• FACE-TO-FACE
Prof Dr Frank Schwarz is from the Department of Oral Surgery and Implantology, Carolinum Johann Wolfgang Goethe-University, Frankfurt, Germany. He is also an Associate Editor for the Journal of Clinical Periodontology and Editorial Board Member for Clinical Oral Implants Research. He is the President of the German Association of Oral Implantology (DGI), and a Board member of the Osteology Foundation. He was awarded the André Schröder Research Prize in 2007, the Miller Research Prize in 2012 and the Jan Lindhe Award in 2017. Professor Schwarz was in Nepal for the first time from October 9 to 11 to educate and train fifty dentists from Nepal and India on Implantology. Bal Krishna Sah of The Himalayan Times caught up with him and discussed the significance of implantology and patient care. Excerpts:
Why is it important to replace missing teeth or what are the options?
Well, the replacement of missing teeth is something that is driven by two components. A medical component, to restore and rehabilitate the function of the dental system. When you lose teeth, you usually have difficulties chewing, but you also have difficulties supporting your joints.The joints are a very important issue so, when you lose teeth, you lose the support of the joints. From that perspective, we have a clear medical indication.But just think about losing a tooth in the aesthetic zone, it also has an aesthetic component. So, in the best case, it fulfils the two aspects.
It has a medical indicationand it has an aesthetic component.
It clearly points to the need to replace teeth and implants are one option.
They are a very good option where we have a very solid basis. It means we have scientific data that show that implants can last forever if the patient provides sufficient oral hygiene, When the dentist provides sufficient oral care. These are the fundamental components. But there are alternatives too, such as conventional prosthesis or bridges.
And depending, of course, on the clinical situation, you may choose one or the other. And this is done during the part of the diagnosis and treatment plan.
What are the prerequisites for getting dental implants?
One prerequisite is always having a sufficient amount of bone because implants are installed inside the bone, they are anchored in the bone.
The bone grows towards the implant and integrates the implant.
So, having bone is a prerequisite.
The good thing is we can compensate for bone deficiency by means of bone grafting procedures. But modern implants also have dimensions that are shorter, more narrow. That means we can, these days, put implants even in areas where we have a limited amount of bone. It has become more comfortable for the patient to receive implants.
What is the importance of hard and soft tissues regeneration around the teeth or implants?
As I've said, implants are anchored in the bone. So, bone is the fundamental basis. But bone is just one component. The gum covers the bone and provides protection. It protects the bone and the implant from bacteria in the oral cavity.
Mouth is a unique place in the body, where billions of bacteria, viruses and other micro-organisms reside.
Some are good as they support health, but there may also be some bad ones that may be aggressive and they may induce inflammation.
This is where the gum comes into play. Gum provides protection against bacteria and acts as a barrier against it. And that's why we have to consider a proper and sufficient gum contour.
What is your role in enhancing patient care?
Well, the role is to clearly inform the patient that just placing the implant is not enough. Consequently, the patient needs to come for regular check-up. Not just for the teeth, but also for implants. And one principle is clear that implants demand more. They require more support than teeth because they are a little bit more susceptible. Which means the role of dentists is to provide clear information on how often the patient needs to be enrolled in maintenance care.
Why is it crucial to continue skill transfer or educate dental experts in the field of oral regeneration?
Because in regular dental education, implants and bone grafting is not the basic component. This is something a little bit part of the standard curriculum, as you don't learn how to place implants when you are in dental or medical school.
So, this is something that comes after you have finished your dental studies and need to go into a postgraduate education.
And that's typically the case for implants and bone grafting which requires education. As this is a very dynamic field, you need education for a lifetime, because techniques and procedures do change over time and you always need to be at the forefront of the techniques.
How technique sensitive is it?
As opposed to medical doctors, when you prescribe a drug or pill, they're going to work by themselves.
You put it in the body and they work.
But here we are dealing with medical devices. That's why they do not work as a basic principle. They do work, they integrate, but you need to have, of course, the technique and the surgical education to put it in the proper way. Accordingly, like in orthopaedic surgery, dental surgery, is highly technique sensitive and therefore education is the key.
What is your advice to patients regarding oral health maintenance and follow-up care?
We always advise patients to follow maintenance care. Maintenance care means we clean teeth, we clean implants and we check the health status of the teeth and the implants.
So, this is what we recommend at least two times a year. And some patients are at higher risk, such as patients suffering from diabetes, just as one example. These are patients that we even put four times a year in maintenance check-up.
What are your suggestions to patients from developing countries where dental treatment is not taken very seriously as they are not life-threatening and are often considered an aesthetic need only?
Actually, this is a problem because the treatment procedures or dental care are usually quite costly. And the easy way is to think that this is just for aesthetic reasons. But what we completely ignore is that we have fundamental medical indications.
So, when you don't have a proper functioning dentition, your nutrition will suffer, and joints will become atrophic. And atrophy in the joints is one of the most severe illnesses or let's say medical compromisations that you can get. So, that means we have good reasons for restoring partial or fully dentulism.
What are your suggestions to fellow dentists who are often confused about the selection of right solutions for a patient's successful treatment because of the plethora of options available in the market with superiority claims? That is a big problem. Marketing claims do not equal scientific data.
Having scientific data is the fundamental basis for marketing claims.
But this does not happen all over the world. That's why for the patient it's crucial to choose the best treatment procedure.
They have to fully rely on the dentist because they make the decision which product and procedures to use. Therefore, the patient can of course select a dentist based on his experience. So, a simple question is how many implants do you place per year?
If a dentist says, well, I'm having one implant every six months, he might be a good dentist but he might not be that experienced.
From that perspective, the patient should ask simple questions. How many procedures do you do per year in order to get a feeling on the level of experience? And for the dentist, it's the same. They should just rely on products that are supported by evidence, by clinical studies.
And at the end, this is something that goes along with a little bit of your own habits or how you consider your job. So, when you want to be at the forefront, at the cutting edge, you have to rely on established procedures.
Otherwise, you will run into more complications and this is what nobody can afford. I think at the end, it's a self-regulating process.
How was your experience in Nepal?
It's my very first time and this is definitely not my last time. I truly like the country very much. You see this, the close connection with nature.
This is what you see at the first spot. So, very well connected with nature, the complete opposite of Germany where nature is not part of your daily life. And this is what I like the most. The people are very relaxed, with different perspectives on life. I am planning to come here next time. Next time in private.
A version of this article appears in the print on October 15, 2023, of The Himalayan Times
