Latest / Straumann® ProTalk / Science behind the perfect illusion: Prof. Urs Belser on biomimetic implant dentistry

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Science behind the perfect illusion: Prof. Urs Belser on biomimetic implant dentistry · Straumann® ProTalk

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Mainly the only instrument we had when I started my career was a diamond bur.
0:05
You graduated in Zurich and you shared a very interesting time
0:09
with the great Peter Schärer.
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You've been leading the department of fixed prosdontics in the University
0:15
of Geneva for almost 30 years.
0:17
You are also very adamant about respecting nature.
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At one point in time, was it clear for you that you would like to
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enjoy your career in academia?
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When I did my doctoral work, I had to do a scientific work, so I started
0:32
with that and I loved also this.
0:34
And what finally made the decision when I got a stipend of the Swiss
0:41
National Foundation for research to spend two years at UBC in Vancouver
0:47
in Alan Hannam, neuroscience lab.
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That was the best.
1:05
Welcome to ProTalk.
1:06
Welcome to the Pules of Dentistry.
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Welcome to this episode that George and myself are very much looking
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forward because we have a very special guest today that we can welcome.
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This is professor Dr. Urs Belser was very much welcome
1:21
to be the guest in our podcast.
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We are very honored that you came over to Basel and that you're our guest today.
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Thank you very much for this invitation and that I have heard a lot about
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these podcasts and I watched a few of them, and so I feel deeply honored.
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Thank you to be part of it.
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Great to have you.
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From a personal note was, who is Urs Belser in one minute?
1:44
You must be aware that i'm coming from the area of mathology and where
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mainly, the only instrument we had when I started my career was a diamond bur,
1:57
and then I overlooking now roughly 50 years of evolution in reconstructive
2:04
dental medicine, including also implants.
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And I think that is something which makes probably it worth for you to
2:12
discuss a little bit the journey.
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Now I am almost completely retired and almost completed.
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I have to admit, I'm enjoying it, a lot of it, what usually goes with retirement,
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more time, family time, grandchildren, playing golf, fly fishing, traveling.
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So there is a lot of that, but still my enthusiasm of clinical dentistry
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is still intact, and I'm still following the evolution because it's
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passionating what we are facing today.
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And you're still lecturing ever now and then?
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I know that you're getting invitations.
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Yeah, occasionally, but I really, oh, I don't like huge podiums anymore.
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It stresses me.
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This stresses me also a little bit, but it should be okay.
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No, what I like is study clubs and smaller meetings.
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And particularly what I like is the graduate students.
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I can still give some seminars.
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In the University of Bern and University of Geneva, and they, this is always
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a huge pleasure with a small group of young, enthusiastic, curious people.
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Yeah.
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To exchange thoughts.
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But starting from the very beginning, has it always been clear
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for you to go into the dentistry?
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Was this part of your family or how did you actually end up in the dentistry?
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Good question.
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Nothing spectacular.
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My father was a dentist.
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Okay.
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And he never pushed me into dentistry, but he took me when
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I was a child to his practice.
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I could watch the laboratory also the work the technician made.
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And then occasionally when he treated, a member of the family I could watch.
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And immediately it appealed to me.
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And then I went to, into medicine the first two years I, together with the
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medical students and I never changed my opinion and I straight went on
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to dentistry and I never regret it.
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And the history with your father's is also why you have such a high opinion and
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let's say respect for dental technicians because this I always felt very special
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about you, that you had such a high respect for your dental technicians.
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Yeah.
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It's nice to mention that this, I have, not only from my father, but from
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Peter Schärer, my academic teacher and chairman at the University of Zurich.
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He always said the dental technician is an integral part of the team and
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he should have access to the patient.
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Because if you want to get his best, then you must give him this,
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that he really feels concerned.
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And that, that we did from the beginning and through.
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I look at Alwin Schenk and Berka and Michel Magne and Pascal Müller.
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It was a pleasure and I always got really the best they could do because
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they knew I was highly respecting them.
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And we must admit that what is visible from a reconstructive
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dentistry in the mouse of the patient is what the technician has done.
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Exactly.
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And makes a difference.
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Makes a difference.
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I think you, you also show in your presentations always basically this
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appreciation of the dental technician.
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And I think that really stands out, the understanding of how
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important this collaboration is.
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And, maybe you can allude a bit more on, on how it also affected
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your career, this this very close correlation with dental technicians?
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Yeah.
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I learned a lot from them.
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Because they wanted to be able to copy really what nature does and then you
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you see how they stratify the ceramics.
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And so I got a lot of of respect because they could do things which I
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probably would not have been able to do.
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And that's why I'm also a little bit surprised that now
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they are a little bit worried.
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Because they say, is our profession not going to disappear because
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all of these digital things, then I think they're wrong.
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It's an opportunity for them.
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Because they know exactly what is needed.
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And I don't think that the dentist will now do everything himself on the computer.
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They will do it better.
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And I think it's an opportunity for them.
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And I always tell them, yeah, it'll go on.
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I'm fully with you.
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And I hope that a lot of people see it like you and have to
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respect for the dental technicians.
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Because it's, it's this combination of technology, craftsmanship of art Yeah.
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And creativity that really makes let's say a unique outcome that you presented very
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often in your cases on congresses, right?
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And this can be translated into digital technology.
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Yes, absolutely.
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And there will always be things that 10 technician can bring
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in that, that, technology will have a hard time to bring in.
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So I fully agree.
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It's an opportunity for technicians rather than a threat.
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Yeah.
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So we know how you got into the dentistry thanks to your father.
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At one point in time, was it clear for you that you would like to
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enjoy your career in academia?
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Yeah.
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And not follow your father into his practice maybe?
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No.
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I actually meant when I went into graduate studies, I did not think I
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wanted to go into a academic career.
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But as graduate students, we also had, I think two half days
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per week we were assigned to the student floor where we should
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supervise the, their practical work.
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I loved it.
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This is really, this is something very rewarding because then
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you have an age group of young people who are really motivated.
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They want to learn because they know it's what they're going to do later on.
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So this is, was easy.
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I loved it.
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So I thought this, I want to keep, even if I would go into private
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practice, maybe one half day per week, go to university and supervise
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students, then the next step towards academia was when I did my doctoral
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work, I had to do a scientific work.
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So I started with that and I loved also this.
8:06
And what finally made the decision when I got a stipend of the Swiss
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National Foundation for research to spend two years at UBC in Vancouver
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in Alen Hannam's neuroscience lab.
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That was the best I could learn electromyography jaw movements.
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We, we were still in the area of occlusion and articulate.
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We made studies on them.
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Movement, jaw movements related activity of the masticatory musculature we
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tested different occlusal schemes like canine guidance or group function or the
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impact of non-working site interferences on the coordination of the muscles.
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I thought that was really something interesting.
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And from then on I thought the combination of teaching research
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and clinics is just fantastic.
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So I could can only recommend there are some sacrifices to be done,
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that's for sure, but it's worth it.
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More than worth it.
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Yeah.
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And how did you end up then in Geneva?
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Was this like a natural opening and-.
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No, that was my boss.
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Good.
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I was still in, in Vancouver and he called me, oh, the position in Geneva is open.
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You have to apply for it now.
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Yeah.
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And then I said, professor I'm not ready yet.
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And it is in French there.
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He says wait, don't worry.
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Go there, apply.
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And so you once have experienced how such a competition goes and
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then you will be prepared for later.
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And then of course I wanted to make a good impression there.
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I really prepared my lecture and the interviews.
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And to my big surprise, they took me.
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Okay.
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I was only 35 years old at that time and became department chair and they
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welcomed me so kindly in Geneva.
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So I really never regret my wife regretted a little bit.
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She loved to stay in Zurich.
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Maybe to close this chapter, if you look on the young generation that I'm
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very happy to see that you're still connected to these students and you
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have this conversation and time with them still, what would you recommend
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to the next generation of dentists how to shape their future in career?
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Yeah, that's an important question.
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Of course, I would encourage everybody who has some doubts, if eventually
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academia would be something, start with the grad, with the graduate training.
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And during that you will be exposed to all the facets of that.
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And then find a field of interest for you and because what I am and
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what made the reputation of our department is based on teamwork.
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It's the young people who come and they are not biased.
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They come with new ideas and enthusiasm, and you have just to create an environment
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so they can develop their talent.
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And I saw that so many times.
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I don't know if I can dwell on that a little bit longer, but when
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I think at German O. Gallucci, he came to Geneva out of a private
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practice in Argentina and suddenly he heard about the ITI scholarship
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program and he applied, he got it.
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And five years later.
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He left to Boston to Harvard, worked with H.P. Weber another few years, and
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now he's head of department at Harvard.
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This is incredible.
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I skipped a lot of steps data.
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Like he, he was of course very talented and also very ambitious to reach
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this goal about an amazing career.
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And I could quote many of the ITI scholars who passed for a year
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and then stayed and then became instrumental for the development
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of the field of implant industry.
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Yeah, there's no doubt.
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Let's go a little bit to your work and research work.
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There is no doubt that you are the father of many concepts in
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prosthetics and, but also especially I think in implant prosthetics now.
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Looking at all the work that you did and all of the research work you are more than
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30,000 times cited with your publications.
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Is there any publication that you look back that you say, look, this is really
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one that I'm super proud of, and that was a bit of surprising also the results?
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Here I have to insist once again, what we have achieved is the result of team.
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There are many people who are not now not mentioned.
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I have to pay attention.
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That I give credit also to those who deserve it.
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But achieved, we've, really developed aesthetics on implants that,
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because I remember at the beginning, integration was almost a miracle.
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So one tolerated that it was not perfect what, which was on top of the implant.
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I heard so often.
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It's not bad for an implant, but that already means it
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is not a perfect illusion.
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And I think we systematically approached this field to look if we
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can come up with decent restorations on implants in the aesthetic zone.
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That was certainly a nice contribution.
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The other one was in the field of not implant dentist dentistry
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to try to be less aggressive.
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And then that brings us then maybe later to biomimetics, an approach which
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was really an eye-opener for many.
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Because as I mentioned it before we were crowning so many teeth
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because the only tool we had was the burr, and we had retention and
13:57
resistance form and full crowns.
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And then this did not satisfy.
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And we thought we, we realized that we are maybe too aggressive.
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The biologic price was too high.
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And there I think we, we contributed significantly that
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this has changed over the years.
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Yeah.
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So you touched already, and I think we come back to the
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topic of biomimetics, later.
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And I think you have spearheaded the concept there, which is
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minimal invasive industry, which is today it's in everybody's mouth.
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Yeah.
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And it's maybe obvious, not yet perfect, but something that is a big trend.
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But you've been.
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In instrumental and also a pioneering implant dentistry and implant prosthetics.
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There's no doubt.
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I think you helped also to progress the implant material up to a point.
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And I like what you said, you always were looking for this perfect illusion, and
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I remember when you were on stage, you often say that's a quite decent result.
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Yeah.
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And we could not see the difference anymore.
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And people
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in, people in the audience would smile because they say, look I would never
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achieve a result like Professor Belser, because it's almost a perfect illusion.
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But, this was not clear from the beginning when you started with implant industry.
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It was not experimental, but it was more functional, osteointegration was solved.
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A lot of topics were unsolved.
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What have been the big milestones in the development of implant industry
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for you and, milestones where you then thought, okay, now it's really working?
15:20
Okay.
15:21
Then let's go back to the end of the 1980s where I remember the head
15:28
of surgery in Geneva came to me and said, Urs, we had so bad experience
15:34
with Subperiosteal implants.
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Can you not, we hear now that there is somebody in Sweden
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who seems to have nice results.
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Can you not take over this part and introduce it to the dental school?
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And then we went to the Brånemark Clinic to watch and we were absolutely thrilled.
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And and then came back and but the suites were quite arrogant to us.
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They say all the research has already been done.
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We said we as a university we would like to participate to studies on that.
16:08
And no, everything is already done.
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And you just can buy the system as any other clinician.
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And then we then heard that there was also somebody at University of
16:19
Bern, which was Andre Schroeder, who had a very different approach.
16:23
And we invited him and he immediately convinced that was the way to go.
16:29
He has a very different approach, nons submerged surgery, and then a
16:36
prosthodontic procedure pretty similar to what we are used to do on teeth.
16:42
This appealed to us with Jean-Pierre Bernard, there was the surgeon
16:47
at the University of Geneva.
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We started very
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cautiously and here edentulous patients in the lower jaw with two
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at implants, non- submerged, and then spherical attachments or bars.
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And we just felt comfortable with that.
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Then we moved gently to the partial dentalist patients
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into posterior mandible.
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We placed the implant very superficially, so no prosthodontic
17:22
interfaces deep into the tissues.
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And I still remember that was still the nicest soft tissue around the
17:29
implants we saw 'cause no margins were there, but obviously we were cementing.
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The restorations, crowns and bridges vary successfully because
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everything was under control.
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And then came finally the moment where we wanted to also use
17:47
these implants in the anterior.
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And there we thought, no, we cannot cement there because there
17:52
are rotation symmetrical and approximately we would be so deep.
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So we need screw retained restorations.
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And then we developed the Synocta® system, and then we were using these tissue level
18:07
implants at that time very successfully.
18:09
Also in the aesthetic zone, I must say.
18:12
No, we did a lot of those.
18:13
And it worked, but we realized it was certainly not the last
18:17
word in development of implants.
18:20
And so that was and then of course came the bone level, 2004-5.
18:27
Yeah.
18:27
Yeah I'm really jumping ahead very much.
18:29
But that was something very excited because before that, it needed to
18:34
be proved that the non- submerged system is exactly as reliable or
18:40
predictable as the one, because it was a dogma from Gothenburg at
18:45
that time that you needed to suber.
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But we didn't want to admit by making bond level that the assumption was wrong.
18:54
But at that time, everybody was convinced that both ways are
18:59
predictable and we could go with the development of the bone level implant.
19:05
And how do you reflect back on this project?
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Because George and myself have been leading this project and you've been
19:11
a close, a very close advisor to us.
19:13
I remember I asked you a lot of stupid questions those days.
19:17
How do you reflect back on, on this project?
19:19
You did the pilot study with Daniel Buser.
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Yeah.
19:21
You placed the first implants into humans.
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It was quite an exciting project.
19:27
How do you reflect back on this?
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It was a great it was from many points of view, this was a great period.
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This prospective case series study on 20 consecutive treated patients because
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the primary objective was can we confirm the platform switching concept, which
19:47
was claiming that you would keep the bone exactly at the implant shoulder.
19:52
So that was the first objective.
19:54
But Daniel Buser team had already developed also the concept of
19:59
early implant placement and simultaneous contra augmentation.
20:03
So this was all also implemented in that study.
20:07
And we published the data then after one year, three year, five year, and 10
20:12
years at the, in the journal of, finally in the Journal of Dent Research, and we
20:18
could confirm the hypothesis that yes, you keep the bone if you have a non-matching
20:25
prosthodontic approach on these implants.
20:28
And at the same time also having a strong clinical documentation or scientific
20:34
documentation on early implant placement, that means waiting for soft tissue
20:39
closer before you place the implants and facial contour augmentation.
20:43
Because we've, we were, if you allow me to say we got the authorization
20:48
by the human experimentation to make four, four times four centimeter cone
20:55
beams on these patients also, if they would, and we could see that we could
21:00
keep that and by this zero recessions on all these implants over 10 years.
21:06
That was for me, really, game changer.
21:08
You said breakthrough.
21:09
Yeah.
21:10
And that was also for us as a company, was a breakthrough, this development and
21:13
finally seeing that it's working out.
21:15
And we come back to this project later.
21:17
But one question I would also like to ask, if we speak about pioneering
21:21
implant industry, I think we also have to speak about the ITI.
21:25
How do you see the contribution of the ITI in this in this context?
21:30
In one word would be major.
21:32
That was, it was a vision of Henri Schroeder and Fritz Straumann, and
21:38
then later on or quite rapidly took over also and followed through all
21:43
these years by Thomas Straumann.
21:46
I cannot say everything with strong, but what I found particularly decisive
21:53
was this synergistic approach between Straumann and the ITI development
22:00
committee and the research committee major contributions, and then
22:07
of course the study club system and the ITI scholarship Program.
22:14
Yes so education, research, and brainstorming with the Straumann
22:20
people to look what in which direction to go, and that it has
22:26
had to be approved from both sides.
22:28
That was long time.
22:30
Then later on, this was not possible anymore because everything grew so fast.
22:36
And and the ITI is now by, I think by far, the largest
22:41
professional organization worldwide.
22:43
And with all which goes with that.
22:46
So I could for hours still, yes, dwell on that, but I don't want to do that.
22:50
But yeah.
22:52
Maybe one anecdote to share to link the bone level development and the
22:55
idea, I think is, I remember still, there was we had a scientific advisory
22:59
board consisting of ITI fellows.
23:01
That was advising us.
23:03
And technically we've been ready to launch the products, but then,
23:07
we got the advice from the advisory board in Geneva at that point.
23:10
We, yeah, we were, yeah, you guys, you cannot launch it because we see great
23:14
data, but we need to have more follow up data from the clinical studies.
23:18
I remember.
23:18
Yeah.
23:18
So please wait.
23:19
Even though we've been, we to have half a
23:20
year, more exactly.
23:21
Half a year, more.
23:22
Even though we have been ready technically to launch a product, we did not launch it.
23:25
Because the ITI, scientific advisory committee told us to
23:29
wait for another nine months.
23:30
So we postponed the launch of the bone level implant by nine months.
23:34
And I think that really, this was a painful nine months for us, but it
23:37
imagine, but it really showed us, it really showed us also the power of
23:40
this collaboration because at the end it was the right thing to be done.
23:43
Yeah.
23:44
From a scientific point of view.
23:45
Yeah.
23:45
Because when we look back, we had never, during all this development of the implant
23:52
system, never major catastrophes, huh?
23:56
Yes.
23:57
Because we were quite very cautious, always tested at least.
24:01
And we set a minimum of one year in pilot studies before this should go to.
24:08
And I think this was a safety marching, which I think was worthwhile.
24:13
Yes.
24:13
Maybe as a company you want to go faster and you think this is slowing us down.
24:19
But I think on long term it paid off.
24:23
We, we saw it very positive, to be honest.
24:25
Yeah.
24:25
At that stage being involved there, I think we saw it, we saw
24:27
the good intention behind this.
24:29
And it was also strong launch afterwards, I think with this
24:31
data of the 20 cases this, I still remember, when we saw this slide for
24:35
the first time with all 20 x-rays.
24:37
Yeah.
24:38
And of course it was like, okay, this is important that it that
24:41
it's, that's showing good results.
24:43
And then finally we had a, I would say a strong launch also involving the ITI
24:49
and the study clubs in disseminating the knowledge on how, and the giving
24:52
the trainings on how to use the product.
24:54
So I think it was a good decision, but it was tough at that, that
24:57
meeting in Geneva was like, oh, okay.
24:59
Now we're putting a temporary halt on on the launch plan.
25:04
Yeah,
25:04
We also have some con community clear questions.
25:07
Because we told people that we will have the conversation today.
25:09
And yeah, we selected two, one from Daniel Vic from I think
25:12
his colleague from Hungary.
25:14
And he said, I'm interested in your opinion about ceramic implants.
25:19
Ceramic implants.
25:21
Okay.
25:22
Okay.
25:23
The first ceramic implants I was aware of, they were one piece implants.
25:28
And so I said, I'm never going to use those because you had to be
25:34
very precise in implant positioning.
25:37
And I still saw that people were grinding on the implants.
25:41
And then of course, the only thing you could do was restoring
25:45
it with the semantic restoration.
25:47
So these were all things which for me, and then also
25:50
reintervention, virtually impossible.
25:52
So that was a no-go.
25:54
Then came the two part ceramic implants.
25:57
Then I thought it still needed a little bit of metal inside to,
26:04
to make a connection and make all the components working in the
26:08
way you would like to do that.
26:10
But for me it's still, I know they zirconia also integrate very predictably.
26:17
That's for sure, but it's still a bri brittle material.
26:21
Then I'm aware that there are some concerns from the
26:25
medical side will say yes.
26:28
It is no metal.
26:30
It is better because we have some people who don't want
26:33
to have metal in their body.
26:36
And there I can only say when you look in the periodic system where circo silicon
26:41
is placed, it's part of the metal.
26:44
But of course, the one which is used is white, and we always
26:48
think white is not metal.
26:51
Which is not completely true also.
26:53
So far I'm sticking to the titanium
26:56
implants.
26:57
Okay.
26:58
Then we have another question from Laurence Adriens that you might know
27:00
because you spent some time in Bern.
27:02
And she said, what she's writing, I have to read it.
27:04
She said, look, the first time I encountered bone level implants was
27:07
through a presentation actually of you.
27:08
And obviously it made a change to, to her and her department.
27:11
And she, they adopted it and it was for them a breakthrough also to work,
27:16
starting working with bone level implants.
27:18
And her question is, how do you look at the recent developments of the Straumann
27:22
system with BLX and BLC implants?
27:26
Do you still follow this and yeah,
27:27
I follow this very much.
27:29
Okay.
27:29
Of course, I have conversations about that with Daniel Buser almost every week.
27:35
But my point right now is that it would appear that this, the TLC and
27:46
TLX are for me, the perfect synthesis of the last 30 years because.
27:56
I said I was a fan of the tissue level implants in the posterior part of the
28:00
mouse because I had no margins in the tissues was, so this was given away
28:07
suddenly that everybody switched to screw, retain restoration and placed the
28:12
bone level implants all over the place.
28:14
Up all over the place.
28:15
Yeah.
28:16
In situations.
28:17
And I understand that in a private practice you don't want to have all
28:20
the different types of implants.
28:22
You want to streamline a little bit your approach.
28:25
So I could understand that, but when I look at what is relevant today that
28:33
we saw or worldwide one could observe more, was a peri-implantitis cases not
28:42
especially on Straumann implant, but worldwide it become really a problem.
28:46
This has various reasons why this is but that's why this development is now
28:53
that we have still a machined top of the implant, we can still put it in a
29:01
little bit into the bone there, but we will have very little adverse effect
29:07
if this surface would once be exposed.
29:11
We will not have the same problems as we have experienced with the micro rough
29:16
surface being exposed and fantastic is that we have now two prosthodontic
29:22
approach possible on the same implant.
29:24
This is just fantastic.
29:25
I think this is for me, really,
29:30
the perfect thing, but we can still, for the time being, I think this
29:35
will work for quite some long time.
29:37
But it is, will certainly not be the last word in implant.
29:42
I agree.
29:43
I agree.
29:43
No.
29:44
I cannot even.
29:45
But for the time being, this is by far the best approach.
29:49
And and I hear from the clinicians that, that they are so thrilled about this.
29:54
And that was a major contribution of Straumann.
29:57
That's so a
29:58
strong word for the TLC and the TLX implants.
30:01
Yeah.
30:01
In this case.
30:01
Yeah.
30:02
Thanks for that.
30:03
No this is really a masterpiece.
30:05
I must say that, I hope this will be confirmed by the broad use.
30:11
But it looks so logic.
30:13
And then it calls it a hybrid implant.
30:16
But it and also you are when I look, we started with the Morse taper and the
30:23
anti-rotational feature was only on the secondary component on the prosthetics.
30:28
Then it was SynOcta.
30:30
We had an octagon, eight different positions, but quite tricky.
30:34
To find all this, the right then was, the CrossFit was fantastic to use.
30:40
It was touch and feel.
30:41
It was deep in the tissues, but you knew exactly you turn and then you fall in, you
30:46
knew you didn't need any X-ray controls.
30:49
But still a little bit limited because only four, you need a B components and
30:54
now you are to, to six to hex again.
30:58
Okay.
30:59
But a absolutely perfect connection, virtually no micro movement.
31:05
And also the precision if you have a peripheral margin so precise
31:09
that we have much less a micro gap, much less effect on socialization.
31:16
And and also that you have no micro movement.
31:19
Also, this contributes that we have much less bone re resorption.
31:26
A masterpiece.
31:27
I really must say that.
31:28
We still have a lot of ideas what to do else.
31:31
Exactly.
31:32
Yes.
31:33
Thanks a lot for the feedback a lot and it means a lot.
31:35
And it, I'm not only saying this because I'm sitting here in a room of Straumann,
31:39
but it is my honest opinion there,
31:41
and it feels like you're still a hundred percent on it.
31:44
It's very impressive to see how you follow all this developments and yeah.
31:48
Good.
31:48
So now let's talk about some of the concepts that we touched
31:52
already upon before, quickly.
31:54
And I'd like to start with Biomimetic Restorative Dentistry.
31:58
So in 2002, if I'm not mistaken, you brought a book out together with
32:03
Pascal Magne which is describing that philosophy and it's a really
32:08
minimally invasive and biologically mimicking approach to only touch upon
32:15
teeth where it's absolutely needed.
32:16
So very reducing the invasiveness and and making the best out of theology.
32:23
Can you explain a bit how that concept develops and why
32:26
it is still important today?
32:28
Yeah, I like to, but I have to put first Pascal Magne here in, in the picture.
32:34
He, this is one of the most extraordinary talents I've ever met.
32:38
And can you imagine he was a dental student already there.
32:41
He came always with difficult questions and when he applied then to make his
32:46
graduate training in our department might be just, were thrilled about that.
32:50
And I could follow really this young personality and to come now to your
32:56
question this term of Biomimetics it started, but that Pascal wanted to
33:03
look, can I really come very close to the perfect illusion on crowns?
33:09
That's how it started.
33:10
And he had a very talented technician brother, and so together, I remember they,
33:18
we are brought a lot of extracted incisors and then they really photographed them.
33:24
Then they removed the enamel to look inside what is really the
33:30
details of the dentine underlying to, to make this appearance, which
33:34
we all know from a natural tooth.
33:36
And then his brother very rapidly was able to copy this almost perfectly
33:42
under different optical conditions.
33:44
So perfect optical illusions.
33:47
And then it went further on that Pascal made research in Minnesota for two years.
33:57
And to make a long story short, the before that period all we thought we
34:02
needed the strongest material to restore.
34:06
A broken down tooth and quite often in, we had to revitalize the teeth to get
34:13
adequate retention and resistance form.
34:15
So we were using posts and the strongest and the longest, the better.
34:20
And also the material on the ceramics, very
34:26
resistant material.
34:27
We thought that was the way to go, but still we saw fractures, but we
34:31
saw all these bad fractures that when it fractured, we lost the tooth.
34:37
And then
34:40
Pascal came with this.
34:42
We have to look a little bit more what really nature does because it's amazing
34:48
our Permanente, they come into our mouth when we are at age six and we
34:55
see, still have them at age almost 80.
34:58
It's annu rivaled success story.
35:00
And why is it because if you.
35:03
If the tooth would be only made out of enamel, which is very brittle.
35:08
It is actually the weakest ceramics we have in dentistry
35:11
is the fel spot ceramics.
35:13
It is way stronger than that.
35:15
And if the tooth would be only made out of dentin, it would not
35:19
resist very long because it's a hostile environment, a human mouse.
35:24
So why make it when they are together, it such a success story because
35:31
of the dentin enamel junction.
35:34
This is a miracle which nature has done.
35:36
Can you imagine?
35:37
We have stem cells when the embryo develops, which have the potential to
35:44
create ultimate tissues like a tooth.
35:47
Because, and this junction makes that the tooth.
35:53
Is performing so extraordinary.
35:55
And what could we learn from that?
35:57
The one which comes closest to, to dentin would be composite.
36:02
And the one closest is the weakest ceramic is spath and how to put them together.
36:10
That's, we need adhesion, the hybrid layer, the development of it.
36:16
And so that is the whole story about matics, not more and more or less.
36:21
We try to be inspired and where it's applicable and it's only applicable ONTs
36:29
that we try to avoid whenever possible to make crowns with strong materials because
36:34
we know that this can, yes, to transfer this into the field of implant dentistry
36:40
is something completely different.
36:42
And we don't want to develop now theories.
36:45
It, it is a mindset.
36:47
That you try to in get inspired what nature does so successfully,
36:53
but don't expect now a huge of evolution of that concept anymore,
36:57
because there is not more on it.
36:59
In my opinion.
37:00
It's just that,
37:02
So you are also very adamant about respecting nature.
37:06
Yeah.
37:07
I think this is something that you're very you have strong opinions on.
37:10
And I, I think here Andreas you also had a very interesting conversation with Urs.
37:16
Maybe you want to, you wanna ask the question because respecting
37:19
nature has also to do with, what type of requests are patients
37:23
actually coming with to the dentists.
37:27
I think I was always very impressed not only by, your goal of mimicking nature
37:32
and creating the perfect illusion, but also your sense of perfection.
37:36
And, not the, having the willingness to do conseque to compromises.
37:41
And I remember once you told me the story, that a very famous patient showed
37:45
up in your practice and asked you for, in your opinion, maybe an unreasonable
37:49
ask to, to have a very aesthetic outcome.
37:51
It was Michael Schumacher at that point.
37:53
And I think a lot of dentists would've loved to, to treat him.
37:56
But I remember he came with a very aesthetic demand which you found from
38:01
your concepts probably unreasonable.
38:04
He was really a gentleman that I must just put at the beginning.
38:09
But of course sometimes when you look in the mirror and you see some
38:13
imperfections and then he, they ask you, can you not make crowns?
38:19
And then I really don't compromise.
38:22
I say, no, nah, I will not cut down healthy teeth.
38:25
That's, I did it so often in my, at the beginning of my career, I will just
38:30
not do, you will find a clinician who will do it will be willing to do it.
38:34
You can, one can meet crowns, make everything uniform, but how
38:39
long will it rest or what is the biologic price you pay for that?
38:43
And so there I tried as much as possible not to compromise on that.
38:47
But at the end he came back for because you convinced him about your philosophy.
38:51
Yeah, he did.
38:51
He not, I could convince him.
38:53
Listened to your advice.
38:54
That it not everybody's perfect, but but it's natural.
38:57
And that's something which appeals a lot.
39:00
I think that's a very strong testimony for how you actually
39:02
live this matic philosophy and also respecting nature and not just
39:06
providing any type of restoration.
39:08
Yeah.
39:09
It's not only respect, it's also observing.
39:12
And if I have the possibility to come close to that, then I do that.
39:16
Now let's also look a little bit in advancements in
39:18
materials and technologies.
39:20
So over your very impressive career of the spans four decades, five decades almost.
39:25
You have been in contact with a lot of changes and it started with
39:30
for example, moving to all ceramic restorations then CAD/CAM technology
39:35
now later came also the digital planning of restorative components.
39:39
Yeah.
39:39
Now latest is ai.
39:42
What were some of the most important technologies that you advocated for
39:47
very early on because you thought this will change dentistry to the better?
39:51
That's difficult because it came so slowly on them.
39:56
It was not just moment, but I realized that in that ceramics was something which
40:03
was aging very well in the human mouth.
40:06
If you master occlusion and many other parameters, which I can
40:11
maybe not dwell on them now.
40:13
And on the other hand, we had the polymers, which are much easier for
40:19
handling and also for reintervention.
40:23
And for a long time I thought the polymers will make the race.
40:29
The latest generation of composite blanks, which are already stratified
40:33
and subtractive approach by milling.
40:37
That is something which I thought, because you, they are industrialized,
40:41
produced, have no flaws.
40:43
And that was something which I thought was really the way to go.
40:47
And I was completely surprised when I realized that also 3D printing is
40:53
because I thought this is will never be possible in ceramics because when
40:58
I saw how Michel Magne and all the technicians, how they stratify, how
41:03
complex it is to make all the effects, they wanted to make it naturally looking.
41:09
This with 3D printing, I thought this was really for surgical guides
41:15
and and temporary restorations.
41:17
But but now to my big surprise I realize that no, it is possible
41:23
also to make 3D printing.
41:25
And so in this field we will see a lot of evolution in the very few years to come.
41:32
And this helps that we are less dependent on the individual skills of a technician.
41:40
By manual skill, but we need the skills to direct the machine to do that.
41:46
But if a machine can do it, then it's of course much more predictable and it should
41:51
ultimately needs a lot of learning curve and equipment, but ultimately it should
41:58
make the restorations less expensive.
42:00
That's still my dream because I'm a little bit worried that many of what of
42:06
the tools we are using today are without reach of a big part of our population.
42:13
And there I have to make an additional comment also for the
42:17
young, because we have now so many tools, attractive tools to treat
42:23
different problems in a human mouse.
42:27
That we have sometimes problems to see the woods for the trees.
42:35
The trees are all the different instruments we have.
42:38
Technology is going, but the tree at the woods, what is it?
42:44
Why are we dentists?
42:45
I have to say that.
42:46
Yeah.
42:47
What is the population expecting from us from the dental profession?
42:53
Very simple.
42:55
We should promote and maintain long-term oral health and oral function.
43:03
It's as simple as that.
43:04
And we should only use tools which go into that direction,
43:11
and that is the most important.
43:15
So knowing this, what tools do we have?
43:20
We want to be predictable.
43:22
That means we want to have evidence.
43:23
I have a problem in the mouth.
43:25
How going to solve it?
43:27
Do I know it'll work?
43:29
That is number one.
43:31
Number two is try to be as conservative as possible.
43:36
Not always replace what is missing, but keep what is there.
43:42
That's for me.
43:43
Then no low risk for clinician and patient, and B, cost and time
43:51
efficient and always keep the door open if something will go wrong.
43:57
These are the five criteria which really count, and to put it in a very blunt way.
44:04
The most important today, because we have so many possibilities of
44:08
treatment, do the right thing.
44:12
Once this has been confirmed, then do the thing.
44:15
Main execution also, particularly in the field of now we go back
44:19
to biometric, to adhesion.
44:21
You have to do it meticulously, stick to the protocol, then it'll work.
44:29
And then if you want to be perfect cost and time efficient.
44:35
That's the perfect segue.
44:36
So in your view, or maybe what is your vision on how we could further
44:40
develop on one hand prosdontics, but also restorations on implants
44:45
for the next five to 10 years?
44:46
What sticks out for you and what could actually be major changes that are coming?
44:51
Good question.
44:54
If I think about the level you have reached now with implant design and
44:58
prosthodontic components and everything, I think this will be valid for quite,
45:03
sometimes I do not expect a quantum leap.
45:06
In the next five to 10 years that my look, it's always difficult.
45:12
I learned early, make predictions is very dangerous if you, people say, if
45:19
you want, really make a fool of yourself.
45:21
Make predictions.
45:22
Make predictions.
45:22
Predictions.
45:22
Okay.
45:23
So I don't want to do that.
45:25
And what I also realized that the more experience you have,
45:31
the less visionary you become.
45:34
That's why I'm always say young people who have not all these
45:38
experience can come with fresh ideas.
45:41
They're not polluted.
45:42
In a positive, they're assimilated basically with knowledge by experience
45:45
and they can imagine things and that then suddenly a, there's a breakthrough
45:50
or a Beijing can come, people like me who have a lot of experience they've
45:55
seen, so they are not the best.
45:57
Person and you have also seen fail certain things, right?
46:00
Yeah.
46:00
I've seen failures also and a lot of things which epi, but look
46:06
we could imagine and people have done that, a periodontal ligament.
46:10
It's can they not call it the periodontal ligaments?
46:12
There were peri-implant ligament with this, with the main
46:15
ingredients of the natural tools.
46:17
Prop reception, little bit of resilience.
46:20
That would probably be, that would be a major breakthrough.
46:23
I agree.
46:24
That would be a major breakthrough, but it has been tried.
46:26
I remember that carrying mans had in an animal study, he broke a tooth
46:33
when he wanted to extract it to place later on an implant, and he
46:36
left a little root tip in there, and then he still placed the implant.
46:41
And then the periodontal ligament crawled up.
46:44
Tried to crawl it up.
46:45
Yeah, no, it covered the implant.
46:47
But from that to have a functional peri-implants ligament with
46:54
proprio receptors and all this, we are far away from that.
46:59
That's why.
47:00
But it's an interesting vision.
47:02
If you want to say what's happening the next five to 10 years, it is
47:07
probably the most refinement will be on the restorative part for implant.
47:15
That means digital technology from planning to placement of implants, to
47:20
also to to fabricate the same thing.
47:23
There is still a lot of things to do to make, you are on the way,
47:26
and then industry is on the way on that, but still not that easy.
47:31
But and that, that brings me maybe to my last question from that section.
47:34
So we also heard a lot about your, I would say, respect for dental technicians.
47:41
And now we also see with digital technology, there is a lot changing.
47:44
And you talked about 3D printing before, and we see ceramic 3D printing,
47:48
multicolor ceramic 3D printing really move into realm of reality.
47:52
So this is going to happen in the next couple of years.
47:54
What would you recommend dental technicians on how to be best
47:58
set up for this type of future?
48:00
Yes.
48:01
Start with equipment that is available today, of course.
48:06
There are so different companies and which have a little bit different approach.
48:11
And the problem is how much you want to invest and suddenly it is outdated.
48:15
And then, and another way that just.
48:20
Watch and talk to your colleagues and like in study groups, they
48:24
should also take then technicians should gather bits in study groups
48:30
together or we should in integrate them also, some study groups do it.
48:35
But that is the best because that's how evolution will take, right?
48:41
To give a precise advice for technicians how not to miss the train.
48:49
I would've problems to to formulate.
48:52
Formulate this.
48:53
Also, thanks a lot for sharing a lot of great insights and success formulas.
48:58
That, that you distilled it down to I know you also brought a question
49:02
because we also want to give you the opportunity to ask a question to us.
49:06
Yeah.
49:07
We quite often hear on dental conferences that some of the speakers
49:12
say this is only marketing hype.
49:14
Be careful on that one.
49:16
And it's true that when I look back 30, 40 years, medical companies in the medical
49:26
field in January were very discreet.
49:29
They were, of course, talking to the clinicians, to the healthcare
49:33
providers, but not to the patients.
49:36
And now I see that, and this is not Straumann but I see some companies who
49:42
try now to directly focus on the patient, that the patient may put pressure on the
49:50
clinician what he thinks he should need.
49:53
And so this marketing hype, it is a negative term.
49:58
Yeah.
49:58
It's something I would like not to see.
50:01
And what do would you this defin to define as being helpful and decent
50:10
marketing, which a company needs marketing, there's no doubt about that.
50:15
No I can take this.
50:16
George, I think it's a really good question, and honestly, we have a lot
50:20
of specialists in marketing and it's one of the most difficult ones that,
50:23
that you could ask because there is a lot of different layers to this.
50:27
I think if we start, in the field of, let's say the healthcare
50:30
professionals, it's a crowded space that the implant industry and I think
50:34
marketing became more important and we need to be, make ourselves seen.
50:39
But I think what is really important is that whenever we have a new concept, a
50:43
new product a new workflow, we market.
50:47
What is really true, that there is continues to be data behind and,
50:51
we are not committing something that at the end we cannot keep.
50:54
So I think this is really important that we stick to an ethic approach here
50:57
that we really try to spearhead this.
51:00
But the other topic and the other layer you mentioned is that the patient layer.
51:05
And that's a very interesting one because the truth is I think today
51:09
that a lot of patients are still not aware about implant dentistry.
51:13
So it's a fine line, I think making patients aware that there is implant
51:18
dentistry and yes, for maybe the problem that you have, implant dentistry
51:21
is actually one of the options.
51:23
So please go and ask your dentist if in your case it is an option, but I
51:27
think we should not teach, try to teach the patient on how it's been done.
51:31
I think this, we really have to leave to the healthcare professionals.
51:34
Is this, is this a case that can be done by implants?
51:37
Could it be done like an immediate approach?
51:39
Yes or no?
51:39
This is not the patient that, that, that should be marketed to.
51:43
I think we need to leave this to the healthcare professionals at the end to, to
51:47
direct the patient to the right treatment.
51:50
Is it an implant or not an implant?
51:51
And if it is an implant, what is the best approach for this patient?
51:54
I think we have to keep the patient out of this.
51:56
But I think helping, educating the patient probably makes sense that implants exist.
52:01
And, the best way probably still is to do this through
52:03
health, healthcare professional.
52:05
And I imagine it's also not an easy job as a healthcare professional
52:09
to educate the patients.
52:10
So I think here we might also give tools and help the healthcare professional
52:14
to do a good education of the patient.
52:16
So it's really, it's a tricky question, but I think.
52:20
Having an ethical approach still is important.
52:23
And I think for us as a company, we spoke before the podcast about this, I think we
52:28
are publicly listed company, but still, we have owners that are very close to
52:33
patients and that put a lot of emphasis on an ethical approach like Thomas Straumann.
52:38
Yeah.
52:38
The family, people like Dymark and this gives us also, I would say,
52:44
the stability that, we can have an ethical approach to this at all times.
52:49
To add on this, I think it has also become more regulated in the
52:53
last, I would say, couple of years.
52:55
So with the onset of MDR, I mean we are producing medical devices and they
53:01
need claims that can be supported, and this is regulated where we see
53:06
big differences is from, large listed companies towards also very small
53:10
companies because they sometimes fly under the radar and, they're too small
53:15
that actually a lot of, authorities would care about what they're saying.
53:19
So I think here on our end, I think we really need our homework.
53:22
We can substantiate whatever we use as let's say marketing
53:25
material towards professionals.
53:27
And, then it also needs to be called out if there is misuse from smaller companies
53:33
that actually, are a bit in a gray zone what they actually can do on proof.
53:36
But I think this ethical approach and also being science founded is very important
53:41
for our core of the company and, how we want to be perceived and how we want to
53:46
remain at the forefront in that field.
53:49
I'm very happy to hear that now.
53:53
I knew it, but my question was a little bit motivated by the fact that although
53:59
maybe it's not the end of the story of, but the potential and the impact worldwide
54:06
implant dentistry has had, we should be careful to flourish it and not to
54:13
jeopardize it by aggressive techniques like cowboy techniques, Daniel Buser
54:19
called it cowboy techniques that put in discredit implant dentistry, which
54:25
can you imagine hundreds of millions of people have still fixed teeth in their
54:31
mouth thanks to this, that the advent of us integration and this we should never
54:36
give away because it really has an impact on general health of the population.
54:42
And and we should be careful not to give this away.
54:45
That's true.
54:46
No, thanks for the question.
54:47
It's also an interesting impulse for us to think about, and then
54:50
I think it's a long term game.
54:52
Yeah.
54:53
And we need to be mindful and, topics like this and cowboy approaches like this
54:57
will backfire on implant dentistry, which is like ultimately not a good thing.
55:01
And I think it's also, we need to have an honest approach also towards topics
55:05
like peri-implantitis, these topics are existing and we need to find solutions to
55:09
this also for the sake of, let's say the long term successful patients, but also
55:13
for the whole field of implant industry.
55:15
So that was really good questions.
55:18
So thanks a lot Urs.
55:19
And we come to an end, George.
55:22
To a very inspiring podcast.
55:24
What stood out for you?
55:26
So for me Urs, maybe two or maybe three things stood out very strongly for me.
55:31
So fir first of all it's fascinating to see how you actually bridge the let's
55:35
say this gap or chasm between biology and technology and, your principles that you
55:41
brought forward are really doing this.
55:42
So it, it helps understanding the nature and replicating nature
55:46
to the best extent that we can.
55:48
And I think that was standing out for me as a guiding principle very strongly.
55:52
And secondly, I think you are let's say having a huge legacy on your
55:59
work with a lot of scholars of people that you trained, that you helped in
56:04
their development as you have been helped maybe in your fantastic career.
56:08
Absolutely.
56:09
And linked to this what also stood out to me is your gratitude.
56:12
The way on, on how you respect other people's work on how you
56:16
want to bring together, teams that can actually solve problems.
56:20
That is something fantastic to see, and I think it's exactly the right approach.
56:24
No, thank you.
56:26
The one thing I would add is that is really impressing me and you are
56:29
a really good role model for this.
56:30
Also, your humbleness.
56:31
Having such a distinct career and achievements of this magnitude over
56:36
many years and the humbleness and this combination for me is very unique.
56:40
And that's something I always wanted to congratulate you for so
56:44
. Thank you.
56:45
Thanks a lot for being here.
56:46
This was really a big pleasure.
56:48
I wish you all the best for your future, and we meet hopefully soon again.
56:51
And for all the listeners, thanks a lot for joining in, for listening in.
56:56
Continue to look out for the next episodes on any of the podcast players,
57:01
the best ways to subscribe for the podcast, and you will be informed
57:03
about the next episodes to come.
57:06
And also look out for our next guest and don't miss out to also have
57:09
the opportunity to ask questions that we raise here in the podcast.
57:12
So thank you George, and thank you Urs for the Great hour of conversation.
57:16
It's been a privilege.
57:17
Thank you.
57:18
Thanks a lot.