Latest / Straumann® ProTalk / Maximum outcome, least intervention: Dr. German Gallucci on bio-restorative implant dentistry

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Maximum outcome, least intervention: Dr. German Gallucci on bio-restorative implant dentistry · Straumann® ProTalk

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  If every job required previous experience, nobody would have
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  gotten the first job, right?
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  Really this emotional intelligence is probably underrated in the
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  early stage of your career.
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  You think it, it's all about IQ, but then I think over time you
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  realize it's more about EQ and
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  I like to achieve the maximum outcome with the least amount of intervention.
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  Because if you don't know how to do it in the patient's mouth, you won't know
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  how to do it in the computer or anything.
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  At the end of the day, you can use all your technology, you can use everything,
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  but patients, they come for you.
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  They come to see you.
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  They come to hear from you because they trust you
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  Welcome to ProTalk.
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  Welcome to the Pulse of Dentistry.
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  Welcome to this episode where it's my pleasure to welcome Professor
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  German Gallucci from Harvard University in Boston here to Basel.
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  Welcome, German.
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  Hi, Andreas.
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  Thank you very much for, this, invitation.
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  It's a pleasure for me to be here.
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  Thanks.
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  Thanks for coming over from Boston.
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  German, you, no doubt you shaped the implant dentistry a lot.
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  You had a journey from Argentina to Geneva to, Harvard to Boston now,
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  and also you had a journey from being an ITI scholar to now being part of
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  the global leadership, of the ITI.
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  And today in this episode, we will talk with German about his personal journey.
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  We will clearly talk about the, bio-restorative concept.
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  We will speak about immediacy and I think very exciting.
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  We also look ahead and speak about the, the future of digital
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  dentistry in implantology.
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  So looking forward to this, German.
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  start, as usual, who is German Gallucci in one minute?
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  I am a, a husband, a father.
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  I am a clinician scientist.
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  I'm passionate about excellence, talent, innovation, and, and a big
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  proponent of doing cool things.
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  Yes.
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  Yeah.
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  I know this, German, from many conversations with you, and you
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  are also a, I have to say, a quite visionary person if it comes to,
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  implant dentistry especially.
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  But before we start to dive into the industry for the next 45
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  minutes, I have a personal question.
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  we spoke a lot about sports, and I know you, you have this passion for your son,
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  playing volleyball, and I just saw that w- in one of the last, ITI courses in Boston,
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  you took a team of lecturers to one of the championship matches of your son.
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  So what is more intense, for You your passion for dentistry or the passion
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  for, seeing your son playing volleyball, and what makes you more nervous?
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  that's, Yeah, that was actually during the ITI Education Week.
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  I promised the speakers and the team that we would go for dinner, and that was the
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  same day of the match, So I, said, "Before dinner, we will go to, to see the match."
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  It was quite, an interesting experience that, that draw, a lot of reflections,
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  because at the end, a team is a team.
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  Whether it's a team in sports or whether it's a professional team, it's a group of
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  people working together towards, one goal.
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  I would say I'm, more intense as the, volleyball dad than
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  the, professional version of me.
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  I, have been doing this for longer time than being a, a volleyball dad, and,
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  on the other side I, am in control.
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  On the other side, on, on the court, I am just an expectator, but, I think they
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  got to see, the true passion coming out of me, celebrating the point, involved
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  in, in supporting the team, which is also another similarity with what I do at work,
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  I think that the, support that we need to provide to our teams, especially when you
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  are in leadership positions- it's, it's no different, at the end, great things
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  happens when, the team works together.
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  And you as a coach helping the team win.
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  Yeah.
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  As a coach, as a player, as a supporter- whatever role you, you
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  play, it's, the team come, comes always above, everybody else.
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  Nobody wins alone
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  Exactly.
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  No one wins alone.
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  That- Yeah … that's … And you, win together, you lose together,
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  and you, learn from the losses, and you celebrate the wins.
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  Correct.
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  That's how it works.
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  how did you start to get into dentistry in the first place?
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  Was this a family thing or?
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  No.
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  I, actually grew up in, Argentina, a very small town, rural town
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  in the center of the country.
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  And, I knew that, I wanted to do something in the biology-related area, and, I was,
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  hesitating between pharmacy and dentistry.
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  And then I started thinking, what would the job look like, And, I thought that
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  dentistry would be a much more int- interesting field- than pharmacy, And
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  I was lucky that I did like it, It started, very early on, and I had a
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  lot of professors that they really, installed in me that curiosity of
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  how good of a journey this could be.
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  Yeah.
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  No, you did the right choice.
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  you're very passionate about what you do.
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  I think that's the best that, that can happen.
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  is it true that, this ITI scholarship that brought you to Geneva was
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  probably a bit of a game changer for- It's- … for you and your career?
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  It's, it was a big game changer, and, it all started, 1998.
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  I was,
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  when I was in, second year of my dental, school, I had never,
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  treated a patient or anything.
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  I experienced, one of the first implant lectures in Argentina.
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  It's 19 88, And, so then I was telling my classmates, I saw this, guy, placing
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  a screw in the jaw bone, and they didn't believe me, they, my classmates, So I
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  said, "Yeah." And then when I finished dental school, I started my post-grad
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  in implant dentistry in Buenos Aires.
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  I got an invitation to come to, Lucerne for one of the first bone symposiums then.
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  And I remember, very distinctively in one of the slides, they were
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  introducing the ITI scholarship.
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  It was the very first- time the, the program was being launched-
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  Yep … and I was in the audience.
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  So going back, I was talking to, some people and I said, "Look, this
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  is very interesting." but I, thought that my chances would be zero, Yeah.
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  And I started asking, what are my chances?
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  Yeah.
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  And somebody told me, "The only way to know what your chances are is to apply."
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  To try.
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  Yeah.
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  And then I sent in my application and, I didn't hear anything for quite a few
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  months, like six months, eight months, and I completely forgot about that.
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  And one day I arrived to my office and there was, an envelope from the ITI.
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  my assistant gave it to me.
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  I went to my office and I sat with the envelope on my hands like that, and before
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  I opened it, I knew that it was good.
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  The weight on that envelope, it was, it was, it was good news,
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  Yeah.
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  Yeah.
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  So that, that brought you in the first wave of the, the scholarships
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  to Geneva, where you met Urs Belser as well, and, I think we can say Urs
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  has been a, a mentor and, an important person for you, during those times.
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  So- How, did Urs Belser shape the, the Galmancu Lucci we see today?
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  I wouldn't be where I am if it wasn't for him, not only that he gave me the
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  opportunity to, train under him, but, he, was, such a role model in every
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  aspect, clinically, academically, and, he was, very supportive and, always
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  pushing for develop your own ideas and, And, a- and I would say that without
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  hesitation, he is my most influential mentor in my career, obviously, for
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  the quality of dentistry, for the… But also the way he, motivated us-
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  to do better, And I tell you a, a quite, interesting story that 2004 there was
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  the US, there was a world symposium in the US, and I participated with
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  a case competition, one of my first, immediate, loading cases, full arch that
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  I was doing with, Urs, and the team.
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  And, for me, just being there was, a triumph, presenting the case and all that.
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  And then, I got, We were at the dinner and he said, tomorrow you need to be
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  at 1:00, at the, main podium because there will be something for you." And,
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  basically I, won the best case, Prize
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  presentation of the congress.
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  and I remember very distinctively the first thing I did, I went to my
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  computer and I wrote Urs an email because I wanted to share that with him.
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  It was that important, for me, that he knew how happy.
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  when you call your parents when you did a good test, Exactly the same.
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  The same feeling- Yeah, was back then,
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  yeah.
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  No, I can imagine.
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  That was, the ITI World Symposium in San Diego 2004.
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  Yes.
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  Correct.
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  Yeah.
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  Exactly.
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  h- how did your journey continue then?
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  you, ended up in, in Harvard now and, then changed a lot also
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  there, introduced a lot of stuff.
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  How did you make the step from Geneva then to Harvard?
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  Because you stayed long in Geneva then intentionally.
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  Yeah.
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  yeah.
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  my original plan was to come learn implants and go back to Argentina.
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  What happened, with, my ITI scholarship is that I develop my passion for academia,
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  which I had not, experienced before.
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  And- So
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  research and science and-
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  Research, publishing, and- Yeah … I had already started to, give some
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  small talks around and, I, felt that,
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  that all of a sudden dentistry became visible.
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  dentistry is a very, solitary profession.
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  you're there, you, and the patient only see it.
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  But, I had a, an opportunity to share, ideas and cases and,
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  I really like that, through publication, through presentations.
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  And so then Urs offered me, to stay as a faculty and train a little bit
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  more and then, he said, if you wanna have an academic career, you will
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  need to, test yourself in the US."
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  And that is when we contacted H.P. Webber- whom I consider my second mentor.
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  he welcomed me in, Boston and, opened a lot of doors, both internally and,
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  throughout the country, introduced me to, all the pros implant societies and,
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  I, cannot press how influential H.P. Webber was in, in my career as well.
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  And, so but my plan was to go there with a research project for one year and, make
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  connections and come back to Switzerland.
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  And then one day H.P. said, "Why don't we go play golf this weekend?" and,
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  basically he, offered me to, start the, first implantology, program at, Harvard.
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  That was about '97, 199- 2007.
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  And at the time I said it was, for me, a difficult decision to make, I had already
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  plans to be back in Geneva and continue as a faculty and, but at the same time,
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  that opportunity was, very appealing and, turned out to be, the good decision.
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  Yeah.
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  Now that research project, I did finish it, but it's, I have
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  been in Boston now for 22 years.
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  S- since then.
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  Since.
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  And this is how- Yeah … how all started.
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  Yeah.
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  And H.P. Webber is another
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  key player ear- in early days already in the, the ITI.
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  So you were diving in as a young clinician into this ITI network and, the, the
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  ITI network was also supporting you.
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  based of course, on the great work, that you did and the great ideas that you had.
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  Now there's another full circle that I would like to point at.
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  So you started as a ITI scholar, with Urs Belser in Geneva.
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  Today you are on the ITI board.
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  You are one of five board members globally for the ITI.
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  What does that mean for you?
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  And, you benefited a lot and now you can give so much back.
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  what does the ITI mean for you and the responsibility that you have today?
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  Yeah.
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  this is,
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  I, would like to put the ITI also in the category of mentors, although
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  - Good … you always associate the mentor with the person, but an
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  institution can also mentor you- Yeah
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  or provide opportunities.
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  and,
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  look, the ITI has done for me, like it has done for many others, fantastic
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  things, And, it's a, a network of, professionals worldwide, that open doors
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  at every level, at the local level, at the regional level, at the national level,
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  at the global level, and it does so in under the, principle of, evidence-based,
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  patient care, which is something that, we really need to, leverage and, disseminate.
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  and, for me, the, it's not a responsibility, it's a, true
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  privilege to now be able to,
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  do, in my role as a board member what the ITI did to me to others.
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  I think, when you provide opportunities, especially the, the first time
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  opportunities to the, right people, those are, seeds that you plant- that
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  they don't stop growing, I always, think of this, analogy when you, post a job
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  position and you say, "Previous experience required," and I always think if every
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  job required previous experience, nobody would have gotten the first job, right?
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  Yes.
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  And, so this is what I really like, From this position, identify talent, identify
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  potential, and make sure that, that you don't pave the road, but you open doors,
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  I, believe that people should, do their own path, but, we all need, at some point,
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  someone or something to open doors- or show us the direction where we're going.
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  And-
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  so as I said, it's not a responsibility, it's a true privilege- to, to be in
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  this role and use my experience as, as a driver to do the same for the-
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  for the next ones.
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  Yeah.
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  And, I, see you and I know you're very passionate about helping the
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  young generation to grow through your role in the ITI, and, you
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  particularly, you're leading the, leadership and the next generation
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  development committee, if you want.
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  And, I see you put a lot of passion in this and- And I think it's
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  impressive how the ITI stayed actually a quite young, organization.
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  Of course, the, the more experienced clinicians are more on stage
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  naturally, but if you go and visit ITI organizations and events, it's a
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  quite young network we have to say.
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  And, you guys do a lot for the young generation.
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  Yeah, there was a, a, very, interesting program, Like I am the chair now
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  of the Leadership Development Committee as a board member, and,
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  that committee historically has only managed the scholarship.
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  And, when we started this, this new role, I, thought that there was much more to
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  do with scholarship and invested in young talent is, it's really, fascinating.
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  So we put these future leaders programs in place- Yes … which,
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  now is in the third iteration.
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  and it has turned out to be something that they know globally.
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  everywhere you go, they know about the future leaders, and they ask,
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  "How can I, be part of that?" Yes.
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  "How can I…" and it's a, it's a s- bittersweet feeling because you would
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  like to help everyone, you know- Yeah
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  to, get to that level.
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  But, and, that is what the power of the ITI is.
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  it has, it's putting opportunities in, the, careers of, people- that, potential.
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  like over the years working in academia, we interview students, we recruit talent.
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  It becomes a little bit like, like an interest…
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  I'm sure with your leadership roles, you are, doing the same.
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  it's that, element of discovery or at, at the, the human level,
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  Yeah.
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  I always say to, my colleagues when we interview for different programs,
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  I, said, "Your CV will only buy you the ticket to the interview,"
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  I, I, for me, the, the CV at the moment of interview is, it's irrelevant.
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  It's just already buy you the ticket for the interview.
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  But who you are as a person is what really makes the, the, final switch.
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  Because I have this, this notion that has- solidified over the years is that,
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  we can teach anything to every- anyone, but we cannot change who you are.
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  Nor is, the role of, the educational institution- Yeah … or the ITI
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  is to change you as a person.
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  But, so that's why the personal element is influential at the,
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  moment of recruiting talent, And they all have the same traits, Yeah.
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  They're curious, they're hungry, they're- Yeah
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  ambitious.
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  And, when you fuel that It's just beautiful to watch
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  No, it's absolutely true.
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  And, after all, it's not so few because I said, look, it's a bittersweet feeling.
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  it's just very few that you can help.
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  But the, the truth is, with the Young Leader Program, it's already now more
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  than 20 that you help, Then there's the research grants that you do.
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  There's the scholarship program.
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  There's speaking opportunities for a lot of young speakers, from
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  national to the global scale.
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  There is a local committee position.
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  so there's multiple positions and ways how young clinicians, get, supported,
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  throughout their career in the ITI.
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  So I think my encouragement and motivation to the listeners, I know that a lot of
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  young clinicians are listening as well, is, as you said in the beginning, go
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  try, and you will only learn if you try, and there's more opportunities in the
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  ITI to get support, develop and build your network than you think, I guess
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  looking at the- That's, things happens to those who do something.
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  Exactly, yeah.
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  let's move into the, let's say the first concept discussion, which, I, would
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  like to touch on the, biorestorative concept that, a paper you wrote with
• 21:56
  Inacio- and people like Alejandro Lañez and Mariano Sanz and, many others,
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  where you describe implant dentistry not only being surgically driven,
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  prosthetic driven, which was for a long time a trend, but you say, look, that
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  there also needs to be, it needs to be biologic driven from the beginning,
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  supported by, by, by, digital tools.
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  if you would explain this in a few sentences to, the listeners,
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  what, is the biorestorative concept or the bigger idea behind?
• 22:27
  Yeah.
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  So that's, that was a, a, paper that, is very dear to me because it was born, from
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  a relationship with Inacio Perinacci.
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  He was my ITI scholar when he came in.
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  And, before I answer your question, I, have to go into this because
• 22:47
  it's how everything started.
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  So we were placing implants, and then, Inacio will come, and he will measure
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  all my implant placements- and, and after I observe him for a couple of
• 23:02
  months, I say, "Why are you measuring your implants every time I place them?"
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  He say, I think they're too deep." And then they all started with the implant
• 23:12
  position, and then we went to how the implant position is important for,
• 23:18
  preserving the bone that is around the implant and then how the abutment
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  will have an influence and, then the whole idea of the, the biorestorative
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  concept, which is basically a digital strategy That allows you to
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  combine all these three components- biology, surgical implant placement-
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  Restorative … and restorative.
• 23:41
  Yes.
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  and, basically that paper is replacing two major concepts, which is the
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  restorative driven is no longer restorative driven because, oftentimes
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  we wanna favor the, implant position.
• 23:57
  so we have to do less grafting and less invasive procedures for the patient
• 24:02
  and solve that in a different way.
• 24:05
  Whereas in the restorative driven, you will have to graft a lot of, that
• 24:09
  bone to place the implant, right?
• 24:12
  And, the second thing that paper did, it really replaced the notion of the
• 24:17
  vertical position of the implant.
• 24:19
  That's a question that a lot of clinicians ask.
• 24:21
  Yes.
• 24:22
  How deep should I place my implants?
• 24:24
  And historically, that has been translated into three millimeters
• 24:29
  from the CEJ and all that.
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  Exactly.
• 24:31
  And, we move completely away from that.
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  Now we are gonna use real clinical, components like, the gingival height
• 24:40
  of your abutment and the running space for the ceramic, the position
• 24:45
  of the interface, because you can see it in 3D in your virtual planning.
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  so it's like, we are determining the implant position based on the real
• 24:56
  components that we're gonna use.
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  And when we explain that to patients, to, colleagues in conferences I- it,
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  it's a concept that is getting a lot of traction, And it's only possible due to
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  digital technology- because now you can pre-visualize the, the treatment that
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  you're doing in, the virtual environment.
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  how much is it, it's a bit maybe a provocative question, but how much is
• 25:22
  it optimizing every single item like the implant position, the, restoration, the
• 25:28
  biology, or is it more of, finding the best compromise be- between the three?
• 25:33
  It, it is always finding the best compromise, And, the best compromise
• 25:38
  in, providing simple solutions to the patient or the simplest one.
• 25:46
  I like to say that in my, treatment planning philosophy, I like to
• 25:51
  achieve the maximum outcome with the least amount of intervention.
• 25:56
  that's- that is, a, a winning formula.
• 26:00
  Because morbidity of the patient plays another role, right?
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  It's, a part in the equation we didn't manage, but for
• 26:06
  you plays an important role.
• 26:08
  I- it does.
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  and also, the more complicated your approach is, the more openings
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  for complications you have is.
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  Or the more complex your, approach is.
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  The … With, I placed my first implant 1996, so it's 30 years of
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  implant, work now, and, I cannot emphasize how much I love simplicity.
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  And my, my- thing is going back to how can we make it simpler?
• 26:43
  and people think that the ideal situation is the one that you use everything.
• 26:47
  I- the ideal situation is the one, for me at least- is the one that you achieve the
• 26:53
  maximum outcome that you're looking for with the least amount of intervention.
• 26:59
  Makes sense.
• 26:59
  I, think also the patient will appreciate it.
• 27:01
  Oh, patients love it.
• 27:04
  let's bring immediacy into the e- equation.
• 27:07
  H- how do you see, immediate implant placement being a key component
• 27:11
  of the bio-restorative concept?
• 27:13
  Because it doesn't do a lot to, maintenance of hard and soft tissue.
• 27:20
  It does.
• 27:20
  and, I, would even, go a little bit farther that the, the first attempt of
• 27:26
  the biorestorative was my 2018 paper on placement and loading protocols.
• 27:33
  That's, that was during the ITI Consensus, conference, and it's the first time that,
• 27:42
  we propose that the time of placement should be assessed in
• 27:49
  combination with the time of loading.
• 27:52
  And this is a, work we did with Alan Hamilton.
• 27:55
  He was a program director in, M- in my department, and we were working on this
• 28:00
  systematic review, and I'm telling you this small story because it reflects,
• 28:05
  it answers your questions, exactly.
• 28:08
  and, we were working with a statistician, and the idea was to
• 28:14
  have a placement protocol group and a loading protocol group- like
• 28:19
  historically had been done, right?
• 28:21
  Yeah.
• 28:21
  Yeah,
• 28:21
  exactly.
• 28:21
  Separated out.
• 28:22
  Separated out.
• 28:23
  And then the statistician said, he said, "But wait a second. Isn't that
• 28:28
  an implant to be successful has to have a placement time and a loading time?"
• 28:36
  And there was a moment of silence, And I say yes, because if you
• 28:43
  don't place the implant or if the implant doesn't stay af- after you
• 28:47
  place it, it won't be successful.
• 28:49
  And if you place the implant and it's osseointegrated but you never load
• 28:54
  that implant, it's also not successful.
• 28:57
  So then we came back and, and we talked to, Danny Buser, Steven Chen,
• 29:03
  and, Waldemar Palido, and all that.
• 29:06
  We brought the, the surgeons and the restorative guys together, and we came
• 29:11
  up with that classification that's still nowadays being used, a lot.
• 29:16
  So that has been the beginning of, thinking of a implant prosthetic complex.
• 29:26
  And now going back to your question on immediate implant placement, that
• 29:31
  has always been there very appealing, for, treatment simplicity, for
• 29:39
  treatment, one surgical intervention.
• 29:42
  And I-- But I think that it was, for many years, it was looked at from
• 29:47
  the survival rate viewpoint only.
• 29:50
  So does the implant stay- in there or not?
• 29:53
  And I think we have been doing it for many years without having-
• 29:57
  the full extent of knowledge that we do have today.
• 30:01
  And that shows in the results clinically.
• 30:04
  The main advantage or the main shift that we see in this is, that is, it's
• 30:10
  not just, shorten the, shortening the treatment time, but there is
• 30:15
  also a biological, benefit- of, preserving peri-implant tissues-
• 30:22
  when the, the indication is correct.
• 30:24
  And, I think this is a very interesting outcome because, so far people were
• 30:30
  always discussing, you can have immediacy.
• 30:32
  it simplifies the procedure, shortens time to teeth, less visits,
• 30:37
  but you're compromising on the long-term biological outcomes of the
• 30:41
  treatment, and you don't want this.
• 30:43
  But actually, what you're saying is that if patients and treatments are selected
• 30:47
  well, it goes well together and rather creates better outcomes in the long
• 30:53
  term.
• 30:53
  I-- All, all the papers are showing that.
• 30:56
  everybody agrees that, case selection is, it's essential.
• 31:02
  Yeah.
• 31:03
  and that's part of the, the learning curve that we have made.
• 31:07
  it's, We understood what cases, are good for that.
• 31:12
  We understood what, how the implant should be placed.
• 31:16
  we understood that the, treatment decisions after tooth extraction are no
• 31:21
  longer do nothing, that you have to do something after you extract the tooth.
• 31:26
  we know that doing nothing is not the best option nowadays, So
• 31:32
  I think we have come a long way.
• 31:34
  Come a long way.
• 31:35
  And, you mentioned this, this paper, this, scientific review that you
• 31:39
  published through, in the context of the ITI Consensus Conference 2018.
• 31:44
  You did an update this year, and, I recommend everybody to read the update
• 31:49
  because there's a lot of depth to it.
• 31:52
  But what, what, has changed in those eight years that you would
• 31:55
  say every clinician should know?
• 32:01
  if you, if you compare the two papers, and, I'm gonna focus just
• 32:06
  on, as an example on immediate placement, and immediate loading.
• 32:12
  So for instance, in 2018, we had six randomized clinical studies.
• 32:18
  In 2026, we have 16.
• 32:23
  Comparative studies, we went from 12 to 36, and the number of
• 32:28
  implants that we included tripled.
• 32:33
  and that is on one side.
• 32:35
  The scientific community understood based on all these studies and this
• 32:40
  clinical experience over the years, like in implant dentistry, like
• 32:46
  most things in den- in dentistry, you learn from long-term outcomes.
• 32:50
  The… It's very… The-- I would say implant dentistry failures are very slow
• 32:54
  to come and get you- over time, right?
• 32:57
  But they're coming.
• 32:58
  They're coming, yeah.
• 32:59
  And so then we learn that on that aspect.
• 33:02
  There's another element that is also related to the work industry has done in,
• 33:08
  developing, implant designs that they are more, favorable for immediate placement.
• 33:17
  they increase, insertion torque and, so there was, a big development on that side
• 33:23
  that, that really makes a difference- with the, new, micro design of the implants.
• 33:29
  and the, third component is that there are a lot of studies that they showed
• 33:34
  what we spoke at the beginning, a little bit earlier, the, biological advantages
• 33:39
  of, doing these, these techniques.
• 33:43
  Yeah.
• 33:44
  So I think the, the body of evidence is, making a big difference, right?
• 33:48
  I think we feel more comfortable, and the ITI has also progressed
• 33:51
  in, recommending to making it the treatment of choice in more areas-
• 33:56
  Correct
• 33:56
  … ba- based on the evidence, available.
• 33:59
  Correct.
• 33:59
  Based on, the evidence available,
• 34:00
  yeah.
• 34:01
  Yeah.
• 34:01
  Yeah.
• 34:02
  Let's move a bit into, one of your… one other of your favorite topics, which
• 34:07
  is, digital dentistry and implantology.
• 34:11
  I think a topic that you embarked very early on.
• 34:13
  What, is your, was your first touchpoint on digital and implant dentistry?
• 34:17
  Ooh, we, we,
• 34:21
  we bought our first intraoral scanner in 2009.
• 34:25
  Okay.
• 34:26
  Yeah.
• 34:27
  the s- Which was
• 34:27
  what?
• 34:28
  It was iTero?
• 34:29
  It was, iTero, yeah.
• 34:30
  Okay.
• 34:30
  Serial number was, two digits.
• 34:33
  Okay.
• 34:34
  And, calling customer service those days, they were really,
• 34:38
  an interesting experience,
• 34:40
  I, I can imagine.
• 34:41
  Yeah.
• 34:42
  we published, the, first implant comparative study, conventional
• 34:47
  versus, digital in 2012 with, Sang Lee, one of the, the first studies.
• 34:54
  And, that study was very interesting because I took a
• 34:57
  class of pre-doctoral students.
• 35:00
  They had never taken an impression, and we gave them a, a tray and,
• 35:06
  silicone material- Oh, wow … to take an impression on the same model.
• 35:09
  Yeah.
• 35:09
  And then we gave them the scanner, and the scanner was so natural to them, It
• 35:15
  was… A- and when you asked them, "Which one do you prefer?" it was, So that, that
• 35:21
  was the moment I, knew very early that, this will not be just a fashion- that
• 35:28
  this will be a, a, a way of changing-
• 35:31
  A fundamental game changer.
• 35:33
  Yeah, So looking back, what do you think have been the, biggest
• 35:37
  innovation steps, like the…
• 35:38
  What, have been the two things that have changed implant dentistry the
• 35:42
  most from the digital development?
• 35:45
  So I, without hesitation, the digital impressions- the opportunity to
• 35:50
  digitalize the patient intraorally and, also now all the, virtual planning and
• 35:57
  the possibility of treat the patient beforehand, So I think that's, I,
• 36:04
  like to use an analogy when I give my lectures on digital dentistry.
• 36:09
  I say, I ask the audience, "When you go to work in the morning, do you use your
• 36:14
  GPS?" And the majority says yes, right?
• 36:19
  And then I ask them, "Why do you use it?
• 36:23
  because you know how to drive.
• 36:24
  You know where you're going.
• 36:26
  You technically don't need your GPS to go to your work, right?
• 36:30
  You do it every day." and the answer is always the same. You
• 36:33
  say, "Oh, it gives me the traffic.
• 36:35
  It tells me where the, police controls are.
• 36:39
  It gives me the ETA and, all that." And basically, what that- comparison
• 36:47
  draws to digital dentistry, it provides information that otherwise-
• 36:51
  you cannot have as a clinician.
• 36:53
  See what I mean?
• 36:54
  and that makes us- by default better professionals- when you do that.
• 37:01
  it doesn't replace the knowledge.
• 37:03
  I remember conversations that we had early on when industry came up with the
• 37:08
  guided approach for implant placement.
• 37:10
  They were looking at, so how can we get every dentist to-
• 37:14
  Place
• 37:14
  implants
• 37:14
  place implants with a guide?
• 37:16
  And I said, "This is not the answer because if you don't know how to do it in
• 37:21
  the patient's mouth, you won't know how to do it in the computer or anything."
• 37:26
  The guide and the virtual planning, it still requires the fundamental knowledge
• 37:31
  of implant dentistry to be successful.
• 37:34
  Yeah.
• 37:35
  But makes us m- more reproducible- Yeah … in what we do.
• 37:39
  I think that's a key principle and, and a mistake, some industry
• 37:43
  players made in the early days.
• 37:45
  It's not about making someone, an, an unexperienced clinician a great clinician.
• 37:51
  It's about making an experienced clinician, more efficient and
• 37:54
  providing data to be more choiceful and mindful about, Absolutely
• 37:58
  what you do.
• 37:59
  If, I link back the digital to your biorestorative concept and thinking
• 38:03
  and planning cases, how well do you feel is the biorestorative
• 38:07
  concept today represented in smile design softwares like Smilecloud?
• 38:14
  I, think it's, getting out there.
• 38:16
  This paper is only, two, three years old, So it's … A- and it
• 38:21
  ha- is having a, a, a great impact.
• 38:25
  I, see, Inácio Perinacci being very successful.
• 38:29
  Maybe he should be here at your next, ProTalk.
• 38:32
  He's, one of my most proud ITS scholars.
• 38:37
  I, really, If I look back, I, see him, as one of my best, or let's say I'm proud
• 38:46
  of what he's doing, Not that I wanna claim a- any credit on his- on his own-
• 38:52
  His talent
• 38:53
  … talent, Exactly.
• 38:54
  But, so it, is out there, a different version of that.
• 38:58
  I think that we all talk in some way about the same thing.
• 39:01
  I think that when AI is picking up this biorestorative concept-
• 39:07
  we will be into the next big step forward in digital dentistry, which
• 39:12
  is AI-driven, treatment planning.
• 39:15
  I think that's gonna be the, in my opinion, a, a game changer coming-
• 39:22
  hopefully not too, distant time.
• 39:25
  too long ago.
• 39:25
  Yeah.
• 39:26
  Yeah.
• 39:26
  I m- a lot of those tools, even co-diagnostic Smilecloud to a big
• 39:30
  extent, that they, are AI supported, to a quite significant, extent to, help
• 39:37
  probably- support thought processes like the thought process around,
• 39:44
  bio-restorative concept, right?
• 39:45
  I think that's a, a very-- I, I see a very parallel development,
• 39:49
  very similar development,
• 39:50
  yeah.
• 39:51
  Yeah, and what is really interesting that is, it's AI will, will do two things.
• 39:59
  It will learn the clinician's preference, but it will also learn
• 40:05
  the patient side of it, And, that will enable the true, personalized care
• 40:12
  that we, everybody's talking about.
• 40:14
  so far the, the personalized care is, a, a, very good concept that-
• 40:20
  that people are embracing and being applicable in certain ways.
• 40:25
  But I see, how we are moving towards that, treating that individual patient
• 40:33
  with individual strategies that they go specifically, planned and designed
• 40:40
  to solve the problem of that patient.
• 40:42
  and that's a concept that we try to share with our students and
• 40:47
  people that come to our courses.
• 40:49
  And- the days where you fixed every problem with the same
• 40:55
  solution, they're long gone.
• 40:58
  they're long gone.
• 40:58
  Yeah.
• 40:58
  Yeah.
• 40:59
  Yeah,
• 41:01
  in this paper that you wrote, Digital Implant Industry: The Past,
• 41:04
  the Present, and, the Future with Tim Yoder and, Rony and many other
• 41:08
  colleagues, in the future section, you're writing exactly what you said
• 41:14
  about this concept of the digital twin.
• 41:17
  That is going to have a fundamental impact in the way we look at
• 41:21
  patients and we work with patients.
• 41:23
  Can you quickly describe what you mean by this digital twin and
• 41:27
  what it would do to clinicians?
• 41:30
  this is, a pioneer work that we started, many years back.
• 41:36
  Tim Yoder was visiting us in, in, Boston for three months and, I remember
• 41:44
  telling him, Tim, everybody's, talking about this and, but nobody was able to
• 41:50
  create the virtual patient, And then we published the, the 2014, the very first
• 41:55
  paper that we were able to, superimpose a face scanner with a cone beam CT
• 42:01
  and, Intraoral scan … intraoral scan.
• 42:03
  Yes.
• 42:04
  And, so I connected Tim with, a medical company that was doing the same, and it
• 42:10
  was a lot of work back then to do it, But that's the first report we called
• 42:14
  the virtual patient in that paper, and that's where the idea… Tim is
• 42:18
  an amazing thinker and, I love the way he, put things into a, into writing.
• 42:26
  And still now, 12 years later, we're not quite there yet.
• 42:32
  What people are doing today, they're still superimposing three files,
• 42:37
  which is the face scanner, the cone beam CT, and the, intraoral scan.
• 42:44
  What we talked about the dental twin, the, is like a, a true file that
• 42:51
  represents a replica of your, head and neck an- anatomy that can move,
• 42:58
  that you can replicate movements.
• 43:01
  I ambition that, when this becomes, mainstream, people
• 43:06
  will, save that data early on.
• 43:08
  So I, would ambition that you will be at age 20, 21- have your first record-
• 43:13
  Yes
• 43:13
  … and keep it safe somewhere in a bank.
• 43:16
  So when you're 60, if you wanna go back and, and have your teeth like you had
• 43:22
  them before, they will be there, But then, we need to go into the fifth dimension.
• 43:29
  it's, not just, three-dimensional elements.
• 43:32
  You need the movement, and then you need the biology going-
• 43:37
  being able to replicate that.
• 43:38
  It will take a little bit of time- but I'm confident that the people
• 43:43
  will be having dental twins.
• 43:46
  And, this, this virtual patient or dental twin, a- as, as you just call it, it
• 43:51
  would also grow with the patient, right?
• 43:52
  it's not a static one-off situation, but, it's something that would always
• 43:57
  evolve and give you always the, best and most recent picture and
• 44:01
  situation of the patient- Absolutely
• 44:03
  that you have in your practice for many years- Yeah … right?
• 44:06
  you update your dental record or your,
• 44:09
  Yeah
• 44:10
  … hard tissue charting or periodontal charting, you will, update your dental
• 44:14
  twin every, every couple of years.
• 44:17
  So based on this, we spoke about AI already.
• 44:21
  how do you see robotics, in, in that context, in, in the context
• 44:24
  of digital implant dentistry?
• 44:27
  I think the, the field of automatization will be a player for sure.
• 44:32
  It is being a player in, in, in many instances.
• 44:36
  We are very early on into that game.
• 44:41
  I think that, in, in my own way, and, obviously nobody has the magic wisdom to
• 44:48
  see into the future, but, thinking as a clinician and how technology could help
• 44:54
  the field is, not gonna be, just a robotic arm that does a pre, planned movement.
• 45:03
  It has to be a robotic that is able to think on the go.
• 45:09
  Is able to adapt if you, encounter something that it
• 45:13
  wasn't supposed to be there.
• 45:16
  So I think that, the combination of, artificial intelligence, real-time
• 45:21
  artificial intelligence with, rapid adjustments of the movement- it will
• 45:27
  be the moment where we will say we, we are ready for something like that.
• 45:33
  It's, it welcome
• 45:36
  So you would use it then at that point, you see there's a big
• 45:38
  support, Yes … supporting again- Yeah … an experienced clinician.
• 45:42
  everything that they help us become more reproducible in what we do, It's,
• 45:49
  It's
• 45:49
  welcome
• 45:50
  … it's, welcome, yeah.
• 45:51
  You will never replace the artistic or, the artistic or the, physician's intu-
• 45:57
  i- intuition or a critical assessment.
• 46:00
  You will not replace that.
• 46:02
  But everything that helps, minimize human errors-
• 46:07
  yeah And execution, yeah
• 46:08
  And execution- Yeah
• 46:09
  it's, welcome, yeah.
• 46:11
  w- what I found particularly interesting as well was that you did not only speak
• 46:15
  about AI, which is a big topic, robotics, virtual patient, technology behind.
• 46:21
  Y- you also spoke about, this capturing of more and more data also leads to a
• 46:26
  security question, a privacy question, around about the security of patient data.
• 46:33
  H- how do you look at this topic, and what is it that clinicians out
• 46:36
  there need to be mindful about?
• 46:39
  Yeah, that's, a big one.
• 46:40
  that, that is, it has two aspect to it.
• 46:44
  Number one is where does the data live, and number two, who owns the data, right?
• 46:52
  So in my opinion, I think that we are in debt with the, profession, because now
• 46:59
  we have several tools for, digitalizing the patients, and all these digital
• 47:07
  fis- files, they live outside of the electronic health records of the patient.
• 47:13
  and for me, there's no doubt that any medical file that you collect from
• 47:18
  a patient should live or should be linked within the, EHR of the patient.
• 47:26
  that's something that we still need to work on.
• 47:30
  I would like to see the day where your X-rays, your, STL, your facial
• 47:35
  scanner, your CAD designs, everything is stored in, the, in the patient's
• 47:43
  record- with a single entry point.
• 47:47
  And, it will be at some point, whether, driven by industry or re- driven by
• 47:53
  regulation, that's where it will happen.
• 47:55
  Accessible to every medical professional, not only-
• 47:58
  And that is the second point, right?
• 48:01
  Is who owns that data.
• 48:03
  So I … In, in an ideal world, that data should be owned to the patient.
• 48:11
  So I as a patient, I should be able to go with my dental twin, with my
• 48:16
  whole history, and with my whole, CAD design and go to the next doctor and
• 48:22
  say, "Look, this is what has happened to me. What are we doing next?" Yeah.
• 48:28
  Yeah.
• 48:28
  I understand the, a little bit the, the challenges of that, but in an
• 48:33
  ideal world, patients should own that.
• 48:37
  Yeah.
• 48:37
  I think it's a, big topic, and it would also lead to the fact that we are not
• 48:40
  repeating, diagnostic measures like- Yes … like home MCTs and others-
• 48:45
  Yes … from dentistry to other medical fields- Yeah … which I think is
• 48:47
  a big topic for patients as well.
• 48:50
  German, to, close it and to look ahead, if we invite you to the Straumann ProTalk in
• 48:56
  10 years from now, so what do you think in this, all of this development will be very
• 49:02
  natural things we will see that we cannot imagine and are very untangible today?
• 49:11
  I was never in the business of, making, predictions, but I, would say that,
• 49:20
  10 years from now, you will see, the role of the healthcare provider being
• 49:25
  completely different, and the role of the healthcare provider will be less
• 49:30
  hands-on, more technology-driven.
• 49:34
  It will be, doctors will have more time to talk to the patients because
• 49:40
  something or somebody else will be doing the work, whether it's a robotic arm
• 49:46
  or a 3D printer or something like that.
• 49:49
  But I do hope that in all this evolution, we, do not lose human contact.
• 49:55
  That is so important in- in treating patients.
• 49:58
  At the end of the day, you can use all your technology, you can use everything,
• 50:02
  but patients, they come for you.
• 50:05
  They come to see you.
• 50:06
  They come to hear from you because they trust you, and that trust
• 50:12
  that is, built between the,
• 50:17
  patient and the doctor cannot be replaced- by anything.
• 50:20
  And I hope that while I embrace all the new things coming, we are able
• 50:25
  to preserve that very sacred, element of the- patient-doctor relationship.
• 50:33
  Yes.
• 50:34
  the, the doctor always being the, connect between the patient and
• 50:40
  technology that supports them, but the doctor is in the center of it, yeah.
• 50:45
  I can very well relate to this as a patient as well, what you're saying.
• 50:49
  Galen, we have the, also the, routine to give the possibility also
• 50:55
  to our guests to ask a question.
• 50:57
  Oh, okay.
• 51:02
  one of the, the a- at least at this stage of my career, one of the topics that
• 51:08
  I'm, very interested in is leadership and, I have seen you, with a, an amazing
• 51:14
  trajectory within the industry of implant dentistry from the beginning until now
• 51:20
  that you are at, at the top of the, global leadership of, implant industry.
• 51:27
  Can you tell me what is your, leadership style and, how are you successful
• 51:33
  in, in, in this leadership role?
• 51:36
  first, thanks for the, question.
• 51:38
  I think that would be a, a full podcast by itself probably.
• 51:42
  We should do another one later.
• 51:43
  Exactly.
• 51:45
  no, thanks for the, question.
• 51:47
  so first of all, I consider myself also lucky because I think the, the environment
• 51:53
  that the industry, implant industry and Straumann gave me was, was just perfect,
• 51:58
  and, there was always people I like with you, Urs Belser, and, and, also HP Weber.
• 52:06
  There were mentors along the way that, supported what I did, and
• 52:10
  of course it's not only luck and the mentors, it's also hard work.
• 52:13
  Let's face it, without, the long hours and the hard work, it, it,
• 52:18
  will not work out at the end.
• 52:21
  and l- leadership style, I think what is interesting is, leadership
• 52:26
  style is evolving over time.
• 52:27
  I think the way I'm leading people today is very different than, in the early
• 52:31
  stage of my careers, and probably people that, I was leading 20 years ago, can
• 52:36
  testify this and, many of them are still in the company, and I, know them today,
• 52:40
  and some are still in my team today.
• 52:42
  So I guess the leadership style has evolved a lot.
• 52:45
  Today I think I, I lead a ro- a lot around, relation to, to, to, people,
• 52:50
  around clarity because I think clarity is something that if you are clear
• 52:55
  about an ambition that you want to achieve, where you wanna go, and you
• 52:59
  have a great team around you- You, don't need to be in all the details to help
• 53:03
  people finding the way because they are smart enough and motivated enough to,
• 53:07
  find the best way to a clear goal and a vision that, that you have agreed.
• 53:12
  And with this, you, can have a leadership that I think is very
• 53:15
  empowering and, and also supporting talent to grow because you, if you
• 53:20
  manage them in every single little step, it's also prohibiting them to grow.
• 53:25
  So, I think leaving them more space, but the basis really, th-
• 53:30
  this clarity that became a, a key principle for me that, that leads
• 53:34
  to many other positive outcomes.
• 53:37
  So
• 53:37
  may I, say that you're talking about the, emotional intelligence?
• 53:42
  I, also relate to that, what you just said is, people associate
• 53:47
  leadership with structural power.
• 53:49
  And, the more I look at that, I, move away from that.
• 53:53
  And leadership is about relationships.
• 53:55
  It's about- Yes
• 53:56
  empowering, it's about, talking to people, let them know where we're going as a unit-
• 54:02
  as a team, understand the differences, and people like to come to work early in the
• 54:06
  morning, sometimes come to work late, as long as you do the work, It's, Exactly.
• 54:11
  Yeah … and it's a fascinating topic is, is the human relationship
• 54:16
  that at the end becomes-
• 54:18
  Yeah.
• 54:19
  I agree.
• 54:20
  This emotional intelligence is, probably underrated in the
• 54:23
  early stage of your career.
• 54:24
  You think it, it's all about, IQ, but then I think over time you realize it's
• 54:30
  more about EQ and the, connection… the true connection to, to people.
• 54:35
  And you will not everybody, like always everybody, and
• 54:38
  not everybody will like you.
• 54:39
  That's just how life is.
• 54:41
  But, the question is, do you care about your people or not?
• 54:43
  Exactly.
• 54:44
  I think that, became a, a critical item.
• 54:48
  Thanks for the, for, the question, and we can deepen the conversation after.
• 54:53
  So German, thanks a lot for, diving into your journey and a lot of,
• 54:58
  inspiring, nuggets that you gave us and the, the young generation.
• 55:02
  I think the first one, the first nugget I found is- And it's simple
• 55:08
  but powerful is, you gotta try.
• 55:12
  the, the world belongs to the people that do stuff and that try stuff, and then you
• 55:16
  will learn, if the things work out or not.
• 55:19
  Like you, you just dared to apply to be one of the first ITI scholars.
• 55:24
  It worked out, and it made a fundamental difference to your career, and you met
• 55:28
  some great people along the, journey.
• 55:32
  Then I think the, second thing I, I take away, and this is the flip side
• 55:35
  that I think is really important for all of us leaders, you give back now.
• 55:42
  You, have this passion to grow talent in the ITI, but I al- I know also in your
• 55:47
  team you have this passion to really help talent to grow and to, connect them to
• 55:52
  other great minds and to give them the opportunity to create projects and come
• 55:57
  with interesting thoughts and papers out that, that have a new, let's say,
• 56:02
  a profound influence on the industry.
• 56:03
  So giving back, supporting the young generation.
• 56:07
  Then I like the, thought at the end, that whatever technology will do, and
• 56:14
  you are very open and supporting the development and embracing technology,
• 56:18
  digital technology, AI, what have you, but it's always this connection between
• 56:23
  the, patient and the dentist first.
• 56:25
  And, technology should somehow sit in the background and be a strong supporter of
• 56:30
  this, but, th- this personal connection, conversations, and feeling each other
• 56:35
  I think will be, key for the future even in, in the implant industry.
• 56:41
  So thanks a lot for, sharing your wisdom.
• 56:45
  And to the listeners, if you like this episode and, you generated even some
• 56:49
  other nuggets out, please recommend it to your friends and, colleagues,
• 56:54
  and subscribe to Straumann ProTalk on Spotify, Apple Podcast, and on YouTube,
• 57:00
  to not miss the, next episodes, and we're always happy to have your comments.
• 57:04
  you can also leave your comments on Instagram, and, we're always
• 57:07
  happy to read those comments and, revert back to those comments.
• 57:10
  So thanks a lot, German.
• 57:12
  Thank you very much, Andreas.
• 57:13
  This has been a very, enlightening conversation, and, I cannot
• 57:19
  tell you how much I enjoyed it.
• 57:21
  Thank you, German.
• 57:22
  Same here, and, watch out for the next episode.
• 57:25
  thanks for your attention and listening in.