In this interview PD Dr. Goran Benic, senior physician at the Clinic for Reconstructive Dentistry of the University of Zurich and user of the Patent™ Dental Implant System (Zircon Medical Management), discusses the importance of the soft tissue around dental implants for long-term health.
Dr. Benic, the COVID-19 pandemic has led to a growing public health awareness. What are the implications for dentistry?
I believe this is a long-term process that has been accelerated by the pandemic. Over the last two years, people all over the world have learned to form distinct opinions on various health issues. Let's just think of the immense public interest in vaccines and the divided opinions on the benefits of getting vaccinated against Covid-19. The internet, with its many social media platforms, has opened up new information channels for people. Patients can now find out about the materials used in dental treatments in advance. Consequently, they develop a precise idea of which materials they want in their bodies, and which they do not. As medical professionals, we would do well to acknowledge this trend and educate our patients accurately about the various materials available to them. A frank discussion about the scientific evidence and the potential risks associated with a particular material must be an integral part of comprehensive patient education. We should be transparent with our patients and constantly be aware of the impact our decisions may have on their long-term health.
What’s your current challenge with dental implants?
My current challenge is... (choose)
Is oral health also gaining in importance? If so, why?
We have known for several years that oral health has a direct impact on the overall health of the human body. Pathogenic bacteria in the oral cavity can bypass the epithelial barrier around natural teeth and dental implants, enter the bloodstream, travel through the bloodstream to other parts of the body and, as a result, promote the development of general diseases. Today, inflammatory diseases in the oral cavity, such as periodontitis or periimplantitis, are associated with chronic diseases, such as cardiovascular diseases or diabetes. Against this background, comprehensive patient education is also extremely important – after all, patients are often unaware of the direct link between oral health and overall health. In particular, when replacing a patient's unsalvageable tooth or closing an existing tooth gap, an implant system should be selected that avoids bacterial infections as much as possible in order to prevent both peri-implant and systemic long-term complications. In this context, close follow-up of implant patients is also of great importance.
What role does the soft tissue around dental implants play in preventing bacterial infections?
First, it is essential to eliminate all bacterial disease, if possible, before any form of reconstructive or implant therapy is performed. It is also advisable to closely follow the clinical treatment protocols of the implant manufacturers and to use only biocompatible materials. In the early days of dental implantology, the focus was predominantly on osseointegration, the bone healing mechanism, and the bone metabolism. In the 1980s and 1990s, at a time when the initial euphoria was beginning to dissipate and practitioners were increasingly confronted with long-term complications associated with implant restorations, the importance of the quantity, quality, and integrity of the soft tissue for the long-term success of implant treatments was already becoming apparent. A tight soft tissue seal against pathogenic bacteria is of great importance for maintaining long-term peri-implant health as well as overall health. Of course, there are differences not only in the myriad of implant systems available in terms of soft tissue response, but also in the various implant materials used today. For some years now, an interesting paradigm shift has been observed in science and newer materials, such as zirconia, are increasingly being investigated with regard to their soft tissue behavior. While more information and further scientific evidence is still needed, there are already promising findings on the highly beneficial soft tissue response to zirconia implants.
What changes are in store for implant dentistry?
Over the past ten years, we have seen metal virtually disappear from the field of prosthodontics, for example, replaced almost entirely by ceramics. I believe that, especially with materials that are inserted into the body, like dental implants, there will be an increasing focus on the biology of the human body compared to superstructures, such as crowns or bridges. Let's take a look at the scientific evidence that we can refer to right now, in 2022: there is good evidence that the clinical performance of a ceramic implant is comparable to that of a titanium implant when you look at survival rates, marginal bone levels, and peri-implant soft tissue health. While this evidence is still comparatively thin at this point, it is only a matter of time before more clinical evidence and scientific studies are published justifying the use of ceramic implants. Just imagine what would happen if we were able to prove conclusively that a "white" implant made of zirconia offers de facto the same long-term performance as an implant made of metal – which implant would you choose?