Carolina
Hello and welcome to the fourth episode of the SDS podcast. Today, Dr. Rebekka Hueber, who is an oral surgeon and specialist in biological dentistry and ceramic implants, as well as the head of the dental department at the SWISS BIOHEALTH CLINIC, will guide you through this episode. As her guest. She welcomes Prof. Dr. Florian Beuer, who is the director of the Department of Prosthodontics, Gerontology and Functional Dentistry at Charité Universitätsmedizin Berlin. In this episode, Professor Dr. Beuer talks about his goals as president of the DGI, including restorative and maintenance dentistry, more integration of dental technicians, more knowledge about ceramics in the dental world, using his international context to strengthen global partnerships and the digital future of dentistry. Another topic is his important work with the CleanImplant Foundation, which is committed to making dentists aware that sterile is not the same as clean. I will now give over to Dr. Rebekka Hueber.

Dr. Rebekka Hueber
Welcome and thank you very much, Prof. Florian Beuer, that you are our today’s guest at this podcast. It is really an honor for me to welcome you here since I know you since my studies at the Ludwigs-Maximilians University of Munich, where you were chief physician of the polyclinic for dental prosthetics. And I was able to learn a lot from you, so especially about ceramics, of course, and prosthetics during my studies. And now you are head of the chair of dental Prosthodontics at the Charité University in Berlin and also the editor in chief of the International Journal of Computerized Dentistry. And not only that, you’re also the president of the DGI (german Society for Implantology). And this is one of the biggest societies in the Germanspeaking region. The DGI plays a very important role in the education and training of dentists, especially in the field of implantology, but of course also prosthetics and offers comprehensive programs. My first question to you would be what is your goal as the president for the society in the next years, and do you already see achievements that occurred during your presidency?

Prof. Florian Beuer
Wow. Welcome, everybody. Rebekka, thank you so much for inviting me and for having me. It’s my first experience, to be honest, in a podcast. But let’s come back to your question. In general, I have three main goals I would like to achieve with a DGI. And DGI is the largest society for implant dentistry in the Germanspeaking region, and I think it’s also the biggest in Europe. And I think we are number three or so in the world. So we have more than 8500 members. And all the presidents before, with just one exception, one exception Hubertus Spiekermann. He was also prosthodontist, but all the other presidents were surgeons, either maxillofacial surgeons or oral surgeons. And my perspective, of course, I also like surgery. I like the surgery and placing the implants. But my strength is definitely a restorative part of implant dentistry. And this is one of my major goals, or perhaps the biggest goal. I would like to strengthen the restorative part of implant dentistry. And really something that is very important for me is also to integrate our lab technicians, because I think they are very important when it comes to successful implantsupported restorations. So really get more knowledge of implant prosthodontics into the general dentistry offices. This is one of my major objectives because the surgeons and also the specially trained prosthodontists, they are pretty much into implant prosthodontics. But the general dentist who is also doing implant prosthetics, the knowledge sometimes is very, very little. And I would like really to enlarge the knowledge in the general dentist office and to integrate the lab technicians more into the DGI. The second the second object is this. I would like to use the context, the international contexts I have and really get the DGI a little bit more internationally based. Tomorrow in the morning, I will fly to Malaga to meet with the SEPA (Student Professionalism & Ethics Association in Dentistry) guys, with the Spanish colleagues. And we have quite successfully made a consensus workshop together with the Osteology, the SEPA and the DGI in March in Madrid. And I would like to strengthen these partnerships to the partners in Europe, but also to partners in America, in the US. In two weeks, I’m going to the American Academy of Prosthodontics and I would like to see the DGI as a hub for knowledge concerning implant dentistry and with a lot of connections all around the world. And my third objective is, and this is perhaps something which is rather unusual, I would like to develop an app for our patients, a patient based implant app, like a passport, where you have all the information about your implant on your smartphone. Because I think you know this problem. Patients come to our offices with implants in their mouth for 20 years or so. And it’s really hard to identify the implant system. It’s hard to identify what parts we need when we want to do a new restoration. And it’s really hard to get knowledge about the maintenance that has been taking place, about the recall appointments. And all this should be integrated in such an app. The patient should be in the driver’s seat. He should have the full access to all the data on his smartphone. And if he likes to, he can share the data with his dentist or perhaps with a DGI or with the scientific organization. And then I think we can get real numbers about implants success and implant survival outside of our controlled clinical studies we have on our universities or special training centers.

Dr. Rebekka Hueber
Wow. So thank you very much. I really like your goals. Yeah, especially to incorporate more prosthodontics and the lab technicians, I see that at our clinic, where our lab technicians are there every day, we work very closely with them and they are young and they love to involve into digital dentistry. So I think it’s also a profession that should be promoted more so that we don’t lose the dental technicians or make it more attractive to young people again, because it has changed over the years and it is really a value to work closely together with them. So that’s wonderful. And also that you want to strengthen the international context, since I’m also a lot in the US. And join a lot of congresses and see how much we can also or how much value we get out of the international context and the knowledge that is all around the world. Wonderful. And also the implant app, I had the same problem in the past. So it is really something that needs to be done so that we have all the information or the patient has the information and we can help them better. So, yeah, I’m really excited to see what you do in the next years. And the consensus conference in Spain, what is it about or what topics will you have there?

Prof. Florian Beuer
Basically, it was about soft tissue. It was about soft tissue dehistences and the coverage of soft tissue dehistences, because when you come together with the SEPA, which is originally a periodontics association, and the osteology, which has a strong focus on regeneration, and the DGI, which has strong focus on implants, perhaps the soft tissue is the common goal of all the three organizations.

Dr. Rebekka Hueber
Yeah, very interesting. Thank you very much.

Prof. Florian Beuer
Like a lot of these consens meetings are organized. First of all, we made up the three different topics, and then we did a scientific review, and the scientific review was published in the clinical implant research. And then we made the consensus. And the consensus of all the three groups will also be published in the clinical or implant research.

Dr. Rebekka Hueber
Okay, wonderful. Thank you. We will definitely have a look. Yeah. As you may know, I’m an oral surgeon, and I changed from placing titanium implants to ceramic implants a few years ago. So that is, of course, something I’m very naturally very interested in our audience. So also in how the DGI is positioning itself in the field of ceramic implants. Is the growing field of ceramic implants already being trained at the DGI, or will this be implemented in training programs in the future? Yeah. And how important do you see ceramic implants in the educational programs?

Prof. Florian Beuer
That’s really a tough question. You know that the DGI is promoting a lot of these scientific guidelines. And last year at our guideline, I don’t know if guideline is really the correct English word for “Leitlinie” this guideline process is pretty much comparable to the consensus, but it’s really just based on scientific facts. So first of all, you make up your scientific question, which was because we did a guideline about ceramic implants. What is the difference in survival and success of ceramic and titanium implants? And then you make a review, scientific review with the meta analysis, and then you write this guideline. And I think the guideline will be published by the end of the year. And I hope when we see each other on the Congress in October, I can present you some of the results or the content of the guidelines. And we had some years ago, there is one one-piece implant system that is really very well scientifically evaluated. We had this implant system at the DGI and we had several courses about ceramic implants with this implant system. However, the implant system is not in the market anymore. There’s a lot of scientific data there are a lot of clinical data on this implant system, but it’s not on the market anymore.

Prof. Florian Beuer
But we definitely have the ceramic implants I would say not in the focus, but it’s one topic that is important for us. Yes, in particular for myself. You’ve met me 20 years ago or 15 years ago at the Munich Dental School and I was always a ceramic guy. So I love ceramics, I love implants. So why don’t do a ceramic implant? From my perspective, I have done several ceramic implants but my standard implant still is the titanium one of various reasons. But when I have a ceramic implant with a hard scientifically, hard proven advantage towards titanium implants, then I think there’s no reason to use a titanium implant anymore. However, from the prosthetic perspective, to be honest, we have more opportunities when we have two-piece titanium implants. But I think there’s a lot of exciting work for the future to work with ceramic implants and to bring them further.

Dr. Rebekka Hueber
Yeah, that’s really interesting. Yeah, I also think that there is already signs out there, but as I can see, it needs more we need to do more scientific research, especially in this field, and see where are the board of like work can we have, where are the indications where we may be better used titanium or ceramic or see the advantages of either the one or the other one material? And yes, I’m very excited because that would have been my next question. Are there any guidelines or is the DGI working on guidelines in the field of ceramic implants? Because I know and I follow the guidelines or always learned from the guidelines of the DGI, they have a high reputation, especially of all the people that work there on these guidelines. And I’m excited to hear about the results in October at the JCCI conference here in Kreuzlingen at our education center. And I’m really happy that you come and grateful that you contribute because your experience in ceramic or zirconia is outstanding. I know that and I always followed your path and it was back then and I can only imagine how much knowledge or how much more knowledge you gained over the years. So, yeah, I’m really excited to hear about this. Wonderful. So something where you’re also very interested in is computerized dentistry. And you already told us about the app, so that’s just one part. But what can you tell us where are we in digital dentistry? And what can we expect for the future?

Prof. Florian Beuer
Wow, this is a very, very interesting topic because yes, but perhaps you also remember when we started in the Munich Dental School 20 years ago, we started with the digitalization in the dental laboratory. So we needed the digitalization in the laboratory to fabricate zirconia restorations. So this was really this was the pacemaker and this was the trigger to get all this digital stuff because we wanted to have the white material. And today, I would really say that also the COVID crisis perhaps has increased the numbers of scanning units in the dental offices. From my perspective, I’m working with intraoral scanners, I think for 15 or 17 years. But in the last four to five years, we have scanners that we can use for almost every case. So we don’t really need the analog impression for or we need it perhaps for 5% of our cases, but not more. And I think that perhaps somewhere around 15% to 30% of our colleagues now have access to the scanning units in the offices. However, if we just scan instead of taking a regular impression, this is not what I think that digitalization is about. Let me give you an example. In the past, when you had high blood pressure, when you went to the doctor, the doctor measured the blood pressure with a stethoscope, wrote down the numbers, and then you came back after some days and you came back a third and a fourth time. And then you got a medication that should work against your high blood pressure or increase your blood pressure. If you have low one, but you just had four or five measurements, and then you got a medication. And perhaps if you have high blood pressure today, you still go to the doctor. And the doctor now has an electronic blood pressure measuring machine which has an LCD screen. And you can read your numbers on the LCD screen, but you still do the same. You go three or four times and then you get the medication. And if you have a smart watch, and if you have the latest model of the Apple Watch, for example, then you have 24/7, your blood pressure monitored. And this is what digitalization is about, not changing from the stethoscope to the LCD screen. And when we compare this to dentistry, I think we are on the shift from the status quo to the LCD screen. We are not on the level of the Apple Watch right now, but I think in the future, what can we expect? For example, when we scan our patients, when we take intraoral scans on a routine basis, every appointment, when we do a checkup, and then if we have artificial intelligence software that can analyze the changes that happen over the years, then I think we are able to learn a lot more about teeth, about our oral environment, things we cannot even imagine today. And this is what digitalization is about, not replacing an impression with a scan. This is just the first step.

Dr. Rebekka Hueber
Okay, interesting. Very good. So, yeah, artificial intelligence and also maybe the evaluation of X rays with artificial intelligence. Do you see that coming, or is it already happening?

Prof. Florian Beuer
Yes, it’s already happening. One of my colleagues here in Berlin is a Prof. Falk Schwendicke, and he’s really a very, very bright guy. And he developed a software where you have a Panoramic Xray. Then you get the dental record by artificial intelligence from the X ray, and you get also some analysis of the Xray. And you just have to double check this. So this is already on the market. You can buy that. And I think that there is also a software and implant planning software from DensplySirona. They also used artificial intelligence to plan the implant position, which is absolutely smart because there is so much knowledge or so much scientific literature about the implant position. But, yeah, usually you don’t know all these factors when you plan the implant. Or this makes it very easy for the artificial intelligence to place your, or to give you a suggestion of the probably best implant position. So there is already the artificial intelligence working for us, and I think in the future, there will be a lot of new applications also come down the road.

Dr. Rebekka Hueber
Sounds exciting. Very good. And what I’m interested, you have a lot of international contacts. You travel around the world. Where would you rank the German speaking in Central or European region in regards of digital dentistry? So do you think Germany or also Central Europe is ahead, or are we in the middle field or are we behind? But what do you feel in that area?

Prof. Florian Beuer
So when we define digital dentistry as CAD/CAM dentistry, and then I think we are pretty much ahead because we have really developed dental laboratories. We have a lot of dental labs with a lot of dental lab technicians. And so the working chain of the dentist and the dental lab is working pretty well in the Germanspeaking countries. So when it comes just to CAT/CAM restorations, I think the Germans are Germans, Austrians, Swiss, they are pretty much ahead. Or when it comes to things like planning, like digital smile design or something like that, where you don’t need so many or so much expensive equipment, there are other countries I think are a little bit ahead of us. So digital smile design was developed by a Brazilian guy, by Christian Coachman. Floridian Kofar from Romania is one of I think he’s one of the one of the keynote leaders when it comes to this digital planning. And I think when you’re just talking about the use of the computer for dentistry outside of CAD/CAM, then perhaps some other countries a little bit more ahead than we are.

Dr. Rebekka Hueber
Okay, which countries do you have in mind?

Prof. Florian Beuer
Not the traditional Western European or North American countries, but countries where we don’t have more ideas to get a solution, where we don’t have the perfect laboratory or the perfect equipment, where we have to find our own solutions. And this is perhaps in countries like Brazil or Romania or Bulgaria, eastern Europe might be a little bit might be a little bit easier because they are not so captured in the in this professional environment of dentistry. So they’re really outside the box thinkers.

Dr. Rebekka Hueber
Okay, okay, that’s interesting. I didn’t know that interesting. Okay. What are the current topics in research in regards to zirconium dioxide or which topics in your mind, do we need to do more research and gain more knowledge and experience when it comes to prosthetics? Maybe also implantology?

Prof. Florian Beuer
From my perspective, when we are talking about Zirconia material and when we are talking about Zirconia based restorations and let’s talk about two supported restorations. I think the chance with Zirconia now is to make minimally invasive dentistry and not to grind down the teeth, but to have a high strength material that allows us to fabricate reservations that are very thin and allows us to save tooth, tooth tissues. And I think we should much more focus on that topic. How thin can our restoration be to have enough stability and not to sacrifice too much too structure. The second thing is when we are talking about 3D printing of Zirconia. I think this is something very, very interesting. We have the technique to do the 3D printing and now we can print restoration layered like the natural tooth with a dentin and a nanostructure and print it from Zirconia. I think this is really something we should also put more effort in. In combination with minimum thickness to have really thin and minimally invasive enamel bonded restoration. Yeah, I would say perhaps this is the most interesting part of Zirconia right now. On the other hand, when it comes to implantology or implant prosthetics, when we print Zirconia, we could also use the printing procedure to get some particles into our Zirconia restoration or into our Zirconia abutment that prevents the inflammation of the soft tissue. And I think this is also very interesting and perhaps in the future customized for every patient. So if we know the distribution of germs of the patient, we can perhaps print the restoration or the implant or the implant abutment for the patient customized really with some contents that prevent in his or her specific situation the inflammation of the soft tissue.

Dr. Rebekka Hueber
That’s really interesting. Okay, very good. Is there already research in this field?

Prof. Florian Beuer
Yes. So in my clinic we are doing some research on the printing of zirconia abutments with this idea to prevent the growth of bacteria around this zirconia.

Dr. Rebekka Hueber
Okay, wow, that’s very interesting. I’m really excited about the results and to hear more about it. Very good. And when we talk about gems, maybe this is also something very interesting. You are a board member of the CleanImplant Foundation. Can you tell us more about that and why this topic is so important to you?

Prof. Florian Beuer
When I first met Dirk Dudek I think it must have been 15 years ago or something like that, I was really yeah, I was surprised by this very, very simple idea of just having a look at the surfaces of implants because I always expected the surface of a sterile implant is completely clean. I just thought this because an implant is a medical device, it’s quite expensive, it goes through a lot of cleaning processes. So I expected this to be clean. And I was completely surprised by his result that there are clean implants and there are implants that have a lot of particles on the surface. And of course, we don’t know yet what those particles are causing in the patient’s mouth or in the bone or in the oral environment. But from my perspective, I think, yes, we have to make sure and this is really the responsibility also of the manufacturers. We have to make sure that we get implants that are really clean into our patient’s mouth. Our patients deserve that and we deserve that. And so, yeah, when I was talking to Dirk and he asked me if I would like to join his group and I said, yes, of course. I really like your idea and I really like the initiative to draw the attention on the cleanness of our implants we are using because I think most of our colleagues are in the same situation I was when I first met Dirk. I always thought a sterile implant sterile means clean, but that’s not the case.

Dr. Rebekka Hueber
Yeah, you’re right. The same happened to me. I also expected that and couldn’t believe that even on zirconia implants you can find titanium particles or steel particles or PTFE, plastic, whatever, and organic particles. So I’m very grateful that you are at the board because you have an impact and to make the dentist aware of that problem. Because, as you say, we have a very high responsibility when we place implants to have absolutely clean implants. And of course, it should be natural that we can rely on that they are clean, but obviously, or unfortunately, it’s not the case. So, yeah, thank you very much that you do this work on top of all your other work and yeah. That you contribute to that foundation. Well, that was really interesting. Thank you very much. I learned a lot and I’m really looking forward to what is coming in the future. And yes, thank you for all your research and your work. And do you like to add something? Because I think we heard a lot about the topics that will come in the future.

Prof. Florian Beuer
I think that we don’t have to be afraid of the future. We can relax because the future will always be better than the past. And I’m really looking forward and I’m looking forward for the next. I hope that I will be around the next 20 years in dentistry, and I’m really looking forward to work more with perhaps ceramic implants, to have different opportunities of digitalization to I really like your point. I haven’t mentioned that yet. I really like your point about the dental lab technicians. We have also to give them a perspective to be a serious partner, an important partner in our business. And I’m completely with you that a lot of young people really have lost or the dental lab technician work has lost the attraction to young people. And this is our responsibility to get this back, because we have talked about digitalization and the German speaking region in the world when it comes to dental laboratory work, the German speaking region is absolutely Champions League. But if we lose this competence, if we don’t attract enough young people taking over this very, very interesting profession, then we will not have this position in the next or in the near future. Yeah, it would also be great perhaps at your congress, if we have some lab technicians there and also exchange our ideas.

Dr. Rebekka Hueber
Definitely there will be some. And it’s so important what you say. Maybe one idea is to implement the digital dentistry lab work into the education already, the first education, so that they are really trained from the beginning, because I think it’s really exciting and it has changed so much. It’s so different than when I started dentistry, how they work there, and there’s so much more development, and that’s very interesting for young people. So maybe we need to make the people or the young people aware that this is now much more digital work than sitting on plastic. I don’t know. And making teas are just prosthetics just with your hands, but also do it digital. And yeah, I hope that this is really supported and this profession will be exciting or interesting again for the young people, because I think it’s really important. We, as dentists, we cannot do this like a trained technician. And for me, it’s such a such a contribution to work directly with the technician, directly at the patient. The results are much more better. So, yeah, we have CAT/CAM and we can do a lot on our own in the dental office, but I think when it comes to full restoration and crowns and everything, it just needs a dental technician. We cannot do everything on our own. I don’t know how you see it, but yeah,

Prof. Florian Beuer
Definitely. I’m a dentist. I don’t like to do dental lab work, so I don’t like chairside dentistry. Just from my personal perspective, I’d like to do the dental work. This is something that really I love that, but I don’t want to make rounds. I don’t want to be a lab technician. I want to be a dentist.

Dr. Rebekka Hueber
Yeah, that’s true. Wonderful. Yeah. I’m really looking forward to meeting you in October here in Switzerland, in Kreuzlingen we are really honored that you come and excited about your lecture and presentation. Our lab technicians will be there and a lot others from the US. Dentists from all over Europe. So it will be a very exciting event. And until then, I wish you a wonderful summer and safe travels to the US. And also to Spain. And thank you very much that you took the time and told us about all these exciting news about the next years of the future in dentistry. Thank you very much.

Prof. Florian Beuer
Okay, so it was my pleasure. Thank you so much. And I’m also very much looking forward to coming to Switzerland in October. And thank you so much for my first podcast experience.

Dr. Rebekka Hueber
Yeah, you did great. Perfect. Thank you.