Latest / Straumann® ProTalk / Straumann® ProTalk with Dr. Prof. Daniel Buser (video version)

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Straumann® ProTalk with Dr. Prof. Daniel Buser (video version) · Straumann® ProTalk

0:13
Daniel Buser: You're going to be surrounded very quickly by Did you
0:15
ever consider not to go into academia?
0:18
I talked with my wife thoroughly about it and she said at the end, let's go for it.
0:22
And then I told him yes.
0:24
It was before we had GBR.
0:26
So then after 10 years, I told the lady, look, I'm so sorry to tell you,
0:30
but I cannot place an implant here.
0:32
Andreas Utz: What is it what you learn from this, sports career
0:34
for your professional career?
0:36
What is it what you transfer from it?
0:38
Daniel Buser: In sports, you learn to win, but you also learn to lose.
0:42
That means when you have a negative experience, you learn to stand up
0:46
very quickly and just go ahead.
0:48
George Räber: When you look back at dentin pathology, What are
0:51
some of the defining moments?
0:53
Daniel Buser: We should stop to use this differentiation
0:55
bone level and tissue level.
0:57
Because we have to say we have hybrid implants and they will give us a chance
1:01
to reduce the prevalence of infections.
1:03
That's the very exciting news we have these days.
1:07
For all our colleagues,
1:12
Andreas Utz: welcome to Pro Talks, the path of dentistry,
1:15
the first episode of our podcast.
1:17
My name is Andreas Utz, and together with my colleague and friend, George
1:21
Reber, it's our pleasure to host this series of inspirational conversations.
1:27
In this podcast, we engage with remarkable personalities in dentistry.
1:32
We discover their personal development journeys.
1:35
We talk about their pivotal moments in their career that helped
1:39
shape them who they are today.
1:41
We talk about clinical innovation.
1:43
We talk about technology.
1:44
And of course, we talk about the future of dentistry as well.
1:48
For this first episode, I'm very pleased and very honored to have and to welcome
1:54
a very special guest, Professor Dr.
1:57
Daniel Buser, Danny.
1:59
Thanks for being with us.
2:00
It's a special honor to have you today.
2:03
I think, Danny, you literally need no introduction or very little introduction.
2:07
Everybody knows you in implant dentistry, but, you've been for 19 years.
2:11
You've been the dean and the head professor of the oral surgery department
2:17
at the University of Bern, and at that time you managed the university to always
2:21
be one of the top ranked universities in dentistry, in implant dentistry.
2:26
You created more than 400 publications, which is amazing with your team.
2:31
You are a key researcher in the field of biomaterials, regenerative therapy,
2:37
implant surfaces, and many more things.
2:39
You've been the president for a lot of very important associations, the ITI, the
2:45
EAO, and just to name a few, many others.
2:48
And of course, for many people, you've been very influential by teaching, by
2:52
educating them, and just creating what implant dentistry is actually today,
2:57
you've been a true pioneer in this.
2:58
So very happy to have you.
3:00
Welcome, Danny.
3:01
Daniel Buser: That's my pleasure.
3:02
Andreas Utz: Danny, what we try to do is also to create
3:04
some habits in this podcast.
3:06
the first habit is we would like to ask every guest to introduce
3:10
himself or herself in one minute.
3:12
So who is Danny Boozer in one minute?
3:15
Daniel Buser: I'm a dentist with a surgical training and have had the
3:19
pleasure to get into the field of implant dentistry early on in the mid eighties.
3:26
Professor Schroeder, my mentor, told me it's a complete open
3:29
field and he was absolutely right.
3:32
He gave me a lot of guidance and with my team we had a fantastic 35 years
3:39
of research and clinical applications.
3:41
George Räber: It's amazing, Donny, 35 years of implantology, you go
3:45
really back to the starting points.
3:48
When you look back and in hindsight, what is one element that you think
3:53
you're most proud of that actually you could contribute to the field?
3:58
Daniel Buser: Yeah, Professor Schroeder was absolutely right.
4:01
So I had my most important discussion with him that was in April 85, because he
4:09
invited me for lunch and I knew now the door is opening, because I knew he's the
4:15
key person when he has been Dean of the medical faculty, rector of the University
4:21
of Bern, ITI president, and he had a great network and was a great person.
4:29
And that's exactly what he said.
4:30
He said you should go into the academic world and stay at university.
4:35
And then when I said after one week, yes.
4:38
It's okay.
4:39
Then he opened all doors for me, and very important was for sure then when you go
4:45
into a academic career in Bern and many other places, you need to have at least
4:51
a one year stay at university abroad.
4:54
And I'm a convinced team player.
4:57
So I thought I want to go to the States.
5:00
And I want to team up with somebody I know very well.
5:04
This was H. P. Weber.
5:05
And H. P. Weber just started to do an one year student education in, at
5:12
Harvard to get an American license.
5:15
So I said, let's go to Harvard.
5:18
And then Schroeder said, let's invite the boss of H. P. to come to Basel.
5:23
It was in 1988, the first ITI Congress in Basel.
5:29
And so Ray Williams came and after that, he said, you can come tomorrow.
5:35
I said no, I want to come next year.
5:37
And this was probably one of the really very important moves to go to Harvard.
5:43
We did four animal studies there.
5:46
One I brought from Bern, it was on surfaces.
5:50
And three on tissue integration and these studies had a huge impact
5:55
because we knew much more about tissue integration of implants.
5:59
That was the beginning.
6:00
And then the second one was GBR.
6:03
First surgery in 88 before I left for Harvard.
6:06
And that of course became then the most important bone
6:09
augmentation technique in the world.
6:12
George Räber: Did you ever consider not to go into academia?
6:15
You said before.
6:16
It took you one week to take the decision and I think it was a
6:19
very important decision to take.
6:22
What would have been the alternative?
6:23
Daniel Buser: See he said you should go into academia and you're
6:27
gonna have a fantastic career.
6:30
However, You also need to know the negative aspects of
6:35
an academic career, he said.
6:37
First of all, you have to work a lot.
6:40
Second, you will earn much less money than all your colleagues
6:44
from your class, because you cannot buy a Mercedes, you cannot buy
6:48
a house in the next 10 15 years.
6:51
When you are a professor, then it will equalize, and so on.
6:54
Thirdly, he said, you're going to be surrounded very quickly by jealousy.
7:00
This is something you need to be able to stand.
7:04
And last but not least, he said, are you married?
7:08
I said, yes.
7:09
Then he said, okay, then now you go back home.
7:13
Talk to your wife if she supports that.
7:15
If she does not support, don't do it.
7:17
Otherwise you get divorced.
7:19
And that's why I had a one week break in between.
7:22
So I talked with my wife thoroughly about it.
7:24
And she said at the end, let's go for it.
7:27
And then I told him, yes.
7:29
I never conceded that because I saw the potential, I was very
7:33
enthusiastic about implants we just had about one year of experience
7:38
and then Schroeder made it happen.
7:42
Andreas Utz: So I think that's beautiful.
7:43
This seems to be a very pivotal moment in your career and it seems you had
7:47
a very strong mentor, which I think is beautiful for everyone to have.
7:51
I think you are very fortunate to have a mentor.
7:53
Yeah.
7:55
You mentioned.
7:56
You are believing in team play, and there's maybe one thing that not
7:59
everybody knows about you, but you've been really an excellent handball player
8:04
up to the first National League with the BSV Bern and playing the first
8:09
league, and in one year you even, managed to win the championship with
8:13
the team, which was a great achievement.
8:16
What is it what you learned from this, Sports career for
8:19
your professional career.
8:20
What is it?
8:20
What you transferred from it?
8:22
Daniel Buser: I think in team sports you learn a lot about team play that
8:27
you can achieve much more when you have a good teamwork with all the other
8:32
players in particular in handball.
8:34
And see, these are six players and the goalkeeper and they
8:37
have all different roles.
8:39
And you can only be successful if you have six team players who work with each other.
8:44
Because you cannot have a Messi and you get a world champion.
8:49
It's impossible.
8:50
That is different in soccer probably, huh?
8:52
And therefore there I learned a lot.
8:55
And of course in sports.
8:57
You we have had a very famous federal counselor in Switzerland, Adolf Wogey,
9:02
who always said, in sports, you learn to win, but you also learn to lose.
9:08
So when you lose, that means when you have a, let's say, a negative
9:12
experience, you learn to stand up very quickly and just go ahead, huh?
9:16
So I think I learned a lot from that one.
9:18
When I got professorship in Bern and had a chance to build up a
9:22
team, also to build up a clinic.
9:24
I told all my senior surgeons, my clinic will be like a handball team.
9:30
So one is the goalkeeper, one is, I don't know, radiologist, dermatologist,
9:34
I'm the implant specialist, and so on.
9:37
And we all have a responsibility.
9:41
When you do a good job, you get all the applause comes to you, not
9:44
to me, because I'm not a pyramid.
9:46
When there is a problem, I want to know it so we can solve it together.
9:50
And as you said before, we have been very successful in
9:53
producing a lot of publications.
9:55
So you need to have excellent team workers.
9:59
People in your team dedicated and open communication, and
10:07
that is really most important.
10:09
It's the same in the business, I'm sure.
10:11
Same here at Straumann.
10:13
You need to have ambitious people, but team players.
10:17
Andreas Utz: Yes, ambitious people.
10:18
You need a good team.
10:19
it's amazing if you win and you need to celebrate it.
10:22
But then it's also if you have negative experiences and
10:25
you make mistakes every day.
10:27
What do you learn from it?
10:28
And how is a mistake making you stronger?
10:30
Daniel Buser: I have had again, I mentioned many times now,
10:33
Professor Schroeder, Andre Schroeder was such a great mentor.
10:35
I remember I had once a surgery, patient was sent to me from Paris.
10:40
I didn't see the patient before, so I opened up and I realized.
10:45
I cannot place an implant, there's no bone here, you'll see, it was
10:48
not carefully examined before.
10:50
And so when I thought, my goodness, she comes from Paris, she will
10:54
devastated, so I was thinking, what I'm doing, that was before we had GBR.
11:00
So then after 10 minutes I told the lady, look, I'm so sorry to tell you,
11:04
but I cannot place an implant here.
11:06
It will have no future.
11:08
It will have a complication in two or three years, the latest.
11:11
I was very, let's say, depressed, huh?
11:14
In the evening, Schroeder came and said, Oh, how is everything?
11:17
Oh, shitty day.
11:18
Congratulations that the guts to say no, so important sometimes to
11:24
say no, because that was his advice, or when you do a mistake, everybody
11:30
makes mistakes, but learn from them, never do the same mistake twice.
11:34
That was his advice.
11:36
Andreas Utz: He was
11:36
Daniel Buser: a great guy.
11:37
Andreas Utz: You're still active at the BSV Bern and I think what is
11:41
really impressing me, Dan, is that you also invest a lot of your personal
11:45
energy and time to help others.
11:47
Daniel Buser: Yeah.
11:48
Andreas Utz: And you're also doing a lot of charity work.
11:51
You're very active in this, what is it what you do there?
11:53
Daniel Buser: Yeah, in 1999 2000, the Bernese team went into the second league.
12:01
And of course, we were all depressed about that one.
12:04
I watched it from the sideline.
12:07
And I heard from many people, it's about time that Somebody's doing something.
12:12
Then I met a guy who told me the same, and I said, we should stop to say, we should.
12:19
We have to do it, so let's engage and bring it back up.
12:24
So that's how I got involved in that one.
12:27
And then I learned, I established like a supporters club.
12:31
And I learned a lot from that supporters club.
12:33
Later on, I also became a member of Rotary for the same reason.
12:37
I learned this gives me a chance to get outside of the dental or medical
12:41
bubble because you are always in a bubble with these professors and so on.
12:47
And they all talk about medical and dental stuff and so on.
12:50
You get into the supporters club or Rotary club and then you have their
12:54
bankers, your finance guy, I don't know, business leaders, entrepreneurs.
12:59
And that was a huge improvement.
13:03
to go outside that bubble.
13:05
That was the first motivation.
13:06
The second one is a motivation to give a payback because I'm engaged
13:12
very much in sports and not of course also for the handball team, but
13:17
actually with the supporters club,
13:19
help kids to get into sports, huh?
13:21
And the kids are five to ten years old.
13:24
The foundation is called Sport for Kids.
13:27
And I have a strong belief, in particular these days, that these kids are surrounded
13:32
by iPhones They have to get into sports to learn to interact in a team, huh,
13:40
with their same age group and so on.
13:42
They learn so much, and that's not because they should become handball players.
13:47
We do that, that they go into, I don't know, floorball or
13:50
football or volleyball, whatever.
13:53
So this foundation is completely open.
13:57
sport for kids.
13:58
And this is such a pleasure to see whenever, let's say a bad day, I go
14:02
to one of these meetings where you see these 50, five to 10 year old kids
14:07
running around and they're so joyful.
14:10
Enjoying the physical moment.
14:12
Fabulous.
14:14
Andreas Utz: That's how we do it.
14:14
Where do you get your energy from?
14:18
Daniel Buser: That's a good point.
14:18
I would say the following, you see the when you are in a profession like
14:22
I was a chairman of a department, you have a lot of meetings and I don't
14:27
know you get tired to attend, huh?
14:30
Once a month you have a board meeting of the dental school,
14:34
you have a board meeting, or you have a meeting of the faculty.
14:36
That's getting boring after 10, 15, 20 years.
14:40
So when you get into retirement, if you do a good job, you have to prepare well.
14:46
And second, then you make a decision, I'm just doing the stuff I love to do.
14:51
That's most important.
14:53
And in the sports area, I'm also very engaged in the medical campus in Bern.
14:58
It's called Insel Campus Bern.
15:00
That's a payback.
15:01
But in the sports field, you primarily work with young people.
15:06
So in sport, when the kids and then the trainees of these kids 25, 30 years old.
15:13
In the clinic, I'm still working with six other dentists.
15:16
I'm working the least.
15:17
I'm the senior consultant.
15:18
I do my two surgeries a week, but the other dentists are all between 35 and 45.
15:26
It's a complete different generation, all digital.
15:30
And I think that gives a lot of energy that you have this collaboration
15:35
between different age groups
15:37
So when I, what I learned as a student, I learned some basics, but.
15:42
Everything we did is not used anymore.
15:45
This is, we did amalgam fillings, we did prosthesis full dentures, we didn't
15:51
do anything in implants, we didn't do anything of fixed orthodontics.
15:56
Of course, all the progress in crown and brain, that is unbelievable.
15:59
So this is actually a very interesting field, and of course now we have
16:03
the whole digital workflow that influenced our lives, and we
16:07
learned so much about the biology.
16:09
I would say I have a very interesting life, although I work Yeah.
16:13
60% about,
16:16
George Räber: So this.
16:18
touch with the different generations that can make a
16:20
huge difference to, to, to life.
16:22
I actually, I brought the book and I'm sure you know this.
16:26
So when I started with Straumann 20 years ago I got this on my as a welcome present.
16:31
And people told me, read this.
16:33
You're one of the authors and It's basically came out 88 and I think it's
16:37
still holds true to a very big degree.
16:41
So the basics of implantology are in there and you have been a very
16:46
important pioneer of implantology.
16:48
So you've been the one that actually.
16:50
co developed the first two piece tissue level implant.
16:53
Then we started to endeavor with the bone level implant, Andreas myself were
16:57
in that project team together with you.
16:59
And you have been part of the IXL development team the latest
17:02
generation of implants that came out.
17:06
Now, when you look back at dental implantology, what are
17:10
some of the defining moments?
17:11
And I know you're very good at also remembering precise dates and places where
17:17
actually action or decisions were made.
17:20
What are two or three important moments for you in the
17:23
development of implantology?
17:26
Daniel Buser: When I agreed to go for an academic career,
17:30
and that was in 84 no, 85.
17:34
Then Schroeder came about a month late and said, ah, at that time we
17:38
were not using our first names, Dr. Buser we go into the next development.
17:43
So second generation and this is from Sutter myself and
17:47
you are the only surgeons.
17:49
who get the chance, huh?
17:51
For six months, also used the chance.
17:53
And then I told them already, at that time already, the decision was made
17:58
that the implant should not be at that time TPS coated all the way up.
18:03
That was reduced already, I think in 83, huge discussion
18:08
among ITI members at that time.
18:11
actually the German group around the curricula said we have
18:15
to get rid of the roughness.
18:17
So then they came and I told them we need implants for crowns and not
18:21
for for the bar type over danger.
18:23
So we need an implant that goes out like this.
18:26
So the first prototype I got from Sutter was in Bern at university was a one
18:31
piece Tulip shaped with an abutment for cementation that told her, no,
18:37
France, it has to be two piece, huh?
18:40
Come back with a connection.
18:41
And he came back with the Morse taper connection a month later.
18:45
And that was then where we moved.
18:47
That was for sure a very important moment because that gave us a chance to go into.
18:53
Posterior single tooth replacement aesthetics, because we started to do
18:57
a static implant dentistry, I would say late 80s, although we have figured
19:03
out, yeah, it's not so ideal with a three millimeter machine neck and
19:06
so on, but that was very important.
19:10
Then the next one, as I said before already, we learned a lot among the
19:14
all these years in the tissue biology.
19:17
So at that time, Bronnemark implants and Strauman tissue level implants
19:22
showed a lot of bones ulcerization.
19:25
Two to three millimeters, bone remodeling.
19:28
I don't like to call it a bone loss because it's a tissue
19:31
reaction to the implant.
19:34
And then you say that, that should be minimized.
19:36
And then some friends in the United States came up with this
19:40
platform switching idea around 2000.
19:44
That's where then we are strong.
19:46
We should get an implant that has a platform switching concept.
19:50
And this is then where then the bone level implants, yeah, and
19:55
there of course we then improved a lot in the aesthetic field.
19:59
Although this implant was rough all the way up and we were very concerned about
20:04
that could cause a lot of infections.
20:07
And therefore 10 years later when we had the paper of Dirks.
20:12
That was confirmed that actually, and this is a big problem today, that we have
20:16
a high prevalence of peri implantitis in the field, that this roughness
20:21
all the way up is a disadvantage.
20:24
So I remember very well that I had many discussions, also then with Marco
20:29
Cadola, that actually we go to the second, third, fourth generation, which
20:35
is then first on those TLX, then TLC.
20:38
So actually, we have now these hybrid implants, and they will give us a chance
20:44
to reduce the prevalence of infections.
20:46
And that's the very exciting news we have these days for all our colleagues.
20:51
When we started with TLX.
20:54
four years ago, TLC two years ago, and our experience in
20:58
patients is extremely positive.
21:01
George Räber: So it's three very beautiful, I would say, defining moments.
21:05
First of all, the birth of the tissue level connection, then the birth
21:08
of platform shift and bone level, and now also the next generation
21:12
of hybrid implants, as you call it.
21:15
So it's really spanning over 30 years of implantology.
21:18
Daniel Buser: I strongly believe today that we should stop
21:21
to use this differentiation bone level and tissue level.
21:24
It's completely wrong, because we have to say we have hybrid implants, because
21:28
they have less risk for infections.
21:30
And you can use them for both prosthetic options.
21:33
And then we can stop to say bone level tissue level.
21:36
And actually that's where we are moving and it will take some time
21:40
to convince our peers, but they will see all the benefits from that one.
21:44
And Strauman of course has excellent products and will benefit from that one.
21:50
George Räber: I can very much relate to this.
21:51
So I remember.
21:52
Very nicely, a tough internal conversation where it was about
21:57
should we make bone level prosthetic matching also tissue level implants.
22:01
And of course, there was a big fear that there could be confusion, but
22:06
now that it's possible, I believe that this is a strength of the system And
22:10
you were also showing this clinically.
22:12
Daniel Buser: remember when BLX was introduced in Vienna
22:15
first presentation with Ophir.
22:18
And I saw him in the hotel and he told me, Oh, Danny, now you
22:21
have to use my implant and so on.
22:23
Then you came with him to Bern.
22:25
And he gave me all these arguments with this better primary
22:28
stability and so on.
22:29
And I told him, look off here, I will never use that implant.
22:33
But when you produce one with a machine neck, you can call it TLX.
22:39
And then I think that's the strength of Stroman that actually, you
22:43
brought it back home to Basel.
22:45
And then two months later, I got the information.
22:48
We're doing it.
22:49
We do it.
22:50
And I think that was then the starting point.
22:52
And I told him, Cadola, that's just the beginning.
22:55
The next one is a TLT, we called it.
22:57
But now it's TLC because it got a different connection.
23:00
And that's also something I did not mention before.
23:03
I'm intrigued by the quality of this torque fit connection.
23:07
You have to see.
23:09
Morse Taper, then Syn Octa, and then with NNC another connection, and now TorqueFit.
23:18
And this is based on the technological progress manufacturing is doing.
23:24
That's why your production plant is in the area where all the watches are
23:28
produced, because they learn how to do this high precision manufacturing.
23:33
That's why you need a company who has this quality.
23:35
And I'm intrigued to see now how this connection really
23:39
helps us in daily practice.
23:42
Andreas Utz: Maybe one more question before we, we might look also a little
23:45
bit how this will evolve in the future.
23:47
I'm very interested in your view on this one.
23:50
You mentioned a couple of
23:51
times the ITI as well.
23:52
Because there was, the industry and the pioneers in industry,
23:55
there was, universities like Bern and Freiburg at that time.
23:59
But the ITI also played a key role.
24:01
How do you see the contribution of the ITI?
24:03
Daniel Buser: the ITI is today the leading association in the
24:07
field of implant education.
24:09
but also implant research support, so ITI is not doing research, but ITI fellows and
24:15
related, let's say departments are doing the research and the foundation supports.
24:21
The ITI foundation, by the way, it was established because of me,
24:27
because when I wanted to go to Harvard, I told Professor Schroeder.
24:32
We need research money.
24:33
And at that time ITI as an association had about 100, 000
24:38
Swiss francs in the bank account.
24:41
Then he said, yeah, we have to talk to Fritz Straumann.
24:46
Come to my home when I'm, I have my birthday, 70th birthday.
24:51
That was 1988 in April.
24:54
Fritz will come for a visit two o'clock Friday.
24:58
So I went to his house and.
25:00
met him only on distance, never one to one.
25:03
And so he was very friendly.
25:05
And then we had a conversation about, I don't know what, and then Audrey
25:09
said, yeah tell Fritz why you are here.
25:12
Then I told Fritz, look, I'm going to Harvard and we are doing
25:15
three animal studies there and we need more research support.
25:19
So we thought we should establish a Sorden ITI Foundation.
25:24
And he said, oh, that's very easy.
25:27
Let's do it.
25:29
He said because we know how to do that from AO Foundation, we just
25:34
will have a different approach with the IP rights, he said, and so on.
25:38
But you will hear from Rudy Mark, that was CEO at that time.
25:43
And then actually Rudy Ma came to Bern a month later and the
25:47
ITI Foundation was established.
25:49
And then at the ITI annual meeting, the two announced that we just established
25:54
a foundation for research support.
25:56
It was, at that time, research and Fritz Strahlmann, they made an agreement
26:03
and Fritz Strahlmann gave, because he said, all the money actually that
26:07
would have been for André Schroeder, I put in a bank account and that's the
26:11
starting capital, a million Swiss franc.
26:14
And then the first 500, 000 they gave to me, to for the preclinical studies,
26:19
for the studies in at Harvard, I became then, of course, after that, not only
26:25
a research supporting foundation, also an implant education foundation.
26:31
That was, that move was made in 92.
26:35
They asked me to be the education delegate in the board.
26:38
And then I think that was then refined about two or three times.
26:43
And then a big important was a meeting in 2002 in Zurich, where then the opening
26:49
of the membership was decided to go from ITI members to ITI fellows in research
26:55
and education and membership for GPs.
26:58
So without educational activities and that's allowed then the growth.
27:03
And today we have, I think, 26, 000.
27:06
And I'm strongly convinced that Strauman's success without ITI would have
27:12
never been like this, but vice versa.
27:15
When you look at it, when you mention that the Bern is so good, Bern was then top
27:19
50, Bern is today top 10 university, ITI is number one, Strauman is number one.
27:28
So it's again teamwork, different roles, but excellent collaboration.
27:33
One and one gives five.
27:35
It's very simple,
27:37
Andreas Utz: simple approach.
27:40
Danny let's start look a little bit ahead, how this evolves.
27:43
And, I'm the first thing I'm interested in, you are famous
27:46
for very clear and scientific.
27:49
based protocols.
27:50
I think that's what people admire you because they know you, you do
27:53
repeatedly what you are good at, what is scientific based and this is how you
27:58
bring patient after patient to success.
28:00
Still, I saw you always evolving your protocol.
28:03
Now recently as an example you enjoy more working digital, as you already mentioned.
28:08
started to do guided surgery, immediate implant placement at one point.
28:13
Where do you learn from and, what makes you adapt your, and let's
28:17
say, develop your protocols?
28:20
Daniel Buser: When I give my lectures, I always say, what
28:22
are the objectives of therapy?
28:25
The primary objectives are successful outcomes.
28:29
with long term stability.
28:31
That means you serve your patient.
28:34
It's not a treatment to maximize my income, to maximize the patient's benefit.
28:40
So that's the primary objective.
28:42
And then I would say around 2000, we figured out that our treatment
28:47
protocols are very demanding, multiple surgeries, lots of swellings, pain,
28:52
long healing periods at that time.
28:54
So we said, these are the secondary objectives, that means that we try
28:58
to improve the technique, but these modified protocols should not, of course,
29:06
jeopardize the primary objectives.
29:08
That means the progress is done in small steps, very carefully.
29:13
I always call them fine tuning of our concepts, learning from studies how the
29:19
tissue biology is, and then you adapt.
29:22
So when we had this first discussion on immediate implants, then we
29:26
have seen tons of complications.
29:29
And we said, before we start to do that, we have to learn where are the risk
29:33
factors, or how is the tissue reacting, and What are the selection criteria?
29:38
ITI on this post extraction place made a tremendous contribution to the field,
29:44
probably the most important one, at five different consensus conferences, 2003,
29:50
eight, 13, 18, and last year in Lisbon.
29:55
published always.
29:56
And I would say after 13, I felt secure that we can start
30:00
to do immediate implants.
30:02
And now we are doing that with enthusiasm in 15 percent of my cases.
30:07
Works extremely well.
30:08
So what I tell them, you have to be open minded, but It should be evidence based.
30:16
So when you are in private office, you should not try everything that is on
30:20
the internet because then your cost, your patients will be your victims.
30:27
You rely on associations like ITI because there are the research groups, they do
30:32
that at universities, they document, they say this worked in our hands,
30:36
ITI confirms that, then you can move.
30:39
So you do it carefully.
30:41
but always open minded.
30:43
Perfect example is digital.
30:45
We did our first digital cases.
30:47
Yeah, 14 years ago, Team Yoda was my collaborator at that time, and of course
30:53
we did only a few cases, and of course, you made a lot of progress every two
30:57
years with IDS in Cologne, and then we adapted that one, and today it's
31:02
complete normality that we do when there is a benefit for the patient, we use
31:07
digital technology, but not all the time.
31:09
About 40 percent of my cases are digital now, and 60 percent
31:14
I do brain guided, everything.
31:19
Andreas Utz: I think that's a good inroad to the next question I had,
31:22
you said there's constant evolvement.
31:24
What we are very often, George, is, from different stakeholders,
31:27
is that, in a way, let's say implant dentistry came a long way.
31:31
A lot of things have been innovated.
31:33
Implants are working now.
31:34
The basics are established.
31:35
It's an established technology.
31:37
A lot of implants are alike and similar.
31:40
And, there is no innovation possible anymore.
31:43
no significant innovation possible anymore.
31:46
How do you look at this statement and how do you see this evolve?
31:50
Daniel Buser: I have shown many, for many years also a graph, that
31:53
showed the progress and it of course in the 80s, 90s, very steep and
31:58
then it started to flatten out, huh?
32:00
So I would say probably 95 percent of the potential is really, is now done,
32:08
and we are doing the fine tuning, and we do the fine tuning to have an
32:14
least invasive protocols, whatever.
32:18
However, I think, our efforts, and that's ITI's efforts in the future, is that we
32:24
have to spend more energy on education.
32:28
Tremendous complications, I'll tell you in the last four weeks I have seen
32:33
three disaster cases I could never have imagined, one was a case with four missing
32:38
teeth in the anterior maxilla and one implant was drilled into the root of a
32:42
canine, done by a certified maxillofacial surgeon, and so I think the challenge
32:50
we have today is that we have to do it.
32:53
Increase our efforts in education and we have to tell the dentists, not every
32:59
dentist must place implants, complete nonsense, in medical field, 5 percent are
33:05
orthopedic surgeons and they do the hips and the knees and go on and 2 percent
33:10
are heart surgeons, they do the hearts and eye surgeons, whatever, I think
33:14
the future, at least in Switzerland, I see that is that the market moves
33:20
away from single practices because the majority of our educated dentists are
33:26
females and they don't work for 100%.
33:29
They want to work 40, 60 percent and have a family as well.
33:33
So therefore they go into group practices.
33:37
And I think we have to work hard to really support that, that they say group
33:42
practice of four or five, we have seven, one of them at least should be top.
33:47
top educated in surgery, and this person serves the whole
33:53
group with implant surgery.
33:54
The others are doing all the other stuff, and when we achieve that one,
33:58
then the complication goes down.
33:59
That includes the right selection of implants, hybrid implants, and so on.
34:04
Because you need to have enough cases per year to develop the
34:09
education to the experience.
34:13
Same in medical field, many of the hospitals don't have enough cases to
34:17
build up the top level of experience.
34:19
Same in our field.
34:22
Reduce number of surgeons, they do more per case, and the quality goes
34:26
George Räber: Talking about new settings in the future of dental practices.
34:31
So dentistry runs in your family.
34:33
Yeah.
34:33
And your daughter is also a dentist.
34:35
Yes.
34:36
What did you learn from her in the last couple of years?
34:39
Daniel Buser: Yeah, she's a, she wanted to become a medical doctor.
34:42
And she worked actually in my department in the reception to earn some money.
34:47
I always told my kids, you can earn your own money so you learn how that works.
34:52
And then after that one also she came and said, I think I'm going
34:55
to switch over to dentistry.
34:58
That's your decision.
35:00
George Räber: Be my guest.
35:00
Daniel Buser: Don't tell anybody that I forced you to do actually my
35:03
postdocs told her, why don't you do dentistry because you work, you love
35:08
to work with your hands, whatever.
35:09
And you have a father with such an influence.
35:11
So then I told her, that's great, but I give you a challenge, don't go into
35:17
the surgical field because otherwise you never get out of my shadow and you're
35:21
always the daughter of Professor Pulser.
35:24
You'll have to do prosthodontics, that could be actually great, because
35:28
then we can continue to work together.
35:30
I would say half of my elderly patients are treated with her.
35:34
She's doing, she tells me what to do actually, we do the planning, we
35:38
do the digital planning, she's doing everything, I just, then we see the
35:43
position, everything, we agree on it, and then she produces the surgical stand.
35:47
Then.
35:48
I do.
35:48
So I learned a lot from her in this digital field, as with the others, with
35:52
Manrique, Fonseca, Samir, and so on.
35:55
She takes care of them because many of them are actually elderly
35:59
patients, in the retirement age.
36:01
And then when there is a tooth loss, then I get a new patient.
36:05
She refers to me.
36:07
Andreas Utz: I see you really enjoy this, working with Manrique, also with
36:10
Samuel, and with your daughter, so that really gives you energy, I realize.
36:14
We see a lot of, the next generation coming in, being male or female, very
36:18
talented young people that wanting to become great implantologists.
36:23
What is the advice you would give to these people?
36:26
Daniel Buser: apply for ITI scholarship, because that is a great program of ITI
36:31
ITI scholarship, I think they have now 35 centers around the globe in my department
36:37
I had 32 ITI scholars, many of them are good friends and I know how they are
36:41
doing family wise, how many kids they have, I hear all the time, fantastic.
36:46
There you learn then also to the ITI side and that gives
36:50
them an entrance into the ITI.
36:53
Many of these ITI scholars are today leading researchers.
37:01
One was Simon Jensen, he's a full professor in Copenhagen, and so on.
37:05
And this is great.
37:06
I just, education, And become active inside ITI, go into the section
37:14
leadership teams and of course they, you normally walk up the ladder, you
37:18
might become education delegate or you are in charge of an ITI study club
37:25
and those who are really capable then they move up very easily and then they
37:29
go to the international committee.
37:31
Some of these ITI scholars today are now ITI presidents, see, that's how it is.
37:36
So as ITI is for sure a very important association for these
37:43
top, top talented youngsters.
37:47
Andreas Utz: Maybe last question before we come to the closing questions,
37:51
also for George and myself, for the past 20 years, you've been a mentor.
37:55
George, you mentioned it.
37:55
We developed the bone level implant together, the first generation
37:58
of the bone level at Straumann together, and you've been always
38:01
a great supporter for us, Danny.
38:04
Now we start a new endeavor with this podcast series.
38:07
What advice would you give us for this podcast series?
38:10
Daniel Buser: Yeah, let me do the following.
38:11
I gonna listen to the next three or four podcasts and I give you a feedback.
38:16
So I think we had a very good beginning.
38:18
I think it's very important.
38:19
I learned.
38:20
That podcasts are actually becoming much, are very popular.
38:24
I'm not driving a lot with my car, but I know for many people are
38:28
driving long distances and they always are listening to podcasts.
38:32
I think that's great and I think that's a very nice tool The storytelling
38:38
is so important in education.
38:41
Like what we said, we're going to go now into this hybrid implant.
38:45
This is a storytelling, which is a no brainer story because it's so logical.
38:50
But we have to Deliver the message and podcast, bring it to the recipients, to
38:56
the customers or to the colleagues in ITI.
38:59
And I'm sure podcasts are very important.
39:03
Actually much probably have much more value than a short post on Instagram
39:09
at the very time, very superficial.
39:12
And many times it's complete garbage, whenever I see stuff
39:16
there, I can only scratch my hands.
39:18
What the heck are they doing?
39:20
Andreas Utz: And I have to say, I'm impressed how active you are on
39:22
Instagram and what a strong profile you built throughout the last five years.
39:26
Daniel Buser: No, of course, I'm still, I think, I have a very famous patient,
39:31
I don't want to mention the name, you know it, and when I retired, I had a
39:36
dinner with him and then he told me, look Danny, you have to leave your department
39:41
because that will never work, you have to be so successful, you have to go
39:45
into a private setting and you have to continuing with continuing education.
39:52
deliver the message to the young generation.
39:54
You have done a lot with undergrad education, postgrad, go for
39:59
continuing education, because it's so valuable for this young
40:03
generation, 30, 35 year old generation.
40:06
And that's what I'm doing.
40:08
And that's why we established and during the pandemic also this Instagram
40:12
account and actually a huge we have some posts when it's a little emotional.
40:17
We did one when professor Schroeder had the 20th.
40:21
This day, he passed away 20 years ago, 2004.
40:24
I think 48, 000 were watching this.
40:28
See, I gave him all the tributes.
40:31
It's amazing.
40:32
It's very emotional.
40:34
That's how we use social media.
40:38
Or with my daughter also.
40:41
Everybody wants to watch that.
40:43
So we're gonna do a few during the Christmas break.
40:46
I know already what we are doing.
40:49
Upcoming meetings, master courses, our international symposium next November.
40:54
You're gonna love it.
40:55
I just told Marcus that detailed program is very excited about it.
41:00
Andreas Utz: That's probably also a secret of life, success is not happening by
41:02
accident, there's a plan behind, right?
41:04
Daniel Buser: you see my activity as surgeon the agreement I have is,
41:08
we're gonna make a decision always in September, if I, continue in another year.
41:13
I have no longterm plan.
41:14
It all depends on my health situation.
41:17
I spend a lot of time with my grandchildren now, do a lot of
41:21
traveling with my wife and every set September we make a decision.
41:25
Yes.
41:26
Of course, my dental assistant tells me we do another five years and she tells
41:30
me this every year now, every five years.
41:33
She wants me to continue.
41:34
I said, yeah, we'll see.
41:36
So we go another year and then probably another year and then we
41:40
have to stop the right time point.
41:42
I said, don't overdo it.
41:43
And you helped me to make that decision this year.
41:46
I want to have feedback, very open minded.
41:48
Perfect.
41:49
George Räber: That brings us already to the last two questions
41:51
and it's going to be a routine.
41:54
We're going to ask every guest the same questions.
41:56
So the first one is, what's your vision of dentistry for in 10 years from now?
42:01
What do you believe will dentistry look like and what are the biggest changes?
42:05
Daniel Buser: I think we have to differentiate between industrialized
42:08
countries and industrializing countries.
42:11
In Western Europe, in North America, we see, of course, this
42:16
demographic change and there geriatric dentists or gerontology
42:20
will play a very important role.
42:22
Of course, the elderly population is much fitter than 30, 40 years ago,
42:28
and they don't want to go into food.
42:31
I think there will play a very important role.
42:33
But when you go then to Southeast Asia, of course, India, the population is very
42:38
young, so they're completely different.
42:40
And there, probably, dentistry is not so well developed.
42:44
There is your great potential of stramen, because there will be a
42:48
tooth loss, because they first have to really learn for the These huge
42:53
populations, how important home care is and dental hygiene, whatever.
43:00
So I think we have these two different groups.
43:05
Digital will play an important role, but we will not have treatments by robots.
43:11
Complete nonsense, we don't think so.
43:15
When I go and do a treatment, and I have all these IDI scholars coming
43:20
to assist me, and we are running into an unexpected situation.
43:26
No robot will ever handle that, you need an experienced
43:29
surgeon to handle the problem.
43:32
They're always impressed how we solve the problems.
43:34
Therefore, Digital dentistry will help us tremendously to do a better job,
43:40
but it will not replace the surgeon.
43:41
George Räber: convinced.
43:42
I'm very much interested in that topic.
43:44
Daniel Buser: Yeah, KIA will be important too because in the treatment
43:47
planning, when I see what you can do with your systems, that means
43:50
we say we would have a three unit bridge and boom, you get by KIA.
43:55
Again, when you modify, say when the prosthodontist tells me that's where
43:59
the implant should be from a prosthetic point of view, I tell him, look,
44:03
that will not work from a biological point, we have to find a compromise.
44:07
See, so you need both expertise, a team to optimize that so the patient has an
44:13
excellent chance for long term success.
44:16
That's how it is.
44:17
George Räber: Last question.
44:18
So when you could invite anyone either living or not living anymore
44:23
to a evening long fireside chat?
44:26
Who would that be?
44:27
H. M. Oh my goodness.
44:28
Daniel Buser: That's a tough question now, I see.
44:30
Could
44:33
be in the field of of medical or dental yeah, but could also mean
44:38
the field of handball, actually.
44:40
Probably I would But in the field of handball, I was
44:44
probably one of the top guys.
44:46
Either the French superstar car or the, or or the Finnish superstar for a dinner.
44:53
That would be fantastic.
44:54
Yes.
44:55
In the dental field or in the medical field that.
44:59
Yeah, in the dental field, I know the many, all of them, I know, in my field,
45:03
that is probably not so interesting because I can have this thing anyhow.
45:06
But in the medical, yeah, why not a Nobel Prize winner in a field,
45:11
but I cannot give you a name now.
45:14
That would be very tough questions, yeah.
45:16
Andreas Utz: But I'm sure the evening with Karabatić would be
45:18
very enjoyable and very interesting.
45:21
He has, he's been also a living legend, right?
45:23
Absolutely.
45:24
Daniel Buser: It will be a
45:25
Andreas Utz: great evening.
45:26
Daniel Buser: Yeah, these old people have achieved tremendous achievements.
45:32
Andreas Utz: With this, we are at the end.
45:34
Danny, thanks a lot for the conversation.
45:36
I hope we are on time.
45:38
Inspirational insights that you provided to us thanks a lot for
45:42
being with us and to all our.
45:44
Guests, thanks a lot for joining the first episode and please look forward
45:47
for many more episodes to come.
45:50
You can see these episodes either on Apple podcast, you can see it on Spotify,
45:55
you can also see it at Instagram.
45:56
So whenever there are questions or comments you want to leave, please
45:59
feel free to do we're also happy to answer the questions and are happy
46:02
to evolve and improve and are always happy to have an interaction with you.
46:06
Thanks a lot for joining our first episode.
46:08
Thanks, George, for co hosting
46:10
Daniel Buser: Thank you.