Dental News - Interview: “People have become more health-conscious and concerned with the type of treatment"

Georg Isbaner, Oemus Media

Thu. 18. January 2018

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Dr. Sammy Noumbissi, founder and President of the International Academy of Ceramic Implantology (IAOCI), is currently organizing the academy’s 7th annual meeting, to be hosted in San Diego, California, U.S., from Feb. 14 to 17. Practicing in his own dental clinic in Silver Spring, Maryland, U.S., the established expert on metal-free full-arch reconstruction also serves on the editorial boards of several journals and has authored a number of publications. Dental Tribune Online spoke with Noumbissi about his field of expertise, its challenges and the program for the seventh IAOCI World Congress.

Dr. Noumbissi, are there any therapeutic indications for which you recommend the use of ceramic implants only?
I started using ceramic implants in late 2009, and believe it or not, it is a patient who pushed me in that direction. Ceramic implants are a wonderful addition to the options implantologists and patients have for the replacement of lost or missing teeth. Like any other medical or dental modality, ceramic implants are not a panacea and certainly cannot be used exclusively. In terms of indications, we have seen the use of implants as a preferred method of tooth replacement grow exponentially. This has led to exposing a very broad range of individuals to dental implants; however, in return, the biological response to these conventional implants has opened a window into re-evaluating the “biocompatible” label given to titanium and titanium alloy implants. We now know from scientific literature that titanium, when compared with zirconia ceramic, did not fare as well in terms of esthetics, plaque retention, epithelial attachment and soft-tissue stability. We also know that ceramic implants with their unique surface treatments osseointegrate as well as titanium-coated implants do. I believe that ceramic implants should be used with consideration given to the biological factors, such as immunology, and of course the dental aspects also. Patients who want superior esthetic results and patients who have a history of allergies and sensitivity to metals are prime candidates for ceramic implants.

In your opinion, what are the ideal properties and functions of a modern ceramic implant system?
A modern ceramic implant, whether a one-piece or two-piece, should be able to function and be as successful as any other conventional implant. Today, the reality is that most ceramic implants on the market do not match the flexural strength of metal alloys, although there are some ceramic composites headed to the market that will address such concerns in a significant manner. Another important thing is that the implants, especially from a prosthetic aspect, need to be versatile; and I mean by that that they have to be easily serviceable. I see manufacturers coming out now with screw-retained two-piece ceramic implants and even metal-free screws—which is exciting.

When do you use a one-piece ceramic implant, and what are the indications for a two-piece system?
When I fully converted to ceramic implantology, the only option available in North America where I practice was one-piece ceramic implants. We managed to treat about 90 percent of cases that came to our clinic. The greatest challenge was the precise and accurate placement of the implant, as there are very few systems that allow one to prep the abutment if one is off by a couple degrees. I was however able to treat a wide range of cases, from single implants to full-mouth reconstructions. In the last four or five years, we have had available two-piece ceramic implants with cementable or screw-retained abutments and that has brought more options and more flexibility. As I see it, I would recommend using one-piece ceramic implants for single-tooth or multiple separate single-tooth replacement mainly in the molar and premolar area. When it comes to anterior teeth or full arches, although one-piece implants will work in some cases, I prefer a two-piece solution. For servicing and maintenance, I recommend two-piece screw-retained implants and, in keeping with the metal-free philosophy, using a system that offers a metal-free screw.

Drawing from your experience, do you think patients who do not want titanium implants are now choosing ceramic implant solutions?
Yes, absolutely. In my experience, when I discuss treatment with patients and I present the option of a metal-free implant, I get approximately 93 percent who would prefer a metal-free solution and 80 percent of that 93 percent are willing to spend extra to replace their teeth with ceramic implants instead of titanium. The reason for that in my opinion is that people have become more and more health-conscious and concerned with the type of treatment they are willing to accept. Just look at the proliferation of organic/biological supermarkets and the rise of alternative medicine, biological dentistry and integrative medicine. There is a shift from old-fashioned health/dental care to what I like to call “wellcare.”

What are the future challenges or goals of ceramic implant technologies?
Ceramic implants still need to improve in terms of flexural strength, but their structural and biological properties are far superior to those of metals. Ceramic implants are not vulnerable to corrosion, do not release ions in the host and should be regarded as the most biocompatible dental implant material available today.

How do you address these challenges?
Continued research and development are the key, but also close collaboration with clinicians who see far more and unfortunately report less than researchers do.

You are the founder and President of the IAOCI. Right now, you are in the process of arranging the 7^th annual IAOCI congress. What will the main focus of the event be and who will the speakers be?
The 2018 edition of the IAOCI congress will take place in San Diego from Feb. 14 to 17 at the Hilton San Diego Resort and Spa. In collaboration with the German Society of Oral Implantology, we will be hosting White Implant Day on Feb. 14, followed by pre-congress implant and ozone therapy workshops the next day. On Feb. 16 and 17 will be the main event and our keynote speaker this year will be Dr. Ulrich Volz. There will be other notables, such as Prof. Mutlu Özcan, Dr. Corrado Piconi, Dr. Marcel Wainwright and Dr. Antonio Scarano, just to name a few. Readers can find more information at http://iaoci.com/iaoci2018/.

Dr. Noumbissi, thank you very much for taking the time to answer our questions.