Latest / Straumann® ProTalk / Clinical edition: Ti-bases as the new standard in implant prosthetics with Vincent Fehmer (video version)

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Clinical edition: Ti-bases as the new standard in implant prosthetics with Vincent Fehmer (video version) · Straumann® ProTalk

0:00
Did I do any of these fundamental mistakes?
0:03
Can you remember of a situation in which you could think of "Hmm. I
0:08
wish I knew then what I know now."
0:11
When we just related zirconia to a framework material and we did beautiful
0:16
frameworks out of zirconia, very precise, but then we veneered them
0:20
completely, especially on implant borne restorations for full arches.
0:24
This was a very-
0:39
Today we're diving into a fundamental pillar of implant dentistry, the
0:43
restoration, and whether you work chairside or with the dental lab, this
0:48
conversation is for you 'cause we're gonna discuss the role of titanium
0:52
basis, the Ti- basis in today's implant dentistry and why it's not just a
0:57
technical option, but a vital element in all the restorative workflow for this.
1:04
I have the pleasure to have with me, Vincent Fehmer from
1:07
the University of Geneva.
1:09
He's a master dental technician and also the editor-in-chief of the International
1:13
Journal of Aesthetic Dentistry, and he brings this unique dual perspective.
1:19
One side, the evidence based formation, and on the other side, the daily work of
1:24
the dental technician, the dental lab.
1:27
Vincent Fehmer, what a luxury to have you with us at Straumann ProTalk Clinical.
1:33
I don't know if it's a luxury, but it's a true pleasure.
1:35
So thank you very much for having me.
1:37
Oh, we're honored.
1:39
Trust me.
1:39
I am particularly honored.
1:42
I would like to start, to begin with, when we talk about titanium basis and we
1:47
see out there commonly referred as Ti- basis, right In the Straumann variobase.
1:54
What is exactly we're talking about in today's workflow?
1:57
Why is it so meaningful today?
1:59
Yeah, first of all, I have to tell that obviously when you asked me
2:02
to discuss this topic, I was very pleased because this is a topic
2:06
that is very close to my heart.
2:07
First of all, it's close to all the dental technicians out there.
2:11
Performing and creating those restorations, but then also with the
2:15
team of with Irena Sailer, Joao Pitta.
2:18
We, just did a lot of research around the topic of the Ti- base
2:22
or Variobase as you called it.
2:25
why is it so important?
2:27
The bottom line, it, unites two worlds.
2:30
On the one hand side, it, enables dental technicians to, with their own
2:34
machinery, five x as milling machines to create dental restorations and connect
2:40
them with these titanium base abutment with the Variobase and thereby have
2:44
the implant manufacturer that performed the best possible implant connection.
2:49
The screw channel, the seating of the screw itself, everything up to
2:54
the standards that no laboratory would ever be able to produce.
2:58
So therefore, the Variobase or t base is exactly the link between
3:03
the laboratory and the implant.
3:06
I like how you phrased it because the restorative side has for many
3:11
years been perceived by many dentists as quite some quite cumbersome.
3:16
There's a lot of push and pull a lot of components to go through.
3:19
Yes.
3:20
And titanium basis, the Ti- base.
3:23
In Straumann universe, the variobase seem to have simplified a lot.
3:27
Is that really the case?
3:28
Absolute.
3:29
I mean in, yeah.
3:30
for all of you who are slightly older, just as we are, maybe not the latest
3:34
youngest generation, you will remember that we had these product catalogs
3:39
that were like little books, there was just an abutment for every indication.
3:45
screw, retain the double screw or even a triple screw.
3:47
there was nothing that didn't exist in, in all angulations,
3:50
in all rotation, in all heights.
3:52
And today, the T base Variobase, just, in a way unified all these components
3:59
and made the workflow so much more efficient and also cost effective because
4:05
in the end, the T base as a concept.
4:08
On an abutment.
4:11
and when you put a price tag to everything In the end, this is also
4:13
a relevant part of our daily routine.
4:15
We have to make accessible restorations for our patients.
4:19
And if you think back on all the UCLA type of gold abutments that
4:23
we have been using in the past, not only that, we had to have the.
4:27
The expensive alloy to it, but also those abutments were very expensive.
4:31
Just the physical abutment was expensive.
4:34
Plus then the goal to it and all the manual labor work that went into it.
4:38
And today we have something that combines both worlds and is very
4:42
price efficient and effective.
4:45
Maybe it's the better word.
4:47
You brought up the UCLA abutment, and this is, this goes hand in hand with my
4:52
next question because I was thinking, I. It needs to solve a problem, right?
4:57
We don't launch things to create more problems.
4:59
Yes, it needs to solve a problem.
5:00
And speaking of solving problems, what is exactly a key workflow
5:05
challenge or a material that this helped you work better with?
5:09
For example, I see this goes hand in hand with monolithic materials.
5:13
Yeah.
5:14
And digital workflows.
5:15
Is it just for that or what is it?
5:17
The challenges and the problems we're solving with type basis?
5:20
there's I think, two questions.
5:23
there's this.
5:23
Two questions.
5:24
So there are also two answers.
5:26
One big aspect is that for a laboratory, there is a huge
5:31
increase in efficiency and.
5:34
user friendliness in the terms that it's very easy to just buy a certain
5:39
range of titanium basis covering certain implant dimensions, on the implant
5:44
manufacturer that you're working with.
5:46
Yeah.
5:46
And that's it.
5:47
So you have a, an easy stockage as we say.
5:51
That allows you to then deliver restorations with a very,
5:55
predictable turnover time.
5:57
that is one aspect when it just, is the ease of use and also the
6:01
integration in the workflow that, that simplifies the entire process.
6:04
Extremely.
6:05
Because you can just reference it, it goes down to the library.
6:08
You have the perfect piece there.
6:10
You don't have to wait for anything.
6:12
Then when it comes to the.
6:13
The quality of the final restoration.
6:16
when we now think back of all the individually made and performed abutments,
6:22
there was a lot of labor work into it, a lot of manual craftsmanship that went
6:27
into creating and shaping a telescopic abutment into something individual.
6:31
creating an individual abutment either by means of digital
6:35
technologies or by means of, casting two, type of UCLA abutment and.
6:42
That then went on that you would have to.
6:45
Invest those abutments, then go into a heat cycle, then, have the lost wax
6:52
technique, then pour the gold inside.
6:55
Then you would have miscast.
6:57
There was all these kind of users, user, interface that was
7:02
very challenging and demanding.
7:04
And then again, divesting it, sun blasting all these critical
7:07
interfaces, which is something that you want to keep absolutely pristine.
7:11
You don't want to touch the internal surface of the implant geometry, but
7:15
just by default, in order to get it de invested, you had to sun blast it.
7:20
Also, the screw head position you had to sun blasts it.
7:23
Yeah.
7:23
So all of these things are basically not ideal for these geometries,
7:29
for this kind of final product.
7:32
So with the T base.
7:34
There is something created for us that allows us to.
7:39
Leave these surfaces absolutely pristine as they were developed
7:43
by the companies, and that makes it such a great, device for me.
7:47
This is something I was reflecting because in your experience with the
7:50
RA base, you mentioned that you have to back in the days, Two elements I
7:56
would like to discuss with you quickly.
7:58
As you mentioned, you have to invest and then cast in some
8:02
blast, and as you mentioned.
8:05
Age factor, let's put it that way.
8:07
Yeah.
8:07
There was a belief that restorative schemes should follow a stacking approach.
8:11
There was a cascade of forces.
8:14
Yeah.
8:14
And today we're going more directly towards implant true
8:17
direct to implant restoration.
8:20
And in your opinion.
8:22
What kind of feature or design is embedded in such a component that
8:27
makes this a trustworthy component to move forward in long-term success?
8:31
Yeah, this is a very, good question and I have to tell you, we are now
8:38
using thet based concept, the bio-based concept, since it has been established,
8:43
since it exists, we are using it even before some other manufacturers.
8:49
But we don't have the long-term evidence, if, especially today,
8:53
focusing on high strengthen, zirconia as a restorative material.
8:56
So we are connecting a very strong restorative material with a titanium, base
9:01
abutment that enter, enters the implant.
9:03
And then obviously the weak part in the middle should be the screw.
9:06
If something happens, it should happen ideally to the screw,
9:10
but is that the best solution?
9:12
Comparing it with the past where maybe we had, like you, you explained it perfectly
9:17
well, a stacking kind of scenario with even a prosthetic screw that certainly the
9:21
implant would never be harmed or damaged.
9:25
So having said all of this, what we could refer to is the research that Irina has
9:30
been doing for such a long time looking also into zirconia abutments and that
9:34
is, I think a very great example of what could happen if you have, for example,
9:38
a screw loosening and then there's a zirconia abutment that would literally.
9:43
Be able to.
9:45
To harm or damage the interface of the implant, which is the absolute
9:49
no-go scenario you wanna have because everything can break, but
9:52
the implant has to stay perfect.
9:55
So for this reason, now that we are combining titanium with titanium, at least
10:00
both of the sides are equally strong.
10:03
Which is I think, a good thing to have.
10:05
And then, for implant surfaces, you even have the rock solid.
10:08
so slightly improved strength of the titanium versus the abutment, which
10:13
again, helps a bit to make sure that if something, has a certain fatigue
10:18
or whatever happens, it happens on the abutment side and not on the implant.
10:22
But do we have 20 years long-term outcomes?
10:27
Unfortunately not.
10:28
But today we have good reasons to believe we're in the right track.
10:31
Absolutely.
10:32
Absolutely.
10:33
And taking in perspective, you have.
10:37
With you, the work you do at University of Geneva, but you also together with,
10:42
because of the journal, you interact with many colleagues out there.
10:45
Yes.
10:45
And to which percentage?
10:47
To what percentage you see the world is moving towards T
10:51
base or how is this balance or
10:53
Yeah.
10:55
This is one of the great pleasures and luxuries to, to be an editor for such
10:59
a journal that you're really constantly exposed to the latest, literature.
11:04
And also working at university where we also have the journal clubs and where we
11:08
read a lot or listen to a lot of things.
11:12
The Tai base concept or the Variobase, obviously is related
11:16
to the implement manufacturer.
11:18
So what you will see is that for some clinicians it is the absolute 95% of all
11:25
their restorations are solved with a Ti- base, concept, and that is very clear.
11:29
And then there might be some special indications where maybe I can't deliver,
11:33
maybe something that, still makes them.
11:36
Deviate from this path and create an individual abutment, full
11:40
titanium, whatever they look for.
11:43
but then for some other manufacturer of implants, the versatility, the
11:48
flexibility that the T bases offer.
11:52
there's, they're just not that large.
11:55
They're, there's just not such a range of Ti- bases that fulfill all the requests.
12:00
So for some of them, the Ti- base only works for a single implant restoration.
12:04
I see.
12:05
So then automatically, once you move to multiple unit restorations,
12:09
you have to deviate from the plan.
12:10
And then some other manufacturers, they don't offer T bases at all.
12:14
So I think if the implant manufacturer today offers T bases.
12:20
And those tai bases in a, let's say, well-developed state, then the
12:25
laboratory workflow in particular digital supported with the libraries
12:32
will lead to the clinician transitioning more and more towards the tai base.
12:36
I like this, and you phrased it really well with the
12:40
digitally supported libraries.
12:43
I would like to pick your brain on a, with a bit of criticism towards the
12:46
dental community, we should all approach our cases top down, restorative first.
12:52
We figure out everything else later, not the other way around.
12:55
Yeah.
12:57
With digital technologies, we have a unique opportunity to really see
13:02
this, how we will look in the future.
13:04
Yeah.
13:04
However, now looking from the dental laboratory reality.
13:09
Is this being reflected or we can improve on our planning?
13:14
What I'm trying to say is that.
13:17
Are we still far behind that implants are being placed, not taking proper care
13:22
of the future restoration, then they get scanned and you have to figure it out
13:26
later, or this is already changing too.
13:28
Yes.
13:29
first of all, I guess every lab technician knows, or is to some
13:33
extent put you in a corner.
13:34
Yeah.
13:35
and acrobat, that has to be able to, once in a while, do a flick flag.
13:39
Yeah.
13:40
Even that he, he doesn't feel comfortable with it, but it's just, something that.
13:44
it, it even can lead to an old implant that has been placed 20
13:48
years ago and that has to be re restored what, whatever the means are.
13:53
I, perfectly, I'm aware where this question is deriving from, but what I
13:58
want to say is that in environ, in my little environment with my laboratory
14:03
with five clinicians that I. Work with, trustfully for many years.
14:10
there is no implant placed without a prosthetic reference.
14:14
And that can be just in order to avoid any kind of misunderstandings.
14:18
This can be, based on a two-dimensional x-ray, but there
14:22
will always be the prosthetic reference on a conventional guide.
14:25
There will, it, it can be the most straightforward, just, giving a
14:30
huge occlusal hole that we reassure, the occlusal screw attention.
14:35
And then it gives the CEJ of the future crown margin so that the implant
14:39
depth, which is absolutely critical for exactly this question that you raised
14:43
right,
14:44
will end up in the right depth.
14:47
and that makes all the difference.
14:48
That makes all the difference in the world because that allows you
14:51
to use straight components with.
14:54
An, a natural emergence profile with a proper gingival height, ev elevating
15:00
the cement layer away from the bone.
15:03
All these important aspects there then incorporated into the restoration.
15:09
that is this small microcosmos that I live in and that I sleep at night quite well.
15:15
I have to say.
15:17
But then I also know from many colleagues that, sometimes obviously implants are not
15:22
placed and planned, prosthetically driven.
15:25
And then t bases have to be the solution to everything.
15:28
Obviously they will also reach their limits.
15:31
And then sometimes you have to do individual abutments and sometimes
15:35
it's just, it'll remain a challenge, in order to create something that
15:39
more or less looks natural and is cleansible at the same time.
15:43
I like this.
15:44
That's very clarifying.
15:46
And the majority of the cases, do they come to you already with a pre definition?
15:51
Let's assume you have.
15:53
Have a referral base.
15:54
Yeah.
15:55
And from a prosthodontist point of view, does it come already with a
15:59
pre-design or a pre wish to you?
16:02
Or you go from the scan, you go top down.
16:04
The reason I'm asking is this question here, I would like to, if I need
16:11
your service now I scanned it and now I would need to create that crown.
16:17
Could you walk me through your Vincent Femr?
16:21
Journey through getting from point A to point B. Okay.
16:24
You got the file from now.
16:25
What, what happens from now on?
16:27
What happens?
16:27
What,
16:28
yeah.
16:28
this is, it's very good.
16:29
And obviously I think on a general note, before we dive into the A, B, C,
16:34
D, E to get to the final, we have a. A, a more global discussion with all my
16:41
customers and they will tell me what they like, how they, they want to connect to
16:48
implants when they're next to each other.
16:50
They prefer, if a distal extension, then it should only be a primo.
16:54
all these individual things that.
16:56
They might vary between clinicians, but this, having said this happens
17:01
maybe once a year or every two or three years, when there has to
17:04
be an adjustment, to some extent.
17:06
Otherwise it's autopilot.
17:08
And then I know exactly what, what is their vision, what is the
17:11
type of implant that they place?
17:13
Tissue level here, bone level there, because that might all have an effect.
17:17
But then you know, the, you sent me the data basically.
17:21
Now what happens next is that.
17:24
if you send me just scans without a cone beam, I will create a WhatsApp.
17:29
if there is a single tooth gap, it is usually very straightforward
17:33
and I will use the neighboring teeth as a reference and I will
17:36
create the perfect tooth really, regardless of the surrounding tissues.
17:43
If there's a huge defect, I will not care.
17:45
I will just deliver the final.
17:46
Perfect.
17:47
Tooth as a surgical template.
17:50
That's it.
17:50
And then the clinician will do all his rationale from there on because
17:54
only he can then literally decide it.
17:56
Can he augment to some extent?
17:58
is there a chance to reach this goal?
18:00
Yes and no.
18:01
And then he will place the implant accordingly.
18:03
So you will send a virtual file
18:05
no,
18:06
to him first.
18:06
I will send him immediately.
18:08
The final surgical guide.
18:10
Clear that is the straightforward, based on only two dimensional x-rays.
18:16
no 3D planning.
18:18
However, if we go to a three dimensional planning with the aim of guided
18:22
surgery, which is maybe 50% of, then the cases, 50% is just a conventional,
18:27
straightforward, surgical guide for the guided implant placement.
18:32
I will upload all of those things.
18:34
Into whatever software we use can be code agnostics can be others.
18:39
They all function more or less the same with different AI integrations.
18:43
I will go through the segmentation.
18:45
I will prepare everything, and obviously I will create the WhatsApp in this software.
18:50
If I can integrate it in there with the tools of the software,
18:53
like in code agnostics, fantastic.
18:55
If the software doesn't allow you to, then I will upload it done in another software.
19:01
Exo card or three shape, whatever, and then it's again on the side
19:06
of the clinician to then plan and place the implants virtually.
19:11
And obviously then I will come back into the game and create a surgical template.
19:17
Sometimes it happens that we are just not sure, avoiding a sinus lift to implants.
19:24
Two premolar, distal count liver versus a three or four unit bridge, and then,
19:29
placing a third implant or a second implant in the second molar area.
19:34
Just one example basically.
19:36
And then I will get this advice and written or this request in written.
19:41
And the great thing is today you just save version one.
19:46
Has two implants in the premolars with a distal cant liver.
19:48
And then I will quickly design a second version and I will do the
19:52
four unit bridge, for example.
19:53
And then the clinician again can perfectly understand what happens if he
19:59
chooses which of the treatment options.
20:02
And this is phenomenal to me because first of all, this is timely disconnected.
20:07
I know exactly what I have to do.
20:08
I can do it whenever I have time.
20:10
I then push the ball back in your field.
20:13
You plan the implants, you give me the thumbs up, I create a surgical
20:17
guide, send it back to you, and you then go on to place the implants.
20:23
Take an optical impression maybe on the day of implant placement if
20:26
there's primary stability, fantastic.
20:29
I can already work with the data to either create a provisional or in
20:32
most of the cases, especially in the posterior area, to then already come up
20:36
with the final, zirconia based crown.
20:39
On a type base, obviously.
20:42
and let's assume I already have my implanting position.
20:45
I just need the restoration because now I understood where you came from
20:49
because I was asking directly about the restoration, but then you were even one
20:53
step behind as how it should be Yes.
20:57
Properly.
20:58
Helping, having that proper discussion even before the surgery.
21:02
Yeah.
21:02
Now, let's fast forward.
21:04
This implant is already also integrated.
21:07
I did the optical scanning I forwarded to you.
21:11
Yeah.
21:12
What will be your next steps?
21:14
My next steps are completely by autopilot.
21:16
I know exactly by a mutual understanding what type of abutment is our
21:22
preferred, what type of gingiva heights are preferred by this clinician.
21:26
And according to this, I will always use, the longest possible abutment height.
21:31
This is the always the first step.
21:33
when you start the case, you literally have to pick the abutment,
21:35
not the gingival part.
21:36
The longest upper part.
21:37
The longest upper part, right?
21:39
When it comes to the gingival part, obviously always the
21:41
further away from the bone.
21:43
From the implant shoulder, the better it is, but it cannot interfere
21:47
obviously with the clinical, scenario.
21:49
So at one point you have to create a transition zone and you have
21:52
to create the emergence profile.
21:53
And it has to be not round in a cross-sectional terms, but it has
21:56
to be three dimensional tooth shape,
21:59
right?
21:59
So there is to some extent then the limit.
22:01
And then I will, once this has been selected, then I will
22:05
digitally design the crown.
22:07
according to the occlusal scheme, that again, is, is mutually agreed on, but
22:13
not for this individual patient, but.
22:15
Again, once per year, something that, this customer likes the contacts in
22:20
that way, proximal contacts in that shape and form, all these kind of
22:24
little details that still, they play a crucial role, to how you like to
22:30
integrate and deliver your restorations.
22:33
And then the whole thing will be processed, created, milled, centered,
22:37
stained, glazed, veneered, whatever it takes, depending anterior, posterior.
22:42
Assembled sent back to the clinician.
22:45
Hopefully the patient will be better off with a great looking crown.
22:49
Do you send the radio back to the clinician pre cemented or you give some
22:53
buffer for adjustment prior to cementing?
22:55
No, I, on a, obviously there is restorations and restorations.
23:00
let's imagine we are doing a super complex anterior six unit restoration.
23:05
You don't assume that this is gonna land on day one, so you could just.
23:08
Pre cemented with some tampon or fast glue, whatever you want to use that is
23:13
easier to dissemble, dis disassemble.
23:17
but on a day-to-day routine, everything is finalized and best
23:24
case scenario, everything works well.
23:27
The bridge integrates well.
23:29
The crowns integrate well, occlusal adjustments, they might be necessary, but.
23:34
Clinicians are perfectly able to do polish them up, deliver the case, and that's it.
23:40
And luckily, knock on wood, that works for quite a bit.
23:44
And then obviously, then some restorations are lacking a contact point.
23:48
Color is of shape, is not, I, all the things that, that we are not machines.
23:54
I would.
23:55
Love to be one to some extent.
23:57
Yeah.
23:57
on, on my efficiency terms, but, I have a good day and a bad day.
24:02
And this reflects then again, also on, on the way that I'm
24:05
mastering each, restoration.
24:08
Better or worse.
24:10
Vincent, for clinicians that are working, with restorative solutions
24:15
chair side and they're listening to us or even, colleagues, master
24:19
dental technicians, do you have any.
24:22
Preference on how you do your cementation protocol or this is standardized?
24:28
Yeah.
24:28
obviously there is a huge.
24:31
Load of work and it was a huge amount of fun.
24:35
Also, again with Irena and Jo and, Felix Bohart at the time to, to go
24:40
through these kind of procedures.
24:42
What is the best cement protocol?
24:43
What is the best surface treatment?
24:45
Air abrasion versus no air abrasion in the beginning, Ti- bases were categorized
24:51
as stock abutments, and you are not allowed to air rate a stock abutments.
24:55
it was an issue.
24:57
if you wanted to have, Straumann being okay with you interfering
25:01
with the components, we had to also tell Straumann, look, we have to
25:05
sun blasts those, machine services.
25:08
Otherwise we will not get the proper bond strength that we need.
25:11
And we might run into d bondings.
25:14
so obviously a few years passed on and today we are looking into
25:18
completely different surfaces and, we are on another level.
25:21
We don't have to air braid them anymore.
25:23
We just have to apply a proper bond and silent system and
25:27
also for aesthetic reasons.
25:28
This gives a huge benefit.
25:30
But making a long story short, if you also ask for the focus on, chairside dentistry,
25:36
and there the big problem is that.
25:40
you have this implant solution blanks.
25:42
when we especially think of the CEREC systems, and then you have
25:46
the value-based C, for example, which is value-based for cerec,
25:50
right?
25:51
that then works very well in, in that kind of closed workflow to create a
25:57
primo or a molar crown or even an.
25:59
even an anterior restoration.
26:01
But obviously then chair site comes to its limits with the aesthetic integration.
26:05
So that is a fantastic solution.
26:08
it offers.
26:09
Really a benefit to to, the customer, the patient, because
26:13
he can have his crown in a day.
26:15
Obviously, there is no lab in the middle.
26:17
That also reduces the cost to some extent.
26:20
But then the problem is that all the developments into more modern, scalable
26:25
T bases, more concave emergence profiles, different gingival heights, all of
26:31
them, they're not to be applied in this kind of closed workflows because
26:35
it always has to go back to these.
26:38
I don't want to say old, but in a way, old geometry, which is the SEI connection
26:42
with this one anti-rotation feature, which is really limiting the potential
26:46
of the T base and has nothing to do with the Variobase that we use today.
26:50
So this works well for maybe premolar molar restorations to some extent,
26:56
but we want to utilize the modern geometries of those components.
27:02
And we can only utilize them with the proper five Xs milling machine.
27:06
and you cannot work with these, prefabricated blanks with a hole,
27:10
even though it might be very convenient, but it just doesn't work.
27:14
Yeah, I see exactly what you're saying.
27:16
And this extension, for example, on the Straumann side with
27:19
the new Vari based family.
27:20
Yes.
27:21
The vari based XC with higher cutting possibilities to customize, surface
27:26
treatment already from the factory.
27:29
It was quite a relief, huh?
27:30
Ah, fantastic.
27:31
you could say that the value-based, the nor the first line, for
27:36
on, on crowns on single crowns.
27:38
Already performed and was a huge upgrade, performed very well.
27:43
but then there was this clear kind of, next logic step, which just make it
27:48
scalable, make it more concave, following the latest literature and research.
27:52
But beyond that pain, all, beyond that point, also doing this kind of, surface
27:56
treatment doing to basically not having.
28:00
To have the dental technicians error rate the surface is another great advantage.
28:06
but the biggest game changer here is multiple unit restorations because
28:10
there the, shift from value-based to value-based exceeds is tremendous.
28:16
This is like a, coming from, I dunno, where to start the Middle Ages.
28:21
Medieval times and now going into a state of the art of dentistry
28:26
where we are, because there's, the step is huge, basically.
28:29
while the step from the Variobase to the Variobase exceeds is
28:34
still huge, but it's not.
28:36
This huge jump anymore.
28:38
Yes, we are.
28:40
In fact, I see we're very good eyes.
28:42
We're leaving a very, fortunate moment with our very base family.
28:47
Absolute
28:47
big kudos to the research development and innovation team as
28:51
Straumann for such an achievement.
28:53
Yeah.
28:53
Facilitating everybody's life.
28:55
Yep.
28:56
Vincent, I would like to shift gears a little bit.
28:58
We discussed about this topic that is called, it's not what we think.
29:02
It's what we know.
29:03
Yeah.
29:04
And I asked you ahead of time if you have, or if you could highlight one article that
29:09
for you as a professional, on a, even on a personal level, that opened your eyes
29:15
to a way of seeing or doing your work or even shifted to a different direction.
29:21
And you highlighted this one paper, which Irina Seiler
29:25
authored, and you also co-authored.
29:27
together with many great colleagues and it's called fracture strength of
29:31
zirconia, implant abutments on narrow diameter implants with internal and
29:36
external implant abutment connection.
29:38
I study on titanium resin based concept.
29:42
Sorry for the long title that I made you go through, but that's how it works.
29:47
Nothing personal.
29:48
No.
29:48
But walk us through because I really like how when guests come and they
29:53
say, this was really meaningful to me.
29:55
Professionally and personally.
29:57
Why was that it for you?
29:58
Yeah.
29:59
that this manuscript, even though it was only published in 2018, is basically
30:03
the first manuscript or one of the first manuscripts, focusing on modern tie basis.
30:09
Yes, it is on narrow diameter implants.
30:11
That, that just pushes the envelope further, but it, I think still it doesn't
30:15
matter because what it shows is that.
30:18
We have been, or Irina has been doing a lot of research on full
30:21
zirconia abutments and they obviously have a huge aesthetic benefit.
30:25
and they're also, the cares abutments from Straumann with the CrossFit
30:30
connection, they, they really performed, spectacularly well.
30:34
but then also we saw quite some failures, associated to them.
30:39
But, they had all these.
30:40
Aesthetic benefits.
30:41
And then obviously the gold standard at the time for us was,
30:45
the cares titanium abutment.
30:47
So an individually shaped titanium abutment manufactured
30:51
from the implant manufacturer.
30:52
So original.
30:53
Original.
30:54
And that would imply then a cemented restoration on top.
30:58
This could be even cemented.
30:59
Extra early in the laboratory and then still be in occlusally screw retained.
31:03
But obviously you see that first you have to have Straumann and produce
31:06
an individual component for you.
31:08
It has to be sent.
31:09
It is more, expensive to produce and.
31:14
then where was the balance when to apply?
31:17
the full zirconia abutments, when to apply the full titanium abutments.
31:22
And obviously this was all digital manufactured based on digital data, but
31:28
it was always as a split file, so you had to have two components manufactured.
31:33
One you could do yourself, the other one was manufactured by Straumann,
31:36
and then, we could assemble the final crown for the patient.
31:40
And then this is the interesting part, why this study changed the way that we
31:43
perceive things and that we, how we work.
31:46
We integrated the tase as one of the control groups.
31:50
So this was the first study then the tase was part of, and the great thing is
31:55
that if you, we age those components for five years, and then we fractured them.
32:01
And what you saw is that.
32:02
Obviously all these zirconia abutments, they would literally
32:05
fracture, like you envision something to fracture just breaks through
32:10
typically in the internal connection.
32:12
but then the gold standard, like a metal abutment, you see
32:16
this kind of, fatigue influence.
32:19
And then at one point there's a bending, a mechanical movement and
32:24
normally at some point the screw head, let's go, but there is no fracture.
32:29
It's just a bending, it's just a defamation.
32:31
And then you saw our control group, which led to this combination of a tie base with
32:38
an abutment to the exactly same, failure behavior as the gold standard, which was.
32:44
The titanium base abutment, the titanium abutment, the
32:47
individual titanium abutment.
32:48
So that led to us understanding that, hey, that high base, not only
32:54
that, it's very efficient in the workflow, it is very precise in
32:59
the way that we can engage with it.
33:02
It is also performing just like our gold standard.
33:06
That is what we were looking for, we don't have to be better than the gold standard.
33:10
It would be nice, but at least we don't want to be worse than it.
33:14
Yes.
33:14
We don't wanna lower the barge Exactly.
33:16
Just to be efficient.
33:17
So we could move and merge those two worlds.
33:19
On the one hand side, being efficient, being cost efficient, effective,
33:24
and still being super stable.
33:26
And that is what this study showed.
33:28
and ever since we have published this study, we followed up with multiple
33:32
other studies, then looking into surface treatments, looking into different
33:36
heights, looking into different cement systems, to make sure that those
33:40
restorations then not only are cemented there, but they also stay cemented
33:45
and different restorative materials.
33:47
the whole thing that, that then followed up on it.
33:49
I like this very much because this gave you.
33:52
A foundational trust to the component itself.
33:57
And from this moment on the quest was what would be the right material to be onap?
34:03
That's your research line now?
34:04
Yes.
34:05
Basically.
34:05
So we went on and on and the great thing is that something that Iena,
34:10
I think understood early on is not only following certain ISO norms with
34:14
certain angulations and how to chew on something for how many times, but it
34:19
was also to try to make those different research lines with the different
34:23
various abutments always comparable by having always the same master.
34:28
Outer design shape, basically.
34:30
So all these different research lines that stretch out now over 10,
34:35
15 years, they all follow the same.
34:39
basically geometry of a final restoration.
34:42
So you can more or less compare all of them among each other and now going into
34:46
the different restorative materials that, that we are focusing in today, again, we
34:51
can compare them to the initial studies, which just, gives more fun and a better
34:55
understanding for what you can do.
34:58
And I don't wanna leave this podcast without mentioning that to all
35:04
of you that you are in love with.
35:07
Individual abutments, cat come fabricated individual abutments.
35:11
This is always and will always be the gold standard.
35:15
Nothing will ever be better than this.
35:17
For a patient created components, that's the best.
35:23
But in terms of efficiency, in terms of,
35:28
the financial aspects, the T base seems to be the best kind of
35:33
balance between all the worlds.
35:36
That you can combine.
35:37
Yes.
35:37
Put it right in the middle.
35:38
Exactly.
35:38
It suits.
35:39
Yeah.
35:41
I love it.
35:43
Vincent, building upon this conversation that you've been working on Evidence
35:48
and Research Bay to put the foundation of your thoughts and directions you're
35:54
going, you've come to this moment.
35:57
But it was not always that way.
35:59
First.
36:00
Your knowledge base and the technology.
36:02
Yeah.
36:02
And we have this section called Experience Taught Me this.
36:05
Can you remember of a situation in which you could think of a, I wish I knew.
36:11
I wish I knew then what I know now.
36:14
What I wish I had, then what I have now, I would've approached in a different way.
36:19
Is that a situation you can remember?
36:21
Yeah.
36:22
you see that?
36:24
when I start my profession, when I started, everything was completely
36:27
analog, so that might, I'm 45 now, but still it's like I'm in this
36:32
profession now 25 years, so it's already quite some years on my backpack and.
36:39
Obviously I would have loved to know then what happens.
36:44
for many reasons, we
36:45
only could.
36:46
Yes, but we will never get to this point.
36:48
But, I have to say that I'm extremely happy that I learned it the analog way.
36:54
I learned morphology the analog way I learned to wax up.
36:57
I learned to do all those things because in this digital environment, a lot of it
37:02
is supported to some extent today, even by AI or by algorithms that help you
37:07
align morphologies and snap morphologies to something that has been preset.
37:13
but.
37:14
I still understand the fundamentals.
37:17
I still understand why a cuspid has to be where it has to be and,
37:20
why you need freedom and space and movement at certain other areas.
37:25
So for these things, I'm happy.
37:29
I would have loved to know what happens, where we are today.
37:33
For me, a lot of things in our profession are still common sense.
37:37
When I looked into the first abutments for multiple unit restorations,
37:41
not on multi-unit, it's always a bit difficult to, differentiate.
37:45
Yeah.
37:45
If you don't have a picture in the background, but if you think of a three
37:48
unit bridge, you would guide, go directly to the implant level, and then I saw for
37:56
many years, components that were conical.
37:59
Because it just made the workflow more easy.
38:01
So you were non engaging and conical on top.
38:04
And then for me it was absolutely clear that this doesn't make any sense.
38:09
I could use the best surface pretreatment on both sides.
38:12
The zirconia as a bridge, as well as the titanium, as a base.
38:17
But there will be lateral forces that eventually will lead to a Deb bonding.
38:21
This is just one of the examples.
38:22
So if you look at it with common sense, you will understand
38:25
this is not gonna work.
38:27
So what we did is we used abutments for crowns in order to have cylindrical
38:31
components that, would give more resistance, more surface, more everything.
38:38
Did I do any of these fundamental mistakes?
38:42
I went through all the mistakes.
38:43
I went through all the failures that if you wanna pinpoint one, I could
38:49
basically go back to the starting point of zirconia when we just.
38:55
Related zirconia to a framework material, and we did beautiful
38:59
frameworks out of zirconia.
39:01
Very precise.
39:03
Beautiful to some extent, but then we veneered them completely, especially on
39:08
implant born restorations for full arches.
39:11
This was a very.
39:12
Costly mistake.
39:14
Luckily for me, I was not self employed at this point.
39:18
So the financial impact was, on, on the one hand side on, on my previous bosses.
39:27
And then today it was, it went back to the university.
39:31
So seeing all these failures, I would have loved to have the vision for utilizing
39:36
it immediately in a monolithic shape.
39:39
But also I have to say that the milling capabilities, the design
39:43
features that were all not there yet.
39:45
Yeah.
39:46
To create a morphology, both occlusal and bcal approximately.
39:52
That, that, that would actually have looked like a tooth.
39:55
So it was just a matter of time and, certain things you just have to learn.
40:01
That they don't work.
40:02
And that's it.
40:03
You mentioned the framework, and that's a very, how would I put this together?
40:11
That's a very dangerous setup, I would say, and in the majority of the cases,
40:16
the question I just asked you, for example, if it's a crown and years later
40:20
you can always start over and you do another one, but in a full arch context
40:26
can be quite cumbersome and expensive,
40:29
I have
40:29
to say.
40:29
And expensive.
40:31
But at least there's not one situation that you could remember
40:34
that the restorative choice affected the whole biology there.
40:38
Yeah.
40:39
None.
40:40
Honestly, obviously, yes, because, you see the first generations of
40:45
T bases, again, certain ones that.
40:50
they would allow the system only to produce, let's say, sorry, it's technical,
40:55
but it's let's say a gingival height one,
40:56
right?
40:57
and some of them would then create very steep angles.
41:04
like having a 60 degree, abutment angle, right?
41:07
Within one millimeter gingival height.
41:09
So that was literally like a, it's like close to 90 degrees, so you can imagine
41:14
we called them the sombrero heads and they really had a severe biologic.
41:20
Negative impact that led to bone loss associated to those
41:25
kind of clearly Ti- base.
41:26
So it was just the Ti- base one, the implant was perfectly fine.
41:30
and before we then delivered those final restoration, and then you had this
41:34
absolutely un physiological abutment design that led to biologic impact.
41:39
And that is certainly something that, yeah.
41:44
I wish that we went not through this phase.
41:47
Jump started directly to today.
41:50
Exactly.
41:51
here we are.
41:52
We learned a lot.
41:53
you also have to keep in mind that this comes from a time where we.
41:58
Would create individual abutments with a lot of, contour supporting tissue.
42:03
So we have a very convex, really filling the space, thereby thinking
42:09
that we would support, the surrounding tissues and prevent them from,
42:14
basically ation or disappearing.
42:18
So we learned a lot, all of us in terms of a dental community
42:23
and to know today we know better.
42:25
And luckily today, also the industry provider listened and
42:29
then came up with components that enable us to, to work properly.
42:36
Listen, before we start heading towards the end of our conversation,
42:43
We've come long ways, right?
42:47
What do you imagine we could go next that will make your life even easier, let's
42:52
put it that way, and that you don't have this conversation 10 years from now, and
42:58
you say, I hope I knew in 2025 what I know now in 2035, which you're missing today.
43:06
I would really love to tell you something because it.
43:09
Obviously also would make me look good or sound good.
43:13
but
43:16
I know that, I don't know, I really understand one thing in
43:20
my life that I. I'm surprised by what comes around the corner.
43:26
We are privileged and happy to see certain degrees of developments by
43:31
industry partners that we trustfully collaborate for many years.
43:35
That we have a certain, sneak and peek into new developments that, maybe
43:40
before they come to the market, we can already work with them or test them,
43:43
or you at least give certain feedbacks.
43:46
That is fantastic, but this is like something that.
43:49
We are looking into the future of one or two years.
43:52
I know there will be more of printing, there will be more of printing, even
43:55
high strength ceramic materials.
43:57
I, this is in to some extent logic, but I assume that in five or 10
44:02
years from now, we will again talk about completely different things
44:06
that again, I don't dare to imagine.
44:09
And also I don't have a proper imagination, so I just can't
44:13
say a proper answer to that.
44:14
And that's a lovely answer already because look, that makes us.
44:19
Healthcare providers.
44:21
Yeah.
44:22
What you're saying today, it means that you feel completely comfortable
44:26
that the technologies that we have today at our hand, yeah.
44:30
we feel good working with, we feel good that patients are in the center
44:35
of everything we're doing safely.
44:37
And what else?
44:38
What else can we expect?
44:40
Good days, huh?
44:41
Yeah.
44:42
definitely.
44:43
what, let's assume that everything that comes beyond today, is gonna
44:49
improve the workflow either in terms of accessibility, efficiency, price
44:55
effectiveness, all of these things should be in favor of something.
45:00
I don't think we will step back in time.
45:02
So it is, it ends up being good for the patient, ends up being good for
45:06
the communication, for efficiency.
45:08
all these things I assume.
45:10
Will be to some point beneficial, but what we are, the type of healthcare
45:15
that we are able to provide today, utilizing the new technologies with,
45:20
let's say, the Variobase in the center.
45:22
One could pick other centers.
45:23
It doesn't matter, but it is a, I think a great period, a great time, and we deliver
45:31
fantastic rehabilitation to our patients.
45:35
Vincent, this for me was a masterclass.
45:39
I wish you could have a whole day here with you.
45:43
I learned tons.
45:44
And to everybody who's watching us today, where can they find you to about your
45:50
educational offerings, the journals you're involved with, how they can start going?
45:56
Yeah, first of all, the journals are a lot of fun together with quintessence,
46:00
the International Journal of Aesthetic Dentistry or Acuity, have a look at it.
46:05
We also published a full book on fixed rehabilitation, that is
46:10
can also be interesting for you.
46:12
You can find us, the entire team at University of Geneva on the homepage,
46:16
all associated with our names, and email addresses so you can always reach out
46:21
for the, for the ones you know that even imagine to travel to Switzerland.
46:26
We also have tons of courses that we offer but even if there is no course
46:31
and you just want to go to the French Alps to ski or to the Swiss Alps,
46:35
just reach out to us and there is always open doors we show you around.
46:40
We have constantly guests, so there was like always space for one more
46:45
and all, obviously we are always on social media, so if you wanna reach
46:49
out to us, I'm sure you will find your means and ways to, to connect to us.
46:54
And, yeah, I can only invite you all to Geneva and, if you're interested in what
47:00
we have just discussed, listen to more from us or also share your thoughts.
47:07
There is always new ideas.
47:10
That also, we are constantly surprised what people are doing and we try to learn
47:16
from everything that you have to teach us.
47:19
Vincent, it was a pleasure.
47:21
Thank you very much for all this.
47:24
My pleasure.
47:24
Thank you so much for having me.
47:26
And to all of you watching us today.
47:28
We're gonna leave the links, how to access his social media accounts, have
47:33
access to the links he mentioned at University of Geneva, and also the
47:37
journals Vincent Fehmer is involved.
47:40
If this episode was relevant to you, make sure you comment.
47:44
We need that comment to know which direction we go if we're doing
47:47
the right things, or where we can improve until the next episode.