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Episode 5 – Guided Surgery with Dr. Markus Sperlich and Dr. Mathias Sperlich

Immediate implantology and the future of guided surgery

Today, Dr. Karl Ulrich Volz talks to Dr. Markus Sperlich and Dr. Mathias Sperlich, who have a dental practice together in Freiburg.

Guided surgery has been an integral part of the working practice of Drs. Sperlich since the joint practice was founded in 2013, as has all-ceramic implantology.

The brothers talk about their entry into ceramic implantology, its advantages and the benefits of Guided Surgery.
They also discuss the clear advantages and future of immediate implant placement, especially with regard to ceramic implants, which are ideally suited for immediate implant placement.

Todays Guests

Dr. Markus Sperlich

Freiburg im Breisgau (DE)

Dr. Markus Sperlich studied dentistry at the Albert Ludwigs University in Freiburg. Following his studies, Dr. Sperlich completed his doctorate at the Clinic for Oral and Maxillofacial Surgery at the Albert Ludwigs University of Freiburg. He spent his residency at the University Hospital in the Clinic for Dental Prosthetics with Prof. Dr. Dr. hc. Jörg Strub.

Dr. Mathias Sperlich

Freiburg im Breisgau (DE)

Dr. Mathias Sperlich studied human and dental medicine at the Universities of Freiburg and Würzburg. During his training, Dr. Sperlich worked in the field of oral and maxillofacial surgery at the University Hospital in Zurich and at the Chhatrapati Shahuji Maharaj Medical University Lucknow (India). He completed his doctorate at the Clinic and Polyclinic for Trauma, Hand, Plastic and Reconstructive Surgery at the Julius Maximillians University of Würzburg under Prof. Dr. Meffert.

Carolina

Hello and welcome to the fifth episode of the SDS Podcast. Today, Dr. Ulrich Volz talks with Dr. Markus Sperlich and Dr. Mathias Sperlich, who together have a dental practice in Freiburg, Germany. The brothers talk about their entry into ceramic implant dentistry, its advantages and the benefits of Guided Surgery, which is in development. They also address the distinct advantages and future of immediate implant placement, especially in relation to ceramic implants, which are ideal for this implant placement. Biological dentistry and micronutrients was new territory for both of them and they talk about what convinced them to use them and the clear difference they experienced in their treatments.

Dr. Ulrich Volz

Dear colleagues, welcome to our new edition of the SDS Podcast. And we are here in Kreuzlingen and we have quite exciting guests for you today, namely the two brothers Sperlich and Sperlich, Markus and Mathias. Welcome here to our podcast in Kreuzlingen.

Dr. Mathias Sperlich

Hello!

Dr. Mathias Sperlich

Hello!

Dr. Ulrich Volz

Nice to have you guys here. Thank you very much. I think we can look forward to an exciting conversation. Maybe you’ll give ours again. Well, many people know you, of course. You’re on the road so much. I see it all the time on Instagram, but my daughters point out to me where we just again you guys are drifting around in the world, in Copenhagen or wherever. And, um, but maybe again very briefly two, three sentences each from you to introduce yourselves again briefly to the audience.

Dr. Mathias Sperlich

Yes, hello, I’m Mathias Sperlich and I studied medicine and dentistry at the universities of Freiburg, Würzburg and Zurich. Then I spent some time abroad in India. Half a year, then I was a sub-assistant in the clinic in Zurich, completed further training as an oral surgeon and then in 2013, together with my brother, the best decision of my life, opened a practice in Freiburg and there we have our location to this day, will now expand from next year and are super happy with our work. And above all, the collaboration is excellent, isn’t it Markus?

Dr. Markus Sperlich
Yes, perfect. So it’s great when you form such a great team with your own brother, and when your ideas cross-fertilize each other and your everyday life is greatly enriched, and above all, there’s a great basis of trust. My name is Markus Sperlich. I completed my studies in Freiburg, but after a short practice and then a long time in the prosthetic department of the University of Freiburg and there I have the great good fortune that I was allowed to get to know ceramic implantology relatively from the beginning and there, above all, the way of the scientific side, as far as all-ceramic implantology is concerned, in preoperative as well as operative side well mapped. And in addition to all-ceramics, my other focus there was already digital implantology with the current systems that were available at that time with 3D Nobel Guide, Simplant, and I also gained a lot of experience there. And as Mathias has already said, in 2013 we founded our practice in Freiburg and focused on guided surgery right from the start. And as a second hobbyhorse, we brought in all-ceramic implantology. So ceramic implants have been our focus of interest from the very beginning. In 2018, there was what I would call a decisive turning point in our work. I had a stay in Brazil in December and in Curitiba in the south of Brazil. Have also worked there clinically and just got to know there the immediate implantation and immediate treatment in extenso.
Dr. Mathias Sperlich
Not a great experience for us.
Dr. Ulrich Volz
Yes, I would say that you are definitely in line with the trend that we are observing and that others are also observing in the market. It goes towards Guided Surgery. For the beginners I think it has great advantages and simply more safety has advantages for the advanced, if you simply get to the goal faster and with ceramic implants anyway. In that respect I think it’s great. Can this be combined particularly well? Do you see a good symbiosis in these two topics in particular? Ceramic implants and guided surgery.
Dr. Mathias Sperlich
Yes, absolutely. It’s true that ceramic implants are still in development, but our experience, which we have simply made over ten years of experience in guided surgery with ceramic implants, can be transferred one-to-one, i.e. in many points to ceramic implants.
Dr. Markus Sperlich
A major advantage of guided surgery is that, especially in the area of immediate implant placement, it is possible to work very well in pre-operative computer planning with congruent shape between the implant and the tooth socket, and it is also a goal, an important goal for us, to preserve the biological structures. In this respect, the ceramic material offers a clear advantage over titanium. And if you symbiosize the two with each other in everyday clinical practice, i.e. digital planning with ceramic implants in an immediate implantation surgery, then you have a super outcome.
Dr. Ulrich Volz

Yes, actually what the patient wants. And the second thing is also that of course we have tremendous advantages in terms of atrophy. I did a ceramic implantology, the largest immediate implant study and was able to show that the bone loss was as high as with a late implantation. So in that sense we can take it out because we always have a certain bone loss of 0.4 0.6. In other words that actually means we don’t have bone loss with immediate implantation because you have the same with late implantation. What else fascinates you so much about immediate implants? Because I have noticed that immediate implantation is your big topic at the moment. How do you see the future for implantation? Why do many people still have reservations about immediate implants? What is your opinion?

Dr. Mathias Sperlich

Yes, in any case we can absolutely share the data you said. We used the corona time, 2020 and we evaluated all our cases. And what you said about maintaining the structures, we can absolutely prove that with our numbers. We have gone one step further, we have not only studied the tissue, but we have also studied with the help of the SF-36 health questionnaire, we have evaluated, what benefit does the patient really get from the immediate care? We compared it. So we took our patients that we implanted immediately and treated immediately. Everything in one session and then we took our normal implant patients. So late restoration or early restoration and also late implant and early implant have compared that. And then you still compared to the normal population and that found a significantly higher standard of quality of life in all two comparisons. When patients received immediate implants and were treated immediately and not only in the period of 2 to 3 months after immediate implantation, but also two or three years later, it remained in the patient’s mind that he was absolutely socially fit again due to this immediate rehabilitation. In everyday life, at work, in the family, everywhere. And of course he had much less pain, because I’m sure you’ll agree with that. You did a lot more immediate implants than we did because you’ve been doing it forever. Is also less significantly less trauma. And we both absolutely see the future in this type of treatment. And that is also in line with what the WHO says. They commissioned a Delphi study and the renowned professors in implantology gave a comment on how they see implantology in 2030. And everyone said that it is moving towards immediacy, i.e. immediate treatment.

Dr. Markus Sperlich

In addition, it is of course also an economic aspect, because this evaluation of the PROMs is of course also reflected in the number of patients – satisfied patients are the best advertising that you can have for a company. And since we’ve been doing this, we’ve had an increasing number of implant cases in our practice, and on the other hand you’re also working more economically, because of course in a surgical procedure, if you look at the classic procedure, you make three appointments, which of course also means more patient time, which you can use for other new patients, which then also pays off in terms of profitability.

Dr. Ulrich Volz

I also believe, which is an important factor that we have to consider from the economic side, that the highest willingness for implantation in patients at the time of extraction is about 95% according to relevant surveys and studies. If I send the patient home to “let heal” in quotation marks, because actually the behavior is nothing but left to atrophy, with loss of volume with loss of aesthetics. I have a smaller diameter, I have a smaller length, which in turn brings a higher risk that then 50 to 70% will not return because other priorities, higher gas prices, whatever personal issues come to the fore. Or they even go to a colleague, then get implanted there. This means that, as an immediate implant planner, there is no question that the number of implants will be higher. And I see it also in such a way that the patients also in the clearing-up, if one says, we make the tooth out, us should I the anyway already existing hole in the gum a new root is inserted from ceramic. I wouldn’t call it that figuratively with drilling screws and talking about it in a big way. And I call it so a little bit the “arthroscopy of the surgeon” or the or the oral surgeon, is actually an arthroscopic procedure. And where do you see the advantages of ceramic as a material with regard to immediate implant placement? Do you see advantages purely from the implant material compared to titanium, that it has no free electrons, no particle abrasion and so on due to its super hardness, that it perhaps offers advantages and that I can possibly go a bit further out on a limb and bring a higher level of safety into ceramic implantology.

Dr. Mathias Sperlich

Just in the case one that Markus operated on two months ago. It was a case Markus where we have absolutely reduced bone, operated together and the tooth came out. Here we had a very thin buccal lamella. We would never have put a titanium implant in there again. But we thought about the properties of the ceramic implant. It is totally stiff and we thought that the ceramic implant would have the buccal lamella, for example. It just occurs to me now, and then of course with immediate implantation the issue, even when we look at our cases. The soft tissue loves the ceramic. Tissue in general, loves the ceramic and you just, if you put in the ceramic implant right away and right away you have the crown on it, which is what we do in a high percentage of our cases. So with us the crown is the wound closure, then we see there already clear – temporary crown – exactly, it is with us the mouth closure. We try to implement this in 80% of all our immediate implants. And the one case Markus, that was, you probably wouldn’t have done that with titanium.

Dr. Markus Sperlich

I absolutely agree with you there. I mean, with you immediate implantation I have one. Our basic goal is to preserve the biological structure. Of course, you also have to see that the biological structure that I have there needs surgical handling, which is very, very careful. This starts with the extraction. I must not destroy this structure and, of course, ceramics also cause less irritation to these very sensitive structures than when I use titanium, for example. And thereby I have from my point of view with the immediate implant so with those, you really also have to say, with the modern ceramic implants has the older generation ceramic implants, offers due to the design disadvantages compared to titanium implants. But just for example your implants, the SDS2.2 is a super implant for immediate implantation and with the new geometries new threads, I have clear advantages over titanium in immediate implantation, because I can simply support these fragile structures in their healing by ceramic better than if I take titanium. And what – especially when someone is starting out and doesn’t have a lot of experience in immediate implant placement, if there is a recession, of course I still have the advantage of the white color. That’s very clear.

Dr. Ulrich Volz

The or in our case of the load-bearing capacity, so that I can also there of course again corrective intervention. In my experience, it is also so that just the, the non-existent particle abrasion just also not like titanium, but activation of tissue macrophages thus cytokine release can lead. That is, I also have a whole series. I also have 12,000 titanium implants placed from my ceramic career. Of course, some immediate implants as well. If something didn’t work out there, I often had a disastrous defect. This was worse than the initial situation, which is of course unpleasant for the patient’s dentist. With ceramics, I have never experienced in the worst case that I fell lower than zero. As initial condition, then it was hal Socket Preservation 2.0 and did not become solid. I think it also certainly a good advantage. Now where do you see another advantage in immediate implant placement in relation to Guided because that’s really the crown of creation, the tip of the iceberg. Immediate implant placement is what patients want. I don’t think we need to talk about it at all, and many dentists have already understood it, have developed concepts that it works well, reproducibly, reliably. But how is the combination of guided and immediate implant placement with ceramic implants another step into the future.

Dr. Mathias Sperlich

Our goal is to use the possibility of computer planning to plan the prosthetics at the same time. We’ve already done that very successfully in Titan, we’ve already tested it, and the results are excellent. That we go here and the fixed implant position that we have in the Guided Program, whether it’s SMOP or Coda Implant, it doesn’t matter which one. First of all, we use this fixed position and export this data to ExoCut or 3shape via a transfer tool, such as a scanner, and design the crown for our immediate restoration right there pre-operatively. In other words, this is how it works for us: the patient comes in, the tooth comes out. Only an alveolar management is done, because we also – you will agree with us – do not shy away from inflammations. So chronic inflammation, acute inflammation, pools, of course we don’t implant in there, but chronic apical inflammation is not an exclusion criterion from our point of view after proper alveolar management for immediate implant placement. So we use these data that we generate and then we can of course have a setup of splint, implant and the crown right at the start of surgery – we screw it all on and the patient is rehabilitated within a very short time and can participate in everyday life again. And that has been the absolute game changer for us, and it works the same way in ceramics. And we are convinced that just putting the crown on post-operatively brings even more gain in esthetics and well-being for the patient, because ceramic is simply the inherent material.

Dr. Ulrich Volz

We are now working on a project together with our dentists or some dentists from the SWISS BIOHEALTH CLINIC together with the oral designer Joachim Meier, dental technician, we are developing or have developed together and are now fine-tuning it, you could say it already works, but we are fine-tuning the SDS Box Service fully guided navigated with SDS implants of both implant series Value and Bright. Um, you were a bit skeptical at the beginning, because you have an infinite amount of experience. What are your first experiences and impressions of the SDS Box, where you see advantages and say that or in which direction do you think we will get there? Are we going to, um what are the advantages? Will we be superior in certain areas, even common conventional systems? What are the big advantages of this this joint activity? In the field is the SDS box.

Dr. Mathias Sperlich

You first of all a huge advantage. Still what I still want to follow up on the previous question, I am of course guided working with ceramic implants as well as with titanium implants I can of course in the immediate implantation the existing structures better protect against trauma. Maybe not quite the super difficult anterior case to restore immediately. There the alveolus is mostly congruent in shape to the implant, but if is already going on. If I’m talking about a molar where I have several roots, especially in the maxilla, where I might have to make optimal use of the bone in the septa to get the implant stable. Of course, with exact planning and guide treatment, i.e. exact preparation of the implant and insertion of the ceramic implant, I can absolutely protect the existing substances, so that I always achieve success if I can see in the preclinical planning that it is possible to drill once with the free hand and the bone is gone. Now to your question about the 2INGIS system or SDS box, a very big advantage is that I have very, very precise guidance via these bidirectional guides, these guide pins, so that I can see right into the operating field. I actually have a clear view of the surgical field, which is sometimes very limited with conventional systems, and I don’t want to mention any names here. Without a view, I tend to work blindly and have to rely blindly on the system. I have a great deal of variability when it comes to implant designs. When I work like this, I don’t need a special guided set. But I can take the existing OP set and can then the appropriate tools here from you super prepared along sent. In the SDS box package, since in the conventional implant form practically apply and can then bring it there to use. A big advantage that I see in SDS Box is that in the future I will also have the possibility, from my point of view, to insert the prosthetics navigated with it. This means that I will be able to plan here in the future and will be able to use this SDS Box template as a guide for the prosthetics at the same time, which will certainly be a great help in full-arch cases, for example, and will also save a considerable amount of time.

Dr. Ulrich Volz

What was your experience regarding the accuracy of the system, precision, which is a very important topic. And perhaps the second topic, which leads to the topic of CleanImplant: Particle abrasion.

Dr. Mathias Sperlich

Yes, in terms of accuracy, the system is outstanding. Just like the studies say. These studies indicate that the average deviation here is almost twice as good as with the sleeve-scoop system. And the things that we have operated bomb accuracy, super fit of the splint really well. And getting to your question: Particle abrasion always zero. So that’s a tip-top clean thing. And if you also compare it to titanium drill in titanium sleeve, we always have a slight abrasion. You can’t deny it, it’s like that, and of course we’re absolutely clean here.

Dr. Ulrich Volz

Yes, that was also the reason for me to go into this system. And I’m glad, because we were a bit skeptical at the beginning, because it approaches the situation quite differently, the system. But for me it was for the reason that we come from immunology. It was decisive. And it is the first and only one. There is a second system, but it is also based at SDS. The SDS AIM, theAd hoc Navigation System, because the only two systems that are accredited by CleanImplant Foundation, which I think will already play a bigger role in the future. I was at the AO Summit in Chicago two weeks ago, where also the highest FDA inspector spoke as a guest speaker, with whom we have been in contact since then and exchange some information. The FDA is looking very closely at the whole issues of particles, release, particle release etc, we know it from other areas orthopedics? That’s a huge issue. With breast implants, it was a huge issue. That’s also kind of where the MDR came from, which is looking very closely, which I think is also good. And in this respect, we think that this is a great concept that we are developing together here. And I’m glad that we’re doing this together and that you’re contributing your expertise. And I am particularly pleased that you are now slowly becoming enthusiastic about this, despite your initial skepticism.

Dr. Mathias Sperlich
We have already changed some things now that we are now also on the program, which is just as fast, just as precise and above all just as simple. And that was the point at the beginning, that we had a very complex system, we had now once created a system. Yes, that can be said in advance, which works at least as easily as the current systems on the market.
Dr. Markus Sperlich
And we still have further potential and it will become even better, if it is now at the moment and even more grazieler, even clearer, even more descriptive and therefore also for the first user a very simple thing.
Dr. Ulrich Volz
Yes actually a great proof for teamwork and cooperation, because then you sit together and several intelligent brains think in the same direction. And in the beginning, that was also for us. How do we get the complexity out? And actually one of you two, I don’t remember who it was. In the Zoom meeting, we suddenly had the brilliant idea. Actually, it was quite simple. We just leave something out and it works, a little bit.
Dr. Mathias Sperlich
The beauty of the system is that the dentist who has been using SDS up to now will be able to continue working completely as before. He simply has two small particles, plus the template, and then he is fully guided, and not just the preparation, but also fully guided insertion.
Dr. Ulrich Volz
As the last point in our podcast, we would like to come to a completely different topic, which actually then also plays a role here again somewhere. It was for you so in our contact, so certainly not the first, but intensive of course, because we see yes, let’s say so the lion’s den. As far as biological dentistry is concerned, the whole micronutrients, that is such a first hardcore encounter for you. Of course, you’ve already heard a lot about it. You yourself are interested in health and performance. What were your first experiences with biological dentistry in the form of micronutrients, where we are actually in such a middle we have the cellular level, osteoprogenitor cells and then we have the bone metabolism and that actually no one has taken care of the last 40 years. And there we have the macroscopic situation, over-extended preparation, healing chambers and so on. And the micronutrients are sitting in the middle, activating the bone metabolism. How did you guys feel about that? Because you guys are already coming from a very scientific corner. This, this concept? Were there any surprises? Was there anything exciting, interesting for you?
Dr. Mathias Sperlich

So surprised me with my background from human medicine the fact that the concept what you have, with the micronutrients BASELINE BOOST is absolutely physiologically explainable. Absolutely medically comprehensible, is top scientifically backed. And it has simply also convinced us completely. And with us it is in the meantime in such a way and we know us now a good year more closely and within that year with us that established itself absolutely that we add better BASELINE and BOOST to our treatments and with fabulous results. The patients have consistently received this very, very positively. Before they gave it to the patients, we also tried it ourselves. And we have also received it absolutely positively and in the whole circle of friends. So you can really say that what is physiologically explained there…

Dr. Ulrich Volz

So you don’t have to believe in it, but you have a feeling that it is…

Dr. Mathias Sperlich

You don’t have to believe in it, deifintivly.

Dr. Ulrich Volz

Outside of a placebo effect, noticeable, visible also for you on the gingiva, how the patient comes back.

Dr. Mathias Sperlich

Is it once so that just this point in time, where we have the contact to biological dentistry, which I have now come to know more closely, which has just coincided with that, where you also much on social media, vitamin D3 for example and osseointegration, are shared quite a lot of studies now. And if you take a closer look with your expertise, you can also see in clinical everyday life, really a clear improvement in the classification, especially with regard to complications. They are reduced. If I prepare the patient pre-operatively accordingly, then it works wonderfully. From my point of view, from the patients’ feedback, it also gives the patients a sense of security if they are treated immediately. And after this clinical phase, after the operation pre- and post-operatively, we now also have quite a few patients who simply come to us, like in the drugstore and say: “can we have a little BASELINE again?”. They also feel an improvement in their well-being in their private everyday life as a result.

Dr. Markus Sperlich

And we use it, it has to be said, not only in implantology, but also very, very successfully in periodontology. Adjuvant to the periodontal treatment. And there we actually got extreme results. That patients…

Dr. Ulrich Volz

So visible really for you?

Dr. Markus Sperlich

Yes visible. None. No more bleeding, nothing within a very short time. That is also the proof for us. Besides knowing that what you all are saying is true, that it is absolutely not a placebo effect. Definitely not.

Dr. Mathias Sperlich

And I think, if you also go further and look, how do we live nowadays in comparison, how did we live in the past? That means sunlight, nutrition, and so on and so forth. Then you almost can’t avoid taking supplements. You have to see that quite clearly.

Dr. Ulrich Volz

So another proof that we have to think from the inside to the outside and not always the attack from the outside. But what is actually happening physiologically, where can we intervene? Last question to you Do you think that at some point we will implant and immediately put the final crown on it?

Dr. Mathias Sperlich

Yes.

Dr. Mathias Sperlich

Yes. Very briefly and succinctly.

Dr. Ulrich Volz

So let’s be surprised. I also believe in it. I have also developed the thread to this end and am also involved in the topic. To insert the first implants with final restoration, where I think that ceramic has advantages, that our thread has advantages, that Dynamic Thread builds up the immense force. But just where I can’t do any damage, not in the marginal bone. And in that sense what is your prognosis? When will we stop using titanium and only use ceramic? How many years would you say until then?

Dr. Mathias Sperlich

Well, I’m very, very optimistic, because very, very many people are looking at ceramics right now. And I’ll put it this way, we’ve already talked about it. Very briefly the forecast I want to correct a little bit upwards, but I think what she also said, 2030 I could definitely imagine that ceramics will dominate.

Dr. Markus Sperlich

So I would put ten years in any case. Okay.

Dr. Ulrich Volz

Good. Marco Gardola said last year at our JCCI congress, in the next five years times 40, multiplier 40, I’m not completely optimistic, because I’m waiting now for 22 years for the dam to break. But I think also, in the next 5 to 8 years, we will certainly get there. In that sense, I thank you for your commitment, for your friendship, for the great things we do together. That a lot of what I was allowed to learn from you, also in terms of Guided Surgery for me new topic actually because I was always freestyler, I actually came through you to the topic and I’m looking forward to the further cooperation, what we will still develop together there. And yes, it’s great that you were here and thank you both very much.

Dr. Mathias Sperlich

You’re welcome and thank you,

Dr. Markus Sperlich

Thank you!

Folgen Sie uns!

Der Gastgeber

DR. KARL ULRICH VOLZ

Keramik-Pionier und Vorreiter seiner Zunft. Mit seinem ganzheitlichen Behandlungskonzept ist es ihm gelungen die Brücke zwischen der Biologischen Zahnheilkunde und der Chirurgie zu schlagen, und somit das beste aus zwei Welten zu vereinen.

CERAMIC IMPLANTOLOGY WEEK

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