Latest / Straumann® ProTalk / From the sausage technique to global recognition: Dr. Istvan Urban's journey in dental regeneration

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From the sausage technique to global recognition: Dr. Istvan Urban's journey in dental regeneration · Straumann® ProTalk

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  now I feel that was like a pioneering time, but at the
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  time I didn't realize that.
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  I think first and foremost you are a great clinician that it
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  puts a lot of focus on excellence.
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  There have been a lot of innovations you brought to the market:
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  books, you were writing articles.
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  What is the achievement looking back that you are most proud of?
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  I would say I'm most proud of in general is that the techniques
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  and some of the developments that we have made which are making the
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  clinicians and the patient's life much better and much more predictable.
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  Welcome to ProTalk.
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  Welcome to the Pulse of Dentistry.
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  Welcome to this episode where I'm thrilled to have a very special guest today, which
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  is Professor Dr. Istvan Ban from Hungary.
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  Welcome, Istvan.
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  Thank you very much for having me here.
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  It's a great pleasure to have you in this podcast episode.
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  Looking forward to our conversation.
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  And Istvan, you have a very interesting journey behind you from Budapest to
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  California and back, you innovated techniques, you teach a lot of clinicians,
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  surgical techniques in vertical and horizontal bone augmentation.
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  You are great lecturer, and I think first and foremost you are a great clinician
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  that puts a lot of focus on excellence.
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  You have a great education journey behind you.
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  I learned you are a DMD.
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  You have a medical doctor as well.
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  You have a PhD in Periodontology and I think for what you do today the very
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  demanding cases you do, you probably need all of this to really succeed.
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  So for the ones that don't know you, Istvan, who is Istvan in one minute?
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  Istvan is a dental professional from Hungary, was born in Hungary,
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  raised in Hungary and was very interested in medicine also and in
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  dentistry and the whole journey.
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  And he wanted to do the perfect bone graft and that's all was his interest.
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  So that's really what was driving you.
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  Where did this interest come from?
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  That's actually, it was not coming from original originally.
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  I was just, interested in, I went to dental school and I became interested
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  in the whole body, so that's why I went back to medical school.
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  Then I started to really like dentistry, but I did not really find my field yet.
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  And then I started to buy books and I really wanted to learn more and more.
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  And then eventually I started to like surgery and then I was exposed
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  at UCLA, in bone regeneration.
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  And then, yeah I knew that this is what I want to do.
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  So it was not immediate.
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  And that's good news for any young clinicians who, or young dentists who
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  not, you don't really find yourself, but you fear something internally that,
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  that is there and you wanna connect that internal self with something.
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  Yeah.
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  It's not gonna happen necessarily in one day.
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  Yeah.
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  So was this something that your visiting stay in the UCLA brought out?
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  And then really gave you a new direction or made it clearer where you want to go?
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  Yeah, so when I went to UCLA I already, I had the Carranza book and which
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  is a periodontology book, which it was very interesting that I spent a
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  couple of months in Los Angeles with some of my friends of relatives.
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  And I was working as a dental assistant.
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  They called me Steve.
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  And they didn't know where Hungary was, by the way, they heard about Europe.
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  And so anyway, then I saved some money.
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  I bought the Carranza book and I was really fascinated by Periodontology.
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  And that's, Carranza book is from UCLA and that's when even after all
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  my other schools, like I went back to oral surgery, went back to medical
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  school, and after that, it ended up at UCLA because of the Hanza book.
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  Okay.
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  So that's where your journey and
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  then Yeah, and then it came, it was already their implants, then it came.
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  So UCLA and then there was also Loma Linda.
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  Yeah.
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  Very closely connected to this.
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  And we just spoke about this before the podcast reporting.
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  These have been really pioneering times when you have been there in Loma
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  Linda doing first immediacy cases.
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  So how was this what did you take from your stay in Loma Linda?
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  Yeah.
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  When I went to UCLA, I already felt like that, the pioneers were, the pioneers were
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  way ahead of me, but the real pioneers.
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  But I already felt like that we're like such a- we came so late into this.
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  And so when I went to from there I went to Tolin, the university where
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  I, met Dr. Jaime Lozada and Dr. Joseph Kan. And Dr. Phillip Boyne
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  and Dr. Joseph Kan, for example, was involving us in immediate implants.
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  And so I had, several patients with him, and we did maybe one of the,
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  one of the first customized healing abutments appointments together and
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  flapless surgeries, immediate loading.
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  Now I feel that was like a pioneering time, but at the time, I, I didn't.
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  Realized that, I realized that, like we were looking at the little details,
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  okay, what we have to make, what we have to prepare for the surgery, how we
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  gonna do it, how we like, strike that tooth without breaking the buckle bone.
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  And so at that time we felt but we felt like everybody do it.
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  We thought everybody's doing the same thing.
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  And it, appeared like years and years later that, we were doing in
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  the nineties, immediate implants and bone graft, stuff like that.
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  Not everywhere was done.
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  Yeah.
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  Also, flatless procedures you already did.
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  And customized abutments.
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  Yeah.
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  Which was very new then, or very, let's say experimental.
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  So very exciting time.
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  So if you look back on your journey, who would you say have been your one or two
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  great mentors that you say, look, these guys really made a big difference for me.
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  So when I went to UCLA, I met two of my very important mentors at UCLA.
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  I would have to say that my, I looked at him like God was, is Dr. Henry H. Takei.
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  And if somebody would know that he's the father of the papilla to me and
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  one of the fathers of mucogingival surgery, and he's a great person, great
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  teacher you all and a great human being.
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  And I was out there from like Eastern Europe and he was always a little bit
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  paying attention to me and supporting me.
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  The other person was Dr. Sascha Jovanovic, who was one of the
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  fathers of guided bone degeneration.
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  So these two together was very, gave me a very important foundation and I relearn
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  a very strong foundation principles.
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  And then when I went to Loma Linda, it was Dr. Jaime Lozada and Dr. Joseph
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  Kan. And Dr. Lozada is one of the most important mentors for me in multiple ways.
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  Number one, he's maybe the most experienced person in sinus grafting, so
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  I was learning sinus grafting from him.
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  But when I went to Loma Linda in the first week I taught him at lunch that I wanna do
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  vertical ridge augmentation, and the spoon stops in his hand and he says, on a human?
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  It was 1999.
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  I said, yes.
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  And I was asking again, he didn't say anything, but he was
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  the first one after two months.
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  And he said, you know what, maybe you can do it.
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  I'll give you a patient.
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  And he was giving me a patient and he was giving me the more patience
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  he was supporting my tuition.
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  At the end, I was in the bank all the time to try to, take a loan and
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  he said, look, if you can do this, I'm gonna, support your tuition.
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  And so I had very good mentors, I have to say.
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  So he identified a talent in you, obviously.
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  He was the one supporting you?
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  Yeah.
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  Do you reflect sometimes today that now you are in a position that you influence
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  a lot of young guys positively, right?
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  You have hundreds of clinicians coming to your Urban regenerative institutes
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  to Budapest and in your lectures.
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  So today you are the influencer and the mentor.
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  Do you reflect sometimes and are you proud of this?
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  Yeah, I'm very proud of this and I, I'm really, would like to support
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  many, as many clinicians as possible.
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  And I really feel like that.
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  That I wanna support them in a way that they grow further than I am growing.
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  Where I've been growing.
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  And I'm very happy if I would, I don't wanna have any reservation.
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  I wanna give it all to them.
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  Because I want people to develop and to have, next generation.
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  And the next generation.
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  I think that's very important because what I felt from my
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  mentors, they gave me everything.
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  Yes.
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  And I always say that a teacher was a teacher who was, my teacher is
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  my teacher and will be my teacher.
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  And I think this is how when you teach, this is how you should do with
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  all your students, give them anything you can uncompromised, uncompromised
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  everything without any reservation.
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  Yeah.
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  So for the young generation, what would you say, what does it take to really build
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  a long-term successful clinical career?
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  I think the basic principles were not changing life.
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  And in this, the basic principle was and will be, I think that you want
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  to do good care for the patient.
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  And I was always very lucky to be very interested in this and very passionate
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  about it, passionate about this, but I see that in many of the young individuals
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  and I think one of the best advice that.
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  That that I could give is to look always, that you wanna do a better job.
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  And for example, I was never in, never, dreamed of becoming like a
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  lecturer or invited here or there.
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  I think that's not the best goal to have.
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  I wouldn't, I would, if I would be young or I would tell my son, he's not.
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  Not ne, your dream is not necessarily, okay, I wanna be
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  in this podium, I wanna do that.
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  No, I wanna do very good work.
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  I wanna do a very good job.
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  I need to be passionate about this.
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  And then if you do a very good job, you can go anywhere.
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  Exactly, yeah.
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  Then success will come.
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  Yeah.
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  But the foundation is success will account.
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  Yeah.
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  The foundation is excellence, right?
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  That's for sure.
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  Yes.
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  So you got a lot of inspiration from great teachers and mentors.
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  I learned I can feel the emotional attachment you still have to them.
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  What is inspiring you today, because you are still in the middle of your career.
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  You still have this hunger to progress and this curiosity.
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  What is inspiring you today?
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  I realized in the last couple of years that you know when people are talking
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  about retirement, and I realized that I don't understand what that is.
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  If I would fear that I wanna retire, then that I would be very disappointed
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  in myself because I fear that I'm very interested in this still.
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  Yeah.
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  And what is inspiring me is to really have a couple of visions
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  that, what could be better?
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  What we could do better already.
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  It's already maybe here we could do it, but we are not doing it
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  because of this or that, and we don't have all the support or.
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  Things like that.
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  So what I would wanna achieve, and I would like to treat a lot of patients,
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  to train people who can treat much more patients that I can treat.
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  And, I'm very lucky that I'm very interested in this.
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  So I think it's luck.
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  So your passion will carry you for many years.
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  I'm not gonna be interested.
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  That's good.
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  Okay.
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  That's excellent.
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  So you are a great clinician, a teacher you write books, you're an
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  author, you're lecturing, you're traveling a lot, you have a family.
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  How do you keep, your balance Istvan?
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  It's very difficult.
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  I can imagine.
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  What's the secret to your balance?
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  I would have to say one of my luck that I was never like a party person.
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  Okay.
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  So I really like to go home.
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  That's great.
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  And I really like to spend time with my family.
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  I really I always like to spend with time with my children.
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  When I had to travel, the worst thing for me in traveling was that tomorrow I
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  cannot tell the night, the evening tale for my kids, which I really enjoyed.
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  When we go to bed and have the evening tales, I did always
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  the three things basically.
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  Apart from my profession, most of the time I spent with my
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  family and I really enjoyed that.
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  That gives me a complete fulfillment.
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  And the third one was I was always doing sports, which was very
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  good for me to regenerate myself.
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  So these three things were, to me, is the full picture, is the full life, gives me
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  a full life and this gives me a balance.
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  But I don't have to go out, to a pub two times a week and get drunk, for example.
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  Yeah.
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  I just, yeah, I think this discipline, it pays off for long term.
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  I'm pretty sure I. On your Instagram account, I saw quite some nice pictures.
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  You and the kayak, right?
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  Yes.
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  Is this the, your favorite summer sports?
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  Because I know you also like to do ski tours in the winter.
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  You a good skier.
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  Yeah.
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  Yeah.
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  So yeah, spring kayaking is my favorite sport.
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  However, I was never very talented in it.
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  But yeah, I tried many sports when I was a kid, and this was
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  the one that I really liked.
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  And and I still do it.
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  And I have friends who we know each other for, I started like 40 years ago or
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  more, and we know each other since then.
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  And we meet we train together.
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  We enjoy this a lot.
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  It's out there.
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  My kids were kayaking and so yeah.
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  Yeah, I'm trying to do it, before and after work if I can.
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  Your kids, that's a good that, that's a good word to catch up.
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  I saw your son is a quite talented musician.
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  He's building a career around musician and I know that
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  you're supporting him big time.
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  How important is this?
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  And what is your role for creating his career and supporting him?
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  I always believed that, that I want my children to become what
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  they want to become what's in them.
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  And I don't want to tell them what they should be.
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  And and I think it's going this way really well.
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  And he was, Isti was very good in school, very good in mathematics.
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  He was always good in mu We put him to music.
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  He was very good in music.
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  And the music teacher told us that he should be a musician.
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  And I even taught him, I said no.
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  I'm doing, I wanna be a doctor.
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  And then he started neuroscience.
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  He did finish neuroscience, but he went back to music and
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  he wants to be a musician.
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  And I completely supported because I see that he is.
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  Happy with this.
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  And I can, I really believe that, believe in him and I believe that,
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  that he can be successful with this.
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  And I want, I really enjoy supporting my children that
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  they become what they can be.
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  Yeah.
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  So really supporting their talents.
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  So let's switch a bit gears let's slowly but surely move into
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  to dentistry and to the field.
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  What you're famous for, which is clearly regeneration and then surgery.
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  So there have been a lot of innovations you brought to the market:
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  books, you were writing articles.
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  What is the achievement looking back that you are most proud of?
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  That's a very good question.
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  I could say that I'm most proud of one of the one, one technique.
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  I would say I'm most proud of in general is that the techniques and and
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  some of the developments that we have made which are making the clinicians
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  and the patient's life much better.
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  And much more predictable.
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  And I always say that I wish I could talk to myself 30 minutes, 25 years ago.
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  Okay.
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  'cause that would already be a big help.
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  That's a very interesting mind experiment, I have to say.
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  Yes.
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  Yeah.
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  Yeah.
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  Of course I'm very proud of the sausage technique, not because
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  it's but it's very popular now.
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  But I think because it's just significantly simpler and less invasive.
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  I'm also very proud of some things like how you can manage protection of the
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  mental nerve protection of the elevation of the lingo lab, how you can minimally
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  invasive reconstructs of tissues.
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  I'm very passionate about the popular that's coming from already
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  from UCLA, from your teacher.
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  Yes.
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  Yeah.
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  And I'm very proud of some of the achievements we had, and I'm very proud
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  that we published a paper together, two papers together with On the popular law.
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  Yeah.
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  Yeah, that's the biggest one, if you can publish together with your teacher.
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  Yeah.
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  Let's go back to one, one technique that you mentioned, the sausage technique.
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  When you invented this.
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  The gold standard technique was much more invasive.
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  I think it was the gold tex technique.
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  And I think there were also soft tissue ahi and issues
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  that, that clinicians would see.
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  Now today, the sausage technique is clear and it's obvious, but, there was
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  a starting point at one point, and, I wonder, how did you have the idea to
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  come up with such a different technique?
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  Because I, I think it takes a lot of thoughts and, yeah, you need
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  to be very mindful about this.
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  How did you come to this idea?
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  I always documented all my cases and really well, but I took, pictures
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  of everything, but basically for myself, I never thought I'm
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  gonna really show it anywhere.
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  And in 2003 I had a patient, but I did a big ology augmentation.
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  And the patient developed three fistulas three weeks later.
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  Healing was soft, healing was perfect, but three fistula clearly
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  indicated that there's an infection.
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  And so I was shocked.
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  I thought, how can you get an infection when the tissue is closed?
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  Anyway, so I was, I, after two sleepless nights, I called the patient and said,
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  patient said, yeah, I have no problem.
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  Don't touch it.
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  I said no.
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  We have to go get back in there and clear the infection out.
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  But it was three weeks old, and at three weeks I removed the goretex membrane.
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  And what do you expect in 2003?
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  You remove a three weeks membrane, a vertical augmentation,
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  the whole will collapse.
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  So what I've seen was that there is this ridge, and on the surface there was a
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  grayish area that I washed out, but the rest of the bone graft was sitting in
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  a blood clot all almost talking to me, don't touch me, just gimme a blanket.
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  And the blanket was a collagen membrane.
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  I put a collagen memory.
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  I did not fixate anything because I. Saw that this fixed, I closed the
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  soft tissues, but I told the patient, look, we remove this membrane and
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  this membrane is very important.
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  This membrane has to be there for nine months, otherwise
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  we're not gonna get bone.
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  And I'm so sorry, but very likely I'm gonna have to do another bone graft.
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  But let's wait.
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  We didn't take, we didn't have CBCT, so we just, I took x-rays, but
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  the xray, it doesn't look so bad.
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  So then in six months I went back, I opened up the flap and the entire
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  bone that I kept at three weeks was there, and I had all the pictures
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  and I started to look at the picture.
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  I said, you know what, maybe this re, this reduction time is not important.
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  And maybe if I could initially fix it with a collagen membrane , a
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  bone graft, at least for horizontal direction that could work.
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  Now, 2003, I told this to some of my mentors and friends that this is what I'm
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  gonna do, and one of them said, this is the most stupid idea you can ever have.
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  You're not gonna get anything.
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  And, but I already did it, and six months later I send the picture, I got dismount.
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  No, this is by accident.
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  Oh,
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  next one.
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  Then I had 30 cases.
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  Then in 2005 I was at the AAP, they had a Sunrise symposium
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  before the main symposium.
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  It was like some university people were there.
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  Yeah, early birds and I presented this and Europe know they were
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  like this, we cannot believe that.
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  So then, this became like a standard for me and I ran two studies on this.
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  Oh.
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  And they really changed.
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  One complication and one documentation complication change the whole thing.
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  So to summarize, its intuition because the bone was speaking to you and you listened.
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  Yeah.
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  It was expertise because you've been a great a greatly educated and skilled
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  clinician already then, but also the conviction that even if some people
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  tell you it's not going to work.
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  Believe in it and then continue doing it and documenting cases.
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  And today it's one of the most famous probably augmentation
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  techniques that, that is out there And very well documented.
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  Is it still like the heart and soul or a key element in your courses today?
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  It is.
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  The people are coming to Budapest for?
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  It is, but today we use it for so many, other regions.
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  Yeah.
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  Okay.
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  Compromised sockets.
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  Yeah.
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  You have developed it.
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  Yes.
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  So that is sausage here and there we put sausage on periodontal regeneration.
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  And so yeah, it is yeah, I'm gonna have a presentation this year and I gave
• 20:04
  the title presentation one for all.
• 20:07
  So one technique for a lot of indications.
• 20:10
  Cause it became so predictable for you.
• 20:12
  Yeah.
• 20:12
  In your hands and of many other clinicians as well.
• 20:15
  I think it's a good time to have a question from the audience because
• 20:18
  we reached out through Instagram and we got a couple of questions
• 20:21
  that I selected two of them.
• 20:23
  So that is Dr. Bizhan and, the question was, do you think allografts have more of
• 20:28
  a place in regeneration in today's world?
• 20:33
  That's a very good question, and it's not easy to answer.
• 20:37
  Because allograft, they have some very good properties.
• 20:40
  They're very natural because they come from a human.
• 20:43
  When they demoralize them, they can expose some growth factors that they're in there
• 20:48
  such as the bone morphogenetic protein.
• 20:50
  But at the, on the other hand, they have a tendency to have more resorption
• 20:54
  than, for example, exogenic Grats.
• 20:56
  I would say that they have a role in regeneration, maybe not alone.
• 21:01
  Maybe in combination with other graft materials such as xenogenic,
• 21:04
  bone graft materials, but I would say because they have a tendency
• 21:07
  for resorption in vertical reju augmentation and don't really see them.
• 21:11
  But for maybe a small dehiscence, very well fixated, maybe with a collagen
• 21:14
  membrane, maybe in conjunction with a, a xenogenic bone graft.
• 21:19
  Yeah.
• 21:20
  Yeah.
• 21:21
  There, there's a place.
• 21:21
  Even though I'm not using them, but I would say I'm not, I would
• 21:24
  not say that I would exclude, yeah.
• 21:26
  This idea.
• 21:27
  We clearly see a development of allograft materials in Yeah.
• 21:30
  The European market.
• 21:31
  We know that in the US it's the dominant.
• 21:32
  US is really Strong.
• 21:33
  It's a dominant material.
• 21:35
  There's also xenographs, but we see the words of allograft
• 21:39
  also in the European context.
• 21:40
  So it's a very good question.
• 21:41
  And the colleague was a very interesting colleague.
• 21:43
  There's another great question that I liked is what is something
• 21:47
  significant in regeneration that you think we don't talk about enough?
• 21:52
  I think we don't talk about enough is we talk a lot about like how you do a lingual
• 21:57
  flap, how you do a buckle flap, how you do this bone graft, and how the bone looks.
• 22:01
  But we don't talk enough about how the bone will look in 10 years.
• 22:06
  And what are the most important factors that you have to do to
• 22:09
  make a bone graft long-lasting?
• 22:14
  And I think that's also including, I think that should be more standardized,
• 22:18
  what people are reporting in regeneration, in terms of implants.
• 22:23
  I think it would be better to have more studies when they report from.
• 22:27
  Yeah.
• 22:27
  Like consecutively one year.
• 22:29
  Five years, 10 years, 15 years, hopefully the same patients.
• 22:32
  Because if you report like a 15 year, it's, it could be a
• 22:35
  little bit of a cherry picking.
• 22:36
  So I think today we have much better implants than when we
• 22:39
  started the external X. Yes.
• 22:41
  We have much better implants, we have a much more choice of implants.
• 22:44
  We have very good materials.
• 22:46
  And also like we have a lot of tools that we can do follow ups.
• 22:49
  We understanding much more soft tissues around the implants.
• 22:52
  So today I would say that for any young researcher.
• 22:57
  To put them all together to make a very good regeneration, but also think about,
• 23:02
  that's this patient wants to chew on that.
• 23:03
  But on the flip side, it would also tell a young clinician, focus
• 23:07
  on techniques that have proven to work and are documented well.
• 23:11
  And not I see a lot of trends on Instagram, on surgical techniques
• 23:14
  that I'm not so sure if they are well documented already.
• 23:16
  I'm not a clinician.
• 23:18
  But it'll also tell the clinicians, look focused on what has worked in great
• 23:22
  clinicians' hands and what is, let's say, documented over, over quite some years.
• 23:26
  Yes.
• 23:27
  But I, but going back to the sausage, which was completely
• 23:29
  like not documented before.
• 23:31
  'cause it didn't exist.
• 23:31
  Yeah.
• 23:32
  But I think, when you look at something which has a biological, which
• 23:36
  biologically sounds and common sense.
• 23:39
  Common sense and biological sound, like sound, biologically sound.
• 23:42
  So that bio makes sense.
• 23:44
  Yeah.
• 23:44
  And there's a common sense, yeah.
• 23:45
  That if you, maybe two, two variations together, that should work.
• 23:49
  That has to be studied.
• 23:50
  But this is how it should be developed.
• 23:52
  Like new techniques.
• 23:53
  Yes.
• 23:55
  I would add another question that I had.
• 23:57
  Let's say to the allograft technique, we see a lot of techniques coming
• 24:00
  now with here luronic acid.
• 24:03
  How do you see this material and the potential of this of this substance to, to
• 24:09
  enhance bone healing or tissue reaction?
• 24:12
  I only used one product.
• 24:14
  Which has, they have they call it poly polynucleotide, inic acid.
• 24:18
  And theoretically, because in dentistry is not so well documented yet.
• 24:23
  And I think it has to be studied more in animal and clinical level.
• 24:26
  Theoretically it's also com communicating potentially with, healing mechy cells and
• 24:31
  also, maybe promote soft tissue healing.
• 24:34
  But also in my experience with this is that.
• 24:37
  It helps my regenera, my regenerative grafts to be more stable.
• 24:41
  Number one, because of the gel.
• 24:44
  It's like they, some people call sticky bone when they put walker.
• 24:47
  It's a little bit like that.
• 24:48
  That's already a big hub.
• 24:49
  Anything that I try and it's, even if it's documented anybody's new.
• 24:54
  First, I want to try and to make sure it doesn't make it worse.
• 24:58
  Okay.
• 24:59
  Yes.
• 24:59
  And I can tell you it doesn't make it worse.
• 25:00
  Okay.
• 25:00
  I think it makes it better, but, and I'm very careful saying it makes it
• 25:04
  better because it's on my assumption.
• 25:06
  Yes.
• 25:06
  And my, your assumption is not so objective.
• 25:09
  Okay.
• 25:10
  But I would say.
• 25:11
  I think it makes it better.
• 25:13
  I think it makes it more stable.
• 25:14
  I think it makes it more easy.
• 25:16
  And very likely you can help also soft tissue healing with it.
• 25:19
  So here, onic acid, do you see the potential in it?
• 25:22
  I do.
• 25:23
  I do see the But you feel that there needs to be more documentation?
• 25:25
  Think there needs to be more,
• 25:26
  yeah.
• 25:26
  Okay.
• 25:26
  Because I see this is a big trend, that there's a lot of products coming
• 25:30
  to the market and there's a big fuzz around it, and I understand the
• 25:33
  potential and the attractiveness of it.
• 25:35
  It's very likely not very expensive too.
• 25:37
  Exactly.
• 25:37
  Yes.
• 25:37
  That that, that's another one.
• 25:39
  Yeah.
• 25:40
  So if we look a little bit back to, let's say, in regeneration in dentistry and
• 25:45
  implant dentistry especially, what have been the big changes and breakthroughs the
• 25:50
  last 10 to 15 years from your perspective?
• 25:53
  For implants, the development of implants.
• 25:56
  I think there was, there, I would say two things.
• 25:59
  One is the screw design.
• 26:02
  That you can do more immediate cases.
• 26:05
  Okay.
• 26:06
  Which was, we know all these implants names that was
• 26:10
  developed for immediate implants.
• 26:11
  I did all the immediate implants and these newer, screw designs,
• 26:15
  they make your life much easier.
• 26:18
  Then you can really put you don't have to put the customized equipment,
• 26:20
  you can put the crown on it.
• 26:21
  Yes,
• 26:22
  that's one.
• 26:22
  The other one is the development of more hybrid design implants.
• 26:26
  Implants that are especially in the posterior regions, are friendly for the
• 26:32
  soft tissues, friendly for the users, easy to use them, and I think it's
• 26:36
  protecting more the bone and the patient.
• 26:39
  I think these two, the combination of these two is that because we really
• 26:43
  need to look at less perim, implantitis in the future and the more stability.
• 26:48
  And and easy.
• 26:50
  Yes.
• 26:52
  This one I get, if you look a little bit in the future, what is it that you
• 26:56
  would love the industry to focus on in terms of innovation and technology?
• 27:01
  Okay, so there's two things.
• 27:03
  One is the, let's talk about maybe the implants and regeneration.
• 27:06
  In terms of the implants.
• 27:07
  I think, implants that focus on easiness and prevention of perlo.
• 27:13
  And one thing is a hybrid implant.
• 27:15
  Okay.
• 27:15
  That or tissue connection type of implants or hybrid screw design to
• 27:19
  make sure it's more cleansable to maybe less bacteria can adhere to it.
• 27:23
  And, but I'm sure there's a lot to develop in this segment.
• 27:26
  What do you exactly mean by a hybrid implant?
• 27:29
  An implant that has a machine surface machine color.
• 27:31
  Okay.
• 27:31
  Yep.
• 27:32
  And and but I'm pretty sure that if we talk, maybe in 15 years, that will be
• 27:36
  okay, but this will let's say that we will cover it with something, that it's even
• 27:41
  better for the soft tissue attachment.
• 27:43
  Better against bacteria and things like that.
• 27:44
  Yeah.
• 27:44
  So I think this has to be, this is very important.
• 27:47
  So enhanced surface treatments for this area of the implant to
• 27:50
  prevent peri-implantitis I think.
• 27:51
  That's so number one.
• 27:53
  And I, to me that's the main main goal for the long term of implants.
• 27:57
  Because I think implants will have a future if there will
• 28:00
  be less peri-implantitis.
• 28:02
  100%.
• 28:03
  Yes.
• 28:03
  They have future, but they, they should have, yeah.
• 28:06
  Very long future.
• 28:07
  Yeah.
• 28:08
  And then in regeneration I think we are not practicing
• 28:12
  what the potential is today.
• 28:15
  Okay.
• 28:15
  I think today we are still taking a lot of, I also take a lot of autogenic
• 28:19
  bone from patient, but I think if the industry, the research and a
• 28:25
  clinical skill would really, all the potential would put together, I
• 28:31
  think there would be techniques when you don't really have to do that.
• 28:35
  Lemme give you one example.
• 28:36
  For example, bone morpho, genetic protein was licensed FD approved in 2007 or so.
• 28:41
  It was developed at UCLA in the sixties.
• 28:44
  They did for decades of research then re research.
• 28:48
  So they approved it.
• 28:49
  They approved it for oral surgery for sinus grafts and extraction
• 28:53
  sockets, but nobody's using them because they're very expensive.
• 28:56
  Nobody knew how to use them.
• 28:57
  They were overdosed.
• 28:59
  And then, the company behind it is not interested in dentistry.
• 29:02
  Okay.
• 29:03
  Because for them it's there, there new research showing.
• 29:06
  For example, we did one article in the coer.
• 29:08
  You people should read it.
• 29:09
  We call it lasagna.
• 29:10
  Which is we do the microdose, if you take a bone graft we do the microdose
• 29:14
  BMP two on top of the bone graft.
• 29:15
  And we see in eight weeks on an animal, a full new mandible.
• 29:21
  And if you look at the microdose could cost you like 200 euros
• 29:25
  instead of 3,500 microdose doesn't give you a lot more swelling.
• 29:29
  But nobody's making a microdose.
• 29:31
  So I was talking to the company, who's making it?
• 29:33
  They said, look, we know.
• 29:34
  But they're not old field of dentist.
• 29:36
  But, it's like for us, to do the licensing and all that is and just
• 29:40
  one example, I'm not saying that BMP two is like the solution for
• 29:43
  everything, but I would say that.
• 29:45
  We don't use it enough.
• 29:46
  Yes.
• 29:46
  There's clearly a lot of potential.
• 29:47
  Don't use it enough.
• 29:48
  Not easy to control, but there's a lot of potential.
• 29:50
  On Monday, I have a big meeting, and this could be very important meeting.
• 29:53
  Yeah.
• 29:54
  To decide if we could get approval in Hungary for randomized clinical
• 29:58
  trial with microdose of BMP two.
• 30:01
  To put data
• 30:01
  to do vertical ridge augmentation.
• 30:03
  Yeah.
• 30:03
  And, but in a way, I have to say that to put it in a normal bone graft and
• 30:09
  on a normal bone graft and a microdose,
• 30:11
  yeah.
• 30:12
  Why not own a hundred percent biomaterial in a microdose, which would be the
• 30:15
  most interesting for the readers.
• 30:16
  But I'm looking at a patient.
• 30:18
  Yes.
• 30:18
  So I don't, I want to add something better as an extra, but I know that I,
• 30:23
  this patient has to have the implants, so I'm not gonna do like an experimental.
• 30:27
  Yeah.
• 30:28
  Okay.
• 30:28
  That potentially fails in this.
• 30:30
  I will do.
• 30:30
  Okay.
• 30:31
  The best bone graph we have today, the best bone graph we have
• 30:34
  today, plus a little bit better.
• 30:35
  Is it gonna be a little better?
• 30:36
  And then you can say, maybe in the future, not me, but maybe in the next clinic.
• 30:40
  Okay.
• 30:41
  Okay.
• 30:42
  Urban did maybe 50%.
• 30:44
  You know what we are gonna do?
• 30:45
  20% autogenous bone and we compare that.
• 30:48
  Oh and that's also good.
• 30:49
  Okay.
• 30:49
  Then we're gonna go for zero.
• 30:51
  So I'm just saying that there's a lot where you know, industry
• 30:55
  research and clinicians.
• 30:56
  If they put their head together, we could improve faster.
• 30:59
  So this is a field where we can progress a lot.
• 31:01
  I have two follow up questions.
• 31:03
  The one is a natural protein Endogain, what is the place of Endogain
• 31:07
  in your daily clinical practice?
• 31:09
  Okay,
• 31:09
  now I have to be honest with you, I really love Endogain.
• 31:12
  And that's a, that is sentimental love also, and that's coming from UCLA.
• 31:17
  Okay.
• 31:18
  So we use a lot of Endogain with Dr. Jovanovic.
• 31:21
  'Cause I was assisting him all the time, preparing everything.
• 31:24
  And we were, and he was also fascinated about, the popular and the interproximal
• 31:27
  bone and was using a lot of Endogain for this type of indications.
• 31:33
  Dr Takei was also very supportive of the Endogain, but endo gain at that
• 31:35
  time was not, in some schools they were like, oh, it's Endo no gain.
• 31:40
  But then the research came.
• 31:42
  Yeah.
• 31:43
  But I always used it.
• 31:45
  For in, for around, mostly single implants when the neighboring bone peak was lost.
• 31:50
  And I tried first with the soft tissue attachment, then a little bit of a
• 31:53
  bone graft, and then a connective tissue graft to the neighboring tooth.
• 31:57
  And then when I didn't have money to buy and the patient didn't have money to
• 32:01
  buy it, then we did then didn't use it.
• 32:03
  And I felt.
• 32:04
  That the result is good, but it was not so stable.
• 32:06
  So I maybe had a popular, but in two years it started to go.
• 32:09
  I have a patient that we published with Dr. Takei 21 year follow up with the
• 32:14
  one of the biggest popular regeneration, the first popular regeneration article,
• 32:17
  one of the biggest popular I've ever done.
• 32:19
  It doesn't change at all.
• 32:21
  Yeah, I do have that.
• 32:22
  So I do have an a kind of a sentimental, but a very
• 32:25
  objective love for or use for it.
• 32:29
  Yeah.
• 32:29
  I remember we met at 30 years of Emdogain Symposium in Vienna at EuroPerio 11.
• 32:35
  Yes.
• 32:36
  You already very, quite passionate about it and it's amazing technology.
• 32:39
  With so many long-term studies 1700 studies documented millions of
• 32:44
  patients that this product has helped.
• 32:46
  So it's great to see that this really still today has a big
• 32:48
  relevance in No, I hope it is.
• 32:50
  Successful product.
• 32:51
  Yeah, exactly.
• 32:53
  Should be.
• 32:53
  Second follow up question.
• 32:55
  You mentioned the topic of peri-implantitis and I loved what you
• 32:58
  said about the hybrid implants and surface texturing to prevent peri-implantitis.
• 33:03
  I believe this is a field we need to look into 100%, but still, today,
• 33:08
  peri-implantitis, we know it's a reality and we have to take it serious.
• 33:11
  And we as a an industry partner or the leader in dental implantology we
• 33:16
  want to take the serious, what this is your standard approach today.
• 33:19
  If you find patients that have an issue with peri-implantitis.
• 33:23
  So I find them and most of the patients that I find are my patients.
• 33:27
  Okay.
• 33:27
  I'm not saying that I have a lot of peri-implantitis , but I
• 33:30
  have to be honest, I have I have patients who come back to me.
• 33:32
  And some with peri-implantitis.
• 33:35
  And so before I would say I was very unsuccessful.
• 33:41
  'cause when my very first lecture in my life was about
• 33:43
  peri-implantitis in Oma Linda, 99.
• 33:45
  Okay.
• 33:46
  Because my very second patient they gave me had peri-implantitis.
• 33:50
  And so I did this peri-implantitis lecture because they told me I
• 33:53
  have to give a lecture and I can choose the topic, and I chose
• 33:56
  peri-implantitis as a topic, 99.
• 33:59
  And so anyway, then we tried everything, but at that time, we were polishing the
• 34:02
  implants and that was for a long time, that was the most successful for us.
• 34:06
  Like receptive surgery, polishing the implant, and it sometimes it worked
• 34:09
  perfectly, sometimes didn't work.
• 34:10
  Then, recently I started to use like, then you use lasers, then use
• 34:14
  prouder, chemicals, doxycycline.
• 34:17
  You tried everything.
• 34:18
  I tried everything and nothing was satisfactory.
• 34:20
  So it was pretty unpredictable for me.
• 34:23
  And then recently we used we started using electrolyte on the implant.
• 34:28
  And, they gave it to me.
• 34:29
  So I put it on, when I removed, it looks like, oh, that looked,
• 34:32
  that implant really looks clean.
• 34:34
  Wow.
• 34:35
  And in very bad selected cases, we started to do like really regeneration.
• 34:40
  In a way that we said, okay, if we clean this implant with something, maybe this
• 34:46
  act right, looks like it's clean, then the principles of regeneration can be applied.
• 34:50
  For example, sausage technique.
• 34:51
  Submerged or transmucosal healing.
• 34:53
  And we started to look at okay, how many walls we have, like
• 34:56
  in normal regeneration, like this would be a new implant.
• 34:59
  Yeah.
• 34:59
  Yeah.
• 34:59
  And if it's a new implant, how would I regenerate this?
• 35:02
  And that's, like it is a little bit of a step back.
• 35:05
  So the cleaning is the key part.
• 35:06
  Cleaning is great because if it's clean, then you can do whatever
• 35:09
  you could do with the new implant.
• 35:11
  And we came as far as I'm embarrassed to say we came as far as that I have
• 35:15
  implants that I regenerated vertically.
• 35:17
  Not that I would say that it, you have to do it or you have to do it
• 35:21
  regularly, but that if you can do that means there's a potential there.
• 35:25
  And then, most of your cases, the e should be, you should go back very early when
• 35:30
  the wall is like four or three walls when it's easier to treat for anybody.
• 35:34
  If you can clean it, you can do much more success with per implantitis treatment.
• 35:38
  Yeah.
• 35:38
  Than, previously, even though, I really admire all the people who are doing panto
• 35:43
  regeneration and all these treatments.
• 35:45
  But.
• 35:45
  I think it was more limited before.
• 35:47
  Today we have.
• 35:47
  What is your experience or your early experience with GalvoSurge?
• 35:51
  Because I know you are
• 35:52
  yeah's That's what I'm talking about.
• 35:53
  That's GalvoSurge.
• 35:53
  Try is gabo search.
• 35:54
  Okay.
• 35:55
  That, and this worked well for you?
• 35:57
  It worked really well for me.
• 35:58
  Okay.
• 35:59
  For the cleaning and then Yeah.
• 36:00
  To make it
• 36:01
  I'm not saying 100% always.
• 36:04
  It's by far better than anything I used before.
• 36:07
  Yeah.
• 36:08
  I'm happy to hear this because I think it's really something that we
• 36:10
  owe to the patients that we also have a way to, to treat peri- implantitis
• 36:15
  cases because these cases do happen.
• 36:16
  And I really like the fact that you also say, look it's also my own patients
• 36:20
  because usually I hear clinicians say, look, I treat peri-implantitis,
• 36:23
  but it's not my own patients.
• 36:24
  Everybody has those patients.
• 36:26
  I think that was a very important statement that you made so.
• 36:30
  Coming to the end, Istvan, how do you see dentistry in 10 years from now?
• 36:36
  What is your vision of dentistry in 10 years from now?
• 36:38
  It's moving fast at the moment.
• 36:39
  I think it'll be a lot of digital and I would say much better digital.
• 36:45
  Yeah.
• 36:45
  Today we are in the digital phase of, on a very advanced phase, but it's
• 36:50
  still like a hybrid, digital and analog.
• 36:53
  We had patients who, we did all, whole digital design of the upper arch.
• 36:57
  And then the patient had, maybe the phonetics is not there.
• 37:01
  And then, we had one of the the colleagues who was very good,
• 37:05
  prosdontics and doing a lot of digital.
• 37:06
  But then he sat down and he, for three hours, he.
• 37:09
  Adjusting by hand, to, and then you know, it became perfect.
• 37:14
  But that's not fully digital.
• 37:15
  Exactly.
• 37:15
  Yeah.
• 37:16
  Yeah.
• 37:16
  No, but I would say that this is gonna improve a lot in regeneration also.
• 37:20
  That would've been my follow up question.
• 37:22
  How do you see digital regeneration?
• 37:24
  Because today, I believe if we speak digital, we speak about, smile design,
• 37:28
  we speak about guided surgery guide production, we speak about prosthetic
• 37:32
  design, prosthetic manufacturing.
• 37:35
  We are not necessarily speaking about digital regeneration.
• 37:38
  How do you see the role of digital in regeneration?
• 37:41
  Number one, there's some digital already, some, Yep.
• 37:44
  The printing bone blocks.
• 37:45
  The printing meshes, which I think is a very good improvement.
• 37:48
  But I think this is gonna improve much more.
• 37:50
  For example, if I wanna print something, I want that to be to resort.
• 37:54
  Okay.
• 37:55
  I don't wanna print something that is gonna be very difficult to remove and it
• 37:58
  will incorporate into the soft tissue.
• 38:00
  And, I wanna give my diploma back by the time I raise the flap from it.
• 38:05
  So I wanna do something which is simple, which is very tissue friendly.
• 38:10
  Hopefully resorts.
• 38:12
  Maybe I can tell that when to resorb dependent on, I can
• 38:16
  customize, okay, this is the defect.
• 38:17
  Okay, this vertical defect, I think, or I know that I need four months
• 38:23
  and I'm gonna print something and tell this synthetic whatever PCL or
• 38:28
  something that this is gonna remove is gonna resolve in four months.
• 38:32
  Okay?
• 38:32
  This is maybe a very soft printed sausage.
• 38:36
  Shell.
• 38:36
  Okay.
• 38:37
  Okay.
• 38:37
  But this, I want in one month out of there.
• 38:40
  And things like that.
• 38:41
  Also with the, in terms of the amount now I was talking about, in terms of sha but
• 38:45
  maybe you can print the whole bone graft.
• 38:47
  And you can spray growth factors, you can spray cells.
• 38:50
  That's not in 10 years.
• 38:51
  Yeah.
• 38:51
  Maybe not.
• 38:52
  That's in 10 years.
• 38:52
  Not, but it's I think it's important and good to have the vision.
• 38:55
  Yeah.
• 38:55
  That we have.
• 38:56
  Yeah.
• 38:56
  And the end goal is this.
• 38:57
  Yes, exactly.
• 38:59
  I think it's good to have a north star and a vision that, that we can work towards.
• 39:01
  So even though we know it's going to take long but I believe that digital
• 39:05
  and regeneration, that there's a lot of potential already in the next five
• 39:08
  years that, that we can do much more.
• 39:10
  And happy to hear that you also see the potential.
• 39:12
  And this being realistic.
• 39:14
  So thanks a lot for the conversation Istvan.
• 39:17
  Thank you very much.
• 39:18
  I experienced a very passionate clinician and researcher, passionate
• 39:23
  about doing great work for the patient first and foremost.
• 39:26
  I think that was a very strong takeaway for me.
• 39:28
  It's not about being on stage, it's about doing good for the patient and doing great
• 39:33
  clinical work, and the rest will come.
• 39:35
  I think that's a very important message.
• 39:36
  And also the innovative part I like and, having this intuition.
• 39:41
  Seeing something like the sausage technique and having, also the willingness
• 39:45
  to believe in it and follow through and making this a great technique
• 39:48
  that people love to use today, 22 years after you had the idea of it.
• 39:52
  So congratulations on this.
• 39:54
  Thank, thanks for being here.
• 39:55
  Thank you so much for having me here.
• 39:56
  So thanks for listening in to this episode of ProTalk together
• 40:00
  with Professor Istvan Urban.
• 40:02
  Look out for the next episodes, and as always, we like to interact with you.
• 40:06
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• 40:10
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• 40:13
  in and see and hear you next.