Categories
A PODCAST BY SDS Carolina Volz

Episode 3 – Dr. Rebekka Hueber on the advantages of ceramic implants, in particular SDS implants

Dr. Rebekka Hueber on the advantages of ceramic implants, in particular SDS implants

Which aspects convinced the experienced oral surgeon of the SDS system?

Dr. Rebekka Hueber is a specialist in oral surgery and successfully completed the curriculum “biological dentistry and ceramic implants”. She is also head of the dental department at the SWISS BIOHEALTH CLINIC and will in this episode of SDS PODCASTS tells us how she came to ceramic implants and why she uses SDS implants exclusively.

Although Dr. Hueber came to the world of implant dentistry via titanium implants, as a practitioner she sees tremendous benefits from ceramic implants, especially SDS implants.

Dr. Hueber followed the classical path of dentistry and accordingly had to deal with various problems, such as peri-implantitis. Therefore, early in her professional career, she dealt with alternative materials such as ceramics, but had to realize that most implant forms, just like titanium, are still awkward and inconvenient to handle, as well as unsatisfactory in terms of results.

With the SDS ceramic implants she achieved immediate success. The handling, the biological drilling protocol, the easy possibility of immediate implant placement and the extremely good soft tissue behavior convinced her and her patients.

In the third episode, Dr. Rebekka Hueber and Coco Volz talk about the many advantages of ceramics and especially the SDS implants.

Today‘s Guest

Dr. Rebekka Hueber

Oral surgeon and specialist in “biological dentistry and ceramic implants”

Specialist in oral surgery and head of the dental department in the SWISS BIOHEALTH CLINIC, personally trained and educated by Dr. Ulrich Volz. Among other things, she is a member of the SWISS BIOHEALTH ACADEMY, where she is involved in current research with great commitment.

Dr. Rebekka Hueber: oral surgeon, specialist in biological dentistry and ceramic implants

Dr. Rebekka Hueber – Specialist for Oral Surgery in the SWISS BIOHEALTH CLINIC

Dr. Rebekka Hueber – international Speaker

Carolina
Hello and welcome to the third episode of the SDS podcast. Today we will talk to Dr. Rebekka Hueber, who is a specialist in oral surgery as well as the head of the dental department at the SWISS BIOHEALTH CLINIC and who successfully completed the curriculum biological dentistry and ceramic implants. Dr. Hueber followed the classical path of dentistry and accordingly had to deal with various problems such as periimplantitis. Therefore, early in her professional career, she dealt with alternative materials such as ceramics, but had to realize that most implant forms, just like titanium, are still awkward and inconvenient to handle as well as unsatisfactory in terms of results. Dr. Hueber will tell us how she came to ceramic implants and why she uses SDS implants exclusively. Hello, Rebekka.

Carolina
Hi Coco.

Dr. Rebekka Hueber
I’m very glad to have you on our podcast.

Carolina
Yes, and thank you for the invitation.

Dr. Rebekka Hueber
So let’s get right into it. My first question for you is how did you get into ceramics?

Carolina
Well, that’s kind of a little bit of story. I did the classical path. I did my studies in Munich, and in a very early stage I realized that I love doing surgery. So I did the specialization for oral surgery in different dental offices, also in a referral practice where we got a lot of patients referred from other dentists. So I saw a lot and I also got referred many problems, especially also with titanium implants or infected teeth. And I had to deal a lot with periimplantitis. And that was kind of the start where I wondered if titanium implants are really the right therapy or why some patients with some patients it’s no problem and some patients really have problems with it. And afterwards I became the head of the surgical department of a dental clinic in Germany and the patients there were treated in very modern ways. The titanium implants were premium manufacturer. We did everything on the highest level, also the technicians. However, after some years with some patients we started to see the same problems, although everything was done on a very high level. In addition, I also always didn’t like the handling very much of titanium.

Dr. Rebekka Hueber
I thought it was a little bit complicated. It includes many steps. So you have a gingiva former gingiva former you have to do the exposure of the implant after some time impression, you have abutment parts, so there are many steps and until you can place the final crown. So that’s something that also I didn’t really like. And I took a lot of trainings in how to treat periimplantitis. But I also realized that there’s no real solution for this problem. And on congresses you often can also hear from leaders of periodontitis or prosthetic departments that we are facing a tsunami of periimplantitis in the next years due to the corrosion process that is happening in the mouth. And that can cause a loss of bone and infection. And that’s what made me search in the end for an alternative material. And I found ceramics. I tried different manufacturers, but what I didn’t know back then, but what I know now, is that often the shape of ceramic implants is the same like titanium. And that’s still a problem because the handling was complicated. I also had losses and I found the handling of these implants not very satisfactory. I didn’t have that much success in the beginning and also immediate implant placement. What I had started with titanium did not really work with these implants. But yeah, I didn’t want to give up. And the ceramic itself is really an interesting material. So yeah, that’s how I found to it. And then I found the SDS ceramic implants and that changed a lot.

Carolina
But how did you specifically get interested in the SDS ceramic implants?

Dr. Rebekka Hueber
Basically, I learned about SDS through a hint from a colleague. He told me you should go to Switzerland and have an educational course there. So I traveled to the education center and I was hooked right away. So not only by the people I met there, but I could really feel that they had understood how ceramic works and also how you should respect the biology of the bone. And it was very impressive that there was a high practical experience with ceramic implants over 20 years. So I learned that this company had placed ceramic implants over 25,000 ceramic implants in the last 20 years, and that they learned by doing that. That was really interesting. And I was also very enthusiastic about the training I got there because the material was explained in detail. And you get a combination with the SWISS BIOHEALTH CONCEPT where the thing is unique because everything that is explained there also matched my own clinical experience. For example, that different metals in the mouth can trigger symptoms or chronic inflammation, the jawbone even. And even if an inflammation doesn’t hurt, it can affect the immune system via the blood system of the patient and so much more. I learned a lot about medical staff and medical therapies, the physiology of the bone. And these were things I had never learned like this at the university or at my specialization for an oral surgeon. And I also learned how to better prepare my patients for procedures, avoid complications and support them in healing. And that was the first really, education where I understood what is important about ceramics. How can I treat my patients that they don’t have a lot of swelling, that they have a better healing? How can I prepare them for their surgical interventions? And that’s how I got hooked by SDS.

Carolina
You are now head of the dental department of the SWISS BIOHEALTH CLINIC. How did that come about?

Dr. Rebekka Hueber
Yeah, after I did the educational program, which I can really recommend, because you really have to think different when it comes to ceramics. So you get a lot of support and you will have faced a lot less failures once you start. So I started to place ses influence in the clinic where I worked. And the success came quickly. The handling was much easier. I had happy patients because they had less interventions, and the soft tissue results were amazing. So I did not have any infected tissue around the implants. And I also like the drilling, according to bone classes, very much so, yeah. Actually, I started to have fun in my surgical experiences with the SDS implants and in my clinic, unfortunately, the implant system could not be changed easily. They had their own manufacturers they worked with. And I just wanted these successes. I just wanted to see these successes going on and work completely with SDS implants. And that’s why I applied to the clinic. And it was basically it was the best decision of my life. Because here I can specialize in ceramic implants, bone graft in combination with ceramic implants. And I have also improved my surgical skills very fast because I can work with a specially, really highly skilled team that works here. And yeah, that’s unique. And also the combination with the medical department where the patients are really treated after their surgical interventions. They don’t have any swelling, no pain. You know, they’re in good hands. And that makes me feel relaxed about what I do, because we do huge interventions. We do ALL IN ONE treatments here, and that needs a special care afterwards.

Carolina
Yes, for sure. Yeah. So today you place ceramic implants every day, but you came into the world of implant dentistry via titanium. Where do you see the advantages of ceramic implants as a practitioner and in particular of SDS implants?

Dr. Rebekka Hueber
First of all, for me, it’s the biocompatibility, because you don’t have any free electrons on Zirconia implants. You don’t see any allergies in the patients, no periimplantitis. If you see bone resorbing around ceramic implants, there was probably too much pressure on the cervical part during the insertion, but not due to particles of the ceramic or anything. You don’t have any corrosion with them. And second, the amazing soft tissue behavior. Also, from histolocigal pictures, we know that we have an epithelial gingival connection between the zirconia and the gingiva. So the gingiva directly grows and connects on the zirconia and closes the door into our body, into our neurological system. So you could say periodontitis and periimplantitis are comparable with leaky gut. The only difference is that we have a leaky gum. That means toxins from bacteria in our environment can entrance the body through our blood system. But that doesn’t happen with ceramic implants because it directly connects. And if you look at patients after surgery, the patient may have old restorations and then next to it, the ceramic implant. The gingiva looks perfect on the ceramic implant. And sometimes it’s a little bit inflamed on old restorations or metal restorations. So that’s really impressive. And SDS in particular, there are many points. First of all, it’s the intelligent drilling protocol, you only work with zirconia drills, which I could consider very important with other systems. I could just take the old drills, the steel drills. But from studies we know we still have a metal debris when we drill into the bone. And when patients ask for ceramics, they want to have pure ceramics. They don’t want to have a contact of seal or metal with the bone, of course. So it’s very important that you drill or prepare the implant bed with a zirconia drill. And then the drilling protocol, it’s not just divided into diameters. It really respects the bone class. So when you do the drilling, you have to feel the bone and decide. And that’s actually it makes so much more sense because the bone has different layers in the deep and the epical part, you have the spongeous bone that has more blood support, that is a little bit softer. On the upper part, you have cervical bone and cortical bone, that’s really hard bone, and it does not have so much blood support. So you have to treat that part of the bone different than the lower part. You can apply much more pressure on the soft bone than on the upper bone because the blood flow would just decrease if you put too much pressure on it. And so the drilling protocol exactly matches the implants and the bone physiology. The handling is amazing for me. They are really easy to place because they have a macro thread and a cutting thread on the epical part. So even in 1 millimeter bone, you get an absolute primary stability of 35 Newton centimeter and have very high strength values. And the cutting thread allows you to position the implants precisely, maybe even if you have drilled in another direction a lot. But you can still correct the direction with your implant with this macro thread. And I don’t know any similar system with which immediate implant placement is as easy. So therefore the patients also save money and time because they don’t need several surgical interventions. And that’s why I love immediate implant placement. But you really have to have a special implant implant shape. In addition, it’s a tapered implant, which makes absolutely sense when you look at the different layers of the bone, because you need the most stability in the epical part, in the region of the spongeous bone, and absolutely no pressure on the upper part, the cortical bone, because you have less blood vessels there. So it does not make sense to have a cylindrical implant that puts pressure, the same pressure on the cervical and on the apical part. But it’s important that you have a tapered implant with zirconia. And the micro thread also provides hollow spaces on the tip in which the blood clot can form and then transform into lamellar bone “de novo bone” is how we call it, and that’s the high quality bone.

Carolina
Does the shape also reduce the friction? Because I could imagine if it’s like a cylindrical shape.

Dr. Rebekka Hueber
Exactly. Yeah. What you need to know is that when you place zirconia, it’s not a good conductor of heat. So if you have a cylindrical implant, you have a high or when you insert it, there’s high heat on the whole bone. So it’s more important that the implant half falls in and only the last turns. You really get it stable and you apply a little bit of heat. As you say, you have pressure on the whole implant from first drilling in on the whole length of your implant bed and preparation. If you have a cylindrical and not with a tapered, the tapered just applies forces in the apical part. Yeah, that’s absolutely true. And in addition, the implants are available in one piece and two piece, but both are tissue level. That means you never have a gap on the bone. Bone level and ceramic implants, for me, actually doesn’t make any sense. And you have a high or a very high diameter tulip that supports the soft tissue so that it can really grow on the zirconia. And what I also like is that you can prep it like a tooth because it’s pure zirconia. There are no added or there’s nothing added in the material. Also, the surface is not changed. Some ceramic implants have biovirt coating or something like this in order to change the color. But then you cannot prep them because you change as soon as the materials change, you cannot prep it anymore. And it’s really easy to restore with a temporary because you just prep it like a normal tooth with a diamond bur, and then you place a temporary. And what I also like is that the implants are available with different prosthetic platforms. So when you place the implants, you have oval forms, you have balcony forms, you have wider oval shapes so that you can match them with the alveolar ridge or with the width of the alveolar ridge or the alveolas where you extracted the tooth. And that’s unique. I don’t know any systems. And what I love also had to work or what I really don’t miss is to work with removables, with prosthesis or something like that, because patients always had pain with them or pressure somewhere in soft tissue. So you have to correct them so often. So we don’t work with any removables. We just work with fixed prosthetics. On zirconia implants, you don’t have any dentures or anything. And that makes it for the patients much easier to handle their teeth. They are easy to brush and they don’t miss any tasting. Like when you have dentures often, you don’t taste that much. You cannot bite that well, and you don’t have any plaque adhesion on the implants and zirconia crowns. So that’s what I really love about these implants.

Carolina
Do you also see advantages in areas where the bone is already resorbed or patients have large inflammations in the jawbone.

Dr. Rebekka Hueber
Yeah, definitely what I told in the beginning. When it comes to ceramic, you really you can really think different. You can do more than with titanium. Titanium needs at least 1 millimeter of circular bone around. So usually you cut the alveolar ridge when it’s very thin, or you have first to do a bone graft, and then you can place the implant. With ceramics, it’s much easier. Bone augmentation possibilities are higher. We can combine techniques with the implant placement, for example, with a split bone technique where you screw bone shells on the alveolar ridge when you have a horizontal resorbtion. And, yeah, if you miss bone on the back of heart, you can just augment it, bone graft it directly. With the implant, you can do a bone split on the alveolar ridge very easily and still get a high primary stability. And you don’t need to cut down the allveolar ridge if it’s thin, you have to do that with titanium because it has a high elasticity module. That means it moves like the wings of a plane in the bone. It also moves a little bit in itself with every tooth contact. And if you don’t have enough bone around, the bone will absorb and zirconia is completely firm. You could not fly with zirconia wings, so they don’t move. And therefore, you can also have a thin alveolar ridge. You don’t have to worry that much about it. The upper part of the implant has a micro thread, small thread, because we don’t want to apply any forces on the upper bone. And even if the bone is very thin there on the micro thread and you see it a little bit, it’s no problem. You can grind it, and you don’t have any resorption or loss of bone over the time. And when it comes to the SDS system, there are also some additions. So SDS also offers three dimensional techniques for bone augmentation in vertical and horizontal dimensions. For example, the BISS or the Bone Implant Stabilization System. So if you, for example, don’t get the primary stability with an implant right away, you can fix it with that system on the bone. With Cortical screws, you can individualize this. It’s an osteosynthesis plate with a connection to the bone, but also to the implants. You can also use them without the implants and just augment your bone. It’s like the mesh technique, but you don’t close the tissue over it. You just keep it open and work with PRF, the rich fibrin and the blood concentrate and the OPEN HEALING technique of Professor Ghanaati. He’s the inventor of it. And we actually grow tissue and bone underneath. And, yeah, the possibilities are huge. And since I changed to ceramics, I just have a lot more fun during my surgeries and see better results, and I have greater patience and yeah, that’s really an advantage.

Carolina
That was very interesting for me as well. It was a very good learning lesson. And, yes, thank you so much for taking part

Dr. Rebekka Hueber
Thank you, too. It was very nice to be here, and yeah. I hope I could share a little bit my enthusiasm for ceramics.

Carolina
For sure. I definitely felt it, and now I’m enthusiastic as well. I might go back to Uni and study medicine.

Dr. Rebekka Hueber
It’s fun. Yeah. It’s really changed my life a little bit because I was not that with titanium. I just didn’t have that much fun. And when you see how healthy the patients become and how happy they are with the results, and that’s just amazing. And you start to like your profession again.

Carolina
Very nice. Thank you so much for being here, Rebekka, and see you soon.

Dr. Rebekka Hueber
Yeah. Bye. Bye.

Categories
A PODCAST BY SDS Carolina Volz

Episode 2 – Dr. Dirk Duddeck talks about Implant Contamination

The "Trusted Quality Mark"

What made a dentist acquire a scanning electron microscope, and—a few years later— establish one of the world’s most recognized “Trusted Quality Marks” for dental implants, whilst continuously running many research projects? In the second episode, Coco Volz will be talking to Dr. Dirk Duddeck, CleanImplant Foundation’s Executive Director and Head of Research.

Dr. Dirk Duddeck will be explaining what type of contaminants are found on implants (titanium and ceramics), describing their clinical relevance and providing implant manufacturers with quality management solutions.

He will also be telling us about the enormous benefit the CleanImplant Certificate for dentists, as it boosts patient confidence and guarantees better implant healing and osseointegration.

Today‘s Guest

Dr. Dirk Duddeck - Clean implant Foundation, Verunreinigung von Implantaten

Dr. Dirk Duddeck

Executive Director of the Clean Implant Foundation

A dentist and biologist who has been researching the consequences and clinical relevance of avoidable contamination and quality defects in dental implants for more than ten years. He wants to equip colleagues with the necessary expertise, and to protect all patients from avoidable risks that often have serious consequences.

Presentation of the Clean Implant Certificate

Awarding of the CleanImplant certificate to SDS SWISS DENTAL SOLUTIONS in October 2021

Carolina
Hello, and welcome to the second episode of the SDS podcast.
My name is Coco and today it’s my great pleasure to welcome to you, Dr. Dick Dudeck, who is the executive director and head of research of the CleanImplant Foundation. Dr. Dudek will explain what kind of contaminants are found on implants, titanium, and ceramics, what clinical relevance they have, and what you can do as an implant manufacturer in the area of quality management.
He will also explain how the clean implants seal is a great benefit to dentists as it inspires confidence in patients and guarantees better healing and osseointegration of implants. Hello, Dr. Duddeck.

Dr. Duddeck
Thank you. Thanks for having me on this new podcast.

Carolina
Yes, it’s great to have you.
Before we talk about the importance of the project, the impact on the market, and the benefits for dentists in private practice, but also the concerns and resistance of some manufacturers. When and how did this all start? Why did you decide to buy a scanning electron microscope? It’s not conventional for a dentist. Was there any initial spark for the project?

Dr. Duddeck
Oh, these are some good questions. Good start. Yeah. Where should I start to answer? Um, I think it was about 15 years ago. I was working at the University of Cologne in the dental department. When I first saw the problem by doing implants that they are not all on the same. You see as a dentist that some implants work quite well and others cause more or fewer problems by the handling or the outcome. This was the beginning when I started to, work with a scanning electron microscope. And to be honest at these at this time, I had very, very, let’s say small experience on, this highly sophisticated electron-microscope. I saw something that I didn’t understand. To that date sterile meant clean to me. If you buy a medical device, like a dental implant as a dentist, you assume whatever incorrectly that these implants are not only sterile but clean, if they are delivered from the manufacturer. Bit I saw so many particles and the high magnification of the scanning electron microscope that I wondered: “Where did they come from? Is there a reason, did I make a mistake, by doing the unpacking.”
This was the beginning. Um, more questions than answers to me. And at that time, the, um, I remember quite well, the European Association of Dental Implantology, EADI, um, was supporting this project. And, um, we made some publications that caused a lot of rumors, the data from some companies. They were angry and, wrote us emails through the association saying, oh, “how can you dare to publish this kind of images?” Because this is not the truth and so on and so on. Um, well later, a few years later I, uh, started to do the, uh, the third study, and I was asking for support from the association and God knows why. They didn’t support it because I had always to wait so long and the long queue of doctoral students on the scanning electron microscope in the clinic.So I thought it was a clever idea to have an, an access full access to our 20 SCM because we had so many implants to check. And well, this was the decision: to invest one hundred, even 120,000 euros in this scanning electron microscope.
Some friends of mine at these days invested in a fancy car and new boats or other hobbies. Um, I decided to buy a scanning electron microscope. In hindsight, this was the best idea ever had, because this offered not only answers to the questions I have, it was kind of Pandora’s box opening and. So, this is kind of the initial spark: driven by curiosity, I wanted to know what are these particles are made of? Why do you find so many particles these days?
We had 23 implants in my first research and even in my doctoral thesis. And, uh, more than 10 showed some interesting particles that were not supposed to be on a sterile, clean dental implant. So this was the beginning of everything.

Carolina
Okay. Wow. This is very interesting. So, um, let’s talk about the CleanImplant Foundation. What is the goal of the CleanImplant Foundation? As a nonprofit foundation, you have to do something for the benefit of all patients and not just one. Your colleagues about inferior medical.

Dr. Dirk Duddeck
Yeah, the Foundation of the CleanImplant Foundation was the logical consequence of all data we achieved, in the years before. As we needed a space, something like, like a, like a project. The idea to develop this as a nonprofit organization, is important because no one can buy a good result. If you do some research in a university environment, it is not okay if companies give you some money, awaiting good results. So we always try to, to produce non-biased data and. So this was the initial goal of the foundation: to give it a framework for this, let’s say the delicate topic of inferior quality dental implants. This is a huge market. A multi-billion dollar market. And if someone comes around from Germany, looking through the eyes of a scanning electron microscope, and see something that is not okay. And no one expected this kind of contaminants on a factory side reason.
So, wedecided, it was in San Diego, actually, I just tried to remember. I gave a lecture, for around 1,200 American dentists. And, um, I showed them some images and complained about the failure of the EU device regulation, because all implants I see under the microscope and not just from the lab or some kind of research and development, uh, department, they are ready to use for the patient. These are the products that my colleagues see on their sterile table, when they start the operation. I showed these images at this conference. And I could see that some people took out their mobile phones. They say “European implants who care for Europe?” You get a good feeling as a lecturer, if you kind of loses the audience, the attraction. And then I said, okay, give me one more minute. And then you guys can take your mobile phone, whatever, you can speak, you can even leave my lecture. I don’t care. But give me one more minute and I’ll show you some more images. And the next images were the SEM images from US-made implants.
And that’s the moment – I can still recall it – It was total silence in these huge room. You could hear a needle fall. And from far, far back, you could see people shocked, just kicking their buddies sitting to them and saying “look at this”. And I said, sorry guys, they are not safe under US law. These are implants with an FDA clearance and they look like this. So some bad apples, even in Europe. And your basket here. And this was the moment after the lecture. I was surrounded by around 20 people. I’m complaining to start the next lecture because it looks like a big fan club and asking me for my business card, no one wants to see my business card.
They’ve all shouting names, like brand names. I said, okay, what about this A-B-C? And they just dropping names. And I thought, Jesus Christ. If I start to do some thumbs up, thumbs down here. I will. I’m on, I cannot leave the US I mean, maybe in handcuffs. I don’t know. So this was a threatening situation later on, by the way, I, um, a colleague came to me and said, okay, lucky, you, you had no brand names on all the dirty images or images of dirty implants. Because, um, maybe you, you will have some legal problems as well here. I guess that from thousand people in the audience, at least one lawyer must be there. He was laughing at what, I know, seven lawyers, I saw the room. So all the big companies sent their legal advisors to see if there was something wrong with my lecture.
10:36 min Spotify
At the beginning of this moment, I thought, we needed protection for this nonprofit project. Telling the truth, even in dentistry is something that is not as easy as it sounds. And then we decided to ask more and more people, renowned professors, to help us, to join the scientific advisory board, give us some rules and then, by finding out a threshold, we came together. People like Tomas Albrektsson and Vanderburgh from Sweden, what does our grand scheme university, uh, even Michael Norton, the former president of the American Academy of Osseointegration, the AAO. So we asked them and all of them said, yes, we’re gonna help you.
This is an interesting topic. We, we see that you need protection. We give you a framework of what is a clean implant meant to be. So is there some other, thresholds and finding? In the end, some, uh, kind of, um, consensus paper, uh, you can download this and on the internet on www.clean-implant.org.
There’s a paper 20 pages long that shows bad and good examples. In the last two pages, we found a consensus about what is clean implant and how many particles can still be accepted. So this was the thing, the question was the goal. And as a nonprofit, we do have to do something that benefits the patients. Yes. Making a, let’s say giving some pressure to the market that, um, beyond every FDA, um, um, uh, clearance is even in the European CE marking process. Some guys are looking at the end product and is this promise of a manufacturer always fulfilled with something real, a real clean implant. So – sorry for the long answer to the short questions.

Carolina
It’s very interesting, but, um, let’s talk a bit more about the contamination. In the meantime, you have examined well over 300 different implants in the SCM for contamination at the factory. What did you find on the sterile packaged implants? Is it only plastics or also foreign matters?

Dr. Drik Duddeck
Yeah, this is the shocking experience I made over the years. Um, it’s not getting better. We informed always the manufacturers about the results, every company that sends us an implant, uh, receives an answer, at least a short information. And total it’s more than 300 different implants from, I think about 200 different manufacturers.
So I think we cover more than 90, 95% of the market. And what we find on the dental implants is, um, You see some organic contaminants in the material contrast image of a backscattered electron imaging. That is a very specific technical detail. You see when something is not made of the core material, if it’s either titanium or zirconia. So we can see quite well if there’s something that is not declared on the, on the paperwork for the implant. So is there a foreign material? And we find very easily organic materials, it’s hard to differentiate what it is. Sometimes we see from the shape of the particles and the elemental signals in the EDS, and out of this we see that there’s a certain combination of elements.
If we want to go deeper and we now have an additional tool. It’s the time of flight, secondary EMS spectrometry, tough SEMS, uh, even how to pronounce in German, by the way. Um, it’s we know not only is made of carbon or something, organic material, but we can also actually now see that this is a plastic material. And what kind of plastic it is. So good example we found Polyacetal, um, Polyoxymethylen “POM” is the technical class of material. We found Polysiloxans. We found remnants from the cleaning process. Uh, this was, for example, this, If I have an implant and my doctor gives me an implant and he has no clue that this implant may contain on the surface Dolyphon Benozo Sulfonic Acid “DBSA”. This is a very aggressive cleaning solvent. They used to use to have it, this get rid of all the oil and all the, um, contribute nation during the process. And if we find even the remnants of the cleaning material, this is an aggressive surfactant. And according to the American environmental protection agency, EPA, it’s a hazardous substance.
This is a toxic hazardous substance remaining on a sterile package implant. While we pay for this implant between 60 and 400 Dollars or Euro. Um, in addition, you ask about foreign metals. Yeah. Interesting. We find particles and not only one, on one implant, we found more than a hundred particles with elements of iron, nickel, chromium. We found remnants of the tank stand from, the turning machine. We find, um, metals, even small particles. We have to speak about, the amount of the size and the clinical relevance, but I find corporate tin, a hundred percent clear signal of a metal particle, small enough for Phagocytosis containing corporate tin, and God knows what tin bronze does to the body. I don’t think it’s good for osseointegration, to say it a little bit sarcastic. So we found many different metals, from an either contaminated blasting material or from touching the implant during the process, even the tungsten remnants of, from the blasting nozzle, this, tin bronze is a very soft metal, most likely, uh, originating from the blasting ozone.
So we have plastics, we have metals and we have even hazardous substances. This is the bad news. The good news, by the way, is there’ll be still have under 300 different implants, at least two-thirds of the implants are not that bad. So we see a lot of implants that, um, really deserve our trust, that are produced on a very high level. I have to speak about this later… The general quality of a dental implant nowadays, it varies from I won’t give my cat to beautiful super-clean implants. Okay. So you see a very high, uh, range of, of different, um, contaminants in these, let’s say total 300 implants.

Carolina
Okay. But I have a question for you. How big are these particles usually? Does the size of the particle play a role in the possible foreign body reaction?

D. Dirk Duddeck
Of course, of course, as fast as I remember from my basic study, and you can read this in many, in many publications, the size of a bit of a, of a particle that is okay for phagocytosis. So macrophages come to. No, let us start it another way around. If, if a body sees a foreign body, it always leads to a foreign body reaction. Even an implant is a foreign body by definition, but this is a controlled foreign body reaction. Osseointegration is nothing else than a controlled foreign body reaction. We see some smaller particles with more or less. They are not so bio-inert like implant materials are. The body is reacting by getting rid of these materials. It’s a foreign body. So we have a foreign body reaction, we see the foreign body giant cells. We can detect and see macrophages. And in macrophages, uh, have a, have a nice appetite for these particles and the size of the limitation is about eight to 10 micron. So if people tell me “these particles you find, are so small, the biologic reaction is not worth to mention because they are so small.” My answer is they are so dangerous because if they are smaller than 10 microns, they most likely they will be, um, intake by these, uh, macrophages by phagocytosis.
The follow-up leads to an increase of osteoclast and osteocluster janitors. In other words, by trying to do a sort of cleaning of the contaminated implant by the biology of the patient. We have a follow-up reaction with an increase of osteoclasts taking away the bone in the moment and in the area we wanted to have the best bone seal. So usually we have an accumulation of these particles in the shoulder area. If you drill, if you take an implant inside the bone with forces up to 17 Newton centimeters, um, there might some particles detache from the surface and they might all accumulate in the shoulder. And this is the place where you want to have a, uh, from a clinical point of view, see a lack of, uh, osseointegration.
But you are forcing the contaminated, implant is forcing the body to, um, increase there, the osteoclast cells. And not only take away these particles by macrophages and phagocytosis, but also by taking away the bone as well. So this is the start of, some cases, I guess, a lot of cases of peri-implantitis induced by an avoidable factory-related contamination. I’d say very slowly, because this is the core message of this complete interview, I guess.

Carolina
Okay. Yes. So what would you say is the general feedback by, um, toxicologists about your results? Do they say that the particles play any role at all in the healing phase? Meaning do they have any clinical relevance?

Dr. Dirk Duddek
I had this question for years. Um, all my friends say, what are you doing for kind of crazy research? Nobody cares. Um, you have to keep in mind that we have, uh, You have to see the the most recent FDA numbers of failed implants. There are some statistics that see an incline and in failed implants, but there must be some reason. And I want you to know this. Exactly the question. Thank you for giving me the question here. Um, I took a flight to Brisbane. In Australia, uh, and visited, uh, one of the most renowned toxicologists Prof. Jack Ng. I don’t know how to pronounce this. However, he’s on the board of American toxicology and I asked him the same question.
We see a very local area, that we are not contaminating the whole body because he’s a specialist in, in an environmental, um, uh, intoxication. So some from water, uh, lead in water and something like this. So I ask him is how can these particles have an effect? And he agreed on this, this might be only with a question mark, uh, a local effect. There is, um, always a reaction. He confirmed that there will be some, maybe some local effects and we, as dentists take care of local effects. I don’t want to have an implant where the body has to do the cleaning work, uh, um, by doing a 50% osseointegration less good than it could be with a clean implant.
Well, the answer is quite easy. Um, there is a kind of foreign body equilibrium. That means there is no technical threshold for how big can the size of a contamination be. How big is the particle? Um, do we have a specific amount of specific toxicity of these particles? It is not, um, uh, the particle amount. We always see the reaction in the body. And even if it’s a local reaction, um, we, we, we have to deal with, um, peri-implantitis parabola. Again, induced most likely by, uh, these avoidable particles. And no patient is the same. And this is why there’s a very nice publication entering the same question.
The answer is there is an individual foreign body equilibrium. That means a 20-year-old basketball player. Um, super healthy and just losing a tooth, a central incisor by an accident might have a wonderful osseointegration, even with a contaminated implant. No doubt about it, could happen. It might even take a rusty nail. I don’t know if it’s sterile.
We have to deal always an hour threshold is the weakest patients we can, can, uh, that is visiting our practice. I have to, I, I was working about 14 years in a university. I have to deal with compromised patients and I speak about pre-radiated, um, um, patients. Patients with heart diseases, and so on. So we, we went to the, to the limit, to the limits of, of, of indication for implant therapy and the last thing you want to have if you have these weak and, and suffering patients are extra contamination on the implant. If it’s technically avoidable. So the far about equilibrium, it gives us the answer that, um, the one patient can deal with it. The other one, not.
And our bar or threshold should be always as we are a medical person, we should always take care of the weakest patients. This is what he confirmed, the toxicologist.

Carolina
In environmental medicine, there is the concept of “precautionary principle”. One assumes a burden on health in this case of contamination until the polluter proves otherwise. Does this also apply to dentistry or implants?

Dr. Dirk Duddeck
The precautionary principle is a German invention, by the way. In the environmental medicine and this was something, that was brought up by Prof. Ng in Brisbane. And he said, um, if this the same rule as in the, environmental topic. If we don’t know how a specific material is good or not good for the bone or the health of our patient. We should always see this as a toxic or let’s say, not having positive effects on health or osseointegration. Unless we have proved that they are healthy and there are no reason for concerns.
The reverse of the burden of proof is something I have to deal with. People always sell, some manufacturers would try to reduce the cost of production by a lack of quality management. This is the only reason why we can see these implants even as a CE mark. They say, well, Dr. Duddeck, please send us any information that the things you find have a negative, um, effect on osseointegration. I said, no, you have to show me if you can’t avoid Dolyphon Benozo Sulfonic Acid, if you cannot avoid massive milligrams of plastic from the packaging remaining on the implant surface, if you can’t avoid this, you have to give me as a dentist proof that these materials are safe.
So this is. I think we have to admit that even dentistry is playing by the same rules and it should be for the sake of our patients, that the precautionary principle is something we follow, even in dentistry.

Carolina
Okay. So you have been observing the problem for several years now. And when you report in your lectures and write in articles that one in three implants examined is significantly contaminated, which by the way, as a patient, I find hard to believe. Is there a tendency over the years towards improvement? Don’t all companies improve their quality management when they learn about contamination in their medical devices?

Dr. Dirk Duddeck
Oh, good question. I hope we have some time to answer this. This would be quite a long podcast here. Yeah, one in three that is still the remaining, um, proportion of, uh, contaminated, significantly contaminated implants. And when I speak significantly, I mean more than 20-30 particles, obviously avoidable on the implant, mainly organic particles, but even some we spoke about before this, even some foreign metals, not by the core material. So, is there a tendency towards improvement? Um, we have very, very positive and we have very, very negative experiences with dealing with the information.
If we give this information to manufacturers. Um, not all companies start to improve their manufacturing, unfortunately. Maybe because they don’t feel the pressure. They don’t see any reaction from their customers at all. And the complaints, um, of failing implants is always easy, to address this to a patient with some diseases or with a lack of hygiene or at least even a lack of education from the dentist. I think it’s too easy. Uh, as long as we see this one-in-three ratio of significantly contaminated implants, there should be some reaction. I would love to see. We are now starting the fifth study, following the same protocol. We do have a very good database, we can compare data from even from 2011, 2012, a study in 2015 a study in 2017.
And now we do study the years 21/22, collecting more than a hundred implants. So we have a huge database. And the problem is, um, two examples I’ve met a CEO in the, in the most recent IDS at the International Dental Show in Cologne. And he told me, well I know your work, Dr. Duddeck. I know what a CleanImplant is doing, giving a lot of pressure on the market, but you know what? I sell a million implants. I don’t care what you do. As long as I sell a million implants, we don’t even stop the research on implant services. That is what a CEO of, one of the major companies told me right into my face. I said, I said, and this is the story behind the story is that I addressed a problem to him, where I found an implant from his factory site, contaminated with hundreds and hundreds of stainless steel particles, mixed with aluminium oxide as blasting material. Iron, chromium and nickel metal are’nt good for osseointegration. I would love to see this, um, this study. Um, he couldn’t give it to me because it’s just a contaminated plastic material. So I found this one example and it was two implants from the same batch. Um, but, um, I don’t want to see the 1 million implants, maybe, as far as I know, he has a lot of sales in India and not in Europe, but, um, I doubt that all these implants, uh, lead to osseointegration. I, for sure I have respect for his success, for his business’ success. But it’s not all about money. It’s not about 1 million sold implants in about 1 million treated patients with inferior quality implants.
Another company told me in 2014, I showed them the results of, uh, two implants that they offered for the study. Um, they have a lot of room for improvement and the answer was very politely asking me, uh, to avoid, publishing any negative data on the company or the implant type.
I checked the same implant three years later. And I found the same or even more contamination, organic material, uh, on the implant. And I received a standard form, I received nearly the same mail, the same information from the company. But in addition, he warned me and he threatened me with legal actions in case of any publication of this.
So this is, let’s say, the dark side of the moon. Uh, on the other hand, we have a lot of positive reactions, and some companies trying to get better. It’s not because of the pressure that CleanImplant gives to the market. Um, control is a very good thing. As long as we have this amount of contaminations, avoidable contaminants on implants, and, um, most likely clinically effects on this contamination, someone has to look at them and there are some companies taking care and asking us, how can we get rid of the problem? We want to sleep better.
We want to sell a good implant, please help us in get better. And this is what we do as well. So even companies that see the room for improvement, we give them a helping hand and whatever we know about this topic, we, uh, we give them a stage and we have candidates in our group of supporting companies who really show a huge improvement in the quality of the dental implants. And I’m very proud that these companies, um, are now better on the market.

Carolina
No. It was very interesting. Yeah, it’s good that there are, um, companies who want to improve their quality. Um, so what would also interest me is how do manufacturers react to this initiative and the CleanImplant foundation? It has become something like the “Stiftung Warentest” for implants. I hope this word also exists in English.

Dr. Dirk Duddeck
I think that’s a comparable institution, and doing the same as the Stiftung Warentest in Germany. It’s the “UL” in the United States, there is an underwriter’s laboratory. They check everything from a toaster to a washing machine. They check every technical issue. So the same as the Germans’ Stiftung Warentest is doing.
Yeah. Um, how do they react? I told you some already spoke about two, two examples. Um, again, we have friends and foes in the market, and, uh, I would like to emphasize that our glass is half full. I would love to give those, who really improved their quality – I show from the first moment on an implant with cleanliness that is promised by, by the packaging that is promised by the name of the company – that we give them a stage. I have no fun in dealing with legal threats and some guys told me “Oh you are the Robin hood of dentistry implantology”. I’m not sure if this is a right, um, a precise description of what we do, however. Sometimes I feel like this, I received a call from a, from a manufacturer I remember quite well, two years ago, he was so angry about the results and about, um, the way we publish this data that he told me. He was driving his car back home from his factory. And he was so angry, shouting into the microphone, saying, Dr. Duddeck, I know that you live in Berlin the next time you will walk in the evening in the streets of Berlin. We have many, many friends there. “Take a look at your back!”
So this was the first time I have received this kind of threat. I have this on tape. This was the first time I ever received, a personal threat. Again, on the other hand, we are so proud and we are so happy that we have, uh, companies that help us. I would love to mention one more thing. It’s not a question, but it’s important to understand.
Implants are not good, just because the company is a big one.
We still find implants with significant contaminants on implants from major manufacturers. And I mean, number one to number five. This is not that they have sometimes, they don’t want to recognize that they maybe even they know that some implants have a lack of quality.
However, the reaction from some major companies differ a lot from the smaller companies. Because they think they are too big to fail. And it’s kind of- the German word is “Majestätsbeleidigung” – It’s uh, if you accused the king that he’s doing something wrong, then you, again, you go into jail.
So, um, It’s kind of, um, uh, we, it is what it is. We open an implant. We don’t care about the size or the name or the reputation of a company. We see the implant as it is. And unfortunately, there is no pattern of, uh, let’s say, market share or price of the implant we have even. Costs implants with significant contaminants.
So there is no safety in the market, and this is why I think the complete, the project the CleanImplant project is so important for the market.

Carolina
Absolutely. Yes. So I understand that there is encouragement and at the same time resistance coming from the industry, but, um, let’s move to the topic of ceramic implants. I’m sure you’ve seen a variety of ceramic implant systems. What about clinically relevant impurities? Shouldn’t the zirconium oxide implants be cleaner since the manufacturing process is fundamentally different from implants made of titanium or titanium allies.

Dr. Dirk Duddeck
True. Um, the process of manufacturing is different. However, um, you can, um, contaminate an implant, even after it’s leaving the oven. The ceramic implants are produced with a high-temperature process and, usually you have a clean implant after this. So at least the organic particles are gone, but if you then take an implant and squeeze it in plastic packaging by using the first the shoulder and the first threat of an implant where the implant packaging is touching the implant. But the surface, as you take the implant out of the packaging, you see, the remnants of the packaging itself. So this is something we found in a, uh, um, major research project performed with the, not only with the Charité University here in Berlin, but also with the University in Gothenburg and the Malmö University in Sweden. Where we collected 25 implants, ceramic implants, to answer your question, from five ceramic implant manufacturers and we, uh, all of these five samples had to follow-up the same protocol of analysis. We measured the roughness. We checked the literature of the implant system. Uh, is there clinical proof of success?
And, um, my job was to check these implants, um, for cleanliness and this scan electron microscope again, using backscattered electron imaging. And what we found unfortunately is the same ratio from these five types. Two types, um, just played significant contaminants, the one with the packaging process problem, having massive milligrams of polyacetal, POM polyoxyethylene on the implant.
So there’s no proof, that simply because they are white, they are not clean. You have to do the same quality management as a titanium implant. This is very important.

Carolina
Okay. As an experienced implantologist, what would you look for when selecting an implant system for your patients or your practice.

Dr. Dirk Duddeck
Let me just add some additional information.
The publication from the JOMI journal, the Journal of Oral Maxillofacial Implants, can be downloaded, it’s on our website. Uh, if you want, uh, they can, people can send me an email and I will send them, uh, a, a print of this publication. It’s important to, to understand. What would I look for when selecting implant for my patients in my practice? When at least I would, for sure don’t buy this in the gray market, I would love to have an, an improvement from a CE mark on FDA clearance, the minimum, but. As I know, and maybe I know too much about this topic. I would love to see additional information about this implant. I want to be on the safe side. I don’t want to have the problem of, uh, legal threats or, um, seeing that. Uh, the patient can, can Sue me for four and have claims of damages. If they get the information I use, an implant showed in a publication significant contamination.
So this is a huge problem in the United States, by the way, where it’s kind of standard that so many patients are suing their dentist and not only their dentists, even the medical clinics for any kind of mistreatment or misbehavior. So there, I would love to have safety and the safety of that, uh, I know from my microscope is then when we give – there’s a process that leads to a, um, the trusted quality mark. The trusted quality mark is awarded to implants that give proof not based on one implant that on five implants. Um, and they show in the microscope in accredited laboratories, by the way, that’s not a kind of backyard SEM it’s an accredited laboratory where they produce data on a very high standard of science.
And I would love to have this quality seal on a dental implant, the trusted quality mark. I think this is where at least the surface is clean. There are more reasons for a good implant, but I would love to have safety on this topic.

Carolina
So as a dentist, you can become a member of CleanImplant and sign up as a certified dentist. And aside from supporting a good cause, what is the benefit, for the dentists?

Dr. Dirk Duddeck
Um, supporting us is one good thing is that we need support from dentists worldwide. And we get them by the way, this is one reason why we have to date. I think, uh, there is a number is 110,000 followers on the internet. It’s even more than the Nobel Biocare by the way. So there’s an impact on the market and people who are supporting the CleanImplant as a clean implant certified dentist, they will be shown on a website that is a “CleanImplant4you” with a four, a numeric four “cleanimplants4 you.com”, uh, German it’s “saubere-implantate.de”, people should check this. They will be mentioned, they will be shown in the map. A certified dentist for himself, he has a safety that he’s on the safe side. And his implants are not contaminated. And he can show it to his patients and we support the practices with marketing material. For the waiting room, um, and for the referral practices. So some dentists don’t do implants on their own, but they have, they, uh, our surgeons, our maxillofacial surgeons doing the, uh, the surgical part of, of implantology.
And this information is even good for these people who can support their practices, showing them that, uh, implants in use are double-checked. They don’t only have the official CE or FDA mark. They have additional tests, uh, and they underwent additional tests in the CleanImplant foundation and a very high level of scientific evidence. So we can see that these implants are finally clean. So it’s a mixture of marketing and material for the practice. They can convince patients that they are using only good implants. And I can see more and more patients are aware of the problem.
Any patient to date knows the difference between a, uh, vaccination, of the vaccines. They want to have either this, uh, standard vaccine or they want to have the MRA. Patients are informed and if they take care of so much of explanation, why don’t they, I think they will, sooner or later they will take care for their implants as well. I can promise this.

Carolina
For sure. Yes. So I did some research on the internet before our conversation. And if I see it correctly, the CleanImplant Foundation has more subscribers on Facebook than, for example, a global market leader like Nobel Biocare, which you just mentioned. But how would you explain the high number of followers in such a short time on social media?

Dr. Dirk Duddeck
Yeah, we are on social media since 2018. I mean, this is not, this is not full four years. And we reached more than a hundred thousand followers. We were surprised by the feedback from colleagues. This topic is something, people, my colleagues don’t want to have in their practice. If they are aware of the problem, they might have a solution.
And, uh, this is why they, um, want to be informed by our emails, by our newsletter. So, um, I think, to kind of put it short: If there wouldn’t be a problem of avoidable contaminants on sterile dental implants, there would be no CleanImplant Foundation. Then I wouldn’t have bought a scanning electron microscope. Maybe I haven’t fancied Cano instead. And, um, we wouldn’t have this discussion for the last 40 minutes. So, um, I think it’s momentum what we see. People, my colleagues, and even patients, although we address only professional colleagues on social media, um, I think there’s a small percentage of patients as well. However, it is something my colleagues are concerned about.

Carolina
So, um, this was very interesting and sadly, we have already reached the end, but I have one final question for you: Where do you see yourself in five or 10 years? What would you like to have achieved with your initiative by then?
Dr. Dirk Duddeck
Oh, good question. I would love to see a higher percentage of implants with no reason to be concerned of. So I would love to see in a, uh, average less than two out of 10 implants, um, being, being contaminated, um, or being, uh, showing something. Giving fulfilling the promise that they, that the companies do with their advertisement.
And I see myself in five or 10 years. Well, I think we just opened the first box of Pandora. I think we should have a look at us your orthopedic screws as well. We would take care of for, um, bone substitution, bone substitutes for, um, we will take care of, for. Um, other medical devices. I think we are, we’re at the beginning of a very, very interesting and a success story here. CleanImplant is something, although some companies don’t like us, I think it’s hard to ignore that there is power of users, of customers that we support. And I think in five or 10 years, we will have, um, and even better standing in the market.

Carolina
This is a very good outlook for the future. And it was, for me, it was a very interesting lecture. So thank you very much. And I’m sure that our users appreciate this episode and all the information you gave us today. So thank you for this.

Dr. Dirk Duddeck
It was my pleasure. Thank you for having me now.

Carolina
Thank you for participating. Bye Mr. Duddeck

Categories
A PODCAST BY SDS Carolina Volz

Episode 1 – The Ceramic Implant Market with Dr. Karl Ulrich Volz

Welcome to the very first episode of the new SDS PODCAST!

In the first episode, Coco Volz will be talking to her father, Dr. Karl Ulrich Volz, who will give a brief introduction to the SDS PODCAST, and explain how this new medium will enrich the lives of the SDS customers on many different levels. He will also give a brief recap of the past year, and explain SDS’s plans for the current year—among others, he will be providing a peek preview of SDS’s new concept, which is comprised of several levels/steps with different levels of difficulty, even though some details are still top secret. 

Todays Guest

Dr. Ulrich Volz

Dr. Karl Ulrich Volz

Founder and Owner of SDS SWISS DENTAL SOLUTIONS

As a ceramic pioneer and leader of his guild, Dr. Ulrich Volz has his own view of the ceramic implant market and its shareholders. With his holistic treatment concept, he has succeeded in bridging the gap between biological dentistry and surgery, thus combining the best of both worlds.

Coco

Hello and welcome to the very first episode of the SDS Podcast. The SDS podcast is designed to provide our customers with exciting and informative conversations between members of the SDS family and specialists in the industry. The podcast will broadcast one episode every two weeks, which will then immediately be uploaded to the SDS Media Library. Today. It’s my pleasure to welcome Dr. Ulrich Volz. We will talk about what are the key pillars in the implant industry and how can these pillars be built? Dr. Volz will share some insights from his long professional experience in the industry and give an insight into SDS future plans. Hello.

Dr. Ulrich Volz

Hello Coco.

Coco

Hi dad. So my first question for you is what is the idea of this podcast that we are starting today?

Dr. Ulrich Volz

We know in those times that the physical meeting or event, of course, always is the best, but it’s a lot more time consuming and you have to go to a certain place at a certain time. So the next level, in my opinion, is the webinar where you have so you have to be there at a certain time, but you don’t have to travel. And the online course, you can do any time, but you can’t do something else at the same time, like traveling or walking or sitting in the train whatsoever. So I think it’s a great idea. And I mean in general, the idea of all what we do if it’s webinar or courses or online courses or congress or whatsoever, is to forward a lot of precious information from the big SDS and SWISS BIOHEALTH family and their friends to the user to make his or her life as a dentist better and more successful. That’s at the end is the idea of any area like webinar courses or this new podcast.

Coco

So let’s dive right into our next question. Why was SDS so successful last year?

Dr. Ulrich Volz

OK, actually it was a super successful year with a growth of almost 30%. But it was not something special last year because we had given in 2020 we had a growth of more than 15% the year before, 25%. So at the end I would say it’s like the Japanese, they say “cani” constant and neverending improvement. And it’s kind of the payoff of a really every day, step by step, millions of steps. And it’s now 21 years since I’m in this field of ceramic implants, producing ceramic implants, doing education, placing ceramic implants. And so it’s always a matter of time and we always totally overestimate what we can do in one year, or maybe with 1 million or with 50 employees, but we totally underestimate what we’re able to do within ten years or 20 years. And at the end, what I saw a lot of new ceramic companies coming up and being sold or being closed, whatever, in the past ten years. It’s not that easy. And at the moment we are still the world market leader with SDS. And I think it’s a consistency over 21 years now. And because after such a long time, we have even some team members and employees, they are now for those long period and maybe even longer in the team.

So 100% trustful, great persons with amazing knowledge. And we are always talking about the SDS and SWISS BIOHEALTH family, because it’s like a family. I mean, you Coco, you have grown up. You were more or less a little bit born before I went to the first ceramic implants. And so you grew up in this kind of family. That is why we call it the family. And we are a family because our family members are working in SDS. So my wife Nicole, and your sister Ann-Sophie. And of course, after such a long time, you know a lot of good people in the field. And so with some, you become friends. This is something that you can’t build up in two or five years. This is something that needs to grow over decades. Or some other people, they came from other areas or from other infant companies where I was a customer maybe 25 years ago, and now they’re working with SDS. So this is something that takes a long time. I mean, nobody likes to become older and getting gray hairs. The huge benefit of getting older is getting more experience, getting more knowledge, getting more people to know and to know what is dangerous or difficult, or whether possibilities for failures and so on, and how to move around obstacles, things like that.

And I believe that a big strength of SDS is that with my person as the founder, the inventor, the developer, and the 100% owner of the company of SDS and SWISS BIOHEALTH, it’s all in one person. And at the same time, I’m the one who has placed the most ceramic implants in the world. It’s no more than 25000, actually. I do not believe that there will be another person in the future who is going to place more implants than I. Because when I started, there was already a huge demand in the population, in the patient, but there was no experience, no offer. So the demand was much higher than what was offered by the dentist. And so I was invited in many big clinics to place implants. And I remember I had one year where I played with my own right hand, two and a half thousand ceramic implants. It was an incredible year, super tiring, but at the end, that made the experience. And so this is, I think, another important thing, that’s now more and more paying off, because SDS is 100% super based on experience, on practicing dentistry on a super high level.

And of course, like in the SDS company, for a clinic, it takes a lot of time and years to build trust and to get the best dentist, surgeons and prosthodontist.

Coco

In your clinic, would you say that the physical closeness between SDS and the clinic is another advantage for the company.

Dr. Ulrich Volz

I think there is another huge strength of our SDS SWISS BIOHEALTH family, that it’s not just that we are super close, but we are actually physically super close. It’s all in 200 meters in the same building the SWISS BIOHEALTH CLINIC, with ten dentists working there in the meanwhile. And the nice thing is that we have five medical doctors as well. So it’s not just a biological dental clinic. It’s as well as biological medical clinic with some of the best people in the field. Like Dr. Klinghardt is several times voted as one of the best biological or the best biological medical doctor in the world. So it’s in the same place like SDS, where all the employees of SDS are working. It’s the same place where the education center is located, where we are training the last two years, around 4000 dentists a year. And even the German company SDS Deutschland GmbH is just 2 km away. So we’re all super close, even physically. And I think that makes us super strong and quick and fast and we can put everything together. And at the same time, like this complexity. We have a huge complexity regarding the concept, because we are not selling an implant, because I didn’t develop implants and had the idea it’s a good business concept, I’m going to make a lot of money out of it.

There is the concept I’ve followed since 91 and for this concept I needed a ceramic implant. And that is because nothing was in the market. I invented it. And I was lucky that at that time, the market leader for ceramic hips, the owner of the treatment chair, and he helped me on that. So we started in 2000. But at the end, what we sell or teach is a concept, a treatment concept on a super high level, always outcome focused. That means we want the patient to improve and to make the patient healthier. I mean, this is why we created the slogan MAKING THE WORLD A HEALTHIER PLACE. And at the end we are kind of maybe even we are kind of consultants, because all our users, they tell us after some years they are so much more successful. They have mostly just got one problem left, that is finding and then hiring good dentists and nurses and employees and technicians whatsoever. And this is why they get all the information.

Firsthand and I was the youngest dentist who started a private practice 32 years ago. And I was the first dentist who started with a private practice based on the government insurance. So I have proven that I was able able to found and to run super successful practices and clinics over the past 32 years. And so I would say there’s always two ways you listen to a consultant who is in the first place, a consultant, but he never proved that he’s able to run the marathon under 2 hours, or you listen to somebody who run the marathon under 2 hours. And that is in my case, it’s the case that I think is another very important thing. So I think that is as well the reason why I was voted again as the president for the ISMI (International Society of Metalfree Implantology), which was founded about, I think eight years ago. And since I’m so long in the field and so well known, I was able to get different implant companies, bring different implant companies and very good speakers and organizations together to create the JCCI this year. What is the JOINT CONGRESS for CERAMIC IMPLANTOLOGY. Because my idea was there is on one side and SDS, but on the other side we have to move forward with ceramic implants and we have to join forces.

And there are a lot of ways that lead to Rome, and we all want to Rome, but there are different ways and paths to go to Rome. So actually I was able to bring several influence companies and organizations and amazing speakers together. And we had from zero to 100, we had more than 300 participants. It was super successful and it became the first year the biggest congress of its kind for ceramic implants. And so we are super happy and super proud about that. And I think that is as well kind of one of the pieces in the mosaic or in the jigsaw. What makes SDS so successful. I think all ceramic implant companies are becoming more and more successful in the coming years because we have now joined forces with other companies in the JCCI congress. And so ceramic is more and more getting into the brains of the patients and the needs, the demand becomes bigger and bigger by the year. Of course we know that titanium is getting a little bit under pressure in the past years because titanium oxide was banned by the European Union and many other things. And a lot of people are talking about bio, corrosion and so on.

But on the other side, in the past 21 years, the ceramic implant industry has managed to make their homework. And now today, if you choose the same diameter, our ceramic implants are more stable than any titanium implant with the same diameter. But this was not the case 20 years ago. And we have super well working shapes like our dynamic threads, so we can do even in upper Molars in 95% of the cases, immediate implants. So I don’t know any titanium implants that would be able to do so.

Coco

Did you discover a trend towards health and aesthetics within the last years?

Dr. Ulrich Volz

In the past year, more and more people started to care about their aesthetics and to care about their health. Because we have seen that this is the most important thing, like health, family longevity and so on. So this is that while the patient who could afford it is more and more asking for ceramic implants and we are more stable, we have the better shapes, we have the biology integrated as well, kind of like according to the Zeitgeist that the people are going for healthy, beautiful, nice aesthetic treatments.

Coco

Recently, SDS received the CleanImplant label. Can you tell us about that?

Dr. Ulrich Volz

We are super happy that we some time ago at the JCCI Congress received an implant label with SDS. And on one hand that there is no other company yet where this label two times, one is on the production side and one is on the manufacturer side. We’re the first company who has these two labels and we are going to certify a lot of our users for the user label. And at the same time we’re at the moment working on a navigation system which is going to receive the CleanImplant label as well. So we are going super clean. And because I think this is going to become a huge issue in the future, we know that from the silicon breast implants that this is going to be a really big thing. I strongly believe in that. And so my idea ten years ago when I first heard of it, I said you can’t beat him, meet him. And so we worked super hard and invested a lot of money, spent a lot of time and money to be able to be according to the really strict rules of the CleanImplant label and Foundation. This is something that is, in my opinion, really important as well.

And of course, there is no other material. Let’s say if you compare titanium and zirconia in titanium, I personally believe in zirconia. It’s much easier to be super clean on the surface. Why? Because the last process is a process with 1500 degrees, for example, this is going to burn off everything, what was there. And you just have to create a kind of interface how you get it out of the oven straight into the clean room. And then not to make it dirty again. But we’ve worked on that now for 20 years and we’re able to offer a super clean implant. And so I would say today at least, the SDS ceramic implant is on a much higher level in any aspects than any titanium implant. So I think that is the reason why we’ve been super successful in 21. And I believe it’s going to be the same, maybe even more in 22.

Coco

This is really exciting. And actually this brings me directly to my next question, which is what are the plans for this year? What are SDS’ plans for the year 2022?

Dr. Ulrich Volz

We are now working super hard, the whole  team. We’re using, let’s say, the time of Lockdown, what we always perfectly anticipated and forecasted, so we knew when it’s going to open again the last two years. And we have not planned any physical event at our education center. Actually, we’re using the time and we are making it at the moment again, investing money, making it again bigger and nicer and better education center. So we won’t have any physical event until end of April and we’re using the time to kind of build a structure into our huge concept. I mean, there is no other implant company definitely has got such four dimensional concepts, how to treat and how to make the surgeon’s life better and to improve the health of the patient. But to be honest, when you start it’s a little bit difficult. You have to be really dedicated to get into the “ALL IN ONE CONCEPT”, how we call it, what is on the medical side based on the biologically immunological side, based on the physicals concept, what are you approving in the clinic day by day. But it is, to be honest, a little bit like I would offer you a yoga course and we’ll ask you in the very first course to bend your foot behind your neck, for example.

So if you’re able to do so, it’s exciting and it’s great. And it proves that your flexibility is really great, but it’s too much and not attainable for many dentists out there because I still remember when I started dentistry 32 years ago. It is you improve year by year by year by year. Some are more talented, some are less talented, but at the end it is year by year you become better and better, definitely, if you stay healthy and energized. This is not their good dentist and not so good dentist. It’s like it has something to do with the experience, what you could collect by the years. But we do not want those dentists to have to wait for another ten years and collecting more experience before they would start with SDS ceramic implants. So we have built a lot of structure. I would say 22 will be the year of structure and support. So we have started to build a structure and have built three levels. So the first of those three levels will be generally we call it SDS Light, let’s say the beginner level, the basic level, the starter level. So to get the feet wet and to have successful, easy, quick access to ceramic implantology by SDS.

So this will be based on healed and delayed implantation sites. So with easy to reach goal, you would focus on the six basic shapes. What is the 3.8 and 4.6, 8, 11 and 14 millimeter. By the way, we are going to launch a new implant around April/May. What will be the 2.1 value implant. It will be a really nice implant, the same shape, but much easier and cheaper and already altogether with the post. So you just buy the implant and everything you have in the first place, so you don’t have to have a second order. What would be as well easier for us. And this will be just in the shape of 3.8 and 4.6, 8, 11 and 14 mm. But of course you can use the regular implant.

Coco

Will the regular implant also receive an upgrade?

Dr. Ulrich Volz

The regular implant will get an upgrade as well. Let’s say we already have the new upgrades in US now for two years. It’s SDS1.2 and SDS2.2. It’s exactly the same then the implants we have sold in the past year. But it’s beautiful packaging, it’s gamma sterilized and the package has a little window where you can see the implants of what you see, what you get. It’s even a little bit more stable and a little bit more precise in the thread. And it’s the one who has received the CleanImplant Lable. So it’s the cleanest implant ever. And we have already started to do kind of a silent or soft launch in the second half of the last year because we were not able to produce enough implants because of the huge demand of the SDS2.0 and SDS1.1. But the official launch will be around April and May. So stay tuned, we will inform you about that. What I wanted to say is that in this basic level you could start with the basic shapes of the, let’s say, premium implant and those six shapes but you could use as a one-piece or as a two-piece implant at the same time of the new 2.1 Value implant.

Then the next level is, let’s say, an advanced level where we are focusing on the immediate implants. I mean, in general, ceramic implants are way better than titanium implants if it comes to immediate implantation. Why? Because there are no free electrons on the surface. So there will never ever be an inflammation around a ceramic implant. Just if you take care about the biology and the immunology, that means that you take care about the vitamin D3 & K2 and some others. So in this level, we are taking care of D3 & K2, Omega 3, magnesium and vitamin C for example, with supplements. But in titanium it quite often works. But if something goes wrong, you’re going to face a huge defect because titanium has got free electrons on the surface. So there could be an infection, inflammation, but you will never see that on ceramic implants. The second thing is the shape plays a big role in immediate implantation because you need root shaped implant. One should be not tapered. So our implant is not a tapered implant. So we call it step implant because when it starts at the gum line it’s vertically, then it’s angled, then it’s vertically and it’s angled as well in the core adjust the outer shape.

That is what we call the dynamic thread is like parable whatsoever curve and that means that any place of the thread there is a different depth of the thread. So it starts with a very thin epical part. So you could easily get into the drilling hole even if it’s the angled side. Like when you drill for an incisor you always are going to drill palatinal into the socket. And if you would have a parallel implant or cylindrical implant it’s impossible to cut the thread into angled drilling side. So this is why the SDS implant works so well in any sites. And even we are able to do lower and upper molars as immediate implants. We have done thousands of those and they work perfectly. And with the development of the balcony implants we have a perfect emergence profile. So this second level. What is let’s say the advanced level for immediate implantation is able to place implants in all sites and to create even if you would not go in the middle. Like if you would use the palatinal socket or the distal socket in the lower through the balcony implant you would have a perfect symmetrical emergence profile which is quite wide because it’s 6 to 8 millimeters. Highest level like it was is let’s say the all in one concept where the SWISS BIOHEALTH CONCEPT comes to play.

And this is why this ALL IN ONE CONCEPT we are not anymore going to teach outside of the education center because we need the CLINIC right beside the EDUCATION CENTER. So it will be always part of the CERAMIC IMPLANTOLOGY WEEK. So that means the first day at the same time we are going to have a huge ALL IN ONE surgery and several times during the day we are going to connect to the surgery and have live hospitation at the same time. And especially on a Saturday we’re going to do a lot of practical education in the CLINIC. So it will be based on the first two levels. That is something those participants should have been educated before already. And then we will focus just on the ALL IN ONE CONCEPT if I come back to the yoga course. So the first step is like you would get with your fingertips. So the basic level if you get with your fingertips to the floor and the immediate implant level is maybe with the flat hand and then in the ALL IN ONE CONCEPT you would bend your foot behind your neck something like this. Another thing is that we are working very hard on the concept of navigation.

We have already last year launched the AIM system. What is system where what is an ad hoc navigation system where you don’t have to plan anything. You could just start with it but this is more for the experienced user and it’s more based into the ALL IN ONE CONCEPT but we are going to very soon we are going to provide very nice. Beautiful and especially super healthy and clean that is why we are going to go for the CleanImplant Lable for the navigation concept as well where you would receive where you would support the user there with the position of the implant and the shape and the position of the temporary and like other companies like Straumann “Smile in the Box” we’re going to support the user with everything you would need to do a guided surgery and to follow the completely digital workflow. That is something that is definitely new and will be another, let’s say vertical level, which of course you could use if it’s in the basic level, if it’s in the immediate implant level or if it’s the ALL IN ONE CONCEPT and as well we already have improved our prosthodontics concept where we are not just have integrated a method to test the perfect position for the bite with the method of Dr. Klinghardt, the Autonomic Response Testing but as well we’ve integrated Dr. Mosetter used to be the sports doctor of the US soccer team and he’s taking care of many Olympic gold medal winners and he is the founder and inventor of the Myoreflextherapy and this is something he’s training our participants on the jaw and neck muscles. So this is instantly within two or three minutes you will be able to relax all the muscles around the bite so if it’s the chewing muscles or the muscles in the neck and so that is what you need to test and install the perfect bite. So of course you could send your patient to a physician to relax the muscles but just when they come back and on the road being in a hurry whatsoever. Waiting too long at the traffic light they will be tense again and it will be impossible to find a perfect bite and as well we have started to address not just the upper chain but the lower chain as well that means it’s all connected and we are taking care now of the posture of the patient so we joined forces with a company with the world market leader of the inserts what you put into shoes so to make that even better so this is a really top top professional and outcome focused prosthodontics concept. And as last year we’re going to still have the weeks, like the CERAMIC IMPLANTOLOGY WEEK where at the end I’m going to teach in two days the ALL IN ONE CONCEPT. We will have the BONE AUGMENTATION WEEK, where we created very good structure for bone augmentation and a very nice system with our BISS-System “BONE IMPLANT STABILIZATION SYSTEM” where you could even place implants without

any contact to the bone and it works. We have proven that in many cases and we will have the ART FAST TRACK WEEK, we will have the PERFORMANCE WEEK, with some of the best doctors and speakers from the Sports medicine. You know, last year we had the annual Sports Medicine congress at our education center and it will be the same this year. So we have learned a lot from this area, what we have half implemented into our concepts as well. We are going to have some roadshows where I’m going to teach the concept about immediate implantation and we’re going to have a lot of micro events where we’re going to teach the first level. And so, as I said, everything will be perfectly structured and based on different levels. And as well, the education will be based on those levels as well. And inside those levels, as you know, we have every week one or two virtual shadowings. We will have from February on every week a webinar, what will be at 06:00 p.m., European Time Zone and in English at night, European Time Zone. So it will be perfectly accessible for our US community.

And we are taking a lot of tutorials. We have now these podcast. So I think education and staying and transport of information and support of our customers will be a very big focus this year. And of course, to finish with that, the most important event again will be the JCCI. And based on the huge success of the first year, we were able to now to have five ceramic implant companies. So beside SDS there will be Straumann, there will be Ceramex, there will be BreDent and there will be Patent. So it’s amazing that we’ll have five ceramic implant companies at the JCCI congress. We will have several organizations besides the ISMI, the Society for Blood Concentrates and biomaterials, which was founded by Professor Ghanaati, and we will have the DGOI, possibly one or two more and they’re going to bring the most amazing speakers to this venue, which is very hard to get in contact to in other places. So just to give you one example, we will have Professor Albrektsson, I mean, he’s one of the biggest pioneers in dentistry or especially in implantology, and he’s going to come to our place and many others on this level.

So this is really going to be a huge congress regarding the companies presented there, regarding the organizations presented there, regarding the speakers, and of course regarding the quantity, because we have already sold 96% of the physical seatings that you will have interactive Zoom and of course unlimited number of online participation reconstructing our education center. So to have another more 40 physical places and we’re expecting way more than 500 participants. So this will be a huge congress this year. And yeah, I think that should be all. And let’s say the most important thing, of course we’re working on a thousand things at the same time, but I would say this is the most important part of improvement on changes and benefits, what the SDS used and the community for income could expect from SDS in 22.

Coco

Yes, I myself feel a great sense of excitement for what is to come. And I’m even familiar with the concepts which are being developed currently. And I can tell you that great things are coming up. And, yes, I think we can close this episode. And it was very informative and it was great to talk to you. See you at dinner.

Dr. Ulrich Volz

Thanks a lot. It was a lot of fun and I think it’s a great format. It was your idea. And I think it’s a huge benefit for our users, for our community out there, to get more information in a special form where they can listen to it while driving. Always happily engagement.

Coco

Exactly. Thank you so much and bye.

Dr. Ulrich Volz

Thank you, Coco. Bye bye. See you.