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The comprehensive dental care concept is almost lost

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Dr. Giulia Cerino | Switzerland

Prof. Lang, let’s start from square one. What induced you to take a dental degree and then to continue with the academic profession?

Prof. Lang: My father was a dentist. When he turned 50 and it was my turn to go to university, I asked him for advice. He said “I would still go back into dentistry because it is the last free, really free, professional art.” Therefore, I said to myself “If my father is still so satisfied at the age of 50, it cannot be all that bad!” This is how I became a dentist. But I admit there was a time when I wanted to change. For reasons of study I was in Vienna four months during which I was at the opera house 86 times! I had decided that I wanted to become a baritone. Well you can all imagine how it went and fortunately I became a very enthusiastic dentist. I liked to treat patients, but what I liked most was the academic part. Even if I didn't know it at the beginning, it was my mentor in Denmark who told me ... “you're made for academia, go for it!”

Key word: Periodontology. After 30 years as professor and director of the Dental Medicine School of the University of Bern, you have achieved great advances. What stage are we at now and what does the future have in store for us?

Prof. Lang: I cannot answer; I do not have a crystal ball…but I can speculate (laughs)! I was part of the development of periodontology and the major paradigm shift was that in the early 80s we realized how to regenerate periodontal tissues. The breakthrough was not immediately realized by the profession and the whole field almost died. It was the advent of RCTs in the 90s that enabled the creation of a decision tree useful for understanding when and how to proceed with a periodontal treatment. With some modifications, it is still the decision tree used today. On the other hand, where developments in the field of regeneration will go is very hard to say. People are trying substances, growth factors…anything that is promising is being tried. The question is how far does the investment go? What will aid in getting a factor clinically approved, but that costs 4000 CHF? So, I think that in the field of regeneration we are probably not on the verge of another paradigm shift!

…So what about stem cells? Do they have potential for regenerating periodontal tissues?

Prof. Lang: They absolutely do, if asked in that way. But again…what is the cost for developing a routine procedure? Is there an easy step available to introduce specialists or dentists to the approach? Do we really need stem cells in the treatment of periodontitis? My answer would be no. We can treat periodontitis successfully even without stem cells, but if I had stem cells readily available, it would be another story.

What is your thought about peri-implantitis?

Prof. Lang: I don’t think peri-implantitis is the disease of the future, because it has already started. I used to compare it to a tsunami. We really have a tsunami coming in the next few years. We can, to a great extent, prevent peri-implantitis by having patients who are willing to have optimum oral hygiene, who are treated for any other disease in the oral cavity, who are willing to be monitored at regular intervals. But the reality is that about 10% of all implants develop peri-implantitis after 10 years. Now you can imagine that when we look at the fact that about 4 to 5 million implants are placed per year, in 10 years 5 million will have peri-implantitis. I think the treatment of peri-implantitis, although we know how to treat it to a certain extent, is not so predictable. Research is looking at treatment with antimicrobials, but also at how to regenerate the tissue that has been lost during the disease.

What is the biggest breakthrough in dentistry that you were part of?

Prof. Lang: (laughs) Not only one, but three! Firstly, the plaque revolution, which can be dated exactly to 1965 with the experimental gingivitis study. Secondly, the development of guided tissue regeneration. Thirdly, implant dentistry. Osseointegration changed the way we reconstruct today.

Could you tell us more about your experience in Hong Kong?

Prof. Lang: The best thing I did in my life. Hong Kong is very unique; it is a really vibrant city that you can live 24/7. In addition, Hong Kong University has a very positive attitude towards research; we have been number one in dentistry for three years in a row and just because of scientific achievements. I started the implant dentistry master program there and it was really a great experience.

You are currently mentoring the up-and-coming generation. What is the main message you teach?

Prof. Lang: During the last few years, especially those of retirement, I have noticed that the comprehensive dental care concept is almost lost. So, today when I teach or give lectures in Madrid, London, Hong Kong, Singapore, I try to convey this comprehensive dentistry approach. It is not just a matter of scraping teeth, but to have an all cleaned oral ecosystem.

Some numbers: More than 620 publications, four honorary doctorates, more than ten honorary memberships of national and international associations, and over 3000 lectures in five continents. Do you still have a goal you would like to achieve?

Prof. Lang: I've never really had a goal! I just did what I felt when it was time to do it! But I had and I have a drive in me to be nosy, questioning, analytical, to find out things and then the activity develops into scientific papers. When I retired from Bern, I had around 400 papers. I have produced more than 200 papers in the last 10 years. I have had no free lunches, but this was my most enthusiastic part during retirement. So my goal is to finish what I started years ago in a good way and for as long as I can.

Is there any other thought you would like to share?

Prof. Lang:  Be always open to discussions and challenges and don’t be afraid if, in the end, things do not turn out as planned!

But at the end what about your desire to become a baritone?

Prof. Lang:  In retrospect, I am happy with the decision I have taken. However, I took voice lessons and this experience has given me an all-round respect for opera singers. Today, when I go to the opera, I can enjoy the performance even more because I know all the effort that goes into it.

Dr. Giulia Cerino

Dr. Giulia Cerino | Switzerland

Manager Medical Communications
Geistlich Pharma

Photo Header: Larissa Achermann

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