November 8, 2015
When Geistlich Pharma AG invited me to do a roadshow in China, I thought this was going to be just “another day in the office”. What I didn’t expect was a cultural and culinary experience that would leave a lasting impression.
Geistlich Pharma are the manufacturers of the biomaterials Bio-Oss and Bioguide. These materials are used in the reconstruction of deficient jawbone, often in combination with dental implants. There are over 1,000 publications since 1990 on these materials with favourable outcomes, and they avoid the need for surgeons to obtain bone from other parts of the body. Over the last 10 years I have developed some techniques that utilise these biomaterials, and which apart from rebuilding deficient bone, also help in facilitating a more aesthetic outcome, immediacy, longevity, and which also incorporate a build-in contingency into implant rehabilitation.
I kicked off the roadshow at the Days Hotel in Xi’An, pictured above and below.
My topic was “The Role of Bone Grafting in Dental Implant Rehabilitation”. My focus was to try and help the audience to be able to distinguish between implant “survival”, as it is described in the literature, versus true “success”. I wanted to highlight that the mere “survival” of implants is not enough. We know that implants survive, in other words they are bio-compatible and the bone biologically adheres to them. Our patient’s don’t want “implants”, although this is what they might say. What they want is a beautiful healthy smiles and long term function. What they expect is success, and there is a big difference.
Oral implantology is a discipline which requires the dentist or surgeon to adopt techniques and strategies that are quite different to conventional dentistry taught at university. As a result, like elsewhere in the world, the implant surgeons in China appear to place a lot of emphasis on implant design, components, armamentarium and techniques to install the fixtures within bone. This focus often leads to a void in the overall treatment planning. However, success begins in the planning.
The high “survival” and biologic adaptability or permanency of dental implants is only an advantage if they is done well, planned and executed. The case can be quite the opposite if done poorly because dental implants are irreversible, they are difficult to undo. So its important that they are done in a way that will lead to a successful result.
Once I put my point across I demonstrated a number of techniques with bone grafting and soft tissue augmentation procedures that are key to the attainment of success, whether in replacing a single tooth or full set rehabilitation with dental implants.
Attendance was at capacity in Xi’An, with 350 delegates attending, 120 attended in Xiamen, and 160 delegates in Guangzhou. Below is the conference at Crowne Plaza, Guangzhou.
Among the audience were dentists and specialists from the 3 provinces that I visited, and included some prominent professors, with whom I later toasted with a shot of Chinese white wine, which is more like Vodka than wine. Actually, one shot is somewhat inaccurate, …perhaps one shot, after another, after another. In their culture the Chinese people welcome, thank and honour each other over wine. And this is reciprocated by all individuals present. Save to say I was a little light headed by the end of the night, and which also made an interesting start to my presentation the following morning.
I had the pleasure of dining with Professor Dehua Li, Chairman of Chinese Association of Oral Implantology and Head of Oral Implantology at the Chinese National 4th Military University, Xi’An; Professor Jiangwu Yao, Head of the Xiamen Dental Hospital in Xiamen; Professor Lei Zhou, Head of Oral Implantology and Vice Head of Guangdong Province Stomatological Hospital in Guagzhou; and Professor Feilong Deng, Head of Oral Implantology, Guanghua School of Stomatology, Sun Yat-Sen University, Guagzhou. All are very active in the field of Oral Implantology in China.
Following my lectures I also had the honour of being invited to visit some of the hospitals where implant work is being carried out. The highlight of these visits was the tour of the Xi’An School of Dentistry museum specially organised by Professor Dehua Li. There I saw the original prototypes of the modern dental implants from the 1960’s. The late Professor PI Branemark, the person who discovered that the body accepted the titanium material as though it had been its own biologic substance, donated them to the University. There were also PI’s lab coats and some of the instruments used in the early days also donated by PI.
I received a special tour of his department by Professor Feilong Deng. Professor Deng and attended one of my prior lectures in China, and we have communicated with each other regarding collaboration and training of the clinicians of his department.
From my visits to the various departments of Oral Implantology, my conversation with the various heads, and the questions that the delegates who attended the lectures raised during my delivery, it would appear that there are certain complexities in implementing some of the procedures that I covered in my lectures, particularly in relation to immediate rehabilitation. This is likely due to the divisions that exist between the various departments that deal with dental implants. For example, the department of oral implantology does not have access to the operating theatres, and the department of maxillofacial surgery, which does have access to the operating theatres, but not to the laboratory. Furthermore they use conventional hospital-style anaesthetic techniques, where patients need a longer period of recovery because of paralysing agents that are typically used, which is not conducive to immediate restorations.
These divisions are not unique to China, but the difference is that in Australia and other western countries the private sector dominates the delivery of dental services, whereas in China delivery of dental services is mainly through public hospitals, albeit the patients still pay as private patients. As a result, there are far more obstacles for Chinese dentists, whether political, cultural or logistical, to enable them to match up to the opportunities that are often simply bought, for a lack of a better word, by business-savvy dentists in western countries.
For dentistry in China, just because there are hurdles does not mean its the end of the road. China is a developing country and in major cities there is already an emerging private sector. The problem is that the people are used to receiving treatment in public hospitals. Therefore changing the culture may take some time. I was surprised to discover that patients have to pay $3,500 AUD for a standard implant crown at a public hospital, and that the hospitals only use the top implant brands, whereas private clinics have to offer lower rates and use cheaper implant systems.
The dentists that I met in China were very thirsty for knowledge, but do not come across as gung-ho. They were of the most engaged professionals that I met anywhere in the world.
On a level playing field they are certainly not less skilled than dentists in western countries, its just that they are forced to operate with one hand tied behind their back.
This can and will change, but until there is a cultural change to nurture the private sector, or a departmental set-up and logistical changes to improve the public sector facilities, dentists in China will not have all the necessary pieces to complete the puzzle, and to take them to the next level in delivering superlative care that competes with the west.
I have to say that Geistlich China have put on outstanding events in each of the places that I visited. The atmosphere was as electric as it was chilled and elegant. Everything fell into place effortlessly, or at least they made it seem that way. Apart from the lecture events themselves, representatives from the company gave me special treatment, showed me some local culture and allowed me to experience some phenomenal local cuisine. The places that left the biggest impression were Xi’An and Guangzhou. Xiamen is a smaller island, and it was more of a fly-in fly-out type of a visit, whereas in both Xi’An and Guangzhou I had more time to enjoy their varied cultures and cuisines. In Xi’An the food was somewhat spicy, wide noodles (Biangbiang Noodles) and meats and organs that appear somewhat weird to westerners like me. In Guangzhou the dishes were more of a Cantonese style. They were sweet, and more vegetables and birds. The highlight was Goose. It looks a bit like Pecking duck with the crispy skin, but its less fatty and the taste of the meat and the skin, with the sauce that it was cooked in, was insatiable. I’m pretty sure I ate the whole bird on my own. Noodles were common everywhere, even for breakfast. Great as the dishes were, I was pretty noodled out by the end of my trip.
The people who made the wheels turn are Qui Wang, General Manager Geistlich China, who runs a well oiled and highly professional operation without the stigma, and who made the trip from Beijing to join me for 2 days in Guangzhou; Xiaolong Liu, the National Sales Manager who accompanied us in Xiamen; Bob, from Sales and Concierge who drove me around and showed me the best parts of Xi’An; my interpreter who had to put up with my Aussie accent; and last but certainly not least, my full-time escort, Zhifeng Cao, who has not left my site from the time I landed in Xi’An to the time I flew out of Guangzhou, and who stressed about every detail to make sure I don’t.