Hi! - ENG
We interview Dr. Rui Figueiredo, the Coordinator of the Master’s in Oral Surgery and Orofacial Implantology at the Universitat de Barcelona (UB). Awarded a special prize for his doctorate in dentistry, he has written 50 scientific articles (40 published in influential journals) and four chapters in books specializing in the subject. Dr. Figueiredo has presented over 30 papers at Spanish and international congresses, and was one of the leading figures behind the setting up of the Implant Maintenance Unit at the UB.
In the interview, Dr. Figueiredo talks about the aims of the master’s course, which are to train students to become specialists in oral surgery in accordance with EU standards, as well as to provide course participants with training as specialists in basic oral surgery techniques and specifically in placing osseointegrated implants and preparing and placing implant-supported prostheses. In addition, the master’s degree coordinated by Dr. Figueiredo gives students an opportunity to acquire training in periodontal pathology and surgery, laser surgery, oral pathology and pathologies of the temporomandibular joint and orofacial pain.
The Master’s in Oral Surgery and Orofacial Implantology taught at the UB takes three years. Why is that?
The Master’s in Oral Surgery and Orofacial Implantology at the UB takes three years for two reasons. The first is merely legal, as European rules on creating specialisms in dentistry stipulate that in order to become a specialist in oral surgery, a dentist must have three years of fulltime training, encompassing a set number of hours and particular content. Our master’s degree was devised based on these requirements, and we have always fought for specialisms to exist in Spain, which today is the only country in the EU, along with Luxembourg, that does not have official specialisms in dentistry. If some day, which we hope will be soon, the specialism of oral surgery is recognized in Spain, our students will be able to enter the field without any problems in terms of content or postgraduate course duration. Moreover, we believe that training in oral surgery should be gradual, and having three years to train makes this possible.
What teaching method is employed to achieve this gradual skills acquisition?
In the first year, we focus on surgery involving the simplest procedures. In the second year, we move on to more advanced procedures such as included wisdom teeth and dental fenestration, and we also begin to work on implant placement in the most straightforward cases, such as single teeth or the restoration of small edentulous areas that do not require regeneration procedures. Finally, in the third year, when students have acquired broad surgical skills, they can embark on and treat all cases, including bone regeneration and restorations in patients with limited amounts of bone or large cystic lesions.
One of the most successful and unusual aspects of this master’s degree is the Implant Maintenance Unit? How busy is this unit?
The Implant Maintenance Unit was set up in 2012 because we had an in-house need to treat patients who developed peri-implant diseases such as peri-implantitis. Bear in mind that our master’s degree has been treating and placing implants since 1990 and so, in particular from the year 2000 onwards, we started to note that we had a considerable number of patients whose treatment was spread over various days because we did not have a specific unit for treating their cases. The unit was designed to cover all these patients, with treatment protocols, and to attempt to treat their diseases but above all to prevent the emergence of peri-implant diseases in new patients. It is particularly interesting that in 2012, we published a study in the Journal of Clinical Periodontology in which we demonstrated that approximately 12-22% of patients will develop peri-implantitis within five years of the placement of an implant. It is extremely important to bear this figure in mind in order to have a clear understanding of the real impact that these diseases may have in the future.
How does this unit operate? Why did you come to think that creating it was important?
In the beginning, it was a small unit that extended over half a day and which treated in-house patients. But today, five years on, the unit has grown enormously and treats over 40 patients a week, meaning that it is important to pass on the message to dental clinics that there is a need to diagnose pathologies and to create mechanisms for identifying whether a patient has not turned up at a check-up. We need to stress to patients the fact that if they miss sessions, their risk of developing peri-implantitis will increase significantly. We also published a study by the author Javier Mir in the International Journal of Oral & Maxillofacial Implants in which we demonstrated that patients with a history of periodontitis who do not attend check-ups or maintenance visits suffer significantly higher peri-implant bone loss than patients who do attend these sessions.
What would you recommend to the dental sector to prevent patients from needing to attend this Implant Maintenance Unit?
The message is not so much about avoiding the need to attend this unit but that creating a unit like it – in other words, doing preventive work – is the best way to reduce the incidence of peri-implantitis in the future. We need to bear in mind that treating peri-implantitis is still difficult, and that the results are far from ideal in my opinion. And so the main tool we have is prevention. Creating units like this one, which formulates prevention protocols, is the best means we have today to halt this pathology.
Given that peri-implantitis is different in every case, what are the most common premises of your day-to-day work?
We have good protocols for everything and we base our treatment on diagnosis (mucositis must be borne in mind as a factor, as it’s an inflammation limited to soft tissue and does not affect bone, but it may lead to peri-implantitis). In these cases, we provide non-surgical treatment based on mechanical debridement, and we normally add some adjuvant treatment or additional form of hygiene or cleaning, which may be chemical or mechanical. In cases of peri-implantitis, we use a sequential treatment plan, which calls first for non-surgical treatment before patients are operated on after four to six weeks. It is sequential treatment that cannot be done successfully without surgery.
We use a number of methods for surgical treatment. One is a receptive approach to factors having a negative effect on bone regeneration. In addition, what we do is place the implant while reducing sacs and carrying out implantoplasty: eliminating coils and the surface of the implant and leaving it as polished of possible, thereby decreasing the formation of biofilm on the implant. I have to thank AVINENT and its R&D department for their involvement in the project. We are currently conducting a number of studies, one of which is virtually finished, and we have another two in progress. They really deserve to be thanked because it is not easy to find private companies that will devote their own resources to research.
And lastly, does the future of dentistry call for cross-discipline skills?
On the master’s degree course, many treatments are planned in conjunction with the Master’s on Prosthetics and interdepartmental meetings are frequently held with the postgraduate course on orthodontics. In truth, it is not that the future of dentistry will be cross-disciplinary but that the present is already interdisciplinary. Nowadays, carrying out implant treatment without bearing in mind the final prosthetic and the surgical perspective is unthinkable. Ideal treatment can only be achieved by considering these two perspectives. We have to take into account not just prosthetics and oral surgery but other specialisms as well. Orthodontics is an example in which there are many cases in which spaces must be opened up so that implants can be placed in the ideal position.
One of the potential causes of bone loss is not respecting spaces between implants and teeth, and this results in problems. Endodontic treatments are necessary before implant treatment. These days, you have to have a global and interdisciplinary vision in dentistry because if you do not, treatments are unlikely to be successful.