the implanting
• 27:39
  position and do the reconstruction.
• 27:41
  Yeah.
• 27:41
  So they can go back to, yeah.
• 27:44
  But it's true that, again, are we coming to the planning and to know exactly
• 27:47
  where we're going and for example, yeah, even for smaller cases, but
• 27:53
  pro prosthetically and biologically driven bone augmentation procedure make
• 27:59
  totally sense as well, so from it's it we working just the other way around.
• 28:04
  France, here's the thing.
• 28:06
  We would love to pick your brain for a full day.
• 28:09
  Sadly, time is against us, so I like to thank you for.
• 28:13
  Very much for stopping by, for sharing all this expertise
• 28:17
  to have this phenomenal chat.
• 28:19
  We really apologize for a bit of a technical detail we had before,
• 28:23
  but I'm glad we're overcome that.
• 28:26
  And to our listeners out there, whether they would like to start reading or
• 28:30
  getting more familiar with the ITI treatment guide, how they can get there.
• 28:35
  And I understand you also have a few educational offerings that you would
• 28:39
  like to tell our audience about.
• 28:40
  Yeah, absolutely.
• 28:41
  But of course starting by reading and getting less in the ITI
• 28:45
  treatment guys about immediacy is is definitely a good trick.
• 28:49
  And there are also plenty of education within the ITI of course.
• 28:53
  Everybody is welcome to, to follow us and also is invited in Lige at the university.
• 28:59
  To my Department of Perio and Dental surgery.
• 29:03
  And implant surgery is it's actually branded as EU perio because the name of my
• 29:09
  department is so long and so complicated that we actually branded it EU perio.
• 29:13
  So we do different type of continuing education.
• 29:17
  This is mainly in French.
• 29:19
  But when it comes specifically to immediacy, we have also developed
• 29:24
  an educational program called Dental Flow together with Garry
• 29:28
  Fennell because he's also a big a, a big expert in the field Yes.
• 29:32
  Of immediate implant.
• 29:33
  And we are very complimentary and we have basically masterclasses.
• 29:37
  So this is modules of two days and a half.
• 29:41
  One focusing on the posterior region and the other one
• 29:44
  focusing on the anterior region.
• 29:46
  And this is combining of course theoretical lectures, but also hands-on.
• 29:51
  So this is small groups and and we are we also focusing on the workflows
• 29:55
  and all the logistics of this.
• 29:57
  And yeah, we also have life surgeries.
• 29:59
  So to dive deep into the.
• 30:02
  Immediate treatment.
• 30:03
  That's definitely a cool a cool program or
• 30:06
  education, educational offers.
• 30:09
  And this is in English.
• 30:10
  Now we have all opportunities to everybody.
• 30:13
  To all of you watching that, you'll be interested to take part of one of
• 30:18
  the educational offerings directly in the edge with Professor Lamber.
• 30:22
  We're gonna leave the links in the description below.
• 30:24
  If you're interested to learn all about immediacy in English,
• 30:28
  then in the dental flow.
• 30:30
  We're also gonna leave the links right below.
• 30:34
  If you like this episode, drop us a message.
• 30:36
  We'll be very curious to hear from you.
• 30:39
  And also if you like it, we hope you did, you shared to a
• 30:43
  friend 'cause sharing is caring.
• 30:45
  Thanks, Lambert.
• 30:46
  It was a pleasure to
• 30:47
  have you.
• 30:47
  Thank you so much Christian.
• 30:48
  It was really nice discussion.