Interview: “Eventually, all companies will prioritise simplicity”
During this year’s FDI Annual World Dental Congress (AWDC) in Poznań in Poland, Dental Tribune Online had the opportunity to talk to restoration specialist Dr Maciej Żarow. As a member of the GC Europe Restorative Advisory Board, the Cracow-based dentist helped develop Essentia, GC’s simplified restorative system that achieves complex aesthetic results with just seven syringes. The clinician discussed the challenging task of creating a new product and a general paradigm shift towards greater simplicity in dentistry, which he believes is only a matter of time.
Dental Tribune Online: During the 2016 AWDC, you presented four, fully-booked, hands-on courses. How important is the practical introduction of new materials for practitioners?
Dr Maciej Żarow: A hands-on course gives clinicians the opportunity to try something new or that they were not able to do before—at least not with control. Many evidence-based studies show that dentists are able to achieve better bond strength with the same material they used before, because the course taught them how to use it properly.
To reduce treatment risks and costs and facilitate processes, new techniques are continually being developed. Take direct composite veneers, for example. They are reproducible and less time-consuming if one is familiar with the protocol—it is important to know the protocol. By that, I do not mean only instructions on how to use it, but also how to check functionality and wear. It may sound easy, but these kinds of things need practice, repetition and understanding.
Together with seven other clinicians, you played an important role in developing the Essentia system. Could you tell us how you came up with the idea in the first place?
At the time, GC was eager to gather independent practitioners—Dr Javier Tapia Guadix, Dr Stephane Browet, Dr Jason Smithson, Dr Lucile Dahan, Prof. Joseph Sabbagh and me—and researchers—Prof. Marleen Peumans and Prof. Marco Ferrari—to work on a new composite. When we met as a group—most of us were practitioners, some had lectured on composite materials already, some were based at universities and were involved in materials studies—we started to think about creating something simplified, something different from the composite materials the company offered at that time. Back then, GC sold many shades and components, just like all the other companies. Since we used a very limited number of shades for most cases anyway, we thought of developing something simpler and that could be combined. That way, we would be able to achieve great results using only five or so syringes.
From the initial idea to the final development, it must have been a challenging time. Could you describe the creative process?
Physicians and chemists from GC’s composite materials department in Japan worked with us, and they attended our meetings regularly. We explained to them what we wanted to achieve more or less, constantly weighing our wishes and needs from the dentistry perspective against the molecular possibilities of the material. The whole process took five years. For us, as practitioners, it was difficult to communicate our needs to the scientists, because they had knowledge of the limitations due to the biomechanical properties. It involved many challenging, but fruitful, discussions about what we wanted to achieve in the patient’s mouth and what was possible chemically speaking.
Three years in, we were having a really difficult time and were not certain that we would succeed really. Sometimes in the process, we were progressing and all of a sudden the next step would ruin all our previous efforts. For example, we were focusing on improving the X-ray visibility and the chemists added something to improve the material in this regard; however, it resulted in poor outcomes aesthetically. In summary, the process was difficult at times, but we succeeded in the end and developed something amazing. We are very happy that we were able to improve the existing material and create this special composition, especially that of the enamel material, which has a completely new structure.
Is this the dawn of a paradigm shift towards greater simplicity in dentistry?
Simplicity is the philosophy of GC and Essentia and of Styleitaliano, a group of which I am a member. Styleitaliano is a movement that consists of a group of 29 dentists, scientists and practitioners from all over the world. Our key idea is to teach something easy, feasible and reproducible, to simplify things in dentistry. Most dentists do not want to be artists. They want to do something visibly good for their patients using a procedure that is predictable and able to deliver high-quality results.
That is where the philosophies of GC and of Styleitaliano meet: mainly, we want to present dentists with the opportunity to achieve high-end results that perhaps only the top 10 per cent of practitioners were able to achieve in the past. With simplified products, however, this would be possible for everybody, and with an easier and faster process to boot.
So, this philosophy will be adopted by other companies as well in the future?
Eventually, all companies will prioritise simplicity in their products. Even more so than today, people of the future will want to achieve everything quickly. Probably, this will affect procedures that are very complex, such as occlusal adjustment and rehabilitation. Essentia is a material that addresses the needs of the future dentist now. It consists of three dentine versions—young, adult and aged dentine—and two types of enamel for use in younger or older people. With only these few components, we are able to produce 95 per cent of dentition.
With materials such as Essentia, it is possible to shorten a case of complex occlusal rehabilitation that previously would have taken half a year or longer to one or two procedures. This is incredible for the patient. Furthermore, there is no tooth preparation involved. The dentist does not need to actually touch the tooth structure. In the past, 60 or 70 per cent of the crown structure was removed in the tooth preparation process. Today, we can follow the principle of additive dentistry: we rather add something to the tooth. Hence, even if the restoration wears down over time, one is back to zero after many years of clinical use without having damaged the tooth at all. However, this approach is not yet widespread; we still have a long way to go.
Thank you very much for the interview.
Editorial note: To learn more about additive dentistry and the use of Essentia, download Dr Żarow’s article “Full-mouth composite rehabilitation in one day” from the Styleitaliano website free of charge.