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In a time machine with Jan Lindhe

The early days of GBR

04.04.2016
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Jan Lindhe shaped periodontology and implant dentistry research like few others. Here he looks back to the early days of oral tissue regeneration and compares 1985 to 2015.

Prof. Jan Lindhe | Sweden

Prof. Lindhe, can you visualize the Jan Lindhe of the early 1980s?

Prof. Lindhe: Yes, that was the time when I was still young enough to be offered different new positions around the world. So it was sort of a “temptation time.” But we also did very interesting research in Gothenburg.


What was your regenerative focus at that time?

Prof. Lindhe: Together with Stüre Nyman and Thorkild Karring we were trying to find out which cells produced new root cementum, for example: gingival connective tissue cells or bone cells. Then Nyman and Karring were the first to place a membrane between the tooth and the soft tissues in order to give the periodontal ligament and the root cementum space and time to regenerate and form new attachment. This was the basis for the later Gore-Tex® membrane. The predictability of this technique was not so good though, due to the frequent soft-tissue dehiscenses. We never used bone substitutes at that time in Gothenburg.


And then you met Dr. Peter Geistlich who changed your mind?

Prof. Lindhe: No, first two other people visited us in Gothenburg. I think it was the former Managing Director Michael Peetz and the American researcher Prof. Myron Spector. We were very, very sceptical about the new bovine bone material they showed us.


Why?

Prof. Lindhe: We thought it was just another hydroxylapatite, and we knew that this material didn’t have any regenerative potential. We were also not enthusiastic about the allografts that were used in America. Our concentration on membranes – pure Guided Tissue Regeneration – was very strict at that time.


Then what happened?

Prof. Lindhe: One thing was that we in Gothenburg started to place implants, and we were thinking about the bony defects that arise after extracting a tooth. That was, I think, in the end of the 80s or the early 90s. So our focus shifted from only periodontal regeneration to also bony defect regeneration. And then the Geistlich people came back together with Dr. Peter Geistlich, who was a very nice gentleman. We agreed to conduct an animal study where we placed implants into native bone and into Geistlich­Bio-Oss® augmented bone.1


Is this the study that was awarded a prize last year for being the most cited study with Geistlich biomaterials?

Prof. Lindhe: Yes it is. The funny thing is that we mainly conducted it to investigate the soft tissues. Our focus was: is there any difference regarding epithelium cells, connective tissue cells, etc., between the soft tissues above bone and the soft tissues above a bone substitute material?

But the reason this study is cited so often is, of course, that we could also show that the osseointegration in the Geistlich Bio-Oss® augmented area was just as good as in the native bone. This much more important finding was, at the time, just a side observation.


If you compare the early days of regenerative dentistry with today, where do you see the biggest changes or advantages?

Prof. Lindhe: The biggest advantage is the predictability. Regenerative procedures are highly predictable today, if you follow the protocols. This is because we have done a lot to prepare a sound scientific basis, for example, with systematic reviews, consensus meetings and so on.

On the other hand, the people involved in clinical studies are mainly excellent surgeons, who sometimes make a technique seem more predictable than it is.


Is regenerative dentistry still very skill dependent?

Prof. Lindhe: No, for example Ridge Preservation following tooth extraction is nowadays a common procedure all over the world. I think most dentists can manage this straightforward technique and thereby simplify the treatment. Therefore, I have claimed many times: following tooth extraction, care for the ridge! But when it comes to using autologous grafts or combining patient tissue and biomaterial, when it comes to larger augmentations or more difficult soft tissue management, the individual clinician skills are still very important.


What is the biggest breakthrough you hope for in the near future of regenerative dentistry?

Prof. Lindhe: The identification of a growth factor locally stimulating cementoblasts to produce new root cementum, because in order to create new tooth attachment, you first have to produce a docking site at the root surface for the fibers of the periodontal ligament. Without this, the fibers cannot invest and, subsequently, the newly formed periodontal ligament cannot support the tooth. This growth factor product will come sooner or later.


Do you think that the research on Geistlich biomaterials has contributed to a better understanding of human bone and bone regeneration?

Prof. Lindhe: Absolutely. For Periodontists, what matters are the tooth and the tooth-retaining structures – periodontal ligament and root cementum. So, before Geistlich came, bone was just the hard wall between the roots. Then, suddenly, one asked how new bone was formed around Geistlich Bio-Oss® and how the particles were being resorbed. And so the research started.

Prof. Jan Lindhe

Prof. Jan Lindhe | Sweden

Faculty of Odontology
University of Gothenburg

References
  1. Berglundh T, Lindhe J: Clin Oral Implants Res 1997; 8(2): 117–24.


Interview by Verena Vermeulen

Illustration Header: Trend in the numbers of implantations from 1986 to 2016 (forecast) with the USA as an example: 1986: 120,000 implants, first clinical use of Geistlich Bio-Oss®; 2006: 1,526,225 implants, 983,860 bone replacement procedures; 2016: 2,579,559 implants, 1,999,309 bone replacement procedures (Sources: iData Research Inc.,US Dental Bone Graft Substitutes and other Biomaterials Market / Medical Data International Report 1999)

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Comments

Fernan Lopez wrote:

"Dear Prof. Lindhe,
Precise and clear concepts that will end up in Science!
Best
Fernan"

Answer