Latest / Straumann® ProTalk / Don't trust nice results: Lessons in digital dentistry with Dr. Bilal Al-Nawas

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Don't trust nice results: Lessons in digital dentistry with Dr. Bilal Al-Nawas · Straumann® ProTalk

0:00
In the beginning, my first idea of leadership, of course, was a sailing boat.
0:04
Yeah.
0:04
You cannot run a sailing boat yourself.
0:06
You need good sailors, but there you need to be a captain somehow.
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We had some very interesting discussions in the recent years about digital toys
0:15
that we both, are very passionate about.
0:17
Where does this curiosity come from?
0:18
Bilal.
0:19
We are all sure that the big revolution in medicine and
0:23
dentistry will come from this.
0:24
And I always tell my young students, if somebody just shows
0:28
you nice results, don't trust it.
0:30
So there is a certain failure rate we learn from this, and
0:33
so you should be self-critical.
0:49
Welcome to Straumann ProTalk.
0:50
Welcome to the Pulse of Dentistry.
0:53
My name is George Raeber, and together with Andreas Utz, we are really pleased
0:56
and also honored to have, Prof. Dr. Bilal Al-Nawas here with us today.
1:00
Welcome, Bial.
1:01
Hello, welcome.
1:03
It's, it's really a great honor to have you here.
1:06
We had a lot of contact and for the audience, what you can learn today is
1:12
actually from, one of the leading oral maxillofacial surgeons to hear about
1:17
very complex surgeries, often about patients that have, actually tumors
1:22
and that need massive reconstructions.
1:24
We're going to talk about the tools that, Bilal is using for helping those patients.
1:29
Secondly, we want to discuss on a more lighter side about digital dentistry.
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I know you are very playful with digital and we are certainly going
1:37
to, touch upon this and how it's actually going to change how we do
1:41
dentistry in a few years from now.
1:43
And then last but not least, very importantly, we also
1:45
want to talk about education.
1:47
below you are very.
1:49
Dedicated and passionate educator, and we're going to, talk about this, the
1:53
ITI, and also the impact it's going to have on the younger generation,
1:57
how important education actually is.
2:00
So bial for those that don't know you that already, who are you in?
2:05
Just one minute.
2:06
Yeah.
2:06
My name is Bilal Al-Nawas.
2:08
A typical German name.
2:10
no.
2:10
My father came from Iraq, I think, 60 years ago.
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And my mother's German, so I'm really half and half somehow.
2:16
And, yeah, I'm a teacher at the university full-time.
2:21
I studied medicine and dentistry, and now I am the head of the Department of
2:25
Oral and Maxillofacial Surgery in Mainz.
2:29
Okay.
2:29
Very short and sweet.
2:30
So as you, mentioned, you are a medical doctor and a dentist and for Germany this
2:35
is a prerequisite for or maxillofacial surgery, but that's not the case globally.
2:41
So I would just like to, kick out with the question, how
2:46
did it actually influence you?
2:47
So you have both in you medical doctor, but also dentist.
2:51
How did it change how you look at patients today, how you do treatments and.
2:57
Which site?
2:59
Important In which cases.
3:00
That's an important question.
3:02
my father was a dentist and I studied dentistry first.
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So deep in my heart, I'm a dentist.
3:08
but when I come to a hospital and there are the, main problems, the big problems.
3:13
I feel a little bit at home.
3:14
Yeah.
3:15
And so I think modern dentistry requires a lot of medical skills because patients
3:21
get older, they're compromised, and also the dentist in the private office has to
3:26
teach, to, reach these patients somehow.
3:29
On the other hand, what we are doing in the dental field
3:32
influences the medical part.
3:34
and I think even in future there will be much more things happening
3:38
on this interaction and somebody has to speak both languages.
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So you need to be.
3:43
Both to tell the medical doctors that dentistry is important 'cause no
3:48
medical doctor looks into the mouth.
3:49
And also the other way around when the dentists are there, somebody has to
3:53
translate the complicated things into, let's say the surgical dental part.
3:58
Maybe to extend on this, in the US it's different, so you don't need to
4:02
have this, let's say medical degree.
4:05
How do you see the differences in how patients are treated?
4:09
that's a little bit of political, where it came from?
4:12
it came from the first World War when, patients came back with
4:15
severe injuries of the face.
4:17
Nobody could treat them, but dentists could because they used
4:21
the methods of dentistry to reshape the face, Prosthetics and they said,
4:25
okay, we have to study medicine.
4:28
That's why most of the OMS departments in Germany are located in the dental school.
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Yeah.
4:33
So it came via the dental field.
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And so in Germany we are much more involved into the dental part.
4:40
And when we, for instance, treated tumor for cancer, we plan
4:45
the reconstruction, the tooth.
4:47
Before we resect the jaw.
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Yeah, so in the US it's totally different.
4:52
So usually the big surgery is done by head and neck surgeons.
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or cleft surgery is done by plastic surgeons.
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and so in Germany this is a little bit more integrated into dentistry.
5:03
That's how we think a little bit different.
5:07
Bilal Mainz is, your home since a long time, for 15 years plus you, you are
5:11
leading person or deleting person in the department, in the University of Mainz.
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what made you choose the academic path in the first instance?
5:21
That's a very interesting question because I always want
5:24
to become a private practitioner.
5:26
I went into.
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the conferences and there in the parking lot, you see the very nice
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Porsche cars and, tanned cool doctors.
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These were usually the private practitioners and
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usually the pale, hardworking.
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So these were usually people coming from university.
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I thought, which will become my way.
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And then, I already had an idea where I wanted to go.
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And then came the ITI World Con Conference in San Diego and I had a
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little lecture, I think 15 minutes and was in front of a big audience.
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800 people translated into seven languages.
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And on this stage, I really felt at home on, on the way back.
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My former professor, Mark Wagner, he took me even in the airplane and
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said, Bilal, you have to reconsider going into private practice.
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Perhaps universities readjust your priorities.
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Readjust your priorities.
6:18
Yeah.
6:19
And so I said, okay.
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yeah.
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This is a good option.
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So he, he realized there was a window of opportunity and made use of it, and then
6:26
it is, yeah.
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You should strengthen the strength.
6:29
Yeah.
6:29
Yeah, absolutely.
6:30
Yeah.
6:30
And now you have a big impact, on the department in, mine, since a long time.
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What, makes mine so, specific?
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not only that.
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Your department in specific, but the whole university and also the ecosystem
6:42
around companies like BioNTech.
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Do you realize something like this?
6:46
We do.
6:46
We do.
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it, there are so many aspects.
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So we had an OMS professor there for many years with Wagner who was very
6:53
much attached to dentistry and plays an influential role still in Implantology.
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So there's a long background attachment.
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Between the dental school and the OMS department, that's not normal.
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So usually this is more separated.
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we have the airport, they're very close.
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That means we are always quite international.
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So Frankfurt is 20 minutes away.
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We always had the interaction, one of the earliest scholarship centers there.
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so it's very easy to reach.
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And of course the whole university now is shifting to immunology, with.
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BioNTech, the two founders were part of our internal medical, department.
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We have good relationships, and of course, if you do something with
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immunology there, every door is open.
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Yeah.
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So I think, it's a good setting.
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And now with Samia, Abu has prosdontics.
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we, have a very good team.
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So the master program in Implantology is international.
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We are trying to open up the.
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German speaking a little bit.
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Closed universities, a little bit more to the international part.
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Now
7:55
I'm good.
7:57
Bilal, your daily work covers probably some of the most complex, let's say
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OMF surgeries that, that can be done.
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And, I had a chance actually to, visit you on several locations and also
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participate in some of these surgeries.
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And, for me it was very impressive on what actually.
8:13
Can be done.
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And I think, the, way how you, change also the course of the patient's life
8:19
is, is amazing because these are large reconstructions and, without them, I
8:25
think the quality of life for these patients, they would be just really,
8:28
lower than, what's the outcome allows now.
8:32
Part of this spectrum also involves specialty implants.
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Of course.
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This is something that, we would like to discuss a bit, and you have
8:39
been very at the forefront of also defining the usage of these specialty
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implants, be it now, short implants, small demetry implants, matic implants.
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We discussed about, sub implants and I think this is now a topic that we would
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like to deep dive a little bit into.
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Could you start with just describing maybe one of the cases that were.
9:02
Really some of your most complicated cases, what made them complicated
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and what did you learn by actually treating, the patient?
9:12
Yeah, there's so many.
9:13
But, to make it clear, so we, do everything, we do undergraduate teaching
9:18
where we treat simple cases also, but as you said, the most, influential things we
9:24
can change, are those complex situations where, really a team approach is needed.
9:31
often even the orthodontist is, part of the team.
9:34
The pro orthodontist is part of the team, and one of the situations I can remember.
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That was a 90-year-old lady where we did a resection of the jaw and the
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anesthesiologist said, so this was.
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Close to what we can ever do.
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We will never do general anesthesia in her again because it's so difficult.
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But the problem was she had no reconstruction.
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So there was an open large fistula to, the nose, how can she eat now?
10:03
And at that time we were discussing different options.
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The, job was nearly gone.
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She had one of the first Subperiosteal implants, but the problem was I had
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to bring this in local anesthesia.
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So I made the deal with the patient.
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She was still so clever, said This is one option we have and
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you have to stand it somehow.
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and we both were sweating.
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The patient was sweating.
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I was sweating.
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I cut a little bit away.
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Don't tell anybody of the superior implant.
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But the funny thing is now she's still wearing this without teeth.
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It's just closed.
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But she says, I'm happy with that.
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I can eat and this thing, this device is still there.
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And without this option, the, there was technology, but there was
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also the empathy and the emotional interaction with a patient.
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And I still love it when she comes back for recall.
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Now
10:54
I think even with those.
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Or even more with those very large, interventions.
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I think this, the link to the patient is, is extremely important
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and Probably you see also these patients over a long period.
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it's not a standard treatment that, gets referred to you, you place an
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implant and, probably you don't see them anymore, but it's like you, you
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really walk a part of their life.
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Which is probably one of the most difficult ones together.
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It is the case.
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we have this, with the oncological patients.
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Usually they come for the follow up and sometimes they need the attachment.
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We have this also with the children when we operate a cleft palate.
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You are part of the family forever.
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And it's the same with the, reconstruction because we have, nice
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conferences with, red and whites.
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Statics and everything, but some patients, they will not find
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help in this standard system.
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And when you can offer them this by a good team approach and good technology at the
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end, yeah, you'll be attached forever.
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I'd like to come back to your patient and you mentioned you placed a superior
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implant at, that stage, and this is a topic that we see coming back,
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but we know it has a long history and a very controversial history,
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with a lot of complications in the early stages of superior implants.
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Now we see coming back with new technology, new imaging technology,
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planification 3D printing, how do you look at this, how do
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you see the potential of this?
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Is it like.
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Really a future solution for let's say that is much needed for some patients?
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Or are we repeating old mistakes?
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Hopefully not.
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yeah, the point is, German surgeons are always a little bit critical.
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Usually if you see such a new device, you always think this cannot work.
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and they saw it before.
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Yeah, we saw it before.
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It will not work.
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But the point is, then you come to these.
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Patients like the elderly lady where you say, okay, this is the right person.
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This is why often surgeons believe in this, let's say niche implant.
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Yeah.
12:56
Because you have, this is a solution for this special
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implant, this special patient.
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And, yeah.
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So we tried it in a few patient, it worked well.
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We did a systematic review on it, and the outcomes are not that bad.
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So the technology is not comparable what was available earlier.
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So with the digital technology, this.
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Is a clear, let's say, step ahead, and I'm fully convinced that, especially in
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the atrophic jaw, the severely atrophic jaw, this will be a very good option.
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The point is a little bit the, critical point.
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it's even a little bit too easy to insert.
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there's a goma too easy.
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Yeah, everybody can do it.
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there's a Goma implant is difficult, so it will be reserved for specialists.
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And these specialists usually know what they do.
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So that's fine.
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The subperiosteal implant is something you can plan.
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It's backward planned and you screw it in.
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You have to open the flap and close it again.
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But there's so many things to consider, the soft tissue, a
13:52
different biomechanical aspect.
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So I think, it's even a little bit more dangerous, because of The, the
14:01
side effects we cannot control yet properly soft tissue coverage and all
14:06
these things, but the technology is something which will not disappear.
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I'm sure.
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you did this, systematic review on superior implants.
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How much have you been surprised about.
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actually quite positive, outcomes of it.
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I was quite surprised by that, especially as we have different companies coming in.
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We have some companies who do it in the very structured, I would say typical
14:27
German way, very strong structures.
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And we have others who produce very delicate, small implants.
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we have others who treat.
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Do different surface treatment.
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And it was very interesting that there are some, there's some common sense behind it.
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and there are also some differences.
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So the next step will be to bring this common sense together and try to bring
14:47
out an educational message what is needed.
14:50
Can I add one question?
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how much do you see it in the future also outside of a hospital set up?
14:57
Like in private practice?
14:58
Because, for you.
14:59
If you have an arbitrary construction to be done, you use the same
15:02
technology and it's not, attached to, to, let's say a two structure.
15:08
so for you, it's very natural to use this, but how, much would you see
15:11
this outside of a university setup?
15:14
There?
15:14
There, there's an easy example, and this is the 3D printed
15:18
titanium meshes everybody.
15:20
In the private setting who does a lot of augmentation procedure.
15:24
Is using these meshes.
15:25
Yeah.
15:25
In certain indications.
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And so I'm sure that also Sal implants for specialized centers for people who
15:32
have, let's say, outpatient general anesthesia available will use it.
15:36
Okay.
15:38
How do you distinguish.
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Sub implants from zygomatic implants and what is the, what comes first,
15:45
maybe what comes later, because also the zygomatic implants, there is
15:48
some kind of a rescue, system after.
15:52
Very severe atrophies happened.
15:54
How do you position PIs versus matic and other treatments?
15:59
George, I waited for this question.
16:00
You waited for this question.
16:02
Yeah.
16:03
Yeah.
16:04
I think, the zygomatic implants requires quite a lot of skills.
16:08
If you have these skills and if you know how to do them, why should
16:12
you use the superior implant?
16:14
So these people, they are good and they produce perfect results.
16:18
We saw this also in our consensus conference.
16:21
But the, learning curve of the zygomatic implants is, not very fast.
16:27
And of course you have a little bit.
16:30
A different setup of complications there.
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You're close to the orbit.
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on the other hand, the Subperiosteal implants are very close in the
16:38
indication, but I think there will be dif different group of people using it.
16:42
They will be both together.
16:44
Should be more, when you do the teaching, which.
16:48
If you are the patient, what would be your first option?
16:51
You can tell me later when the mic is off.
16:52
I hope I never going to need one of them, but I don't know.
16:56
Yeah, but it's, interesting.
16:58
So on one hand you say it's easy to be placed, but obviously it seems also
17:01
to be not so easy to have the right patient selection and maybe that also
17:06
drives then you know who uses what.
17:08
So private practice versus clinical setting.
17:13
How do you foresee the future of the user tools?
17:14
If you do such a tools, if you do such a sub perusal implant, it's
17:18
quite easy because you do a scan, you do a backward planning, and these 3D
17:22
printed items, they fit perfectly.
17:25
So you just need to raise a flap and put it in.
17:27
So from my point of view, it's even too easy.
17:29
So if you have a hammer, everything feels like a nail, and that means
17:34
finding the right indication and not overextending the image.
17:37
Still we have the sinus floor elevation.
17:39
Still we can do all on.
17:40
Four or pro arch concepts.
17:43
so that means, I would see more the risk that people overextend the
17:48
use because it's so easy and fast.
17:50
so we will find, we have, we'll have to balance not
17:53
against the zygomatic implants.
17:54
We have to balance against the standard concept, which patient benefits from
17:58
a standard sinus flow elevation and four or six implants compared to
18:03
subperiosteal immediate loading.
18:05
Where do you see the biggest risks if it's overused?
18:08
Is it the soft tissue complications?
18:10
Yeah, it's soft tissue.
18:11
The problem is you have a full metal, framework and if you have
18:15
an infection there, it might be difficult to get rid of it.
18:19
and if you have an infection, you will lose a lot of the bone.
18:22
that's a little bit tricky
18:24
and probably we need to gain a bit this long term data back, which is now with
18:28
difficult or with different technologies.
18:30
It's not the same as we had before, so probably.
18:33
There needs to be some, cases, some long term.
18:36
Yeah.
18:36
And I want to hear about the complications also.
18:38
It's not about talking how to do this and how to bring it in.
18:42
It works.
18:42
The survival rate is good.
18:43
I want to see how to deal with complications.
18:45
How can we treat a periimplantitis in a superiors implant?
18:49
What soft tissue proce procedures do I have to do to, let's
18:53
say, prevent that situation?
18:54
So these are the interesting items.
18:57
ITI comes back to answer that Exactly.
18:59
It's, not just about device.
19:00
It's how, do you use it?
19:03
maybe let's dive a little bit more into matic implants.
19:06
So Bilal there has also been quite involvement on, in Sigmatic implants.
19:12
What did you, let's say, observe in the last 10, 20 years or so,
19:17
two decades of how it evolved?
19:19
Where is it today and how could it look in the future?
19:22
Is it something that, an indication that grows?
19:24
Is it something that has reached a plateau?
19:26
Do we need new technologies, associated with psychometric implants?
19:30
Yeah, we started very early when, they came to the market, and I know that my
19:35
former professor, he went to Sweden to get, the training there and was always
19:39
an exciting, procedure to do with these five centimeter long implants.
19:44
and the interesting thing is when Straumann came back to the market,
19:48
we recalled the old patients and we still have some of these.
19:52
20 year reconstructions working.
19:55
And I was so surprised that, you can have such a long-term stability
20:00
with these, with these, indications.
20:02
And interestingly, especially the oncological patients,
20:07
they benefited quite a lot.
20:09
And so you have to say that when we reconstruct the maxilla.
20:13
It can be after severe atrophy.
20:15
It can be after trauma or oncology.
20:18
This is always a question, should we do this using some grafts from
20:21
the hip, which is complicated, or should we do it with implants?
20:24
And there also for atrophy, the Zygoma implant plays a role.
20:30
And I think when, you know how to do it, you can really reach nice results.
20:35
That was a good learning for me and I really respect what we, the group we had
20:39
together for the consensus conference.
20:41
Two,
20:41
three.
20:41
Yeah,
20:41
that was amazing.
20:43
What was the main outcome there?
20:45
when you maybe can summarize for, the listeners.
20:48
The main outcome was that we were fighting each other.
20:51
It was one of the hardest consensus conferences ever.
20:54
And I think when we met in Frankfurt at that time, we,
20:57
really found a kind of consensus.
20:59
We saw that we, can agree on certain procedures and that showed me, sorry
21:05
for that, the importance of the university and the ITI because the
21:09
company has a tool, has an implant.
21:11
And I think you need also the interaction with, a group
21:14
like the ITI to define these.
21:17
These settings.
21:18
And that was, for me, the eyeopener in Frankfurt.
21:21
I can imagine it, it must have been quite hard.
21:24
There is a, lot of, let's say particular, qls that play in
21:28
that space that are important.
21:29
I
21:29
still love them all.
21:30
You still love them all.
21:32
So it is the next, consensus conference that we need, how to position matic.
21:37
Relative to sub the use of superior implants, or
21:40
somehow we should talk about the Subperiosteal implants because they,
21:43
look so different and we have to define somehow the indications and
21:47
I think they will live side by side.
21:49
You don't need to balance them against each other.
21:51
Yeah.
21:53
There was a study that you participated in that was a very interesting
21:57
one, looking at 20 years survival success and survival rates of
22:00
dental implants and it's, I think.
22:03
It's always a bit surprising if we reflect back on the history of the implants.
22:07
it's not 70 or 80 years old.
22:09
it's, I think we have data.
22:12
20 years is a lot of data.
22:15
So what did you learn in this study and, what were your key takeaways, let's
22:19
say on the implant side, the material, but also for the clinicians and the
22:23
responsibilities clinicians have.
22:25
Yeah, this is, always, for us also an eyeopener when these patients come back.
22:30
So I have some patients at my university, before.
22:34
The professor before the one like Wagner, hat professor teach.
22:40
He, started with IMZ implants in the eighties.
22:43
So I have patients coming back to my department, which is
22:47
implants from the eighties.
22:48
Please find a screwdriver for that.
22:50
Yeah.
22:51
but they still work.
22:53
that seems the first thing, what, you know as company, as you, we have most
22:57
of the complications in the beginning.
22:59
But when you have the implants in for 10 years, then you have
23:02
a kind of steady state there.
23:04
And I think this is something we, have to learn a little bit.
23:06
And that's why we are more also looking at the immunological part.
23:10
Why is this working in certain patients and why not?
23:13
It cannot be only the periodontal disease.
23:16
the other point is that we, learn from these long term studies that
23:20
some of the, let's say reconstructions we did, which were borderline,
23:25
still work on the long term.
23:27
Reduce diameter implants, shorter diameter implants, situations
23:31
where we thought was a compromise.
23:33
They still work.
23:35
and the other point is, of course, that the implants 20
23:37
years ago looked different.
23:40
So they're not on the market anymore.
23:43
So what, mindset shift would you wish younger clinicians actually to, do
23:48
based on those kind of long-term data?
23:50
Is there a misconception that you actually would like to, get rid of?
23:55
Yeah, the, misconception is coming a little bit from the, let's say conferences
24:02
we are doing also as societies.
24:03
Things always look easy and everything ends up very nice
24:07
and it should be self-critical when you treat your patients.
24:11
I always tell my young students, if somebody just shows you nice results.
24:15
Don't trust it.
24:16
If I want to see on the big stage also a failure.
24:19
So there is a certain failure rate we learn from this, and
24:22
so you should be self-critical.
24:25
I is now always discussing the, debriefing.
24:28
When you do the surgery, come back and think, what should I do better next time?
24:33
And so I think learning and also being self-critical with the procedures
24:39
you're using, that's so important.
24:42
Bilal, I would like to speak also about your leadership, in, in, in
24:47
minds because I realize, I know a lot of your people and I realize
24:49
there's something special about this.
24:51
What is your leadership mantra?
24:54
in, in this setting as you have to collaborate on very complex cases with
24:57
a lot of different specialties, for the greater good of, of a patient ultimately.
25:03
So how do you approach leadership?
25:05
Yeah.
25:05
Now you are touching the secrets.
25:07
Yeah.
25:07
Yeah.
25:07
I see that.
25:09
Yeah.
25:10
In the beginning, my, my first idea of leadership, of course was a sailing boat.
25:14
Yeah.
25:14
You cannot run a sailing boat yourself.
25:17
You need, good sailors, but there need to be a captain somehow.
25:22
but there is also another point, and, this is an interesting.
25:27
Aspect also in, in, surgery where people are powerful.
25:31
Yeah.
25:32
And I always like the idea of the tribe.
25:34
So how, is the leader in a rural society or in a pirate boat who
25:42
elects the captain in the pirate boat, they will not fight for it.
25:47
The, strong pirates think Andreas, he can lead the team.
25:52
So I think, to stand in such a strong community, like with
25:57
strong surgeons around you, you have to build up this trust.
26:01
You have to show them the direction somehow.
26:04
But there are situations where you have to step in, take the scalpel and cut.
26:09
Yeah.
26:10
it's a very delicate balance.
26:14
I can imagine now, and I see that you, help also young talents to develop and
26:19
you give them the room also freedom.
26:20
Yeah, it's the future.
26:21
When I go to the lecture hall and I see these young dentists sitting there and I
26:25
see the glances in their eyes and I think, look, the future is bright, is happening.
26:30
I just have to, they even know how the future looks like.
26:32
They just cannot tell me, but I just have to listen to them.
26:35
Yeah.
26:37
Yeah.
26:37
Let's, switch gears to digital danger.
26:40
Digital, I think, that's a good segue to it.
26:42
So you, you are very digital and, we had some very interesting discussions, in,
26:48
the recent years about, also, digital toys that we both, are very passionate about.
26:56
Where does this curiosity come from Bilal, that you want to try those kind
27:01
of digital tools, for the future also in your, let's say, clinical reality?
27:06
It's very simple.
27:07
I had a Apple two E computer when I was young.
27:10
Exactly.
27:10
With a screen like this.
27:12
Yeah.
27:12
Yeah.
27:13
And the floppy disc, nobody knows what it is anymore.
27:16
still, no.
27:17
I think we, we are all sure that the big revolution in medicine.
27:21
And, dentistry will come from this.
27:23
And, I'm, totally addicted to the idea that you, they, can make the
27:28
treatment easier and more predictive.
27:29
A very simple thing is, think of backward planning.
27:33
somebody told me once the, biggest lie of the last 10 years, because that means.
27:39
I promise you as a surgeon you can ask as a pros, orthodontist,
27:42
where do you want the implant?
27:44
And I give you this position.
27:45
I build a bone every like a miracle.
27:48
This is not true.
27:49
You need two eyes.
27:50
You need both.
27:51
You need both.
27:51
And the digital planning helps you so much with that.
27:55
What does it mean?
27:56
It reduces the burden of care?
27:58
Very simple, and this changed so much for us.
28:01
and you see this in so many fields of if you do now, let's say a
28:05
jaw reconstruction, orthotic surgery, jaw advancement, we would
28:09
never plan this without digital tools now no plaster anymore.
28:14
Perfect.
28:15
Yeah.
28:15
So it's really the intersection that you can discuss together basically
28:18
from a prosthetic viewpoint, but also from a surgical what is, a feasible.
28:22
I would say treatment plan.
28:23
Yeah.
28:23
Think, think of the next disruptive part in education, of course I will
28:28
wear, you call it point of view, nowadays a glass and you can come with
28:32
me to the surgical theater or I can assist you when you do the operations.
28:37
so there, there are so many things happening in this field
28:40
and I want to be part of it.
28:42
Which part of the digital ecosystem, in your view, is the most underdeveloped?
28:47
So where should we put a lot of focus to further advance?
28:51
You mean we as company or we,
28:53
as we as being part of, let's say, the, a, common, I would
28:58
say medical field, but yeah.
29:00
Maybe us as company.
29:02
Yeah.
29:02
I think the, next major step when you look at the medical field is quite
29:07
obvious, and this is individualization, you would call it personalization.
29:12
when you think of, the question was subperiosteal, orma, implants,
29:15
short implants, versus bone augmentation, we decide on.
29:20
A basis like this.
29:22
but.
29:24
When you think of the company, you have on file all the different fracture
29:28
modes for the different components.
29:29
You can tell exactly this component can be suitable in this individual situation.
29:34
In the future, we will learn about the chewing forces of the patient, so we will
29:39
come, I'm, sure that we will still live that to an individual recommendation, not
29:44
the digital twin, but something like this.
29:47
we will simulate the situation.
29:49
we know that already for the Subperiosteal implants, some of
29:52
the companies, they simulate some individual situations and we will come
29:56
to that also in dentistry, I'm sure.
29:58
Yeah, I like that a lot because it's, some of the, stringent data sets that
30:02
are missing is still chewing force.
30:04
It sounds weird, but we, don't have a lot of data on chewing force
30:08
and let alone individualized data.
30:10
So how do you chew and what does it actually mean for the.
30:14
Ideal reconstruction that yeah, it's
30:16
still an expert system, but I think the air a lot will come.
30:19
We need to create the measurement devices that actually can take the data.
30:22
Yeah.
30:23
You are also very, I would say, advanced in Dynamic navigation in digital surgery.
30:29
And I saw you performing some, surgeries that you actually, took, in
30:34
a neurological guiding systems that actually you then used also for, dental.
30:39
How do you see this field develop?
30:40
How important is it for the future of dentistry, dynamic
30:43
navigation and maybe even robotics?
30:45
You come back to the point why.
30:47
Should you study medicine and dentistry?
30:49
Because you can do the transport of the technology in a, certain way.
30:53
I, bring the pit surgery to the neurological neurosurgical department,
30:57
but of course we also bring the brain lab, to the, to the dentistry field.
31:02
And, I'm sure that this field is totally underestimated in dentistry.
31:07
I just discussed this, it's not about drilling a hole into bone.
31:11
It's, more about when you know where you.
31:13
Are what you're doing.
31:15
You can have a plan and you can superimpose this plan.
31:19
and this is more than, you can estimate.
31:22
And, I'm sure that this is something which, will open doors in dentistry.
31:26
So you can design your restoration and you can prepare the tooth situation.
31:31
You can prepare everything according to that.
31:35
Maybe to extend this a bit, because I, think it's fascinating that.
31:38
Still, it takes quite a long time for these technologies
31:41
to be adapted in dentistry.
31:43
If you compare it to orthopedics or neurosurgery.
31:47
Dentist relax behind, but it's often not a, let's say, life or death question.
31:52
So why, is that?
31:54
What, is there, let's say, is it working too good so that these
31:59
technologies are actually then.
32:01
Faster adopted or where's this coming from?
32:05
So in, in, the medical field, often the driving force is the
32:09
OR time, which is quite costly because you don't have nurses.
32:13
It's not even a question of money.
32:15
and that means if you have a technology making the or faster, more
32:18
predictable, this will break be a breakthrough in the dental office.
32:23
planning.
32:25
And calibrating these tools is still an issue.
32:27
And I think as soon as we see that these tools are being more easy
32:32
to use, then they will be adopted.
32:35
But dentists also love technology and I'm, sure when you see with the
32:39
scanner systems, with the intraoral scanners, it took I think 10 years they.
32:44
Nothing was really happening in that field.
32:46
And now,
32:47
and now it really takes
32:48
off.
32:48
Everybody has a scanner and I think we will see this with dynamic navigation
32:52
also, if you think of a surgical center, maxillofacial private office,
32:56
they will have these, digital tools.
33:00
Will, I know you also as a very visionary person and creative person,
33:04
how do you envision the future of implant dentistry in 10 years from now?
33:11
Bringing all together.
33:15
Yeah.
33:15
Your,
33:15
your dream setting
33:16
Basically.
33:16
My dream setting.
33:17
Yeah.
33:17
Yeah.
33:17
No, my, my dream setting is of course a very, let's say, individual setting.
33:24
That means I will have my data set of my teeth preserved digital.
33:29
when I lose these teeth, we know that people get older with more
33:32
teeth, so there will be less denture, complete denture, more.
33:37
Elderly patients having teeth, and I would like to have this restored
33:41
using my individual data set, and you as a company will provide the,
33:46
background data for that and we will simulate which implant is the best.
33:50
And, I, think this is, yeah, this development is clear and I'm, also very.
33:59
Convinced that we will work with much more smart devices, so
34:03
we'll not just put a crown in.
34:05
So I per, I'm perhaps prone to periodontal disease.
34:08
Some people wear these glucose sensors.
34:11
why shouldn't they wear a crown monitoring MMP eight.
34:14
Of course it's silly.
34:15
I can use a probe.
34:17
of course I know when I eat that.
34:18
My glucose is rise rising, but people like to see it and you
34:22
cannot measure all the time mpa.
34:24
today,
34:24
so you need to go to the dentist basically.
34:26
Now
34:26
that's it.
34:26
And I, think you can think these monitoring devices, variables,
34:30
they, will be also something which we will see in, in Implantology.
34:34
And this will help to bring also individual, conclusions and individual
34:40
treatment plans, but also in the long term to make it more safe.
34:44
It makes a big impact if you get a notification on your
34:46
smartwatch on those screen, right?
34:47
It
34:47
does.
34:48
It does.
34:48
This is, yeah.
34:49
It truly does.
34:49
Yeah.
34:50
No, thanks for sharing this pillar.
34:52
And I think we also have to, to speak about your deep motivation of
34:57
enabling others and teaching others and being active in associations
35:00
such as the DTI and, the ITI.
35:03
You mentioned this before, the ITI has obviously, changed a little bit, the, path
35:10
forward as you saw it, not going into.
35:13
Prior practice, but ultimately staying at the university.
35:17
and you've been very active in the ITI in the following years.
35:20
You had a huge influence in the ITI in Germany.
35:22
You had an influence in the ITI being member of global committees
35:27
and leading the, research committee and with this also being one of the
35:30
board members in the, ITI globally.
35:32
So one of the top four people leading an organization of 25,000 people.
35:37
Wow.
35:38
Which is a sound speak now, right?
35:39
If
35:40
you tell it like this
35:42
this is what it is.
35:42
And,
35:45
Pilar, if, you look on the ITI, h how do you see especially young
35:50
clinicians, but clinicians in general, benefiting, from the ITI.
35:55
It is a still a very special organization.
35:58
It because it's so big and global, it's well recognized and it's very
36:02
interesting that it's, close to a company.
36:05
But still, if you say I have an ITI grant, it's valuable.
36:09
Yeah.
36:09
And, this is a balance which you cannot buy for money.
36:13
So perhaps to put it in a broader context, I like the interaction between
36:18
a company with a certain mindset, we want to earn money, but also
36:22
having the ITI like, like in a good marriage, we go into the same direction
36:28
sometimes with different viewpoint.
36:31
and I think from, the perspective of young clinicians who have to still.
36:36
stand in a university setting where some people say, Ooh, this
36:40
is too close to a company, helps us to give them this playground.
36:45
you can put it to my perspective, if you start the German leadership part and
36:51
you, want to be creative and you need this setting, some people who help you
36:56
to start a new, let's say, Meeting or a new type of, new format of education.
37:04
this is nothing I could do.
37:05
I can have the idea, but when they are in the background professionals like
37:09
the ITI who can help you, you can move things like the young ITI in Germany.
37:13
We started more than 25 years ago.
37:17
So that's why the ITI can play a big role for young clinicians,
37:22
who want to play a larger role.
37:24
And I know that the ITI is opening up more for this talent search.
37:28
And if you have young talents, they are very open-minded to integrate them.
37:33
And I, think that's why it's still important to have it.
37:37
And Mainz is also a scholarship center.
37:39
You mentioned this, right?
37:41
how many scholars did you already have in Mainz?
37:44
count.
37:44
I cannot count.
37:45
no.
37:45
I think we had from every continent.
37:46
15. Okay.
37:47
Yeah.
37:48
Something.
37:48
And did, how, do they influence, you and your department?
37:53
they, come from all over the world, come to minds.
37:56
They must also influence.
37:58
this goes in both directions.
37:59
For me, the most important thing is that when they go back, we help them to
38:02
establish themselves in their country.
38:04
So usually we try that they, get a grant, also an ITI grant that they write a
38:08
paper and we try to visit them in their country to help them to find their way,
38:13
which is sometimes not diff not easy.
38:16
On the other hand, we have long-term relationships.
38:19
So I will fly to Korea, next week to visit young Dewan, who was a
38:23
former scholar, and now I'm now guest professor at his department.
38:27
So we are like friends.
38:29
Yeah.
38:29
And my dream is that we can open this relationship also to other younger
38:33
people, but of course for, our department, it opens up also our hor horizon.
38:40
We now have a master program in English.
38:42
I think this would not happen without, the ITI scholarship program.
38:46
Okay.
38:48
Then, Bilal, I think one, one very important role you had was leading
38:51
the, global research Committee.
38:54
there, I would say there are two big legs that the ITI is really standing on.
38:57
One is education and one is research.
38:59
Probably first research and then education.
39:02
In your, let's say period, there's a, chair of the research committee,
39:06
what is the achievement that you have been most proud about?
39:10
Yeah, that was an interesting question because most people, even at that time
39:13
thought it TI is mainly for education and we can just stop the research
39:17
because this is done by the company.
39:20
they're just spending money.
39:21
and so I tried to explain to the board, to everybody that.
39:25
Research is shaping careers.
39:28
And behind every research grant there, there is a person, there's a background.
39:33
And so what we did is we, opened this up to several pillars, like
39:38
research, communication, starting to tell the story about it.
39:41
So it's very interesting to look what is he doing in his
39:44
lab and why is he doing that?
39:47
another aspect is.
39:48
The unique situation between ITI and Straumann.
39:52
So I would say ITI can do research you are interested in, but you cannot do yourself.
39:58
so if we align on this, can be very open.
40:01
There's nothing, to be hidden.
40:04
and I like this delicate, situation between, yeah, a private
40:09
company and a scientific society.
40:13
Yeah.
40:14
And can confirm that.
40:15
you opened up, I, I think a lot of the, possibilities to strengthen the
40:20
collaboration and, I think that also on our end has had a, an important
40:25
impact on aligning basically, what we are doing, what the IT is, is doing.
40:31
This is so important because, we have different viewpoints on the same.
40:34
Topic.
40:35
And I think it's so important that we talk to each other because then we
40:38
can move this into the same direction.
40:40
That was a little bit missing beforehand.
40:42
And I like this alignment and, I also like, yeah, this delicate balance between
40:47
a company and the scientific society.
40:51
No, But this is where I think it gets interesting, these conversations and.
40:55
This causes, we, have on, topic because without research
40:59
there is no true innovation.
41:01
so I think we really need each other and I think we cannot continue innovating
41:05
same pace and same impact without doing the, fundamental research behind them.
41:11
Bilal, Teaching is also very close to your heart, and you received actually,
41:16
the award for being the best teacher in the University of Mainz, I think twice.
41:21
And you have, seen, let's say a couple of, years and generations
41:25
of, students coming your way.
41:29
What differences, let's say, what developments did you observe?
41:33
how, are the young students different than maybe they have.
41:36
Been 15 years ago.
41:37
And what, is the, developments you're observing for the good and the bad?
41:41
The whole field is developing.
41:43
when I now open up, the newspaper of the exes, they make their,
41:49
their, let's see, funny journal.
41:52
I'm no longer the best.
41:53
Ike took over.
41:54
I think this is normal.
41:56
But now I became student dean of the whole medical faculty.
41:59
So I'm responsible for 4,000 students and I still, if you wake me up at
42:03
night, teaching is my dedication.
42:05
And, but still, these young students, they like to learn something they like.
42:12
To see role models and I believe if, a lecture is good, they will come.
42:17
so we have to, we are just renovating the whole medical curriculum in minds now.
42:23
We are renovating a little bit the way how to do digital teaching for the DGI,
42:30
because I think the next generation, they will have different, Accessibility,
42:36
different attitude towards learning.
42:38
They will not buy a textbook.
42:40
They will buy a textbook, but for a different reason than we did.
42:43
And a good example is if you want to just, fix something in your
42:48
vacuum cleaner, what would you do?
42:50
You go to YouTube, you will check the video.
42:53
You will fix Exactly.
42:55
If these young people, they want to do surgery, they go to YouTube,
42:59
hopefully it's a good lecture.
43:01
So we need to provide good.
43:03
Digital content on one hand, and we also need to provide comprehensive learning.
43:08
And so I think this's, this is a big obligation for us to, offer this
43:13
and, to shape this a little bit.
43:16
Bilal, we also have the possibilities that, the audience can ask questions.
43:20
And, actually we, received here, a very interesting question.
43:23
So what's one belief about implant dentistry you held early on in your career
43:29
that you no longer believe in today?
43:34
That's, quite a difficult question because, it's more
43:38
a development than, a belief.
43:40
I, I think the, I was taught that this implant is screwed
43:46
into bone and then it's fixed.
43:49
There was a very mechanical aspect, and the belief now is that we are shifting
43:54
to the term called osteo immunology, that things are happening around, which are.
44:01
Let's say balancing the fate of this implant.
44:04
so we are thinking much more of the biological context this
44:08
implant is in as being active.
44:10
Yeah.
44:11
So I, I, was raised in a very passive world.
44:14
So put an implant in six months of healing and then everything is fine.
44:17
If you clean properly, it will stay there forever.
44:18
Stay
44:19
forever.
44:19
Exactly.
44:20
And I like this biological contest context and I'm sure that we will
44:24
dive deeper into this in, the future.
44:27
Very good.
44:28
So now it brings us already to the last part.
44:31
And here we also have, a little, let's say ritual.
44:34
We also would like to give you the possibility to ask us the
44:37
question and Yeah, what would it be?
44:42
yeah, you, the interesting thing is that in implant dentistry you are
44:45
a real global player and, so there comes also some responsibility.
44:52
Do you feel that, you as a big company, as a main player have a certain
44:56
responsibility amongst teaching and dentistry and also amongst your,
45:03
relationship to the ITI perhaps.
45:07
absolutely.
45:08
Yes.
45:08
I think, as a matter of fact, just this year and then last year, we
45:12
reflected on our role in education.
45:14
Again.
45:14
we, it.
45:16
we've always put a lot of emphasis in this, every now and
45:20
then you have to question it.
45:21
And we came to the same conclusion again, that, education is absolutely
45:26
strategic to us as a company because we have a responsibility
45:29
to make sure that, young people.
45:32
Get into Implantology and, do this well with quality, and depth and you know that
45:37
they start their first cases with success and not only the case number 30 or 50,
45:43
but, really start from the beginning.
45:45
And they are obviously partnering with the idea is very powerful because, we
45:49
are the industry we can educate, we need clinicians that educate clinicians or
45:54
researchers that educate, clinicians.
45:57
And then I think the second big topic is also, Still keeping educating,
46:03
advanced procedures because that the learning doesn't stop.
46:06
once you have placed your first, 200 implants, but then you know,
46:10
you as a clinician and you know it, you go through a learning curve
46:13
and you, conquer more and more.
46:16
indications and techniques.
46:18
And we also commit ourselves also to, to, let's say continuously educate,
46:24
every clinician to master new techniques like whatever a sinus lift, a new
46:29
workflow, whatever it might be, a new technology also to be there.
46:32
I think that's a very important, field for us,
46:35
and I think it's a very strong symbiosis also with, the ITI
46:38
and the consensus conferences.
46:40
So we touched before upon.
46:42
the topic, zygomatic versus SPI, it's just a little, nugget, but I think it's
46:47
so important that we are part of this, not over promising and also putting it
46:53
into the right hands to say, this is how you make your patient selection.
46:57
This is actually, the, best way to treat because.
47:01
That's the science behind.
47:03
and we know it.
47:04
And I, think that's, that's a very, privileged situation that we
47:07
have, strongman plus ITI to also be at the forefront, for education.
47:13
And also maybe to add the last point also to, to support associations
47:17
like the DT I in Germany, the EAO, I think we, we should be very fortunate
47:22
that we have associations like this that, put a lot of effort and a
47:26
lot of money actually in education.
47:28
when we see those congresses, we see the courses, the curricular you're
47:31
doing, podcasts, whatever forms.
47:33
You are very creative about this.
47:35
And, I, think we should feel fortunate about this.
47:37
And, supporting those is also, super important because, they are very close
47:42
at the doorstep of the clinicians.
47:44
Huh.
47:46
So thanks a lot, Bilal already for a very, interesting conversation that
47:51
we could have with you now on Andreas.
47:54
How would you summarize what we discussed in this episode?
47:58
It's impossible to summarize Bilal, now in one minute.
48:01
No, Thanks a lot Bilal for, coming over and, I would start with, this
48:06
deep responsibility that you feel for, the patients you're treating.
48:10
Very complex.
48:11
Patients that, come your way.
48:13
And, you said it, you embark a team around a patient and you know you
48:18
wanna do the best for the patient.
48:19
And I think still keeping an open mindset that, that's what really impresses me.
48:25
You, keep an open mindset on technology, new tools, digital stuff.
48:29
SPI.
48:31
To approach it openly, but then put data behind, science behind and, make sure
48:36
this tool really in a, let's say EV, evidence-based way, finds its place.
48:39
But you're not saying no from the beginning, but you are, your
48:43
first instinct is always open and then you put the data behind.
48:46
And I really like this.
48:47
And I think the fundamental of all of this is your curiosity.
48:50
Bilal, you are a very curious person.
48:53
And playfulness, I would say.
48:53
Yeah, playfulness and curiosity.
48:56
You like actually when new tools are coming and you have this
48:59
curiosity and you want to learn more.
49:01
And I think this is, I think where the whole, journey starts and, I
49:05
think Bilal what's impressed me today and also how I knew in the past is,
49:10
your deep motivation also to teach and to enable others and the young
49:14
generation to, to, to really, help them.
49:17
Being great clinicians because you are only one.
49:19
You can treat one patient at a time.
49:21
But this motivation also to multiply and to help others,
49:24
also to do great clinical work.
49:26
So thanks a lot for sharing today, Bilal.
49:28
Thank you.
49:29
It was a pleasure to talk to you both.
49:30
Excellent summary.
49:31
Thanks a lot, Andreas.
49:32
Again, thanks a lot, Bilal for joining us here.
49:34
It was a great pleasure.
49:36
So to our audience, I hope that we could spark, some new ideas with this episode.
49:42
If you liked it, please leave us a message.
49:45
please check out the different channels.
49:46
There is more episodes coming and there is already a quite large, let's say,
49:51
stash of episodes that you can, rewatch and watch out for the next episode.
49:56
Thanks a lot.