Prof. Dr. Giorgio Lombardo, DDS, PhS, Associate Professor
University of Verona; Verona, Italy
Thank you very much. Good afternoon. Thank you very much to Prof. Marincola and to Prof. Ewers that are the president of the session for giving me the floor. And thank you very much for this to the scientific committee and for Dr. Morgan for the kind invitation. For me, it’s a real pleasure, a great honor to be here, share with you sharing with you the academic journey that resides behind the academic publication that that we perform at University of Verona. But to be honest, twenty minutes is a little not maybe not enough to share with you, to recount all the things that we passed through to the event that we met together and the improvement that this journey has has meant for my life, not only academic life. So but I I do what someone asked me why a periodontist is here on this podium to speak about the implant. And in fact, there is a story that I want to tell you for the first time. It went back to 2007. And that day that that day, my director, Prof. Marchini, which we I want to take to thank for the opportunity he gave me to perform this research under the flag of the University of Verona. But this director, my director, called me and said, Giorgio, you are going around to tell everybody that you are a periodontist. Are you a periodontist? Yes. I am periodontist. So please take care of this patient. And pay attention not to let me down because this is dear to a close friend of mine. Don’t worry, professor. I do my best. But when I saw the patient, immediately I felt that the situation was not so sure. And to meet the expectation of my director, probably will be we we they were going to be a real challenge for me because at that time, I didn’t feel myself equipped to to face such a complex case only with not only with my periodontal personal skill, but even from an implant point of view. Because look at what to look, especially when I heard the request of the patient. She doesn’t want any concomitant bone augmentation procedure. She doesn’t want didn’t want to wear removable prosthesis. She doesn’t want a long lasting and expensive treatment. She want predictable, aesthetic outcomes. And at the end of the story, she wanted to floss her teeth. So, really, I didn’t know genuinely, I didn’t know what to do. And I felt that probably I was at a turning point, maybe at the end of my personal academic career. But then, I remember a friend of mine who told me about a professor. A professor, but though, this this nobody exactly knew where what is the address of this professor? Where this professor live? Some said that he live in Rome. Some said that he lived in Cartagena. Some said that he lived in Germany. Some said that he lived in in Boston. Some said that he has no he had no fixed address, and Sam said that he even don’t exist. It’s a might. But I had a phone number, so I called this number. And to tell the truth, I was expecting to find some arrogant and dismissive man, but instead, I was greeted from an extremely friendly and approachable person. He simply said, Giorgio, don’t worry. Be kind. Don’t worry. Tell me. Send me the CBCT scan, and tell me when we want to meet. As soon as possible. Okay. Now I’m a little busy, but I can come in at the end of January. And he can. Remember, it was almost this all happened almost eighteen year ago, and I didn’t know even that Bicon exist. So I greeted him, but he with a great calm, observed the patient observed the patient examined examined the documentation, and immediately started to strut the teeth. I felt desperate. I what’s happened? I have I have no I have no surgical guy. I have no anesthesiologist. I there is no 3D preplanned imaging. There there are no CBCT scan tools. What’s happened? But when but while I was thinking, he keep on drilling, collecting bone, very proud of this. He showed me many times how it is possible to collect bone with strange reamers. And after, he showed me this tiny, strange, screwless, threadless, little implant, using his finger to put inside, and the mallet took place in the final position. And while I was completely shocked with my career at the end, because I who I who is that I called? Who’s doing? He said, please, Giorgio, you are not you know. No? Please, you have done anything till now. Please, do the provisional. And at this point, I felt even more desperate, because I am a periodontist, so I do, and I will do what I could. So this was the results. And I know that now you are thinking, it’s better that you keep on doing periodontist and not change for prosthodontics. But for that time, at that time, the miracle has already happened. This was the situation at noon o’clock, two hours after. This is the patient without pain, smiling with her teeth in his mouth, and perhaps still high with a career in front of me. For all these things, I will be forever grateful to you, Mauro Marincola. Thank you. Thanks to this event and the fact that this patient was so beautifully, beautifully treated without pain, without time, expensive time, expensive treatment, with long lasting, long lasting aesthetic results that speak for themselves. So I show I show my boss, look, this is what we achieved. Thanks, Mauro. Mauro? Yes. Mauro, Bicon company. Bicon company? I to tell the truth, we believe in other kind of company. So the no bell. So but please, director, let me introduce you to the president of the thanks tomorrow. I have the possibility to introduce the president of the Bicon to you, or to you, to the president of the Bicon. You know, he’s like too giant to to giant that we and he was in the middle, so but at the end, Dr. Morgan came, met with Prof. Marchini, and he had a very beautiful and exhaustive conference lecture in the main podium of the university with all the student, and Prof. Marchini was amused from the presentation. They become friends, so I survived. I was very happy of I was very happy of their friendship, and I was allowed, finally, to proceed with our search. But I want, since now I have a little time, I want to thank you, Vince, for your continued support and encouragement to go for big journal. This is your advice, your suggestion, and I tried to do my best to do it. Thank you, Paolo. So, this was the object of the first paper that we published at University of Verona. After this paper, other paper came. For a total of fourteen papers and another in publication. We treated the various aspect of the Bicon implant in that in what is the aspect of the normal, professional daily life of a dental practitioner. And I have a disclaimer I want to disclaim that this case was have been done for me, and I’m not at all a good implantology. So, if I think that this was what I want I was going to show you is the reality that any one of us can achieve after a little period of training with this kind of implant, always following the suggestion of the Paolo, of Stefano, of Andrea, of Dr. Morgan, of Prof. Ewers, and finally, Prof. Marincola. In the aesthetic area, there is not much to have what has so beautifully exposed my previous speaker, Dr. Hernandez from University of Cartagena. And, yes, we this is yet we published three papers, the fourth just released, and the fifth, the long term one in publishing, under review. Within the limits of the presented studies, my studies, really, this implant, for their features, for their design, allow even in a non particular gifted end to reach results that would be very difficult, and in some cases even impossible to reach with other kind of implant. And from the data that I was we were we were collecting, these results seems to last for long period, for along with even after many years. That is not a common features with other kind of implant. But doctor explained more beautifully than me this issue. After we go we focus on cumulative survival rate, We published three paper, and the last one in 2021. What we know at the time? What we know at the time? You know, if you if you look at the literature, you know that short implants suffer high crown implant ratio, especially if restored with single crown. We know from the review that everybody say, agree that six millimeter implants should be splinted. This data was supported from clinical cases, from clinical studies, which showed that even not facing the grade higher crown implant ratio, other kind of implant, famous, didn’t reach the five years threshold time, showing elevated the survival rate. If things go well up to three years, but after three years, the survival rate drop down quickly, reaching the value that are not acceptable. We for so the ITI statement is stated that short implants must be splinted. And if you splint the short implant, you are lucky if you reach 96% of survival rate after five year. In 2021, we published our final five years long term study, which followed the three previous the two previous journal. Thank you, Esteban, for your support, my friend. And, well, it was we we followed one hundred and ninety seven single crown implant in mandible, one hundred and thirty six single crown implants for five years, and at the end, we found that this implant can perform better or at the level of others other implant splinted. So and even if restored with single crown, all these implants restored with single crown, they the statistic the statistical regression showed that their survival is not affected neither by the length of the implant nor by the crown implant ratio. Look, when the crown implant ratio exceed the three, the value of three, while other implant fail, this implant decreased of only one percent. It’s, for me, an incredibly and outstanding results. And so, the study finally had in agreement with all the Bicon utilizer and the Bicon philosophy, and in agreement what was has always said to Dr. Morgan, yes, it’s true, Dr. Morgan. Short lock I agree. Short locking taper implants don’t need to be splinted. And I also agree that this short locking taper implant can face crown implant ratio much higher than other kind of implant. Well, now we focus on the impact of history of periodontitis with on the Bicon implants, because you know that you place implant even in patient that lost their teeth because of periodontitis. We published two papers. The last five years, one, 2022. We followed 332 implants for five years. A great work. I must thank all my students for the help that they gave to me. And 119 implants in the healthy patient, two thousand fifteen implants in the patients with a history of periodontitis. And what is the result? That the survival was exactly the same. So we can assume that history of periodontitis that don’t affect doesn’t affect the survival. But when we go to see the prevalence of periodontitis, I have to spend a little words. In this paper, I fixed the threshold the threshold limit for defining excessive bone loss at one millimeter, Dr. Morgan, at one millimeter. And you can ask why? Because in the literature, everybody say that the threshold for perimplantitis is two millimeter. Yes, but I thought that if you allow an implant length long, six millimeter, to lose two millimeter bone, probably you will have your crown implant ratio shift, a shift of your crown implant ratio, not a little, from two, that is the majority of the implantation with short implant, from two, two, three, and half. Just because you lose two millimeter, it could become four millimeter the endosus portion of the implant, and forty millimeter the length of the crown. The clinical the clinical value. So I think that we don’t allow an implant to lose two millimeter of bone, but it’s better to intervene if we want to intervene before just when you see two millimeter of bone loss, you you it’s better you intervene. And even with real strict limit, the percentage of perimplantitis was only five percent, the lowest percentage of perimplantitis in literature for short implant and even for standard implant. But these three limits make this study very sensible, and so we can detect that in reality, in the group of patient with the history of perimplantitis, there is, in real reality, an higher percentage of perimplantitis. So it’s true. It’s true. Even even Bicon implants in patient with history of perimplantitis suffer the effect of the general health of the patient. But when we go to see the cause of failure the cause of failure, we see that in healthy patient, for perimplantitis, not one implant was lost. The three implants that were lost, two for my error of placement, I bet I said, and one because I placed a 2.5mm post 3.0mm implant in premolar site. So the crown implant ratio, and you know that they’ve broken the the post. I have finished my presentation. So, conclusion, conclusion. The history of perimplantitis has a very negative story. Treatment of perimplantitis. I can tell you that you can treat perimplantitis. There is a protocol. The main the cornerstone of the protocol is all the same. The degranulation, disinfection of the surface, if needed, the implantoplasty of the sloping shoulder, and filling with a material. And we follow the patients, 21 implants placed, 100% survival rate. And you know why? Because because you know why? Because this is the only kind of implant that allow the process of restoration take place because he can maintain stability even if only two three threads, two three plateau are in the bone again, still in the bone. And this allow time for the process of restoration, reconstruction of the bone, to take place. And this for this the for this reason, this is the the only only paper that tell about the the reconstruction treatment of bone around the short implant is restored with single crown affected by perimplantitis. And to regular attendance, to maintain this program is mandatory, always. So, to find internal sinus lift, no work for this. You know this procedure better than me. What we published two paper, the conclusion is that one hundred and fifty five implants that followed for five years showed that even when the residual crestal bone height is inferior to four millimeters, and the crown implant ratio go up to two point five, the implant implant survival is still very high. So the results is that an astonishing 95% of survival? You remember that the laterally approach give a result between 96 and 97. And so the conclusion is this, in my opinion, we should always strive to preserve teeth, for sure. If we have no teeth anymore, Bicon short locking taper implant seems to me to be the best choice. So I have finished. Thank you very much for your kind attention.