Peri-implantitis never sleeps: Catching up with Dr Frank Schwarz

Professor Dr Frank Schwarz, Vice President and Chair of the Education Committee of the Osteology Foundation and a regular visitor to Australia, was one of the stellar presenters at Osteology Barcelona in April. We caught up with Dr Schwarz following his recent trip downunder, the importance of targeted education and his current research interests in peri-implantitis.

Thank you again for your time. Good to see you again after the great unpleasantness of the last few years.

Yes. Thank you.

So you've just come back from Australia. How are we doing there?

Australia's always great from every perspective. The country is of course amazing, but at the same time, I've made so many friends over the years from Australia, so its always a great pleasure to catch up. I was in Brisbane, I was in Melbourne, I was in Sydney and I'm always fascinated about the level of knowledge and education that I see. And it is always amazing to share knowledge and to share, of course, visions for future projects.

Excellent. And one of those future projects, is the new National Osteology Group in Australia one of these?

Yes. The National Osteology Group Australia and New Zealand has just started and I was involved in the process of launching it. Lisa Heitz-Mayfield is taking care of the group. I cannot give you too many details, but there's an extremely well-organised group of young clinicians leading it.

And how does that come about? To launch a National Osteology Group in a country or a region?

It's always the same setup. We identify the most suitable people to lead it and then we have to define the needs of the community. So those are not always the same. What you can successfully use in the United States may not easily apply to Europe or to Australia. That is the core mission in the beginning - to identify the need for education and the right format. Australia is a huge country and it's not so easy to organise face-to-face meetings, so you have to, of course, focus more on online education.

And is there a unique perspective as to how you approach online education? Obviously we've had a lot of experience in that during COVID. What can online do better to engage people more and to educate people better?

It's not so much about better education. As you say, it's about how to attract and engage with people who would not travel to a conference, people that you would never see at a face-to-face symposium, simply because they cannot envision the benefits of attending a symposium. So once you have reached out and engaged with these people, you may also attract them to future symposia. At the end of the day, this is what we're trying to do.

Another core mission of the foundation is to educate people at different levels, not just expert clinicians. So it's also about teaching beginners. This is why you may definitely benefit from the Osteology Foundation. It's about how to apply materials and procedures in day-to-day clinical practice. And this is what we have seen over the past few years. We can learn more and more. So we're always raising the bar.

That's very interesting. And in terms of your current research, your current drivers, is peri-implantitis still front of mind?

It's still the hot topic and it's ongoing. It never sleeps. You never get to the point where you're satisfied. It is in fact a big topic, but you can easily break it down to a core message. The surgical treatment is the key. We have minimally invasive options to control peri-implantitis lesions so we have to go for surgery. And what we can clearly figure out based on the available evidence is that we definitely benefit from reconstructive procedures or placing bone grafts, placing soft tissue grafts, improving the quality and the quantity of tissues that support implants. And again, this is bone and the soft tissue is a key element to keep implants and to satisfy the aesthetic outcomes that are crucial for the patient. Reconstructive procedures are on the rise, so we have more and more evidence supporting their application. This is one of the main backbones for the management of peri-implantitis.

And from the patient's perspective, how do they react to these large surgeries? How do they feel about undergoing treatment?

There is a big shift in patient expectations; they want to keep their implant. This is one thing that is so obvious. Not a single patient comes to our clinic to ask for an implant to be removed. So they will ask to keep the implant, to maintain the implant. And this makes the procedure even more important. If you cannot maintain the implant, you should definitely think about whether you should place implants in the future. If you don't have a solution, then you shouldn't start the implant placement at all. So the awareness is clearly shifting towards keeping implants.

And do you see any obstacles? Such as the financial aspect for example?

It is not necessarily expensive. There are some costs related to the procedures, but you have to calculate, on the other hand, what is the investment for removing the implant and building a site for another implant. This is also very costly. This is even more costly and in many cases even more unpredictable.

Do you feel clinicians need to "sell" the procedure to the patient?

Yes. This is in fact a part of the story and you have to communicate it well in advance - that complications may be part of the implant - that's life. And therefore communication is a key element.

Peri-implantitis is of course just one topic I work on. We're also currently focusing on what we call "pushing the limits in guided bone regeneration". We have learned more and more about surgical techniques and this comes on top of new materials being introduced.

As materials improve, does it lessen the need for surgical skill?

In the best case, the best surgical procedure meets the best material. That would be the optimal situation. And the products are being constantly improved. They are being constantly investigated for specific indications. And this is what we all bring together, the surgical techniques with the clear indication for the best products in specific indications.

Geistlich Fibro-Gide has been launched in Australia since we last met in Barcelona in 2019 and there's a real push on the soft tissue side as a result. How do you see that playing out at the moment? Obviously we've had a lot of focus on bone. Now we've got a lot of focus on soft tissue.

Exactly. And ideally you have to focus on both, though you cannot separate one from the other. And this is what we also see, surgical techniques that combine hard tissue and soft tissue regeneration at the same time in order to give more advanced and comprehensive treatment protocols. So you do not necessarily have to slice it into different steps. Soft tissue grafting has become mandatory and a crucial component for any implant-related surgeries.

And is Australia on board with this?

Definitely. It's even at the forefront. We see countries where the awareness is at a level that needs further improvement but Australia is already on board. And this is of course the scientific basis for education. If you're not well-educated, you don't see the need for something. The awareness comes from education and this is the key. And based on what we have seen in consensus meetings, looking back at the last Osteology Consensus Meeting, which was organized with the SEPA and with the German DGI, we just focused on clinical indications and applications for soft tissue grafting. So that was a whole consensus. We have a bunch of the latest evidence supporting a variety of different procedures, including replacement grafts.

Perfect. Thank you very much for your time.

Thank you so much.