Fundamental implant misconceptions / Interview: “We are working hard on targeting new markets” / Interview: “Dentists cannot blindly rely on the computer-guided approach” / Growing a successful dental implant clinic
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[1] =>
IMPLANT TRIBUNE
The World’s Implantology Newspaper · Asia Pacific Edition
www.dental-tribune.asia
Published in Hong Kong
Vol. 14, No. 10
Fundamental implant misconceptions
HONG KONG, China: Investigating
patients’ knowledge and perceptions regarding implant therapy, a
Chinese study has found that an
alarming number of participants
had inaccurate and unrealistic expectations about dental implants.
Moreover, the study determined
that only 18 per cent felt confident
about the information they had
about the treatment.
In the study, the researchers
investigated preoperative information levels, perceptions and
expectations regarding implant
therapy via a questionnaire. Re-
sponses from 277 patients were
obtained during 2014 and 2015 in
three different locations in China
(Hong Kong, Sichuan and Jiangsu).
The analyses established that
about one-third of the participants had mistaken assumptions
about dental implants. According
to the researchers, common misconceptions were that dental
implants require less care than
natural dentition, implant treatment is appropriate for all patients with missing teeth, dental
implants last longer than natural
dentition, and there are no risks or
complications with implant treatment.
Overall, younger respondents
(< 45) and those with higher education (bachelor’s and postgraduate
degrees) tended to have more realistic perceptions and lower expectations of the treatment outcome.
When asked about their level
of knowledge, 63 per cent of the
participants said that they were
generally informed about implants, but only 18 per cent felt
confident about the information
they had.
Taiwan: Excessive implant prices and fees
TAIPEI, Taiwan: Considering the
country’s per capita income, the
cost of undergoing extensive implant treatment in Taiwan is
equivalent to the price of an imported luxury car, the Taiwanese
Consumers’ Foundation (CF) commented in relation to the findings
of its new survey. In addition to
disproportionately high implant
costs, the CF survey found that
Taiwanese implant patients were
often faced with an array of
vaguely labelled associated fees.
for a single implant, while the fee
in Hsinchu County is NT$60,000–
NT$100,000 (US$1,865–US$3,109),
the China Post reported.
Overall, prices for a single implant ranged from NT$40,000 to
NT$150,000 (US$4,663), which is
very expensive when considered
in relation to the nation’s per capita income. According to the CF report, a Taiwanese earning a minimum hourly wage would have to
work between 334 and 1,250 hours
to afford one dental implant,
while a person in Japan would
have to work between 213 and
284 hours, and someone in the US
between 77 and 359 hours.
Based on a Gallup survey,
Taiwan had a median per capita
income of US$6,882 in 2013, compared with US$10,840 in Japan
and US$15,480 in the US.
As its main finding, the survey
identified considerably varying
costs for implant treatment in the
country. For example, it found
that a patient in Chiayi County
is charged around NT$40,000–
NT$80,000 (US$1,243–US$2,487)
The survey further identified
a number of related costs, sometimes ambiguously named, charged
for implant treatment, including
a tooth implantation evaluation
fee, a tooth implantation surgery
fee, artificial tooth root, prosthetic crowns and periodontal
prostheses. In addition, owing to
a general lack of standardisation
for implant treatment, participants reported confusion regarding the surgical treatment options they were offered, what the
treatments actually entailed and
whether the costs would be covered by their health insurance, the
CF stressed.
In light of the findings, the
foundation called on the Ministry
of Health and Welfare and related
government bodies to review current regulations that standardise
the fees charged by medical care
providers. At present, the fee
schedule is not mandatory.
Advancing biocompatibility of implants
WAKÕ, Japan: Mimicking the adhesive properties of mussels, which
are able to form a tight bond with
smooth surfaces, scientists from
the RIKEN research institute in
Japan have successfully attached
a biologically active molecule to a
titanium surface, a metal used in
artificial joints and dental implants, for example. Their findings
may enable the development of
new cell growth-enhancing materials and thus more biologically
beneficial dental implants.
When it comes to functionality and compatibility, the
achievements of nature are rarely
matched by science. Mussels, for
example, can attach tightly to
almost any surface owing to a
certain protein, L-dopa, which is
able to bind very strongly even to
smooth surfaces such as that of
ceramics or metals.
Taking their inspiration from
this particular feature, the Japanese scientists sought to imitate
nature in order to enhance biocompatibility in medical applications. “We thought it would be interesting to try to use various
techniques to attach a biologically
active protein—in our case we
chose insulin-like growth factor-1,
a promoter of cell proliferation—
to a titanium surface like those
used in implants,” lead author
Chen Zhang from the RIKEN Nano
Medical Engineering Laboratory
explained.
Using a combination of recombinant DNA technology and
treatment with tyrosinase, the
researchers were able to create a
hybrid protein that contained
active parts of both the growth
factor and L-dopa. In additional
experiments, the team was able
to confirm that the proteins
bound strongly to the titanium
surface and remained attached,
even when the metal was washed
in phosphate-buffered saline, a
water-based solution.
“This is similar to the powerful properties of mussel adhesive,
which can remain fixed to metallic materials even underwater,”
Zhang said. According to Dr Yoshihiro Ito, the team leader of the
Emergent Bioengineering Materials Research Team of the RIKEN
Center for Emergent Matter Science, this universal modification
process could be used with other
proteins too and may allow for the
production of new cell growthenhancing materials, with potential applications in cell culture systems and regenerative medicine.
The study, titled “A bioorthogonal approach for the preparation
of a titanium-binding insulinlike growth-factor-1 derivative by
using tyrosinase”, was published
online ahead of print on 6 July in the
Angewandte Chemie International
Edition journal.
[2] =>
IMPLANT BUSINESS
18
Implant Tribune Asia Pacific Edition | 10/2016
“We are working hard on targeting new
markets”
An interview with Oliver Klein, BEGO Implant Systems
Dental implantology is in a constant state of change. New implants, surgical protocols and innovative materials present dental
professionals with the challenge
of identifying technically reliable
and high-quality solutions. For the
past 25 years, German dental company BEGO has been well known
for its implant systems. Dental
Tribune spoke with Oliver Klein,
Director of International Sales and
Business Development at BEGO Implant Systems, about the company’s implant solutions and its next
steps into Asia.
Dental Tribune: Your BEGO Semados
RS/RSX 3.0 implants have been available for over a year now. Intended
for the restoration of incisors, they
use an advanced connector design
to ensure optimal stability. This
technology is being used by an increasing number of international
dental implant manufacturers. What
distinguishes RS/RSX 3.0 from competing solutions?
Oliver Klein: The main advantage of the RS/RSX 3.0 is
the true diameter of 3 mm. This
implant line is mainly indicated
for narrow anterior gaps. In addition, the user can select between two different implant
types: a machined collar and
a rough collar for solutions in
the aesthetic zone. The dentist
can choose the most suitable
solution for all prosthetic indications from a wide range of
abutments.
Could you please elaborate on the
Semados range of solutions? What
different types of implants and
prostheses does BEGO offer?
The BEGO Semados implant
family consists of several implant
lines for different indications.
The well-known S-Line, launched
25 years ago, is the global top
seller. Owing to its straight implant shape and the simple surgical procedure, this implant system became a reliable brand on
the market. The tapered, selfcondensing RI- and Mini-Line implants are mainly used in poor
bone qualities and quantities. The
RS/RSX-Line—the implant twins—
are becoming increasingly popular owing to their conical implant
shape and self-tapping thread
AD
Oliver Klein
design. The concept of platform
switching has been adapted to the
RS/RSX-Line and an additional
prosthetic line (PS-Line) has been
developed. The implant family
has been completed with a provisional implant (PI-Line). A complete range of prosthetic components is available, including
screw-retained bridge restorations (MultiPlus) and CAD/CAM
solutions.
Pacific. What has the response
been so far? Which markets will be
targeted next?
We have already been very
successful in China and Taiwan,
and our products are available
in several smaller markets too.
To provide a better service and
strengthen our further growth in
the APAC region, we opened an
office in Hong Kong in February.
We are launching our products in
Online Advanced Mentoring and Clinical Program
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Advanced clinical online learning with the Masters
This course includes a variety of live-patient dental procedures and on-demand
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As Klein notes, dental companies need to produce high-quality solutions in times
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Tribune Group GmbH is an ADA CERP provider. ADA CERP is a service of
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quality providers of continuing dental education. ADA CERP does not
approve or endorse individual courses or instructors, nor does it imply
acceptance of credit hours by boards of dentistry.
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contact us at tel.: +49-341-484-74134
email: request@tribunecme.com
15 C.E.
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of General Dentistry. The formal continuing dental education programs of this program
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endorsement. The current term of approval extends from 7/1/2014 to 6/30/2016.
Provider ID# 355051.
What is the major purpose of
the BEGO Guide System, and how
does it help dentists to better
plan and place the company’s implants?
With the BEGO Guide Trays
(available for the S- and RS/RSXLine), the user can plan the implant positions properly using
various software programs and
reduce treatment time owing to
predictable implant positioning
and prosthetic rehabilitation. The
convenient handling of the tools,
especially the self-locking spoons,
has more and more implantologists convinced.
BEGO have introduced its implant
technologies in different markets,
such as the Middle East and Asia
Vietnam in the third quarter of
this year and are pursuing market
entry to Thailand and Australia.
We are very pleased to have had
a great response regarding our
product portfolio, quality and service. Products made in Germany
and offered by a family-owned
company are very popular in
these markets. The same applies
to the Middle East, where we are
very active in Turkey, Saudi Arabia
and Iran—just to name some
countries. Also in this region, we
are working hard on targeting new
markets to extend our business
and meet our substantial growth
goals.
Thank you very much for the interview.
[3] =>
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[4] =>
OPINION
20
Implant Tribune Asia Pacific Edition | 10/2016
“Dentists cannot blindly rely on the
computer-guided approach”
An interview with Prof. Daniel Wismeijer, The Netherlands
Technologies such as cone beam
computed tomography (CBCT),
intra-oral scanners and CAD/CAM
techniques have introduced a computer-guided workflow into dentistry, specifically implantology.
While a computer-guided approach can make treatment more
precise, safe and predictable, it
requires a practised, experienced
and focused practitioner to implement a digital workflow. At
the recent EAO congress in Paris,
Dental Tribune spoke with Prof.
Daniel Wismeijer from the Netherlands about the problems that
implantologists are still facing in
using digital technologies and
the future of computer-guided implant surgery.
AD
Dental Tribune: Prof. Wismeijer,
with the emergence of new digital
technologies, novel treatment approaches have become available to
dentists—particularly in the field
of implant dentistry. While some
implantologists embrace these
new technologies, others are still
sceptical of them. Why do you think
that is?
Prof. Daniel Wismeijer: Novel
technologies do not only affect
implantology; they introduce digitisation into other areas of dental
practice too. Consider the applications of intra-oral scanners
and CEREC (Dentsply Sirona) machines and the use of new technologies in planning and designing
customised implant superstruc-
some cases be more rewarding,
as at least then the practitioner
knows what he or she can expect
and what his or her limitations
are.
tures. While some dentists use
quite a lot of these tools, others do
not use them at all and leave
everything up to the dental technicians. This largely depends on
the dentist and his or her attitude
towards digital technologies and
digitisation in general—be it at
home or in the dental practice.
Then, of course, dentists have
to invest in this sort of technology,
as well as learn it and be prepared
to unlearn their current practices.
This too depends on the dentist:
is he or she ready to use new technologies or would he or she prefer
to stick with what he or she had
learnt previously? On the one
hand, we see many young dentists
Prof. Daniel Wismeijer
start working with these new technologies immediately and thereby
become very experienced in new
treatment approaches. On the
other hand, dentists who are more
experienced in established treatment protocols are, of course, less
inclined to unlearn the old and
start learning the new technologies.
In the “Emerging technologies: Head
to head” session at the EAO congress, you will be talking about
computer-guided implant surgery.
What advantages does such surgery
offer? Has it already proven itself in
research and clinical practice, and
what results can it achieve compared with free-hand surgery?
In my opinion, guided surgery
helps dentists become increasingly precise in our work. Digital
technologies are proving themselves in implant dentistry and
I think that they are improving
with time. If the practitioner can
plan up front where he or she
wants to place an implant and
what sort of superstructure he or
she wants to put on top of that,
and if he or she can also place the
implant in that exact position and
implement a superstructure that
fits precisely, that will show that
we have come a long way.
However, we are not there yet.
There are still certain problems
we have to deal with, problems in
precision, problems in combining
all the tools needed for guided
implant surgery and the limitations of these tools. For example,
in order to plan the position of an
implant and its superstructure
exactly, we have to superimpose
CBCT scans and intra-oral scans
using software. Factors such as
voxel size and the absence of clear
landmarks by which to superimpose the different scans correctly
can affect precision and cause
deviations between the planned
and the realised positions. I am
not saying that free-hand surgery
is more precise; however, the freehand surgical approach may in
So what can dentists do to better
implement a digital workflow in
implant treatment?
Dentists have to know that
they cannot blindly rely on the
computer-guided approach. They
still need to get their heads around
the technology first and stay focused while using it. Moreover,
they have to accept that there is a
learning curve and that computer-guided surgery will not work
100 per cent the first time it is
applied.
In my lecture, I will be discussing the variables that influence
the precision of the guided surgery workflow and what dentists
are able to do to overcome associated problems. Primarily, they
have to become comfortable with
the different tools and software
packages and gain experience in
working with them. In the long
run—and I think that we are not
so far away from that now—computer-guided surgery is a treatment approach that will probably
be much more precise than planning and placing implants without any guidance at all.
How will digital technology further
change implant dentistry in the
future?
One of the tools that I will be
demonstrating during my presentation is a dynamic navigation
system that provides real-time
guidance based on the patient’s
CBCT scan. During surgery, the
dentist sees the planned implant
position on a screen while sensors
track the drill and the patient’s
jaw and the system provides
visual and tactile feedback to ensure that the dentist drills exactly
at the planned osteotomy site.
Dynamic navigation systems
like this one are the next step
towards robotisation in implant
dentistry. From there, it will not
take much to develop a computer-steered robot arm that calculates whether the drill is in line
with the planning and, supervised
and handled by the dentist, drills
the osteotomy. In various surgical
disciplines, for example neurosurgery, operations are already being
performed using robotic technologies, as they are able to perform
much more precisely than the
human hand alone. It is only a
matter of time until these technologies enter dentistry as well.
Thank you very much for the interview.
[5] =>
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This course consists of 2 intensive days in Dubai
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Online access to our
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Sponsor:
Registration information:
www.TribuneCME.com
Curriculum fee: €2,500
tel.: +49-341-484-74134 | email: request@tribunecme.com
Tribune Group GmbH is an ADA CERP provider. ADA CERP is a service of
the American Dental Association to assist dental professionals in identifying
quality providers of continuing dental education. ADA CERP does not
approve or endorse individual courses or instructors, nor does it imply
acceptance of credit hours by boards of dentistry.
16
C.E.
CREDITS
Certiicates will be
awarded upon completion
Tribune Group GmbH is designated as an Approved PACE Program Provider by the Academy
of General Dentistry. The formal continuing dental education programs of this program
provider are accepted by AGD for Fellowship, Mastership and membership maintenance
credit. Approval does not imply acceptance by a state or province board of dentistry or AGD
endorsement. The current term of approval extends from 7/1/2014 to 6/30/2016.
Provider ID# 355051.
[6] =>
TRENDS & APPLICATIONS
22
Implant Tribune Asia Pacific Edition | 10/2016
Growing a successful dental implant clinic
By DTI
In April 2016, Dr Ian Lane, a managing partner at Queensway Dental
Clinic, together with Richard Elliott,
Managing Director of Queensway’s
Dental Laboratory, presented a webinar to a global audience of over
350 dentists, giving their insights
into what they feel have been the
most fundamental factors of growing a successful dental implant
clinic.
Queensway Dental Clinic
(www.queensway.co.uk) was founded in 1993, when Dr Paul Averley
took over the north-eastern clinic.
At the time, it was at the heart of
an area where the population’s
oral health was significantly lower
than that of the national average.
Over the next 23 years, the practice grew into the award-winning
business it is today—a journey
that Lane believes would not have
been possible without the partners, specialists, nurses, managers, technicians and therapists
who have invested their time and
passion in every step.
Between 1998 and 2013, Queensway Dental Clinic was the largest
referral centre for conscious sedation in the region, and the clinic
treated over 100,000 patients
Dr Ian Lane
tistry: “We focus on holistic care,
meaning there is real choice for
the patient, as well as ensuring
that shared decisions are made,
over which patients have full control.”
“We have always invested in
our team,” continued Lane. “Indeed, the strong foundations of
our clinic have been built on the
knowledge and experience of our
team. To build a truly successful
implant clinic, it is vital to have
the right team in place.”
Of course, it is not just the
clinical skills that contribute to
the success of an implant practice.
Queensway Dental Clinic has
striven to improve the training of
its front-of-house staff to ensure
that patients receive only the very
highest standard of service from
the moment they enter the practice. This has included sending the
team on lunch-and-learn sessions
with Nobel Biocare representatives, having cue cards developed
to act as prompts on the phone,
and giving each of the staff the
necessary understanding of implant treatment options in order
for them to communicate this effectively to prospective and current patients.
Furthermore, Queensway understands the importance of investing in the skills of its partners
and takes great pride in the individual achievements of its team
members. Indeed, the partners at
Queensway Dental Clinic have all
graduated from the Kois Centre
in Seattle in the US—five of only
15 practitioners in the UK to have
done so.
“The skills we have learnt at
the Kois Centre have transformed
Elliott too graduated from the
Kois Centre and was the very first
technician in the UK to have done
so. This significant achievement is
mirrored in the way Queensway
invests in the skills and CPD of its
laboratory technicians, representing recognition of the importance
of technicians in the provision of
implant therapy.
Indeed, owing to the training
provided by the Kois Centre, as
well as the benefits of NobelClinician Software, the team at
Queensway has managed to
streamline their case assessment
and treatment planning process.
“We’re all speaking in the same
language now,” said Lane. “We can
provide effective risk assessments
for our patients, deliver effective
and reliable treatment plans for
implant treatments, design our
patients’ smiles, provide diagnostic assessments with models and
photos, and review cases with the
entire team present.”
Vital to all this, Lane went
on to explain, are communication and working alongside colleagues who all have the same
skill and experience. “This is
why,” he said. “We take our train-
Working with Nobel Biocare
enables the Queensway team to
use a variety of different techniques, including immediate loading, and provides the opportunity to scan and plan treatments
in full 3-D. It also allows the
clinical staff of Queensway to liaise effectively with the laboratory staff, expediting and improving the process from start to
finish.
This kind of professional knowledge, when brought together effectively with clinical, technical
and management skills, has been
one of the greatest contributing
factors to the success of Queensway’s implant business. “It’s been
a challenge,” admitted Lane. “And
it requires excellent communication from all aspects of our business, but it has certainly paid
dividends—and it certainly would
not have been possible without
the relationship we share with
Nobel Biocare.”
This relationship seems in no
way likely to end soon; indeed, the
team at Queensway Dental Clinic
and laboratory has found working
with Nobel Biocare so effective
that it has seen an 87 per cent
increase in spending on Nobel
clinical products, as well as a 250
per cent increase for laboratory
items since 2011. “Having a single
company solution in our busy
practice has been incredibly useful in boosting our business,” said
Lane.
The figures speak for themselves. Since 2011, Queensway
Dental Clinic has experienced an
increase in its implant turnover of
220 per cent with up to 50 per cent
of all of its private activity originating from its provision of implants. There has also been a concurrent growth of 125 per cent in
its laboratory business and this
can be directly linked to its implant success.
during that time. However, as of
2011, the business model started
to change and the partners turned
their attentions to expanding the
private side of the clinic. By applying the same principles learnt
from building a successful NHS
practice, Queensway Dental Clinic
grew from a four-surgery practice
into a 25-surgery practice over
time.
Lane suggested that this success can largely be attributed to
the Queensway ethos with its patient-centred approach to den-
With Gold Standard Investors
in People accreditation, it is clear
that Queensway Dental Clinic
understands the importance of
nurturing the skills of its team.
Investing heavily in the continuing professional development (CPD)
of every single member, it has
seen its nursing teams progress
through the Nobel Biocare basic
and advanced nursing courses, as
well as attain the dental implant
nursing qualification from King’s
College London—and all are experienced to some degree with the
All-on-4 treatment modality.
the way we practise,” said Lane.
“As well as improving the outcomes we can achieve for our patients. Seeing many patients who
have suffered from many different problems with their teeth, it’s
vital that we have the skills—like
those that the Kois Centre teaches
so well—to be able to manage
the complexity of these cases in
a reliable way. Without a doubt,
these skills have also enabled us
to reassure our patients that they
are being treated with the most
up-to-date and predictable procedures and techniques.”
ing and education seriously at
Queensway.”
It is also down to the implant
provider. Since 1993 (with the
exception of a very short departure in 2009), Queensway Dental
Clinic has used Nobel Biocare implants. “It’s the mix of quality
service and quality products,” explained Lane. “We don’t use cheap
products and Nobel Biocare doesn’t
provide them. In all, it helps us
minimise the risk to our patients
and enables us to achieve excellent results.”
However, having the knowledge and the products is just
one part of achieving success.
Putting everything into practice
represents the greatest struggle
for a large and busy centre like
Queensway Dental Clinic. For this
reason, the team strives to follow
five essential tenets to ensure
success.
Firstly, it is important to provide one point of contact. Lane explained that having so many disciplines together under one roof has
created a service in which patients
can feel confident. Rather than
being passed around between different teams, patients at Queensway can conveniently be treated
by one dedicated and well-trained
team.
Furthermore, Queensway invests in progressive treatment
[7] =>
TRENDS & APPLICATIONS
Implant Tribune Asia Pacific Edition | 10/2016
protocols. The team works hard
to ensure patients’ teeth can be
restored in the shortest predictable time. This includes adopting
new technologies and techniques,
as well as learning to communicate effectively with all necessary
services to ensure the optimum
result can be achieved in the
shortest, safest and most nontraumatic manner.
While Lane emphasised the
importance of communication
within the Queensway team, he
also stressed how important it is
to communicate effectively with
patients. By conducting applicable and in-depth research of the
patient demographic in the area,
the Queensway team can target
its treatments to those who need
them most. This information can
then be transferred to triedand-tested marketing campaigns,
such as those used on the practice
website, through Google or via
social media. Queensway also
utilises local advertising, which
can often be the most successful
method of reaching patients in
the area.
Lane explained how crucial
it is to invest in a good website:
“As one of the main points of contact for most patients, a website
has to be responsive; it has to be
image led and easy to navigate.
Our website is both smartphone
and tablet friendly, in recognition
of the massive usage of these
two devices. All of the images on
our website are of our own patients as well—no stock images
are used.”
Another key factor of Queensway’s success is its ability to accept high-end treatments at any
time. This means that whenever
an enquiry is made about any
treatment, it can be answered
succinctly and accurately by a
member of the team who understands precisely what is needed.
Queensway Dental Clinic has a
highly trained treatment adviser
who can answer these queries, and
the clinic offers a free 30-minute
consultation with an implant
dentist.
Lastly, Queensway Dental
Clinic recognises the importance
of delivering patient satisfaction and encouraging patients
to recruit others. According to
Lane, “At Queensway, approximately 80 per cent of all new patient enquiries are made through
word of mouth or recommendations.”
Everything the Queensway
team does is geared towards ensuring that patients receive a service they cannot help but recommend. By carrying out monthly
patient surveys, running patient
forums and open evenings, taking
testimonials and Google reviews,
and building up a strong referral
network, the Queensway team can
collect, review and build upon
patient feedback to ensure that
its service always reaches a high
standard.
23
“To build a truly successful implant clinic, it is vital
to have the right team in place.”
In conclusion, by investing in
exceptional training, by communicating effectively, by working
with high-quality and supportive
companies, and by maintaining
high levels of service, Queensway
Dental Clinic has achieved a great
deal over the last 20-plus years.
The dedication and hard work
shown by its team are a testament
to its past and continued success
and serve as a shining example
of what an implant business can
achieve today and tomorrow.
www.queensway.co.uk
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