Interview: “Long-term studies show that not all implants and prostheses survive”

Prof. Hämmerle, implantology is one field of dentistry that has undergone major changes in recent years. What do you regard as some of the biggest developments since you started working in implantology?
Nowadays, implant treatment is primarily prosthetically driven, meaning that implants are placed correctly positioned in the jaw prosthetically. As a result, the placed implants are often not completely surrounded by bone. However, in order for the implants to be completely surrounded by bone, bone is locally grafted using regenerative methods. In certain cases, the bone is first grafted and then the implants are placed. By far the most common method, however, is to regenerate the existing bone defects in combination with the implantation. It is fair to say that developments in the field of bone regeneration in recent years have been among the most lasting improvements for the quality of treatments in implant dentistry.

Further progress has been achieved in the field of biomechanics. In the past, as many implants as possible were placed; today, however, only as many implants as necessary are strategically placed in the correct positions for retention of the restoration. In addition to the number, the length of implants has been significantly reduced, because now we understand more about biomechanics, the survival rates of implants have increased and we no longer place “reserve implants”.

Also new is the certainty that, statistically speaking, a relatively high rate of failures and complications will occur. Long-term studies show that not all implants and prostheses survive and that follow-up treatments are often necessary. Therefore, practitioners and patients have to be prepared for maintenance care.

Digitalisation is currently an important topic in dentistry. New technologies offer the possibility of simulating treatment outcomes, of placing implants guided by 3-D imaging and of creating surface or depth scans. The digitally controlled industrial production of restorations has led to a major change in reconstructive dentistry.

Would you say that digitalisation has made it easier to place implants?
It has become safer and easier to plan, but the word “easy” should not be used in this context. Using these new technologies requires a great deal of expertise. Placing implants manually is not very demanding, but you need sound knowledge and consolidated skills to achieve the desired result.

For which implant indications are improved treatment options available today, and for which do we need further research? Which indications still pose great challenges for implantologists?
Bone availability continues to be a challenging medical aspect. In order for implants to be successful, they must be embedded in bone. As a result, the need for bone augmentation and suitable biomaterials is still quite high.

Costs are also a major challenge. It would be desirable for treatments to be redesigned in such a way that prices fall and more patients can benefit from implant-retained restorations.

Significantly improved treatment options are available in the area of alveolar ridge preservation. Studies show that measures can be taken immediately after tooth extraction to prevent the alveolar ridge from resorbing severely, and thus the conditions for implantation in the second stage are improved.

From 25 to 27 April, the Osteology Foundation is holding its international symposium in Barcelona. As former president of the foundation and a scientific chairman of the upcoming event, what would you say dentists can look forward to?
We want to build on the great successes of previous international symposia of the Osteology Foundation. To this end, we have invited excellent speakers and aimed at creating a congress environment in which dentists can meet and exchange ideas with each other or with the speakers.

What will be new at the Barcelona event, ​​compared with the one in Monaco in 2016?
A new addition are the host organisations, the German Association of Oral Implantology, which is holding its own programme session on Thursday, and the Sociedad Española de Periodoncia y Osteointegración [Spanish society of periodontology and osseointegration], which is hosting its own session on Saturday morning. Furthermore, we have exciting competitions in our programme, such as for the poster and clinical presentations by researchers.

In addition, we are introducing a completely new item: on Friday, highly topical subjects in research and clinical practice will be discussed in four parallel sessions. For this purpose, we have recruited young speakers who have special expertise in and are active in research in these areas. The topics will include alveolar ridge preservation, bone and soft-tissue regeneration, periodontal regeneration, the planning of regenerative procedures with technological innovations in the future, as well as biological factors that influence healing processes.

Thank you for taking the time to talk with us.

 

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