In Conversation with Dr. Christian Schubert 

Dental implant capabilities have come a long way in recent years, thanks to advanced technologies, artificial intelligence, zirconia implants, and other factors. Dr. Christian Schubert, the owner of a dental practice in Beeskow, is an enthusiastic adopter of the latest dental implant capabilities, including ceramic implants, 3D X-ray technologies, and more. His focus on advanced technologies and sustainability has recently won him the "Praxis Plus Award" for incredibly high patient satisfaction.

Our team at Zircon Medical recently hosted Dr. Schubert on our podcast series to discuss the adoption of advanced dental implant capabilities.

Introducing Dr. Christian Schubert, the owner of a dental practice in Beeskow

Dr. Christian Schubert is the owner and leading dentist at an eco-friendly dental practice in Beeskow, Germany. He focuses on laser therapy, implantology, and aesthetic dentistry, with a sharp emphasis on sustainability. Dr. Schubert's driving force is the desire to ensure his patients’ happiness and satisfaction, which doesn’t end with the treatment but rather continues through regular care over the years. His dedication to optimal patient satisfaction has won him and his clinic a coveted “Praxis Plus Award".

Nutritional counseling and preliminary treatments before dental implants

Dr. Schubert’s dental practice has a streamlined process that takes the patients from A to Z. The process starts with a complex admission procedure, followed by a certain pre-treatment, such as a professional tooth cleaning or several sessions of periodontitis therapy. During these preliminary treatments, the patient mainly sees the prophylaxis assistant, and the dentist is simply available for medical supervision. Dr. Schubert is increasingly embracing biological dentistry in dental implantology, implementing tests for diabetes and vitamin D deficiencies.

The implementation of diabetes and vitamin D tests has been driven by a recent outcrop of inexplicable implant failures over the past year. In most cases, the root cause of implant failure is evident, especially when it’s caused by inflammation. However, Dr. Schubert states that they recently had 1 or 2 cases wherein the specific root cause was hard to establish. Dr. Schubert integrated nutritional counseling to improve the patient experience even further because advanced optimization significantly improves the implant’s prospects.

The link between dental implants and diabetes

Dr. Schubert reaffirms the close link between periodontitis and diabetes, with both conditions influencing each other. To prevent implant failures, Dr. Schubert has integrated diabetes checks into the dental implant process. Generally speaking, hormone imbalances caused by periodontitis lead to chronic inflammation and prevent the extraction socket from healing or ossifying correctly, affecting the dental implants. Early diagnosis of diabetes and periodontitis facilitates early periodontal therapy, which, in turn, ensures successful implantology.

(We recently discussed the link between diabetes and dental health in a podcast with Ms. Sona Alkozei.) 

The gradual shift towards ceramic implants

Dr. Schubert currently places about 300-400 implants per year, including both titanium and zirconia implants. While he certainly places more titanium implants, he believes the trend is shifting more in favor of ceramic implants. Until recently, they had been placing 10-20% ceramic implants, with the rest being titanium. However, Dr. Schubert anticipates that the number will shift to 20-30% in 2021. 

His practice has been digging deeper into biological dentistry for a year, using advanced diagnostics for titanium stimulation tests to identify the possibility of titanium intolerance. Ceramic implants allow them to skirt around that potential problem. However, he’s still slightly wary of ceramic implants because he believes prosthetic safety and flexibility are better with titanium. 

Individualized denture planning with 3D x-rays

3D x-rays are an integrated part of Dr. Schubert’s planning process. In his view, 2D x-rays are no longer sufficient for perfect planning, especially for complex cases, such as the entire jaw. 3D x-rays cover far more area, showing things you can’t see with 2D x-rays, even on teeth that the patient would like to preserve.

Dr. Schubert cites apical periodontitis as an example. Root apex inflammations might look good in 2D x-rays in root-treated teeth, even if they’re not actually healthy. It can place additional stress on the implant, eventually leading to a failure. If the patient has multiple chronic inflammations in the jaw, and they all go undetected by 2D x-rays, then there’s a strong chance of implant failure.

Dr. Schubert also uses 3D x-rays as a basis for navigated implantology using splint therapy made via models or scans. The implementation of 3D x-rays can also prove useful in live surgeries. 

(We recently discussed the increasing role of artificial intelligence and technologies in dentistry in a podcast with Dr. Lukas Berr.)

The most challenging cases in dental implantology

Dr. Schubert doesn’t consider dealing with inflammation a challenging problem, especially since inflammatory cases are incredibly rare. Instead, he believes the most challenging cases are those wherein you have to accommodate the patient’s specific expectations.

Dr. Schubert provides the example of a patient who needed to get a fixed temporary restoration for the entire treatment journey. The patient initially had insufficient residual dentition and wanted a new fixed implant restoration. Dr. Schubert’s task was to provide a permanent fixed provisional restoration, manage the logistics to accommodate the patient’s incredibly busy and erratic travel schedule, and ensure optimal safety and comfort. For him, the most challenging and rewarding cases are those wherein he has to find creative solutions to the kinds of problems mentioned above. 

Dr. Schubert’s advice to younger dentists attempting implantology

Dr. Schubert would advise younger colleagues to “think dental, and not purely surgical.” Implantology, according to him, isn’t just about surgery and x-rays. It’s also about how the implants feel, look, heal, and their long-term success. The surgery’s success isn’t immediately evident — an implant surgery can only be deemed successful if the patient is completely satisfied and there are no future inflammations. Furthermore, dental implants are also about tooth replacement and prosthetics.

As such, the dentist or surgeon must determine if the crown has enough space, if the axes are correct, and if the material clarification was done in advance. Patients are becoming increasingly aware of their choices. They understand that titanium implants aren’t the only option and can get crowns with combined dental restorations or multiple alloys. As such, dentists and surgeons must emphasize the planning, ensuring the patient has all the answers.

In the near future, Dr. Schubert would like to take his implantology capabilities to the “next level” so his patients can rest assured they’re putting themselves in the safest hands. He’s particularly eager about implementing AI or navigation-assisted implantation, using digital scans to prepare dentures faster, and consistently improving technological implementations in the dental workflow. Other than that, he aims to continue improving his relationship with his dental team to ensure everyone works towards a collective goal.

You can find him at Breite Straße 45, 15848 Beeskow, just between Spreewald and Berlin. You can also listen to Dr. Schubert in our Zircon Medical podcast or continue reading for a detailed article on recent advances in dental implant capabilities. 

Dental implants have gained increasing acceptance amongst patients in recent years due to technological advancements. The improved reliability of ceramic implants and new techniques that simplify the workflow have made dental implants more accessible to patients. Furthermore, clinical trials have shown that the success rate of dental implants has surpassed 95%, with over 99% success rate in the anterior mandible. These shifts have occurred due to changing patient attitudes, which have, in turn, been led by recent innovations in dental technologies and capabilities.

This article interrogates some of the most exciting recent advances in dental implant capabilities.

Computer-Designed Dental Implants

Traditional implant restorations have increasingly been replaced by computer-designed dental implants. The traditional implant restoration process is time and labor-intensive because it includes multiple steps, such as casting, fabrication, and fitting. Computer-aided design and computer-aided manufacturing (CAD/CAM) technologies have satisfied a growing need for efficiency, allowing dentists to produce computer-aided dental implants that exactly replicate the lost teeth and can be fitted instantly. 

Image-Guided Implant Placement

The success of dental implants relies heavily on their optimal placement. Cone Beam Computed Tomography (CBCT) uses 3D images from the axial, coronal, and sagittal planes to help dental surgeons ensure optimal dental implant placement, giving them access to accurate images without exposing the patient to radiation. IGI utilizes the surgeon’s 3D treatment plans to direct the precise placement of implants in real-time.

Osteoconductive and Osteoinductive Materials

As most people are aware, the longevity and success of dental implants depend on having sufficient bone width and height during the placement. Insufficient width and height due to the resorption of alveolar bone increase the risk of inflammation and peri-implantitis. Traditional bone augmentation methods include the simple onlay bone graft, inlay bone graft, and the maxillary sinus floor augmentation. However, recent advances have made it possible to perform bone augmentation with osteoconductive and osteoinductive materials that facilitate improved healing. 

Growth Factors for Superior Osseointegration

The dental implant’s success also depends on the body’s osseointegration rate. In recent years, researchers have been coating the implants with bone growth factors to speed up the osseointegration, improving the recovery speed and implant longevity. Growth factors are natural proteins in the human body that facilitate tissue regeneration, and their application on dental implants can potentially induce superior osseointegration, dramatically reducing the recovery periods after the implant surgery.

Antibacterial Teeth Coating 

Most problems related to dental implants, such as peri-implantitis and peri-mucositis, occur due to bacterial colonization and infections. However, recent studies have shown that anti-bacterial coatings can enhance the osseointegration of dental implants while minimizing the risk of bacterial infections. Early clinical studies have shown that the coated surfaces inhibit the growth and colonization of P. gingivalis, thereby improving the implants’ success rates.

Zirconia Implants

In recent years, significant progress has been made in normalizing the use of zirconia implants instead of titanium implants. Zirconia implants reduce the exposure of the metallic implant above the gingival level, reduce the risk of titanium allergies, and improve osseointegration. Zirconia Medical has recently released one-piece and two-piece zirconia implants backed by considerable clinical evidence. Studies show that zirconia implants have a comparable survival rate as titanium implants, making them ripe to become the new standards in dental implantology.