Celebrating 40 years of advances in the field of dental implant surgery, Harvard Dental School on Monday honored Daniel Buser — University of Bern professor and visiting lecturer at Harvard — with the Paul Goldhaber Award. Accepting the honor, the most prestigious given by the School of Dentistry, the renowned dental surgeon gave a speech that spanned both his academic career and advances in the field, four decades of “pioneers and breakthroughs.”
Since 2000, Buser said, dental implant surgery has become both “routine” and “highly successful.” Nearly 3 million Americans have dental implants, a number that is growing by 500,000 a year, according to the American Academy of Implant Dentistry. Despite the bias toward older patients, with good hygiene (and a warning “don’t smoke too much”), the procedure has success and survival rates of 95% and 98%. “Much better than conventional prosthetics,” Buser said. “Better than a hip replacement.” He added that the field reduced the number of surgeries, reduced pain and morbidity, and shortened healing and treatment times.
During his career, Buser saw a “paradigm shift” in surgical dental implant surfaces. While early implants were anchored with a smooth, polished titanium screw (known as the Brånemark surface after Swedish researcher Per-Ingvar Brånemark), the field has trended toward “micro-rough” surfaces after research found they reduced average healing time and failure rates.
Dental implants have success and survival rates of 95% and 98%. “Better than a hip replacement.”
Daniel Buser
The next big breakthrough, Buser explained, was guided bone regeneration, which uses barrier membranes to direct the growth of new bone around an implant. In Bern, he said, the first clinical case, involving the extraction of a premolar that was replaced by an implant, “worked very well.”
However, the technique had complications. The breakdown of membranes and difficulties in healing spark the search for better materials. By researching tiny pigs, “we learned very quickly that we needed something to support the membrane.” The answer? Two different fillers, the so-called composite graft, which has now become standard.
Further research revealed that the placement of the implant has an impact, as does the so-called microgap, the space between the various elements of the implant. Looking at “possible ways to minimize or eliminate inflammation,” Buser said, “you either want to reduce or eliminate the micro-gap, seal it, or you can naturally move the micro-gap up, higher in the jaw. , which reduces the possibility of inflammation and bone loss.
Another advance was bone preparation, which uses the patient’s own bone chips. Bathing the chips in a mixture of the patient’s blood and an isotype bath known as Ringer’s solution to prevent clotting prompts the bone chips to release a growth factor. “We’ve seen that two of the most important growth factors can be detected very quickly,” he said, opening up more options for treatment.
Such advances have been aided by the introduction of cone-beam computed tomography, a volumetric scanning machine that provides three-dimensional models and serves as a diagnostic tool. Now routine, “this gives us so much information.”
With so many options — such as immediate implant placement after extraction or waiting — the current challenge is “all about case selection,” Buser said, noting that each case must dictate an individual approach. Adding that most complications are caused by poorly trained professionals, he emphasized the importance of the kind of teamwork that encourages both research and personal development. “You have to have lifelong learning. You have to go to conferences to stay informed.”
Speaking to a packed audience as well as an online audience, Buser also touched on being a mentor, a role shared by the late Goldhaber, who served as dean of the School of Dentistry for 22 years.
“For an academic career, you have to have a good mentor,” Buser said. Naming such luminaries in the field as the late André Schroeder, professor of dental and endodontic surgery at the University of Bern; Robert Schenck, whom Buser recruited into oral and maxillofacial surgery from his original field of orthopedics. and Ray Williams, PD ’73, a 2013 Goldhaber honoree and former associate dean for postdoctoral education and head of the Department of Periodontology at HSDM, encouraged young academics to seek out those who could help them.
He also emphasized that such cooperation is two-way. “You have to be a good team player.” Noting the lessons he learned from his own participation in the 1980 Swiss handball team, Bern, he said: “With a good team you achieve much more.”
