Interview: Prominent dental specialists speak about power of an interdisciplinary approach
Dr Daniel Edelhoff is director and chair of the department of prosthodontics and dental material sciences at the Ludwig-Maximilians-Universität in Munich in Germany. He is a member of the Deutsche Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie and the Deutsche Gesellschaft für Prothetische Zahnmedizin und Biomaterialien , DGPro. He is vice president of the Arbeitsgemeinschaft Dentale Technologie , a member of the advisory board of the DGPro, and a member of the American Academy of Esthetic Dentistry and the International College of Dentists. Dr Otto Zuhr studied dentistry at RWTH Aachen University in Germany from 1986 to 1992. He is a specialist in periodontics and is board certified by the Deutsche Gesellschaft für Parodontologie , DG PARO, and runs a private office together with Dr Marc Hürzeler in Munich in Germany dedicated to periodontics and implant dentistry. Zuhr is an associate professor in the department of periodontics at Goethe University in Frankfurt in Germany. He has written several refereed scientific articles in the fields of periodontics and implant dentistry and is the author of Plastic-Esthetic Periodontal and Implant Surgery (Quintessence, 2012). His research activities are focused on oral soft-tissue wound healing and reconstruction. With more than 25 years of clinical experience and teaching practice, he has become a proven expert in his field well beyond European borders. From 2007 to 2014, he was a board member of DG PARO. After their joint lecture, which took place during the MASTERMINDS2 conference in Athens in Greece and in which they presented a well-established and proven interdisciplinary treatment concept, they took the time to answer some questions.
Dr Edelhoff, do you feel the prosthodontist can at times be the last resort in complex endodontic cases?
It would be more accurate to say that treatment planning normally starts with prosthodontics, to decide which tooth can be used as an abutment, which not and so on. In complex cases, you need the prosthodontist to organise the treatment plan. He will be doing the final work, such as crowns, veneers and onlays. Both disciplines are equally important, but it is the prosthodontist who has to synchronise the treatment.
You seem to be a perfect team, and you give the impression that an interdisciplinary treatment approach can work in such a smooth way—that it is successful and also appears necessary. Could you tell me how this collaborative work started?
Edelhoff: We are very good friends. I met Otto at RWTH Aachen University more than 30 years ago, and since then, we have worked and spent time together.
Do you often collaborate with one another?
Edelhoff: After we had completed our studies, Otto moved back to the Munich area and I stayed in Aachen for many years.
Zuhr: We also followed different paths, one might say. Daniel started an academic career, while I started as a clinician. We saw each other privately but, being in very different fields, did not attend the same congresses and scientific meetings.
Edelhoff: Later, I was offered a teaching position in Munich which I thought would be temporary, but both my family and I grew to be happy living in Munich and decided not to go back to Aachen. I then told Otto that I thought it would be a good idea for us to work together on difficult cases.
Dr Zuhr, you attended various educational programmes, mainly in the US. Was there something missing in Germany that caused you to decide to further your education in other countries?
Zuhr: I would not say that I was missing something particular in Germany. It’s just that in those days there was not a really well-structured postgraduate education programme in Germany. That’s why I finally ended up going to the US.
Over time, I became more and more interested in research. If one starts as a clinician, one can of course learn how to do experimental and clinical research later on, but that is not so easy to do. It was a period in my life during which I really put a lot of time and energy into my career. But it was very important for me and I still benefit from it today.
Dr Edelhoff, you are a dental technician as well as a dentist. Both of you being involved in teaching, do you feel that courses in dental technology and digital technology should be prerequisites in training for dentistry?
The problem is that you have to think about different groups of patients. Some do not have so much money to spend and we need very efficient tools for a satisfying result. I think digital dentistry can give you satisfying results because the main trend is about the layering technique, where several layers are added and shrunk during firing, in ceramics for instance to monolithic restorations. It is faster and easier to design, and even the dentist can colour a little bit.
But we have patients with extremely high demands and even more so depending on where they live. In Munich, for example, the demands and expectations are most likely different to those in a smaller city. If you want to satisfy these patients, you need specialists and dental technicians as well, to meet the patients’ needs and desires. This creates another dimension, and the cost the patient pays is one of the factors to consider. Manual skills are crucial and such skills are dying out. The new generation is more interested in digital dentistry and fascinated by the machines which help them achieve what is required. However, sometimes they do not know how to proceed without the machines.
I think that the dental technician’s profession is changing and the tasks they have to do will change. Therefore, the new generation needs to have an in-depth understanding of digital dentistry.
I would even say that they need to have a double education. They certainly need to be proficient with the basics of analogue technology as well as be able to understand how to use digital tools. I see it constantly in our department. We have so many specialised people, even master dental technicians, to whom I sometimes give something simple to repair, and it often happens that they don’t know how to do it if they don’t have a computer.
When things are easy, one has a tendency to delegate and forget prior knowledge, don’t you think?
Zuhr: I think that digital dentistry has changed the whole profession significantly. In the past, for many indications, it was nothing but a modern alternative to well-proven analogue procedures. Today, digital dentistry offers possibilities that we just did not have in the past. Digital technology cannot replace profound basic knowledge and manual dexterity, but it can undoubtedly expand and improve diagnostic tools as well as the safety and predictability of clinical interventions. Digital dentistry can no longer be ignored by clinicians; it must become a serious part of dental education, for the good of patients.
How did you each choose your specialties?
Zuhr: It was from the very beginning the biological aspects of dentistry that fascinated me the most. We had also always had very good periodontists teaching us during my undergraduate education in Aachen. I feel that this also played a role in my decision. I like periodontics very much and I have never regretted my choice.
Edelhoff: For me, it was actually the dental technician training. I was interested in prosthodontics, and even though I knew a lot about it, I wanted to learn more. I had always been interested in understanding how material behaves, so I chose to do my thesis in the field of dental material science. This was the main reason, to acquire more knowledge for prosthodontics.
What motivates you?
Zuhr: It is a general attitude. If you want to progress, you need to have a goal and my goal has always been to make things better for the patient. I also have always believed in working in a team and have never had the experience of working alone. Being part of a team is not always easy, just like every human relationship is not always easy. But at the end, teamwork can be very inspiring, stimulating and motivating to advance care for our patients—this has always been my driving force.
Edelhoff: For me, it is the same—the team—and Otto, of course. I am curious to know what he is doing, what his technique is, what surgical options we have and how we can improve the treatment of our patients and simplify it, making it easier for us but still with the goal of retaining the same level of quality.
I have a very good team in Munich, consisting of very smart, self-driven people. I give them a lot of freedom and this increases their creativity. The head of the dental lab in our department holds 22 patents! I like this. When we talk, we both have ideas and feed from one another.
An interdisciplinary approach seems to be a recurring theme nowadays. Some people have difficulty going outside of their comfort zone to collaborate with others. Do you believe it is something uncommon today?
Edelhoff: I would say it is not new, but the patient, especially, benefits from it, and I do as well, because in collaborating, I get so much inspiration from Otto or from my dental technicians, who have very interesting ideas, and from general practitioners also. A lot of good ideas come from them and I learn from them all constantly. One needs a functioning network.
Zuhr: The biggest issue is whether or not you are open-minded. You need to know what other disciplines can do. If you don’t, you cannot offer it to your patients.
You are both teachers and therefore in your own ways defining or sculpting the future of dentistry. What do you focus on giving your students and what do you wish them to have when they graduate in order to become well-rounded practitioners?
Edelhoff: I always tell them to stay curious. I give myself as an example. When I graduated, I had a feeling that I knew nothing. I could do simple cases but did not understand the whole connection between the different specialties very well or the chronology of treatment. Therefore, one needs sessions where one can discuss and exchange ideas.
It is a question of character, personality. Some will only focus on money and I would not like to be a patient of such a dentist.
Otto and I have similar personalities. We are sort of perfectionists. I would do some treatments free of charge, only to gain more experience. For me, it has to do with passion, curiosity about something new, developing something or a new idea.
Do you think you manage to give your students all of this?
Zuhr: I think you can open their minds and motivate them to continue expanding their knowledge and improving their manual skills. Our profession is not so easy. On the one hand, you might be the most skilled professional, the best surgeon in the world, able to do everything with your hands. However, if you are lacking the fundamental knowledge and thus every second decision that you take for your patients is wrong, few of your patients will really benefit from your manual dexterity. On the other hand, you might be the brightest, smartest person in the world, know everything and make the right decision for your patients every time, but if you cannot transfer this knowledge with your manual skills to the patient’s mouth, hardly any patients will benefit from your knowledge. Patients need both from us: profound knowledge and manual skills.
This is not a reason to be frustrated; it is actually the beauty of our profession. It is a journey that never ends. If you think “That’s it, I’m good enough now”, it’s over; there is no more space for improvement. That is the mindset that I want to communicate to my students.
Edelhoff: To motivate the young students, I always tell them that it is a very motivating and passionate profession, because you, as a clinician, achieve technical success and what you give to your patients can have such a great impact on their lives.