Talking the walk: implant experts speak out
NK: Tell me a little about how you come to be here in Dublin.
EE: Being part of the World Tour in Ireland was a fairly late-term arrangement but I was very happy to be free to come for the Dublin leg.
I’m in private practice now. I was at the university before part-time, but I left the university and now do a lot of lecturing all over the world for Nobel Biocare and other organisations that invite me,
NK: How did you get involved with implants?
EE: I was lucky to learn the right things at the right time. Then implantology really went to the next level in the early 1990s and my knowledge then, let’s say, was above average, allowing me to be on the crest of the wave. I rode that wave!
NK: How do you think things have changed in that time?
EE: You know, our skills become better, our hardware is better over time and there is an increasing interest in aesthetics so that in what we do now our main focus is to try to combine high-end soft tissue management and implants in general with metal-free prosthetic work. So we focus a lot on that part. It’s not only about bone grafting and soft tissue grafts, my main fields of interest. We want also to finalise the job as neatly, as well as possible, using the right materials, which have to be aesthetic, biocompatible and strong.
NK: What about the future?
EE: The future is in metal-free material. Zirconia is the upcoming material and you know it’s not only the colour to be looked at. You have to rethink the way you work with these materials, you have to know how the light transmission in the material is. You have to learn how to handle these materials because they are quite different to what we are used to with the more traditional porcelain-fused-to-metal restorations.
When you have porcelain on metal the rigid part is the porcelain. With zirconia the rigid part is the structure and the flexible part is the porcelain and there are many, many other differences, both clinically and in the lab. I could talk about this for hours.
It’s very easy to make a mistake with the material and that comes back to you like a boomerang!
To give you a small example, sometimes details can make all the difference. If you tighten a zirconia structure with the wrong screw, a metal-designed abutment crew for instance, you can introduce micro-cracks into the material if you tighten too much. So at any time the abutment or structure can break. The shape of the screw has to have a rounded bevel. Metal screws have a straight shoulder and that does not work on the zirconium.
People can think zirconia is just zirconia, but the danger is that people might not choose the right products or use the right protocols. I am afraid that it will strike back at the material in the future if we do not do a lot of training to share how it works.
For lab technicians we have a product specialist to explain how to treat these materials and how to get the good benefits out of this extremely aesthetic material, and to use it in the right way to make it long-lasting also.
NK: How do you balance your time in the practice with lecturing?
EE: In my own practice I practise three days a week and then I go one day out to do surgery in other offices. Then, let’s say normally from Thursday on, I am travelling doing conferences, which, like today, start on a Friday. It’s tiring but I have learned to focus on what I am doing so I am not bothered so much by the travelling and sleeping in different places,
We are doing a lot of postgraduate training and I am a faculty member of a global institute for dental education. I think it is important when you go for education to stay with a good group and go through the different levels of postgraduate education.
If you go from left to right and back and forth and try out many things, you don’t have the knowledge at that stage to be selective with the information that gets thrown at you. Then you run into the danger of being completely confused and maybe make your choices based on things that are not really relevant when it comes down to how to work in the best way.
NK: For dentists starting out on the implantology route, what do you recommend they look for when choosing a course?
EE: They should get used to the idea that they should go through a learning curve. So start with basic things, strive to understand that everything you do in the mouth of a patient has to follow a certain logic, and build up that logic. If something does not work out the way you expect it to do, you should try to learn from that mistake and then maybe next time you won’t make the same mistake again; that way you get better.
But no two patients are the same so one protocol cannot cover all patients in all situations. So when you learn how to apply a certain type of logical biological thinking you should become more creative and flexible, and you find out that you can find nice solutions for the patients in many different situations.
NK: What is the most satisfying aspect of your work?
EE: For me the most important thing is to work with patients. I do that of course for myself but also the patients have the benefit of that, and they feel that because you transmit that you are doing your very best to get a good result, although not everybody appreciates it.
They say the applause should be in your own head, not in your ears!
To work with patients you should keep the challenge in everything and try to become better every day. I do it for the ultimate outcome.
NK: What has been your biggest challenge so far?
EE: There are challenges on different levels. Of course when you get into the speaker circuit and become a global presenter it is nice to be in contact with the world and to be able to challenge your own results, and compare them with the results of your global colleagues. That is what is nice for me.
I also have the challenge of treating my patients the best way I can. There are some very difficult situations in the mouth where a lot of soft tissue is missing and patients want to have the best aesthetic outcome possible, so that’s our clinical challenge.
On top of that, of course, we are still dentists and have to run a business. When you are so often on the road it is sometimes difficult to stay in contact with your staff and to follow what is being done by the dentists who are working for you. You need to meet with your team sometimes and know what the other team members are thinking to see if you are going in the same direction and make the best of it.
I feel that, for instance in bigger clinics and hospital settings, it’s not enough to cut treatment into five specialist treatments and then think they can resolve it better than one person alone. So teamwork can lose out when there is no good communication. It is more than the sum of the performances of all the individual specialists. We have to try to find some synergy. One person is good, the other is also good but together they can be unbeatable if they work in the right way together.
This is sometimes what’s missing. Then you need to the courage to make changes but if you have a winning team then you stick with that.
NK: Where do you see implantology going in the next 10 to 15 years?
EE: I definitely think there will be a bigger place occupied by the CAD/CAM technology, so we need to combine that industrial production with quality control.
In dentistry now we are used to doing everything in-house and so are dependent upon the skill of a single person. Now we have an outside production that guarantees that quality.
So the role of the dentist and the technician will be more and more how to design these pieces and where to send them out for production. Then they will get them back and have to know how to veneer them with the porcelain, for instance, or other materials.
Dr Euwe obtained his degree in 1982 from the University of Utrecht, Holland. Since 1986, his main interests have been periodontics and oral implantology. He followed postgraduate courses under Dr Sascha Jovanovic at UCLA. He became a member of the UCLA European Study Club and, in January of 1997, this group presented him an award for the ‘Best Clinical-Scientific Presentation’.
He, with his prosthodontist and lab technician, won first and second prize in two categories in the international competition of the ‘Parallelometro d’oro 1999’ (Dental Labor Journal). He is a frequent international lecturer and co-author of several scientific publications. He was involved in the Department of Periodontics of the University of Milan at the San Paolo Hospital, where he did clinical research on the resorption of newly formed bone. He worked at the Department of Periodontology with Prof. Massimo Simion at Milan University.