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1322 Increasing Implant Success with Dr. Yuval Zubery : Dentistry Uncensored with Howard Farran

1322 Increasing Implant Success with Dr. Yuval Zubery : Dentistry Uncensored with Howard Farran

12/30/2019 6:00:00 AM   |   Comments: 0   |   Views: 154
Dr. Yuval Zubery has over 25 years of experience in dentistry and periodontics. ?Since 1995, Dr. Zubery has had his own private practice specializing in periodontics and dental implants. Author of over 30 publications, he lectures on periodontics, regeneration and dental implantology at international events.

VIDEO - DUwHF #1322 - Yuval Zubery

AUDIO - DUwHF #1322 - Yuval Zubery

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Howard: It is just an honor and a privilege to be in Tel Aviv Israel and I get to podcast interview Dr Yuval: Zubery DMD from datum dental so tell us about your journey you used to be used to teach in Texas 

Dr Yuval: yes  91 91 99-92 now you know how old I am yeah I did two years of research and teaching in San Antonio in the Theriault Department and it was the best time dear more memories of San Antonio Texas Wow I love the boardwalk there yeah it was the boardwalk yes River Walk

Howard: loved it so you graduated from dental school at the University of Jerusalem and so tell us about your private practice and tell us about your journey how do you engage in dental 

Dr Yuval: so the datum dental I actually met it Tel Aviv University in 1992 when I came back from San Antonio and we did I actually did the first clinical study on membrane produced with this technology so we did it was on periodontal defects back then actually vocation defects and the technology continued to develop in Tel Aviv University and was finally commercialized and purchased by a company named cold bar Cole bar continued to develop products and the technology in the year 2000 the first membrane called oh six I came to the market oh six was in college and based membrane and it was long lasting really long lasting almost non resolvable then it too and then I joined the company as a consultant and we continued to develop the product line and brought to the market in 2006 new membrane called a six plus the change was from protein collagen from bovine collagen 2% collagen and the membrane was the cross-linking level was lower than with the O six what we found out in the studies that we did both animal and human studies that the change actually made collagen and membrane that ossified so in addition to being a barrier for six months and we had ossification of the membrane and the membrane actually contributed actively to the ossification of the bone graft underneath so that was in 2006 the company produced other products for medical purposes especially in the static field and hey the product injectable filler a dermal filler called evelin's the company was bought by Johnson & Johnson and continued that continue to develop the product and increase the production capacity but in the year 2009 decided to shut down the company and the production and the employees were let go and the production stopped in 2011 we group of ex kolbar employees were able to buy the technology and the entire IP from Johnson & Johnson we started a new company called Datum Dental and in the year 2004 started sales production and sales of the new products since then we developed two new product or six-volume accent oh six bone so the company now has three  products or six plus dental membrane or six volume accidental scaffold and or six bone that is designed to be a bone substitute for DVR for augmentation in the maxillofacial area

Howard: so some go through each one of those products and remember a quarter of the viewers are still in dental school so some of these abbreviations and terminologies might be going to their head so go back before your University of Texas days and try to put your dental school student hat on and talk about your three products in which what each one of them does

Dr Yuval:  so what we are trying to do is actually give the dentist GP specialists better materials and better tools to cope with the problem that we all encounter that is insufficient bony housing for dental implants we are also in the parental generation arena but most of the products the moment are aimed to the guided bone regeneration procedures the three products is a include a dental barrier membrane and the term barrier is very important because most of the collagen devices collagen membranes today are short lasting that means that the barrier the membrane barrier effect is sometimes can vary between two weeks to two months at the most and the reason is because this collagen is either non cross-linked or with a low cross-linking and that determines the longevity of the device in the site so all six plus is a is a membrane that will last six months and over that means that every time you open up the site if you had primary closure that means first intention healing and the flap will close within a week or two you will see the membrane on either side over the new bone and this is allow you to get a better quality bone plus in cases where you have exposure of the membrane this membrane will last between three to five weeks exposed and will continue to protect the bone graft underneath and allow for more bone formation in the site so many times you can even leave the oh six plus membrane deliberately exposed we call it intentional exposure and we see nice outcome with this with this technique that sometimes is needed to to allow preservation of the keratinized tissue and in cases where you do not want to advance the flap to death primary closure so this is the oh six plus the or six hole Maps is based on the same collagen and this is again pure collagen but this is not a barrier that means that cells and blood vessels can penetrate the material as soon as two weeks post implantation so we have a device that is thicker than the Earth's expanse is actually ten times thicker it's two millimeter thick and the device will create volume and eventually if you wait long enough between eight to twelve months you will have bone so this device serves as what we call a bone bandage that you can place for example on teen buccal Wars following placement of implants and you will get over time you will get additional volume and additional bone to protect your implant volume acts is also used in some K in some cases in some indications for gingival augmentation but this is a technique technically sensitive use and has to be practiced and understood before you try to do this type of procedures the third product is awesome spoon or six bone is actually a sponge this sponge contains the same collagen say sugar cross-linked collagen as they all 6 plus and volume acts and the device will completely ossify and the ossification is actually in situ that means that even in areas of the sponge that are not in contact or maybe more distant from the bone you will see ossification of the device so it's actually an Asif eyeing actively ossifying device this is ideal for procedures like socket preservation if you place it in a socket regardless of the number of walls around the device you will see complete ossification of the device and in many cases you will be able to place your implant without additional augmentation the aussicht foam is also used for closed or transgressed and sinus elevation where you can use osteo toms or other techniques to elevate the sinus membrane through the osteotomy and when you use the o6 bone you get the advantage of have that material has less tendency to tear the sinus membrane because it's a sponge it is soft and following placement it will all also expand in the science so in some cases you will see additional bone to the original volume that you placed at the day that you place your implants the third indication is lateral bone augmentation in that indication you need a membrane so we recommend to place all six plans over the or six bone and secure the membrane and bone underneath with peri Austell sutures you cannot suture through these three devices because this collagen is not tissue derived it is collagen that is extracted from pigs from person tenders cleaned to a very high level in its molecular form and only then reconstituted to form these devices so this is not tissue you cannot suture through it and it tends to tear if you handle it aggressively or should I say the handling properties are different than other membranes and there is a learning curve when using these devices 

Howard;so now these would all be two-stage implants where you place the implant are you still placing implants or replacing these yeah sure and how often how often are you placing these Tom tell me about your history with these 

Dr Yuval: every day in the in the clinic I use these materials I use it almost exclusively today so I have I have boned I have a membrane I have this device the o6 volume acts and this materials actually changed the way I do my cases so in the past I used to do immediate implants mostly I would take our teeth event it without buccal Wars or missing bony Wars and place the implants and do the continuous augmentation senior simultaneously today I if I have if if the patient still has the tooth and need expansion I do the extraction I place the o6 bone I wait and I place my implants many cases without additional augmentation and in some cases I just use the volume marks for additional volume or additional protection of the site so these are actually game changes I would say in the way I do my implants today and now what lenz do you place and immediately load very few explain explain why I've been doing implants in the last 25 almost 30 years now and I see the failures and to me the right way is the long way I used to do it in the short way I placed implants immediate loading and today I went back to doing stage the stage the approach will allow you to get better quality and quantity of bone around your implant which is always needed in the long run because I see implant 15-20 years post placement the most of them are losing bone losing bone on the buccal side you see recessions you see loss of soft tissue and and I believe that if you place your implants in in a properly prepared housing boney housing with sufficient keratinized tissue and delayed loading you get a better long-term outcome with these implants and

Howard: how long do you think delay the loading 

Dr Yuval: I take out the tooth place the implant three and a half to five months later I plane by I'm sorry place the or six bone in the socket I weighed 350 four months I place my implant and three four months later we do the restoration so it's probably delaying the process by four months three four months so that's that's no money and do you I this implant agnostic or do you prefer a certain implant you with this product line no you can do any the amazing in my office I am using three or four in blood systems because I get referrals so he's you're very honest because I'm a periodontist is so much do my restorations 

Howard: so you have three or four systems because some of your referrals want you to use this certain implant system and what are the what are the systems most commonly asked they asked you to use

Dr Yuval:  I use Zimmer implants for many many years I use Mis v3 implants which are used in Mis Mis v3 which stands for make me make it simple yeah that's really imply yeah who bought that with that dead spot next identify that's quite calm how long ago did they buy that two years two years maybe three so it's so Zimmer and mi ass which is done dance playing work what are the other tubes and I then I use Stallman implants straumann these are the systems that I currently use I usually use bio rises in the past and now is I use mostly Stallman Mis v3 and the  singer 

Howard: so why did you why do you use less bio rises these days because of the restoring dentists they are not asking for this system so sorry I have good experience with these implants yeah so so as the periodontist you've got to respond to your referring dentists yes and they're mostly asking you to restore with Zimmer and Mitch Stallman and 

Dr Yuval: strong but if a dental student just as someone just wanted to start implants or saying if I if I only buy one system what would be your top recommendation or no when you laughed is that because it causes channel conflict with you if someone I mean here are you afraid if you recommend one system the other systems would get mad because yeah I feel a little bit uncomfortable because the the reason why I changed or the reason why I use these systems is mostly because I'm comfortable with this long term I have long term experience with some of these systems and and because of the referring dentist yeah so 

Howard: so the patient is always putting pressure on the dentist for immediate you know they they want everything same day so what would skills or how would you advise the dentist to try to convince the patient to wait and long term do it right instead of because they're always 

Dr Yuval: afraid they're gonna be able to go down the street and get an immediate loading implant to me it's easy because the explanation makes sense make a lot of sense because and and I heard it from one of the speakers that I really appreciate and and look up to the the body cannot do two miracles at the time so we are never able to predict which patients will be will have good regenerate regenerative potential those who may have complications elderly patients smokers and those who which you do not expect so if you do it in a staged approach you have a lower chance of falling into these pitfalls that I used to follow

Howard: in the past one of the bigger problems with implant dentistry is the people that seem to lose the most teeth and need the most implants usually are you're smoking drinking you know the  vegan who yoga every day so what would but some of these kids come out of school and they say well no you can't do it if you're a smoker have diabetes or old or all these things but that tends to be the people you show up at your door missing teeth so what would you advise younger kids in treatment planning

Dr Yuval:  well what do you have you Harry diagnosis they come in smoking with gum disease and diabetes well obviously gum disease did this is a total uncontrolled periodontitis is it definitely no  for implants you can also implants on  an active president itis patient so with those I do not do the implants until I do full mouth scaling and root planning and I mean deep root planning I do I make sure that the patient is brushing properly for some time not just for the week or two and then and with smokers I insist that those who smoke package a day twenty cigarettes per day and over I'm not I'm too damned I'm not doing England's just not doing England's and what 

Howard: would you say the failure rate is for some he smokes a pack a day

Dr Yuval:  I'm not sure about the literature not fully updated recently but I for my experience they losing plants and quickly like five seven  years you start to see the complications and then they lose the implants and bits second time when you when you try to do this implants you're in even worse situation so it's better in those cases to make sure that the patient is compliant he's coming for regularly for a dental hygiene reducing the number of cigarettes per day try to get below ten cigarettes and  he does it does not have any active form tightest pockets as much as we can as we can you know determined it 

Howard: so a big problem with implants is peri-implantitis exam to treatment planning because you and I have been doing this for thirty years and thirty years ago when we got out of school periodontist tried to do periodontal procedures they tried to lay flaps and do the old school network and then it seemed like between somewhere between 1990 and 2000 everybody thought the fastest easiest way to treat periodontal disease is with titanium let's just pull that no good to replace titanium and then ten years of doing that they started realizing where we still have the same problem we had in the beginning so and you notice yourself as a periodontist that you used to do all pareo surgery then the pendulum swung towards implants but now you see yourself swinging back towards saving natural teeth repair you all alon

Dr Yuval: g I was one of the more conservative periodontists I did mostly scaling in good running and all hygiene and maintenance most of my cases from time to time I have a case or I had a case in the past where I had like deep into a bony defect that I believed that I could get good regenerative response in that defect then I would do surgery other than that very few periodontal surgery and I did not fall out it I would I have patients with 20% bone support the time he maintained for many  years I believe in the tooth and the tooth we know what to do we can save teeth that looks that look old homeplace with implants once it starts very very difficult to stop the progression and the defects around implants are much more severe and difficult to treat especially if you place the implant in a regenerated bone with many remnants like bovine bone mineral like FD bas where you have those bone remnants in the site and the site begin to get infected at that point sometimes there is not  much you can do and I'm again very  conservative I pull out it's obviously that are fractured or have or non restorable but never apparently faulty that can be maintained even event for 2-3 years that's the message and easy now because they it's

Howard: it's very obvious that the people who've been doing at 30 years don't see implants as a miracle cure for gum disease but a lot of younger kids are far from it another question they have is they come out with a lot of student loan debt they have two hundred and eighty five thousand dollars and they see these laser machines LANAP for a hundred and thirty five thousand dollars do you think that's you're a periodontist do you by Allah math do you have a laser is that a good investment to treat gum disease not to me not to you I've used lasers

Dr Yuval:  I once had a laser machine in my office or for a trial period I did not find any real common indications to use the laser I'm not really really updated as of today but for what I know there are no indications where you can say only laser can do that or only laser can be highly successful in that indication

Howard: so um the surfaces have changed I'm back in the day they were hydroxyapatite coated there's you know all kinds of coating deals do you think any of the 

Dr Yuval: surfaces of the implants are better to prevent peri-implantitis than others there are differences in surface treatments and implant designs some are more prone to peri-implantitis especially when it starts it's advancing faster in in those implants but to me the smooth surface implants probably one of the answers when we use the smooth surface the old brand mark implants machined titanium the rate of peri-implant Isis was much lower I still see the implants that I did in the early 90s the brand mark implants and significant difference

Howard: did you ever meet Mr Man mark did you meet dr. brand mark professor mark in person his son is a orthopedic surgeon in San Francisco oh yeah yeah I'm going to get on the show he doesn't do dentistry but just that the idea of the it's a cool very fun story photo of his father yeah who's an orthopedic surgeon exactly who only did dentistry because it was a lot easier to do research with little spindles in the jaw than trying to replace a mouse's hip or around a rat tip so in paranormal treatment you would really recommend the kids to really try to save the natural tooth as long as you would you almost took talk about that more because a lot of times they'll see a three routines of for patient involvement and they're quick to through the towel holder to recommend an implant in your daughter is now followed you into Destry yes what would you what would you coach your daughter and young dentists coming out of school you might be a little quick to give up on the natural tooth and cure it with titanium 

Dr Yuval:  I'm not exactly the right person to judge because I have a lot of experience I have lawyer patients that I tell them that they believe what I say and they follow me up and they will if I don't take the tooth out they will not go across the street to another radio dentist so it's a little bit more difficult to give this type of advice I would say that for my experience many years of experience if you do if you do the right thing if you do what what you learn in school at the end of the day it will take maybe longer at the end of the day you will be highly successful because patients appreciate that they understand if you explain it correctly and to me and I did the long way as I said I didn't do many surgeries at that time I did only scaling training which is financially not the bed you know the best treatment to do and I eat things in fact so 

Howard: so I like to call the show dentistry and center because I want to talk about what people argue about not what everybody agrees on some people argue that when the need for drawing blood and spitting blood for the surgical procedures and other people say you don't need to do that and it's supported in the literature do you draw blood when you place implants

Dr Yuval:  I still do sometimes I used to use it more often in the past from the literature this is not supported by the literature on the contrary there are several publications that say that there is no different difference between using and not using the PRF even the sticky ball that is very popular today probably beyond its physical properties that are easier to handle there is not much biologic activity in that in that material so I do I use it less and less if I draw blood anyway if I do treatments under sedation where you already have an open vein and you can draw the blood easily it helps and support soft tissue healing a little bit better than if you do not use it so that's one of the reasons I use it I use it in patients with low lower healing potential and with higher risk of the procedure then I use the PRF other than that I do not see much use for this materials

Howard: some people for bone grafting there's now machines that grind up the extracted tooth so you pull the tooth you pulverize and grind it up and there's your draft what do you think of that technique the whole point of the show I find I like my guest to answer is if we were drinking a beer a bar what's the most since I'm using 

Dr Yuval: I'm also now part of a company that makes biomaterials to me it's ridiculous that you trust so to speak a dentist in his office and his assist and to take something grind it clear first clean it then grind it then disinfect it and then implanted in the tissue I transform what I know about biomaterials and and in this case there is no disease transmitted transmission but there is definitely a risk of infection and to me to me you cannot trust these procedures that are done in the office by inexperienced and then I would not say competent but they are not competent to handle biomaterials and  then you actually implant it in the tissue so  to me this is not the way we should or get biomaterials you know if you harvest bone it's a different story it's a living tissue it's  a steroid at least by the time you you have a seat so it's it's different

Howard: another controversy again I like to stay with where all the arguments are I'm some people when they do when they're treating very honorable patients they like to use systemic antibiotics like maybe tetracycline and or maybe and or local antibiotics period-- ships is antibiotics a big part of your therapy treatment planning when 

Dr Yuval: you're seeing people every three months for our disease for dontoh disease rarely use antibiotics systemically systemic I use local I'm not really sure about its efficacy I know that it's supported by the literature but if you read it carefully you find out that actually you have to use it in a certain way in a certain intervals you cannot just put a place a one-time device if you use arresting or we use pareo chip you need continuous use of the material to be most of the clinicians are not doing that they place a pair of cheap or arresting once every three months when the patient comes in for hygienist treatment and this is not effective in those cases so I'm and best for systemic antibiotics if you'll do the main the mechanical cleaning or disinfection if you do it properly in most cases it will work there are certain indications or additional antibiotics systemic antibiotics but in my office I would say it's almost like one two times a year 

Howard: another confusing thing to the kids when I get out of dental school is you know they would think a periodontist spent your whole life trying to save bone right and then you go to do an O one for but to make room for the teeth you know level off sometimes a lot of bone and the they see these cases in dental school and they like well that's exactly the opposite of everything you've told me for four years and now you're just really destroying a lot of bone to make the teeth fit well how do you explain the all on four - now you're eliminating all that bone to make the process file what are your thoughts on Holland for

Dr Yuval:  I have never done all on four I'm trying to say again politically correct don't be not even be the memory to me to me this this is not well I would say it like this and they really believe in it the original developer of the Orlan for he has written up a lovely yellow mellow yes how do you say Paulo Marlo Paulo Malo and Lisbon Portugal yes and I believe that he did the right things and because the Orang for for example it's not just the implants it's probably most important is the occlusion if you do the occlusion properly it will it can it can last if you do mistakes with the occlusion it's not going to last and you start to lose the implants and lose the bone and everything is lost so unless you are very end and this looks like an easy way of doing implant cases because you place only four implants and you can do it guided and you can you can patient gets the denture cheap end and quick but this I believe is a very  technically sensitive treatment and if you are not really good at what you do and your cognition is not really really good then you will fail so this excludes most of the of the clinicians including myself for example I do not believe that I can do the Orang for opening

Howard: and you placed a lot of implants and I place a no defenses so so it's a very highly implants when you get she plays here

Dr Yuval:  well I used to place many too many implants is between 500 and 1,000 a year that's I know I know the dental surgeon sometimes they can place thousands of implants but the number is going down every year because I am busy with date on dental rather than doing implants in myself or mine for my audience I mean Tony's place five hundred or thousand implants I place three to four hundred you know that's still a lot but in even back with all your expertise for 30 years and I'm periodontist and we won't hold your Texas training against you well to say that that you don't feel comfortable at all on for speaks volumes that it's a UH

Howard: so if that's everything do you see now that you know went back in the day you try to get the longest implant can that you could and now implants are going shorter fatter do you see yourself doing less sinus lists because implants are getting shorter and fatter definitely

Dr Yuval:  I believe in short implants as long as the implant is of good quality and again the occlusion  if you overload the implant any length of implant you will lose the implanted eventually if the if the load is in the wrong direction you will lose you the implant over time you would lose bone and then you lose the implant so it's short implants work but again technically sensitive especially for the restoration

Howard: I'm always glad to hear any good news about anything short and fat I'm very important Canada and we know what you said is profound because that's why Carl mish got into implants he was doing dentures first and when he was building his dentures he was like these people complaining that the some was wrong with the implants they were breaking and he said it had nothing to the implant as your bite was horrible so he thought his foundation of learning how to get a proper bite with full removable was the most important part of his foundation to go onto implants and he agrees that a lot of people are doing implants that don't understand occlusion which is another question I want to ask in dentistry they say there's three diseases cario tario and occlusion but it seems like there's seems like when kids come out of school they know a lot the most about caries and then pareo but not as much why what do you think occlusion is so much of a more difficult concept than say carries

Dr Yuval:  I remember myself in the occlusion classes we had one of the best teachers he was a renowned name in the whole world it was so boring we were half asleep you know when the 10 minutes after the class started so it's kind of none you cannot really hold it feel it see so it's something that you it takes a good teacher but a lot of practice with someone who would know and can teach you what to do and this is something that most of us do not have the  you know the luxury to have this kind of training yeah

Howard: I think it's also like a measurement site you can see 10 cavities on the x-rays in chart them periodontal disease you can probe and chart them and now it looks like because of Invisalign all the clear liners artificial intelligence looks like they're finally developing a clear aligner or artificial intelligence measurement for occlusal disease and so there's a couple of different camps that think that they're going to have an objective AI measurement and I think that will be a game changer an occlusion because if all the measurements are biting down on paper and you're looking at it but you can't see it on a radiograph you don't have a so I think if I think that you like Invisalign they line technology under this line in the unite eros they have all those I Tarot scams they have the biggest data set and they think they are they have a measurement for occlusal disease do you think that would be a game-changer it is definitely  this is something where all this computerized dentistry I would call it it can be really  helpful yeah my family is really looking forward to artificial intelligence because our natural intelligence didn't end too well so we're really looking forward to artificial intelligence um I want to thank you so much for coming by I know they love to humans love to see so if you ever want to post some cases on dental town so they can see and or the thing I'm you know back in our day it was always all day lecture a lot of times flight another city Millennials they love an hour online course but if you'd ever have the time to make an hour online to eat it'd be a real honor if you ever had time to write us an article or an online course or anything like that but you've all zoo buried DMD chief medical officer and co-founder and datum dental thank you so much for coming by and talking you to the dentist

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