Interview: “What can we expect from implant dentistry?”

Increasing the gingival thickness was a recurrent topic at the conference. Dr Alexandre-Amir Aalam told us that it is possible to generate more tissue when there is insufficient thickness. Dr France Lambert stated that it is better to increase the gingival thickness prior to placing an implant; therefore, it is also possible to do so once the implant is already in place. Do you feel that implantology has made good progress relating to this important factor?
Yes, definitely. It is at the moment a major topic in implantology. Everything is about the soft tissue, the connection, the gingival thickness, the bone and lack of it. It is really what we are talking about and working on right now.

Has it become easier to obtain sufficient quantity and quality of tissue for implant placement with the materials that are now available?
It is easier, but the materials need to be chosen carefully. There has been no major progress when it comes to biomaterials, but what is important are the indications, when and which biomaterial should be used. One cannot use the same biomaterials to fill a gap for example as one would to do vertical augmentation of the volume. It is therefore necessary to combine according to need and this is what we do very often now.

In your presentation, you spoke about the intra-oral scanner. Do you think it is the most interesting innovation in implantology?
There are two important topics in implantology. The first one is the soft tissue and how to manage it, which is one of the main problems and very important in implantology. The second is the technology and possibilities of CAD/CAM and mainly the intra-oral scanner. This is the final tool we really needed, the missing tool. It is now really possible to treat a case using a completely digital workflow from beginning to end. We now have the ability to be more precise, to make less mistakes, to truly plan, know and see exactly what we are doing and obtain better, faster treatment results.

Do you think that the majority of dentists use the digital technologies available to them?
This is a new revolution just starting. I would think that less than 10 per cent of practices are equipped with the tools available. Today, everybody can place implants and 80 per cent of dentists do so. All new graduates starting their professional careers place implants. The problem though is that there is a learning curve, training that is necessary and not always done. Therefore, there is a huge difference in the quality of the work and the results. When a dentist attends a congress like ours, he or she will listen to speakers that are excellent in their work, that challenge themselves to learn and do their best, that use the tools available for the best treatment results, but unfortunately it is not a reflection of the majority of dentists.

The last Journées Dentaires de Nice (Nice International Dental Meeting) took place in 2015, and IMAGINA Dental will not take place this year. Are you satisfied with this fourth edition of your congress?
We had around 500 visitors to Euro Implanto, a fifth more than the last congress two years ago. We are therefore very happy, even more so because all the congresses that have taken place in the last 12 months have seen a decrease in the number of attendees. IMAGINA was financed by sponsors. I am not sure that the scientific programme was carefully thought through and it seems that most speakers were recruited by the industry. We have a different approach with Euro Implanto. One third of the speakers are from the region, one third work in France and the last third are international speakers. We are open to everybody and have managed to stay completely independent; we do not have sponsors finance our congress.

The Journées Dentaires de Nice became, I believe, an obsolete model. I was involved in deciding to halt the meeting for now, but not because the idea was bad. The idea of bringing back the Journées Dentaires de Nice is still alive. If it comes back, it will be with a small organisational committee and a different approach. It is important for one to question oneself and re-evaluate what one does. This is what we do with Euro Implanto. We have noticed that it is necessary to show what is done and how it is done and not just focus on conference papers. Therefore, we had a workshop presented by Dr Aalam, who came from Los Angeles in the US. We also limit the duration of papers to 20 minutes.

Biology, new materials, how to manage bone grafting—it is clear that we cannot and should not do without CAD/CAM technology, but it seems that many speakers have addressed the importance of returning to the fundamentals of dentistry. Do you think these have been neglected in favour of technology?
That is a danger. It is the practitioners’ responsibility to be professionals and make sure the foundations are not forgotten and are applied each time. The digital technology is going to be part of dentistry; what is holding it back a bit right now is cost, but that will go down. It is not possible to stop the progress of technology or do without it. Dental technicians have to work with it and it is through them the technology enters our dental offices and we cannot ignore it or do without it. The foundations cannot be forgotten either. The patient is the most important factor and treating him or her, not hurting him or her and giving him or her the best treatment possible are central.

Osseointegration of an implant is essential to treatment success. Do you have the sense that aesthetics has become a more important aspect for the practitioner to consider than it was before?
Without a doubt! The implantology we did 25 years ago has nothing in common with what is being done today. This was demonstrated clearly during the congress. Dr Ady Palti spoke about it in his presentation. Aesthetics is one of the most important factors. Besides the necessary osseointegration, we want a beautiful prosthesis and a healthy and beautiful gingival margin for a perfect aesthetic final result.

In a past interview, Dr Gérard Scortecci stated that practitioners and patients whose requirements increase with implantology advances are constantly challenging a quick consensus, peremptory truths and dogmas. Do you think that the patient is aware of all the possibilities of the ongoing progress in implantology when it comes to possible treatment outcomes?
With all the information available today, professional training and e-learning, it is impossible not to know what is available and the progress being made, unless one is not interested in the evolution of our discipline and therefore has no need to change what one does. Twenty years ago, patients trusted their doctors and did not question them, but nowadays many no longer do. Many patients are getting informed and now ask and know what they want and no longer blindly accept what we propose. Twenty years ago, patients were happy when missing teeth were replaced; now they want the teeth, the smile and the social status.

Dr Jean-Pierre Brun said it well during his presentation: a well-functioning prosthesis fitted on implants does not mean the patient will be happy with the outcome. We try to achieve treatment results that are good, aesthetically beautiful and functional, but it is not always easy. Each case is different; each case is a new challenge.

In dentistry, implantology is the leader in innovations. In which areas do you think we will see new developments and in which areas do you feel they are needed?
Without a doubt, all that has to do with digital technology and faster and cheaper treatments. Automations developed come from the industry and are not always adapted to dentistry. The practitioner’s skills are and will stay necessary to bring about perfect treatment results.

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