#22 - Dr. Željka Perić Kačarević - Socket Management and NovaMag® Shield Explained

00:00:00: Welcome to sixty minutes for GERK, as we meet today from Bodhisattva Materials.

00:00:05: We're going talk about socket management and what happens when you instruct a tooth.

00:00:17: We're gonna have a nice chat about it, we are going to talk about the techniques.

00:00:24: We can also talk some of our products but really go into the tips on clinical aspects and technical assets for this product.

00:00:31: so... It's also an opportunity to get to know Jerker who has been in BOTIS for many years now?

00:00:39: Almost ten!

00:00:40: And yeah because... Yeah..we started.

00:00:45: There was a time where we were working at the beginning.

00:00:47: You wear in different departments, I was doing education so maybe you can tell us a little bit about your life in Portes?

00:00:54: Oh yeah it's quite nice story pretty much... So yes!

00:00:59: It is now around ten years and i do remember you before coming back.

00:01:04: So, this is really nice.

00:01:06: I was pretty much always in research and development because it's somehow my love that drives me all the way through work.

00:01:25: But yeah, I was doing some animal testing.

00:01:28: Implementation in animals, calvarian models subcutaneous models we were traveling during implantations and also histology because i am professor of anatomine histology.

00:01:40: so pretty much histology is one huge love that it is And We Were really discovering lots Of this tissue response on each of biomaterials That we have and membranes grafting materials.

00:01:53: So, I was doing lots of histology and lab work.

00:01:57: Before Buddhism.

00:01:58: so you are an expert in histology.

00:02:00: now we're moving towards more product management.

00:02:04: but what did you study before?

00:02:06: What is your background then?

00:02:07: Pretty much...I have very often questions like Are You Clinician?

00:02:15: Well i'm not a clinician..i am a

00:02:20: scientist.

00:02:22: Yeah, I'm scientist pretty much.

00:02:24: So i did finish molecule biology But then I switched to medicine a lot, and then did my PhD in Medicine.

00:02:32: I did some exams in Medicine so... Then i started to be assistant at Medical University All right!

00:02:39: And then I did my Phd in Medicine.

00:02:41: You

00:02:42: do many surgeries?

00:02:44: Of

00:02:44: course yeah!

00:02:46: We switch to the PHD.

00:02:48: So I did a phd in Anatomy especially on bone.

00:02:51: Bone is huge part of focus for over now.

00:02:56: Can I say how many years?

00:02:59: Please don't.

00:03:00: No, yeah...I'm young but twenty-twenty five years of experience with a bone histology and bone remodulation And this was part of my PhD also, and I stick to the University of Medicine.

00:03:14: Then I switched to the university of stomatology... ...and now associate professor and teacher Natomi in histology for stomatologists.

00:03:21: Pernogio you mentioned bone.

00:03:23: so especially people who are not involved in dentistry or other experts.

00:03:28: they think that bone is there.

00:03:32: You're born, it's a solid static Tissue, but it's not like that.

00:03:38: It

00:03:39: is totally not like That.

00:03:40: its organ.

00:03:41: Hmm?

00:03:41: Its one of our organs.

00:03:43: So it very beautiful its organ and it works.

00:03:46: or life You know till you are growing its grows with you.

00:03:51: But when your then in puberty face how to say it stops with growing.

00:03:56: but if remodeled all right

00:03:59: doesn't mean we model.

00:04:00: it means that it has some certain cells that can reduce pieces of bone and one that can push the growing.

00:04:08: So you always have growing, and resorption-growing... And there's a whole constant remodulation model.

00:04:18: so everything impacts on it!

00:04:21: If you are little bit fatter or stronger with too much force in your bones they will start to be stronger.

00:04:32: purpose to feel this body or to stick to these bodies, take the weight.

00:04:38: And if you are not they will remodel it differently.

00:04:41: so through your whole life they remodelates all of time.

00:04:44: So pressure

00:04:45: is important right?

00:04:47: All the impacts hormones pressures cytokines vitamins...so many things influence on remodulation

00:04:55: for today's conversation.

00:04:56: The pressure I think as one of a nice connection with what we're gonna talk next.

00:05:01: Because of course if we go to the mouth, pressure coming from chewing your teeth will reinforce the bone.

00:05:09: So what happens and why is important?

00:05:13: To be careful with it when you remove a tooth.

00:05:17: that happens through all mouth mandible etc...

00:05:21: So, it's quite lots of signs behind the extractions of tooth.

00:05:26: It so many publications out beautiful ones like one from Dvuzar that is explaining how each extraction little bit reduce the bone.

00:05:36: So pretty much whenever you extract a toot its some kind damage on your bones.

00:05:41: Bone needs to heal and first step will be healing pattern.

00:05:46: blood comes.

00:05:47: So this is the first weeks of healing, what comes in the depthness that we have?

00:05:53: We provide ourselves a hole where the tooth was socket and we get first blood with blood.

00:06:03: it's first type of healings.

00:06:04: so cells are there.

00:06:06: they start boosting vessels forming new vessels their forming healing pattern.

00:06:11: They want to provide place for fill with the first soft tissue And then in the next steps with a bone.

00:06:18: Yeah, but what is happening?

00:06:20: Is that pretty much their whole life and even clinicians now in dentistry they are fighting with the soft tissue soft tissues such a strong organ also because it puts always pressure Constant pressure on a bone.

00:06:35: So if you remove the tooth and pressure of the soft issue goes and goes It will lose the volume off the bone.

00:06:42: Why do I believe so important to keep the volume.

00:06:46: It's very important for us because every change of the volume changes space between two that you have there and also space, the volume or losing the volume where you will maybe need to replace further with a new tooth You know?

00:07:01: We cannot be without tooth all the time With holes inside So... And pressure is crucial The pressure on soft tissue.

00:07:13: well biology is really important there, that soft tissue grows fast.

00:07:18: Bone not so much!

00:07:20: So you always need to give a time for bone to grow?

00:07:24: Yeah

00:07:25: the same reason why.

00:07:26: okay it's this different topic which we'll probably cover some other times but that's why in the GBR procedure et cetera, but that's another topic.

00:07:36: But so let's go back to what happened... Let say we are in the aesthetic zone.

00:07:41: I remove a tooth.

00:07:42: okay there will be immediately some response from the body by what happens to do bone into the aesthetics if you don't do anything?

00:07:51: Yeah!

00:07:52: If he doesn't do any thing this is quite problem.

00:07:55: and somehow it starts almost like standard or people start they're still not doing anything.

00:08:04: And for me, it's very unclear why.

00:08:07: because science and papers showing leaving sockets dry like we say or leave its socket without any treatment in that step of extraction leads you with such a problem after.

00:08:22: You know?

00:08:23: You lose the volume then you need to make an implant maybe further than... Then you need.

00:08:32: It gives our patients situations that they need to spend so many money in the end.

00:08:41: To achieve what could they achieve, at same time of extraction?

00:08:46: They lose their volume because when you extract a tooth and especially an aesthetic zone... You'll loose your volume!

00:08:52: But let's say

00:08:54: for implant or bridges.

00:08:56: So if we lost the volume then the aesthetic for bridges Esthetic for implant will probably not even be possible, but for aesthetic bridge also you lose possibility of long-term good success.

00:09:12: So we've been working on a socket management campaign.

00:09:17: that would come later.

00:09:19: so can you tell us the three major situations and what it's being done today in those three cases?

00:09:30: Yeah, well we can divide it somehow as a three cases.

00:09:32: Like you said I like it.

00:09:34: yeah simple like a socket.

00:09:37: one two three socket to one simple situations when you have all the bone around and after extraction if you really have thick bone and some consensus says that should be at least more than one point five millimeters okay?

00:09:54: And If use had this case then This is the best-case scenario.

00:09:59: It's not so often, to be honest.

00:10:02: As usual?

00:10:04: Life is never easy!

00:10:06: So this best scenario yes if we treat with in my opinion the best products could be here as a cola cone or cola fleece something like a sponge collagen sponges where it will bring these blood inside even more.

00:10:22: This would be treatment for the socket that one.

00:10:24: When

00:10:25: let say when the socket is intact the only thing we need to do is protect basically the clot and that's formation of vascularization and healing.

00:10:35: So, this is an easy part but you said it happens.

00:10:38: so the tatsop socket isn't often the case?

00:10:44: Yes!

00:10:45: The problem usually if you already need to extract a tooth probably because some inflammation.

00:10:52: High inflammation eats the bone also sometimes... it's not the friend of anybody and neither is the soft tissue.

00:11:01: So we have a socket type one like I said, not always the situation but socket tip two where i will say something that we have compromised.

00:11:12: usually this back out plate or lean when we say like this area external area an aesthetic zone line is very, very crucial.

00:11:24: Very steady focus so many signs behind that if this line is stiff strong it will be stability for the implant in long-term life.

00:11:36: So these socket if its compromise we need to protect it?

00:11:41: Protect the buckle plate.

00:11:42: We need a protective stability.

00:11:49: first line of the defense, how to say in the end.

00:11:53: So this is a compromised socket and you have a socket where you don't even have this wall because usually anatomically it's very thin.

00:12:02: so if you extract that too probably... Even these steel lines will be so fast resolved!

00:12:09: This is situation on the socket tip three or like it's really not having a back-up plate at all.

00:12:15: It is

00:12:15: the worst case scenario, and from what I understand type two is most

00:12:20: recurring?

00:12:22: One type II could be recurring because type II pretty much leads to that card.

00:12:28: Type III here if you don't do anything certainly!

00:12:32: So of course today we're gonna talk about both this innovation LavaMark shield How to use it in the socket, what indications property etc.

00:12:45: But What is normally been done or has be done so far In let's say type two socket?

00:12:52: What Is the procedure?

00:12:54: do we used by materials this bone what kind of bone grafting etc.

00:13:00: I hope we use bones and grafting and membranes.

00:13:04: We call this as a socket preservation step, i do believe that most of the clinicians goes on this pathway to if you already extract the tooth And Do these simple one-step off Putting your grafting material and membrane to close it or preserve it To preserve the hole in volume and stability.

00:13:27: You save yourself huge time of the work.

00:13:32: Especially after for the implant, especially for the bridge and anything what you will do after also preserve this volume which is crucial for resorption because biggest resorptions are always in first three months then six month rapidly.

00:13:51: You know study shows that From the paper, you can see that percentage of resorption goes in first three months like twenty percent in horizontal but still six month double sixty percent.

00:14:05: So if you don't put here and I really adore our Cerebon Plus...I need to mention one product of ours.

00:14:13: it's Xenographed and its with hyaluronic acid.

00:14:16: so when you put a few drops on just blood inside or saline doesn't matter.

00:14:21: When you mix it, do have a sticky bone.

00:14:23: Such as simple like application for treatment extract and fulfill the whole or socket with something that is long-term stable because I don't know if You know these are cerebone, it doesn't resorb so fast.

00:14:45: So you see...you will have something for long-term volume in this kind of salt.

00:14:50: That's the main goal of in general bovine bone grafting because we don't resorpt and with botus and cerebone and cerebon plus We have even our long term stability longer than other products in the market.

00:15:04: So I'll say deal, especially imagine that.

00:15:07: what do you think about that?

00:15:08: In the aesthetic zone?

00:15:09: because then we draw the profile with Serabon Plus or Cerebon and then we keep the stability there.

00:15:14: so we kind of fight this resorption...

00:15:17: Of course!

00:15:18: And especially with Serbon Plus iIthinkthis is such a machine product from the ones that we had before, or they are on a market because it has this hyaluronic acid.

00:15:29: Not even handling like I said.

00:15:31: yeah its cool and easy to manipulate Like you drop wherever you need And It doesn't flows particles everywhere.

00:15:40: You don't make so much mess And everybody needs to clean after.

00:15:44: But he has these hyaluranic acids.

00:15:46: Some clinician would say That yes i liked bovine bone grafting materials but i prefer something more biological that remodels like an allograft, like max graft.

00:15:57: So what is the idea behind?

00:16:01: Max grafts are also fantastic by materials.

00:16:03: Oh yeah!

00:16:03: Allographed which you know it will have real bone remodeled more naturally.

00:16:09: so do we mix them or in some cases We use one and then other.

00:16:13: What's your opinion about it?

00:16:15: Well allographes In my opinion golden standard.

00:16:17: we say Autologous Bone is a Golden Standard.

00:16:20: but next what can be from The Box?

00:16:23: it's max graft in that case or allografts.

00:16:27: Lots of clinicians, I'm working with using always this kind of mixture.

00:16:32: and whenever you go inside the envelope they treat and use allografes because they don't need to go over their volume or are not concerned about the volume resorption.

00:16:42: They want to have remodulation on real bone.

00:16:46: And if you go more over the overlap of the envelope or off-the-bone, or lined with a volume.

00:16:52: Yes You go with two more percentage of Xenograph in this case Serabon Plus.

00:16:57: and what is really also cool?

00:16:58: You can use serabon plus and put little bit of max graft Inside mix it all together so everything is sick.

00:17:05: then Everything is very sticky All together.

00:17:08: that's

00:17:08: good.

00:17:09: So then okay We have a socket, we need to protect it.

00:17:14: So we use bone grafted material, cerebral blasts max graft.

00:17:19: Do we leave it exposed or do you want something covered?

00:17:24: I believe that covering is the best option here... ...we don't want materials inside the socket.

00:17:34: and also I said before that soft tissue grows much faster than bone.

00:17:41: you wanna stop soft tissue to go in, the give time for bone to grow.

00:17:47: So putting a membrane it will make this kind of small barrier and It'll gives time for bones to be produced And soft tissues should go on top.

00:17:58: So here, yes.

00:17:59: We have quite a big portfolio and you know like both is three hundred sixty degree.

00:18:04: You can choose whatever you want whenever you want for every indication.

00:18:09: so For collagen members of course we have a huge Portfolio and also Colla co-protect And we have adjacent from pericardium From the soft tissue from dermis quite big source to choose and of course I would like to mention here very beautiful product that i like.

00:18:29: And you know we will celebrate even fifteen years of it!

00:18:33: Of course, I'm a final the product.

00:18:35: You're talking by book or there?

00:18:36: Yes

00:18:37: Yes, so Mukha Dham is like a soft tissue replacement or matrix that you don't even need to close with the palate.

00:18:44: You don't need to do or torture your patient immediately.

00:18:48: close the socket even over this and you boost bone and soft tissue in the same approach.

00:18:53: I mean That's one of the strength of both.

00:18:55: is that?

00:18:56: You can choose different products for every single clinical situation Even in case For example you have patients who might not want to have animal products or human product.

00:19:07: So for example, you could have in a situation like this asymptotically so they feel like pet on them?

00:19:12: Yes!

00:19:13: I love that product because first of all it looks cool.

00:19:15: there's a blue product... Like your scarf!

00:19:18: Exactly, color my scarf and then its easy to use.

00:19:21: these fantastic products yeah..so This is what we've been talking about when we talk about second management.

00:19:31: you know Resorption how we combat it, fight against resorption and this is basically the standard.

00:19:41: But now because in both of these we are a fan of innovation We come up with new ideas.

00:19:47: Now I'm saying that there's something new.

00:19:51: So what are you talking about?

00:19:55: Sneak a peek, huh?

00:19:58: No.

00:19:58: All these products that I was mentioning down the market for some years and years and even this fifteen year.

00:20:05: so but we have innovation that change all of this a lot And you know how big innovations in history changed lots of things.

00:20:15: So here We Have A Shield Such a cool name.

00:20:19: i like it!

00:20:20: It's really a shield.

00:20:22: you shield yourself a buckle plate for long-term success in such as simple technique, in such a simple approach and you protect it.

00:20:35: For volume and for bone quality.

00:20:38: And

00:20:38: also

00:20:39: what is quite cool with this product Is that It has some properties that others doesn't.

00:20:48: so we have something strong its metal but fully resorbable.

00:20:53: Yes, that's a cool thing is... I remember when the first time i showed Novomarchiv to a doctor and i mentioned this metal And of course it's clear because you use it in touch with this clearly metal.

00:21:09: But then when your add to that This is Resorbable Metal They go, wow.

00:21:14: This is such a new concept and today we will continue with understanding about the SHIELD technique which SHIELDS with Novamax SHIELDPT The properties what are the metals that you're talking about?

00:21:28: And what are their advantages?

00:21:30: Now I'm going to focus on our innovation NovamaX SHIELDCT.

00:21:38: It's been in the market for a few years already And we want to understand why SHIELD in Sock and Management is a plus.

00:21:47: What's so cool about it?

00:21:50: Why is it an innovation, so what Jarka...why SHIELDS?

00:21:54: Yeah oh this was quite the journey of developing these products.

00:21:59: I'm really happy!

00:22:07: with development of this product.

00:22:09: It was quite a long journey, around ten years and we finally have now something on the market that has purposes for something rigid strong but fully resolvable like collagen.

00:22:21: so... We are opening new indications, new techniques And it's quite innovative.

00:22:27: what you figure out in these last two or three years and starts to be such huge boom is shield technique using our shield in socket management situation.

00:22:41: So

00:22:42: let me do a step back, how does it look like when I open the box?

00:22:47: Yeah

00:22:48: How Does It Look Like

00:22:49: Metal metal.

00:22:50: yeah very often they tell me what this is something for ringing pictures to doing ringing pictures or What Is This?

00:22:58: Or Like I'm buying bi-material.

00:23:00: that's metal.

00:23:02: Yes, it is.

00:23:02: It looks like as a shield shape of ten by twenty and we are also now in the step that will develop new sizes even for specific implementation or indication.

00:23:18: but its metal shaped like a shield.

00:23:21: you still can cut Shape it, smoothed.

00:23:25: You can make convexity on it such a nice and it stays convex.

00:23:29: like this.

00:23:29: you shape It...you still can pin it!

00:23:32: You can pin with resorbable screws or non-resorbable Screws And you use the same product also with Xenographs, Allographs Collagen, Sponges pretty much all of the products

00:23:44: In Zherko.

00:23:45: you are keeping us to an ender in the dark, but let's say it.

00:23:53: So Nova Mag Shield is a resorbable metal.

00:23:56: magnesium.

00:23:57: we're going to talk about the property of magnesium and why so special later?

00:24:04: But now Let's talk about...so I open the box right.

00:24:09: he has shape of a shield.

00:24:11: Nova Mag shield as mechanically strong.

00:24:15: yeah Cut it or change shape.

00:24:19: It

00:24:20: yes, so it's not like titanium.

00:24:22: You know the tenium is very stiff.

00:24:23: yeah

00:24:24: how you place it?

00:24:25: How are you do it?

00:24:25: It's not so easy to manipulate also if I compare titanium ashes or reinforced membranes.

00:24:33: Titanium is strong this one as a metal but still You can like I said shape and cut But they still provides this stability.

00:24:42: over

00:24:42: much ship is already cut into shape So that you and we're gonna get there, so to apply it you just tunneled.

00:24:51: Okay let's talk then about exactly how this works?

00:24:55: So we've been talking about socket management...so why shield?

00:25:00: in short socket management and when?

00:25:03: Pretty much.

00:25:04: we touched the topic of one-two-three sockets in a previous episode pretty much where we are touching over the problem with back up plate too thin or compromised, not even having a bone.

00:25:23: This is where shield comes.

00:25:25: Okay,

00:25:25: pretty much.

00:25:27: There's several techniques already that are very famous.

00:25:31: one with different products like with collagen ones.

00:25:35: you have this either you know ice cream technique cage techniques for non-resorbable things With these non-reasonable members.

00:25:43: so many other techniques Are already there but all of them I think it takes lots of times to do.

00:25:50: then It needs soft tissue management and no because open up flap, you put a grafting material.

00:25:57: You put the collagen and fixate the collagen...you close the flap or suture it.

00:26:03: Soft tissue management is really hard if you are not experienced one!

00:26:08: And If you decide to NOT do soft tissue management then it has this kind of ice cone technique that goes from inside of alveolus.

00:26:21: Again, you put the collagen.

00:26:23: You put a graft in material and close it then you suture it but they all go from inside of alfellows.

00:26:30: What I am concerned is that whenever you go into alfells you lose this extra part This volume we were talking about especially in aesthetic zone.

00:26:40: you loose these buckle volume Buckle plate and buckle convexity.

00:26:46: This is what we need and concern or will be needed.

00:26:49: focus.

00:26:49: Let's do a step back walk us through Exactly step-by-step in the clinical procedure.

00:26:55: In the cases, we've been talking about

00:26:57: yeah We already did publish some even publications cases then flyers along this topic.

00:27:03: And on this one I really like it such as simple one and pretty much It shows you to do it Step by steps.

00:27:11: You know these pictures for dummies?

00:27:13: I adore them I adore them.

00:27:15: You know, i never read manuals...I just read if they are the pictures and look through their pictures.

00:27:23: so we make it as a picture you know?

00:27:26: Simple fun!

00:27:27: If you do extraction then you lose your bone if you don't protect it.

00:27:32: but when doing this one extra step involving shield there ...you protect the volume.

00:27:40: Just to explain technique by step After extraction, we go with this technique externally from alveolus.

00:27:51: Why?

00:27:52: Because you want to protect even the spot of bone that you have there.

00:27:56: if it's a little bit compromised... If its thin or anything, biology says that you should have it and we wanna protect it!

00:28:05: So what can be done?

00:28:07: very easily?

00:28:08: because it is rigid tunnel shield.

00:28:15: Yes,

00:28:16: you provide yourself shields from down all the way to apex of the root.

00:28:22: and why it's so good as a technique.

00:28:24: or why is different if I compare with tunnelling any other product?

00:28:29: It's very easy to tunnel something that is rigid.

00:28:32: yes You can see on the case That for example i Can show you the case with like this one here.

00:28:41: You see, he just provides the space where he needs.

00:28:45: Tunnel it fully.

00:28:47: If you tunnel collagen as a comparison.

00:28:50: First of all It's not so easy to tunnel...it flows...it soft.

00:28:55: Collagen is really soft.

00:28:57: Second of all..you are never certain that your tunnel till the end or to the lap-axe Because again its such a soft and you don't feel it With this....You tunnel all the way down to the residual part of the bone that you have.

00:29:14: You tunnel it and you place it so... And what is the beauty of the technique?

00:29:19: You don't need a fixate!

00:29:21: So wait a second, we do not need to do fixation.

00:29:26: It stays there in place without fixing

00:29:28: ...you don't want to do flap.

00:29:30: Okay.

00:29:31: Flapless.

00:29:32: You don' t really need to be fully fixed because it's so rigid by itself.

00:29:39: It doesn't need fixation.

00:29:41: Yeah,

00:29:42: it's fixated how you tunneled all the way down.

00:29:45: its fixated by the apical and mesial bones.

00:29:48: so it stays there.

00:29:49: And if you play even nicely and make it convex?

00:29:53: It stays and makes you this stability already of the soft tissue like You can see in a case.

00:29:59: So we are protecting the area and maintaining the space with no flap surgery.

00:30:05: We know fixation and then that's it.

00:30:08: Yeah,

00:30:08: pretty much.

00:30:10: So you can see if I compare now standard procedure flap grafting membrane fixation suture.

00:30:16: first of all i number so many products and numbers so much time off hands over the clinician.

00:30:23: And here it's really extraction detachment and tunneling.

00:30:29: And this tunneling is quite nice, like I said because it gives stability.

00:30:34: It's very important to know that the ability of shield comes from shield itself not form the graft below.

00:30:42: usually all collagen products or collagen membranes.

00:30:47: they will have a stability from the grafts below.

00:30:50: I see what you mean.

00:30:51: yes

00:30:52: and with here stability come from the shield

00:30:58: mechanically strong, resorbable or metal.

00:31:00: So you can really create a shape and so you could create a convex...

00:31:06: Yeah I joke very often You just replace the wall that your missing.

00:31:12: Very often even in Berlin.

00:31:13: now we are talking about walls Walls.

00:31:17: every wall is missing.

00:31:18: Back out play a palatal it doesn't matter where you're missing.

00:31:23: you can tunnel it and provide yourself a wall that you're missing.

00:31:26: In

00:31:27: other words, what we are doing with SHIELD is create temporary walls which would be replaced by BONE.

00:31:34: Yeah!

00:31:35: And will replace with really good quality of the BONE?

00:31:39: I have to say...I heard from many clinicians about the quality of cortical bone as unprecedented but this probably has something to do with magnesium itself Yes,

00:31:52: but also from the stability of the membrane.

00:31:56: Because what is happening if you have something rigid?

00:32:00: You don't have too much micromovements.

00:32:03: and we talk already that micro movements are very important because Every micromoom, it makes problems to the bone or biology of the cells.

00:32:16: Biology of vessels... So if you have something more stable It results with also quite nice outcome for the bones.

00:32:25: And is really that easy?

00:32:28: Tunneling

00:32:29: Yeah.

00:32:30: Well, you've never heard much shield compared to previous techniques?

00:32:34: I'll show you already one case...I can show several of them.

00:32:39: It's quite easier to tunnel this than any other product Of course.

00:32:44: And the outcome how will do closure from above?

00:32:48: Of course it is different.

00:32:50: what would be if you were doing immediacy or delay Or early implant placement?

00:32:57: This is different, but certainly tunneling of something like this.

00:33:01: It's much easier than modulating with all sorts of grafting materials and collagen as a technique simple.

00:33:10: But what I liked the most?

00:33:12: The outcome was quite different.

00:33:14: We've been talking about metal that are strong and mechanically stable but that preserves.

00:33:23: So the question is What does this metal work on?

00:33:26: Oh yeah, this metal is magnesium-based shield for us.

00:33:32: So again the journey was quite long ten years.

00:33:37: Oh development journey!

00:33:40: Like I said i switched to so many departments.

00:33:43: it was research and development new techniques and development...I always like displaying with a new toys.

00:33:49: you know?

00:33:49: This is beauty of booties.

00:33:51: overall We have such a huge portfolio and then I can play with so many products in our hands.

00:33:57: So we play with grafting materials, allografts... We have allographs, xenographs, synthetic grafting material.

00:34:04: Then we have collagen membranes non-resorbable membranes And even metal ones and resorbable ones.

00:34:10: So, so many products that we're still mixing playing and inventing new ones.

00:34:16: And I was quite in the department of New Techniques & Development when were doing this launching and development of The Magnesium.

00:34:26: It's a journey for almost like ten years overall together with other products in Pipeline But it is a journey from in vivo to in vitro all the way human.

00:34:39: We discover so much.

00:34:41: It's nice that the whole journey went and we discovered more through this journey, how it degrades, performs, behaves... ...and how healing patterns are.

00:35:00: things that help us now.

00:35:02: And, um... Now certainly we are in the state of like three years on a market.

00:35:10: We have multi-centric studies for our products because we've got a Novamax pipeline and fixation system, membrane for big augmentation but also this shield ...and registry together with multi-centric study that combines Copenhagen and Hungary, Rome and Croatia.

00:35:30: It's so many different places where we are collecting clinical data And also we have a registry.

00:35:38: it is something like real life data.

00:35:41: So, something that was very popular in Corona time.

00:35:44: I don't know if you were updating all the time results.

00:35:48: what is real life data?

00:35:49: What we are collecting?

00:35:50: it's the same with SHIELD.

00:35:52: so We are collecting all-the-time clinical cases Clinical Data comments from clinicians will listen clinicians all the Time.

00:36:00: my big what i really like Is That listening clinician input and then combining with the knowledge of the biomaterials or science behind products, or science-behind biology combined this together.

00:36:14: This is where you grow pretty much.

00:36:18: And this how shield grows.

00:36:20: So development all these indications.

00:36:23: we have so much data on it.

00:36:24: We achieve CE mark.

00:36:27: It's magnesium.

00:36:29: Let's do a step backwards.

00:36:30: I'm curious about the journey.

00:36:31: so we went of course from the chemistry, the science preclinical and and clinical with magnesium.

00:36:40: but Magnesium as material in other fields has been used even in cardio.

00:36:48: Yeah order kind of application.

00:36:50: So can you tell us a little bit about?

00:36:53: Before both is innovation in dental field.

00:36:56: now magnesium was already in use for specific situations.

00:37:00: Can you tell us a little

00:37:01: bit?

00:37:01: Yeah, it's huge science behind magnesium and its such cool material And It is already For five years on the market from different companies In cardiovascular field and also topidic fields.

00:37:15: So

00:37:16: what do they do with magnesium?

00:37:17: Its more for stents You know like syringe of putting into vessel as a stand so to provide again providing a mechanical stability for the vessel so that it can flow to blood treat pretty much.

00:37:32: It absorbs also there?

00:37:33: Yes, but gives this ability for vessels to heal through time.

00:37:38: So pretty similar what we notice in cardiovascular field and like I said its not discovering hot water.

00:37:46: magnesium is such material has huge signs behind.

00:37:50: We are just from cardiovascular field, from orthopedic fields.

00:37:55: We bring it to the dental field.

00:37:57: so we are in first company and I'm proud of that because i had a beautiful journey with my colleagues Svenja Patrick and everybody concern not only colleagues as a friends, we had the journey of putting this product on market.

00:38:14: So both these companies are first having magnesium-resorbable membrane and fixation system and shield on the markets.

00:38:26: Very

00:38:26: good but I'm a chemist after all.

00:38:30: so even before companies developed for clinical use.

00:38:38: Magnesium is a natural element that the body uses and needs, can you tell us about it?

00:38:46: Did you take your supplement?

00:38:47: I eat a lot of vegetables so i don't need magnesium.

00:38:52: Okay!

00:38:52: I use supplements...I use magnesium regularly Every day.

00:38:56: I do use, maybe different forms.

00:38:59: You have this magnesium citrate and the magnesium all-the one because i do lots of fitness And try to be healthy.

00:39:09: So pretty much supplements of magnesium are so common that everybody is using.

00:39:15: It's an element present in oral food like you supplementing magnesium or as a supplement like me, directly magnesium.

00:39:24: So it's in so many steps on vascularization purposes also muscle or this atrophys.

00:39:33: that why I'm using like for the muscle vasoconstriction of the muscles pretty much

00:39:38: if you're very relaxed after taking.

00:39:40: oh yeah for muscle?

00:39:42: Yeah for spasms and these things.

00:39:44: magnesium is also involved In so many steps of everything in the body, pretty much you can see magnesium everywhere.

00:39:53: Yes and it's a present element but for us...in that case It is very important step That each step offers remodulation on the bone.

00:40:05: So what is happening?

00:40:07: He is one who really boosts this proliferation of cells.

00:40:11: You know proliferation from like cells which doesn't know she should be.

00:40:17: She designed what she should be.

00:40:19: It boos that it can be osteoblast or osteoclasts, so pretty much osteoclust resorbone, osteoblast grow bone but magnesium push like and all these steps in remodulation in proliferation of the both Stooblast's are even more cells to be in that way.

00:40:38: So for us magnesium is very crucial that in all this steps boost bone growth, boost proliferation on the cells.

00:40:46: Okay, so but again walk us through what happened.

00:40:50: So I take magnesium, some Novamax shield from the box and tunnel it very easily.

00:40:56: Flapless no fixation.

00:40:59: now a natural biodegradation starts.

00:41:02: Walk as though what happens to our NovamaX shield in within weeks or months?

00:41:09: First of all it degrades immediately when you open up pouch.

00:41:13: So, when you get to product and open a pouch already on air it starts degrading.

00:41:17: Okay!

00:41:19: Over the time maybe even notice in metal little bit like white spots.

00:41:24: somehow it's magnesium salts.

00:41:26: And

00:41:27: this is what really interesting for us, magnesium salts because they are one who own all these lines of steps in our body.

00:41:37: progress.

00:41:38: But... What is happening?

00:41:40: You put them into your body as a shield technique and provide yourself with nice buckle plate, it starts to degrade.

00:41:48: With blood also mixing with the blood is that's the great?

00:41:52: I like to say an explain degradation of shield in two phases.

00:41:57: so one phase has this metal one It's little bit of like oxidation we have.

00:42:05: We see like hydrogen gas And metal face start be replaced in salty layer.

00:42:12: Then you have a second phase, and this is the salty layer of face.

00:42:17: We call it jelly-face metal phase.

00:42:20: jelly-phase Why?

00:42:21: Because some clinicians who had exposure or leave it exposed initially they notice It looks first metal then whitish or blackish them.

00:42:32: They noticed that it looked like a jelly.

00:42:34: Why?

00:42:35: Because magnesium salts are a much bigger molecule.

00:42:38: They need more time to be replaced in the bone or soft tissue, so they're also providing barrier function.

00:42:45: but it looks not as metal anymore... It's like jelly and metal face.

00:42:56: How long does this process roughly last?

00:42:58: So, from our DOC studies we know that metal phase.

00:43:03: it's finishing with the sixteen weeks.

00:43:05: Okay...

00:43:07: But I do believe still like i said these magnesium salts are still present.

00:43:11: so degradation of the full membrane is a little bit longer than time point.

00:43:16: but in healing pattern what means for clinician Healing is different.

00:43:23: then collagen.

00:43:24: So you put the collagen, first of all, collagen is usually white membranes.

00:43:30: And white below soft tissue looks pinkish and with magnesium or metal below a soft tissue mixed with blood starts to be blackish.

00:43:46: so soft tissue can look reddish.

00:43:50: just the color is a little bit different.

00:43:53: You could experience a little of swellings in that area, but not so much.

00:43:58: why?

00:43:59: Because it degrades slowly.

00:44:02: Magnesium degrades over time and product of degradation is hydrogen gas.

00:44:09: It's very small molecule The smallest pretty much.

00:44:12: Yes

00:44:13: exactly!

00:44:15: And it goes through diffusion to soft tissue out.

00:44:19: and especially if we put buckle platemen like buckle shields, soft tissue of buckle plate is so thin.

00:44:26: So it goes out very easily through the time.

00:44:30: but this is this metal face.

00:44:32: We notice that with magnesium shield you can have these healing or color It's different.

00:44:39: maybe a little bit of swellings in first week Or may be two But the rest is pretty much all of them are the same.

00:44:47: And tell us a little bit, okay so... Of course one side to this story we create space with Navamag shield and we have a membrane or creating a barrier.

00:44:57: more correctly said What's the role in forming the cortical bone?

00:45:05: So why is manizima good thing there?

00:45:09: I like your word a Cortical Bone.

00:45:12: I very often get from clinicians that using magnesium, they're noticing a very strict line between soft tissue and bone.

00:45:20: With other monks?

00:45:21: Yes because first of all it's very rigid membranes.

00:45:25: so the line is strict.

00:45:27: yeah

00:45:28: So this line is strictly dividing soft tissue.

00:45:32: also degradation pattern little bit do tending off the soft tissue.

00:45:39: It gives more time for bones to grow.

00:45:41: And I like to say, and do believe even though i'm coming from botus that not biomaterials making bone.

00:45:50: It's space that makes bone!

00:45:52: If you nicely listen biology and provide yourself this convexity on a buckle plate You give the space for these bones remodulate in a real bone.

00:46:07: So, In that case what is happening with magnesium?

00:46:11: That it gives such an nice outcome of strict line bones.

00:46:16: and very often on Rengen they can see like oh whitish It's so white-ish!

00:46:21: They notice this cortical layer or bone we can achieve And I never get these with any other material

00:46:33: going back, circle back to what we were saying at the beginning.

00:46:36: So we've done a lot of course studies preclinical studies also for registration across different countries which is obviously fundamental step.

00:46:47: and now we are moving from preclinal to as you was saying before collecting clinical data clinical studies on Novamag Shield.

00:47:00: Yes, we are...

00:47:01: There's a little bit about it?

00:47:03: We're running lots of studies.

00:47:04: to be honest I think this product intrigues so much experts over the world and i was privileged to be said that im in contact with all them.

00:47:17: direct contact.

00:47:18: Let me

00:47:19: ask you something.

00:47:20: You've been of course in contact many clinicians using novamag shield Thinking about the interaction with doctors, what is most typical reaction when they see healing and bone formation?

00:47:38: So first of all it's always like wow.

00:47:43: And very often I think it's sometimes misleading in a way that thinks its new titanium mesh.

00:47:52: This is where I want to explain that titanium mesh... ...I don't think it's going in this direction as a titanium mesh.

00:48:00: Titanium can be placed, especially these three D and Mace depending on the effect.

00:48:07: here you need to use.

00:48:08: what is the benefit of this product?

00:48:10: Of course they are used for big D effects but because its new Because the healing is different and because the outcome is different.

00:48:19: I always want each of them And it's my suggestion for everybody who starts with this product to start With the simplest easiest technique, even To start first with a posterior region then come into the static zone.

00:48:34: feel comfortable not that Everybody likes changes you know?

00:48:41: It looks different also.

00:48:45: It looks titanium, but then it's fully resorbable.

00:48:50: And of course you need to get used to how the product behaves in your hand.

00:48:55: The healing as we mentioned is different from collagen membrane.

00:48:59: But I was looking more for like a personal reaction Like what do they say?

00:49:05: Tell me one of the keys where you thought okay this is very cool reaction.

00:49:10: So first all...like i said changes are So heavy especially with some clinicians who are not progressive or doesn't want to change their own techniques, they're on ideas by years.

00:49:23: You know so often They say like this function with is why should I change eggs?

00:49:28: and then if i combine like five, seven reasons why it's the changes because you save time.

00:49:34: Its outcome is a better technique as a beta so you save for patient or clinician and then the outcome... So there are too many reason why not to try at least?

00:49:49: And they tried!

00:49:50: This is where this wow effect comes from.

00:49:53: I had lots of them even on WhatsApps.

00:49:55: so i'm guiding through their operation.

00:49:58: that's beauty.

00:49:59: I learned from them and they learn from me.

00:50:03: And this is where we get in such a short period of three years on such huge level for this shield development, it's that learning together gets us to these points.

00:50:15: so... They say oh if you use this technique its simpler than in comparison with the outcome.

00:50:22: then their sending me full phone pictures like Rengen pictures that's sending me look, look with this.

00:50:33: I just put the picture says more than any words.

00:50:37: i need to say you know and This is The outcome That Is Happening.

00:50:42: but they have one beautiful...I Have One sentence That I want To Say.

00:50:46: It's That They Said Magnesium Will Rewrite Bone Remodulation And I do believe it is.

00:50:53: I really believe in this product, like i said that was on a journey of development so maybe little bit biased Like my child But its changing alot.

00:51:05: We are opening new indications also for sinus lift For the big rupture of schnidarian membrane.

00:51:13: we're opening easy horizontal augmentation with just two screws and not whole sausage.

00:51:21: All this comes from real-life data and all these opening new indications brings them easier life.

00:51:28: And then patient is your life, because we know that if the patients are happy everybody's happy.

00:51:33: Let us talk about a hot indication.

00:51:36: in median implant placement Can be used shield in their indication?

00:51:44: Yes So pretty much immediately start to be like such boom.

00:51:50: Also, development of new things.

00:51:52: I think the development of digital dentistry possibility that you can put in plant and also wish off patient You know?

00:51:58: If i go to dentist then i extract the tooth.

00:52:01: Of course i want get out with a new tooth if it's possible.

00:52:04: Everybody wants this.

00:52:07: So happy patient, happier life.

00:52:09: But in BDSC it's hot topic I agree and very good option for everybody you know?

00:52:16: You save time of course.

00:52:18: um...you provide the patient immediately new tooth And uh..very crucial fo-in my opinion here to involve SHIELD.

00:52:29: because yeah we are maybe opening NEW indication in that area, now if I start talking to many clinicians who may be like oh jump on it.

00:52:39: That we are opening a Pandora box?

00:52:41: No!

00:52:42: We're just opening the new field of research.

00:52:45: Okay let's do step back.

00:52:46: so i'm curious about hearing how with SHIELD were open and the Pandora Box.

00:52:52: but you gonna do this for second tell us An implant is immediately placed.

00:52:59: What's the normal procedure?

00:53:01: And what are the advantages or disadvantages, all of these conditions we have to be careful with when doing this?

00:53:09: So in previous episodes we talked about these socket types one two three like having walls, compromise walls and not having a buckle wall.

00:53:21: So in the media, they say if you have a really perfect situation all walls stick well more than two millimeters or one point five millimeters.

00:53:31: You can do immediacy and then we come to the socket type too.

00:53:37: it's like... If its compromised ,if is too thin this one point that are mentioning all of time.

00:53:43: They said you should not Do It!

00:53:45: What would u do?

00:53:46: Is that for the media scene?

00:53:47: In that case Instead

00:53:49: you would need to save, preserve socket.

00:53:53: Socket preservation... You will need to do drafting and membrane and preserve the volume so it preserves its space.

00:54:00: like in terms of timeline we are talking about let's say six months to wait for the regeneration.

00:54:06: oh

00:54:06: yeah!

00:54:07: First you need to extract, augment Wait for six months or three months depending which grafting material you are using because we also have allografts.

00:54:18: You know with a lot of grass everything is around three four months.

00:54:21: We talk xenograft, so you need to wait like six maybe sometimes seven months Depending how big the effect.

00:54:27: We're going Because I do believe again i'm coming from monatomy.

00:54:31: morphology of defect dictates Everything.

00:54:35: So in that case all these two things are concerns.

00:54:39: So we can talk about year early or delay implant placement, but you have six.

00:54:45: so... We're already talking now four months, six months seven months and then implant placement after implant placement You need to wait again integration of implant for three-six months Or something?

00:54:56: And then provisional upstairs.

00:54:59: Oh!

00:54:59: It's a quiet....

00:55:00: So you've been saying that with the standard procedure we had to wait for basically roughly a year or longer, whereas the compromised socket requires attention in order to be having the correct procedure and being successful.

00:55:16: How does that change with Navamar Shield?

00:55:19: It changed so we can use shielding immediacy immediately even compromise walls.

00:55:28: So what is happening now?

00:55:31: In a mediacy approach you extract the tooth you place the implant, everything in a flatless approach.

00:55:40: Me namely invasive even.

00:55:42: well this is the problem.

00:55:44: if you have a dial situation You can do immediacy.

00:55:49: If we're talking about compromised situations make the implant immediacy.

00:55:55: yeah maybe something who's really experienced could go there as journey.

00:56:01: but it Feb, or Gailan says you should preserve and then do early-or delay implant placement.

00:56:11: And socket type three... Oh my God!

00:56:14: Preservation and then implant placement.

00:56:17: but we are getting so much cases with the socket type two of tree witch shield an implant that if they're opening like you said Pandora Boxer We are opening completely new indication.

00:56:33: Why?

00:56:34: Because they're both flatless, where there are both easy tunneling and their boat providing stability in the same procedure.

00:56:43: Yeah let me understand this because it's gonna be an interesting topic.

00:56:46: I think so.

00:56:48: of course There is a consensus about paying attention to them or compromise socket because we want to have success And as a reason for that Being a compromise socket, you want to preserve first and then add the implant.

00:57:05: How can we do... ...a safe procedure?

00:57:08: Immediate implant placement in a compromise sockets with shields.

00:57:13: Why does shield helps us?

00:57:16: So in compromised sockets they deal with an implant position A little bit maybe changing positions more to the palate or something And they do grafting.

00:57:26: But when you do grafting in such a small hole and small area where you do immediacy, it's not so easy to place grafting.

00:57:36: And especially sometimes you will touch threats of the implant surface.

00:57:42: So In that case You just place it but again like we talked about previous or episode on first episode biology would.

00:57:53: Even though you put implant or don't put implant, biology is always the same.

00:57:59: Soft tissue will do pressure on it so much.

00:58:02: So if only grafting with implant and don't do membrane but soft membranes.

00:58:10: It'll happen that soft tissues would do such a pressure on this crucial part, buckle plate.

00:58:17: it will resolve, and maybe you would not achieve in the same procedure these two millimeters that we are talking about.

00:58:26: because all this studies shows in biology that resorption of a bone is crucial for any procedure.

00:58:35: So if you do immediately and then grafting on the same approach, resorptions could happen especially in aesthetic zone as specially in a back-up plate immediately.

00:58:49: What will happen?

00:58:50: You lose implant and you don't want to lose implant.

00:58:53: if your money wise, time-wise patient wise pain wise...you dont wanna compromise implant that position there then loose it.

00:59:04: Yeah, because the treatment after that it will be even more worse.

00:59:08: Why there's a consensus?

00:59:09: Yes So how is this changing with shield?

00:59:11: so we chilled.

00:59:12: yeah We like you can see in cases and these cases maybe several cases while we are talking now This case shows such a beautiful result and outcome in the same procedure.

00:59:26: And all these cases, I don't know if you know but we get award together with Clinician as best cases for several congresses also in SEPA.

00:59:38: for some congresses Novamak is very like award product In this case.

00:59:44: Yes!

00:59:44: We are collecting so much data on immediacy.

00:59:47: Why?

00:59:48: Because with such a rigid product, if you tunnel it.

00:59:52: You are certain that you came for the apex of the bone?

00:59:56: You're certain that your make convexity with the miziel bone?

00:59:59: Are you certain to make the hole where you will put graft and then graft can go easily tunneling in?

01:00:06: And again, you could use Cerebon Plus like sticky one so nicely put it inside.

01:00:12: Is this correct thing?

01:00:13: these terms off?

01:00:15: Okay I compromise socket... the back wall or the back of all is not there completely.

01:00:21: So I use Novamax shield, which temporarily it's going to work as a wall and with weeks and months he's gonna remodel basically into a cortical bone.

01:00:34: And that's why even in our sockets That this knot intact we can do immediate employment placement.

01:00:41: Is that correct?

01:00:42: Yes!

01:00:42: And walk us through The exact procedure.

01:00:46: Yeah, just before that I want to mention something very crucial.

01:00:51: People adore synthetic products more and more.

01:00:55: you know they don't want to use maybe animal sources... They don't wanna use sometimes human particles or animal particles depending which animals.

01:01:03: it's so many diversity but synthetic ones they won't use it.

01:01:07: Synthetic ones on the market are usually non-resorbable.

01:01:13: Well, you have some products that are like non-resorbable with immediacy.

01:01:18: But can you imagine to use something that is non-reasonable and you already placed an implant?

01:01:24: You've already provided the prosthetic... And then

01:01:27: what?!

01:01:27: You need cut a soft tissue to remove this non- resolvable product or membrane of even the tenure meshes which they are with these implants!

01:01:39: It's such a nightmare for touching already something that we often joke.

01:01:44: Don't touch papillas, don't touch soft tissue!

01:01:46: Don't cut it if you don't need it.

01:01:48: So...it is very crucial.

01:01:50: We have something synthetic but its fully resorbable.

01:01:54: so You can use something stiff immediacy, but still it will be resolved.

01:02:00: So you are not cutting soft tissue or not performing second surgery.

01:02:04: You're not touching this beauty of Soft tissue...you know how they look like around prosthetic and these beautiful area.

01:02:12: so This is important!

01:02:15: place and replace this buckle plate.

01:02:18: Like we are saying, like we're replacing walls you provide a space longer space to soft tissue not collapse And You make grafting material give the time that your giving with volume for bone to be grown and again synthetic fully resorbable it can without fixation and flap less.

01:02:42: so I answer on all questions.

01:02:45: what are requirements for immediacy in the end?

01:02:48: And okay, you said that this kind of indication.

01:02:52: we're receiving a lot clinical data.

01:02:55: Oh yeah!

01:02:56: Are we organizing these clinical data to move towards more systematic studies or will running study prove with stronger evidence than Novomag Shield can be used as an indication?

01:03:12: Yes We are running now four or five studies in that point of view, some of them in this early delay placement because it is the only option for us to get trefine and have a sample on our bones.

01:03:28: And I had my personal problem where I don't believe Rengen pictures still do not have histology you know?

01:03:36: So we were running these kind of sockets evaluations of the bone which shield different kind, is it sponge below?

01:03:47: Is it coaxanograph or collagen.

01:03:49: So depending what we are using as a graft immaterial and depending on which morphology of defect is.

01:03:56: but immediacy yes We're running studies with University in Lisbon also And we were running university in Chile.

01:04:04: so What's quite nice that socket type three even as a crucial deficiency or not having buckle plate We are opening in this indication to place an implant and provide stability with the shield immediately.

01:04:25: So yes, we're running these three four sides.

01:04:27: that's where I am participating.

01:04:29: You know I'm waiting To get results.

01:04:31: And um, I hope you have.

01:04:33: we are opening completely new indication

01:04:35: now.

01:04:36: Okay nice.

01:04:37: so we are exploring all possible options within the three types of sockets with Novomag Shield.

01:04:45: What would be your message to a clinician that opens the box for the first time?

01:04:52: How should they start?

01:04:57: This socket management that we were talking about in previous episodes and everything, is the simplest technique.

01:05:04: And I adore it because...I think in dental practice each day they have at least four or five extractions and some kind of socket managements.

01:05:16: First of all like i said some them don't treat at all sockets.

01:05:21: They leave just blood clotting and sponge.

01:05:25: I believe that if they add just one step of this tunneling and providing stability, please protect these buckle plates because it's so many papers saying like buckle plate depends on implant.

01:05:38: Buckle plate depends volume buckle plate but its all buckle plate, buckle plate.

01:05:42: So If we protected in that once step after extraction i think for them They will see outcomes so easily.

01:05:52: They will know what to do after, but this would be the perfect indication.

01:05:56: To start socket management.

01:06:00: is it about missing little bit buckle plate?

01:06:03: Is it a tin easy destroyed?

01:06:04: and also sometimes when they extract the tooth day they broke they butcher.

01:06:09: Sometimes buckle play today because its then you can broke.

01:06:12: save in that step You will be more than happy in the outcome after for placement of the implant like you would and also maybe bridge construction or volume stability.

01:06:26: But this is first indication that they can do so often, I believe even a classical general practitioner can very easily start with it to see how it behaves.

01:06:39: because like I said comparing with some other techniques and also soft tissue management, maybe not everybody are so on the level.

01:06:49: but this is such a simple technique to try it.

01:06:53: And of course i think every clinician likes have new toy in their drawer.

01:06:59: So if they start something like these ,i believe that many clinicians will trying the other stuff again after also.

01:07:11: You would say then extract a tooth and just shield it?

01:07:15: Just shielded, pretty much!

01:07:18: Good thank you Gerdner.

01:07:20: we will see eachother in all their episodes, sixty minutes We'll have clinicians or colleagues on botus so stay tuned.