#23 - Dr. Martina Stefanini – Why Soft Tissue Decides Implant Success

00:00:01: Welcome everybody to Botterstocks!

00:00:03: Today we are with Martina Stefani.

00:00:05: Ciao, Martina come va?

00:00:06: Ciao

00:00:07: bene grazie!

00:00:08: So uh... We sometimes speak Italian but this podcast is gonna be in English and Martina just start with.

00:00:15: before saying anything I'm going show you a photo.

00:00:18: This is a surprise!

00:00:20: You remember it?

00:00:21: Yes i remember that.

00:00:24: Do you remember where?

00:00:26: San Petersburg or Rafa?

00:00:29: No Ah

00:00:29: no..no

00:00:30: I think this was Colombia

00:00:31: Colombia!

00:00:33: We traveled a lot together.

00:00:34: Yes,

00:00:35: exactly This was when we did the Bonnet Tissue Day in Colombia and with Giovanni Duquelli went up to the mountain.

00:00:42: Yeah

00:00:46: I love this photo because yeah...we were having fun.

00:00:50: I think it was almost eight years ago

00:00:54: or something?

00:00:55: Maybe, yeah something like that.

00:00:57: We look the same.

00:00:58: Exactly,

00:00:59: perfect!

00:01:00: My hair is a little bit darker

00:01:03: Maybe even better like their wine.

00:01:04: Very

00:01:07: good I lost some weight so it's good.

00:01:10: So yeah we did lot of things because...I think i met Zukelli in two thousand fifteen and then you were doing a PhD at that time.

00:01:19: Yes exactly.

00:01:21: And uh..i think in twenty sixteen or seventeen, or something a couple of years later.

00:01:31: Yeah and then we you know... We started pushing the Bothys world so that Giovanni could get to know Munkodermelso Martina And since then with on a lot of congresses events we traveled together.

00:01:48: But yes this is what I wanted say before like We did a radio podcast, do you remember?

00:01:55: Like yes.

00:01:56: Yes!

00:01:57: There was ten minutes of podcasts with only audio and the things that were terrified at this podcast... Do you remember these?

00:02:06: So we tried to say the same thing like in Toronto.

00:02:12: Now I remember…we are in Berlin for another meet event

00:02:16: And there was a previous colleague and I was like, Arturok what are you doing?

00:02:21: Why are you so terrified.

00:02:22: So i'm not terrified but i was saying to Martina that i was terrified when i interviewed Giovanni Zichelli in February.

00:02:30: But now...

00:02:31: You were relaxed with me.

00:02:32: Yes of course

00:02:33: we do much more relaxed but also with Giovanni.

00:02:35: it's okay!

00:02:38: Of course we know each other since ever.

00:02:41: When i came back the boat is in October you know, I missed four or five years and in these four-five years Martina became incredibly influential around the world.

00:02:54: So i was checking at your CV or career.

00:02:57: so yeah university professor RTI fellow um...and you have a lot of applications and a lot citations.

00:03:08: i was tracking the citations.

00:03:10: It really feels like in these years you became very influential In the world of periodontology.

00:03:18: So, The question is do You sometimes at three o'clock in the morning think wow I Really did good?

00:03:27: I Can tell that probably the most powerful experience in my professional career was One year ago At europea during the live surgery in front of more than five thousand participants.

00:03:45: And when I did that, at the end i said you did a good job and you can be proud of yourself!

00:03:53: I think this was the most powerful moment in my career.

00:03:57: but yes...I'm happy..I am satisfied ..but ...i always think that I could do something better.

00:04:07: I'm quite a perfectionist, and so i try to improve everything.

00:04:13: But this is something that I heard from many even you know high-level clinicians the live surgery.

00:04:21: it's not easy?

00:04:23: No

00:04:23: What happens in your head when you have a life surgery in front of five thousand people

00:04:29: ?

00:04:30: From my point of view Life surgery is something that's really useful when you are doing it in front of a small audience because You can explain what you're doing.

00:04:42: People can say across to you and And this is of help when you are trying to teach him.

00:04:51: But in front such a big audience, I can tell that for me it's something people wanted to organize just so they see having trouble or making a failure?

00:05:03: No!

00:05:04: Yes if i would be the one who had to organize a big congress...I wouldn't put live surgery because there were many moments during the live surgery in which you have to turn the head of the patient, You have to do movement.

00:05:19: You cover what you are doing.

00:05:22: so it's boring for the audience.

00:05:24: So it is much better To edit a little bit The life-surgery and to provide a real life Which is smooth and shorter And more interactive and interesting For the...for the audience!

00:05:40: The live surgery Is something that people would like you to make a perforation or some mistake.

00:05:46: And this was what I was thinking before, and saying it myself okay come on Martina if are going to make the perforations have say show must go on.

00:05:55: I will tell you how to deal with the complication and this is not... But

00:05:59: there was no perforation?

00:06:00: No, luckily!

00:06:03: Very good.

00:06:04: but one thing that because when we do events or for example Parastology this year i'm always in the audience so i hear people it's okay.

00:06:15: So first question You know, we've done a lot of events together.

00:06:18: We do lots of events everywhere.

00:06:22: Usually on the academic side you really are an expert in literature and so people think they know about you.

00:06:30: but what is it that people don't know?

00:06:35: What's your difficult question?

00:06:41: There're many things where people at professional level don't even know me.

00:06:50: Probably they didn't know that I am a mother of three biological and one non-biological daughters.

00:07:01: And this is the most important part in my life, i think The biological one, eighteen, sixteen and fifteen.

00:07:10: And the eldest one she's almost twenty-six.

00:07:13: Oh nice!

00:07:14: So you said that were going on holiday?

00:07:16: Yes with them... With all of them we are female power.

00:07:21: Very good You're gonna talk about female powers at some point but let us first discuss a few other things.

00:07:30: I'm very curious also about young Martina.

00:07:38: So I met you when we were doing the PhD, so that was already in the Perio world.

00:07:42: But why did you get there?

00:07:46: Dentistry is okay and maybe new people around do dentistry but how did you choose peri-o?

00:07:53: And where did you realise that soft tissue is such an important thing?

00:07:57: You know...I decided to study dentistry because my father, my grandfather…and also – I don't know what to say in English– the father of my grandfather!

00:08:08: were dentists.

00:08:10: So it's a family tradition, I'm the first woman in my family to be a dentist and so you know when i was little there was my nanny who told me the story that I was saying to her.

00:08:25: please open your mouth!

00:08:27: I have to check if you had some decay on your teeth?

00:08:31: It is something that was probably in my blood.

00:08:38: the university career, at a certain point I met professor of restorative dentistry who asked me to do the thesis with him.

00:08:50: And i started working in restorative field.

00:08:54: but then I met Professor Duccelli and my father told me we need someone to take care of the perio part in our practice.

00:09:05: So if you are interested, maybe you can start being more focused on that!

00:09:11: And after the lesson with Giovanni... ...I was really amazed by this topic.. ..and then i started working with him.

00:09:23: at the beginning I was focused only on the clinical aspect.

00:09:27: In my mind, My job in my private practice with my father and having enough time to take care of my future family.

00:09:38: So that idea wasn't at all to remain a university.

00:09:43: But then The more...I worked for Perio And working as a university The more I started to be passionate in research, teaching and at the end my life is Perio University.

00:10:02: Yeah that's what...I think if you go check or see Martina's career it's like a real balance between clinical and academic world.

00:10:14: but i think people especially from coming through lectures know or, you know like that.

00:10:24: You're really doing amazing research but what do you like about it?

00:10:29: So first of all... Do you like teaching?

00:10:32: Yes, especially in teaching to the undergraduate student at the university because they don't know anything!

00:10:41: They have a very smart mind and are open.

00:10:45: so sometimes they ask me some clever questions.

00:10:49: older people that are already used with some concept, they're familiar with some concepts don't have this smart and brilliant idea.

00:10:59: So I really like to teach young students And i'd like to spend time with them to transfer my passion for this topic.

00:11:13: So yes, teaching probably is one of the best part of my job!

00:11:18: Nice.

00:11:18: so let's say that we have students in front us and why do we need to care about soft tissue?

00:11:26: In general

00:11:28: you know I am focused on soft tissue but i'm also And this is probably the most important part of university in treatment for periodontal disease and maintaining healthy, periodontally and peri-implant soft tissue.

00:11:54: For sure I wanted to teach my student.

00:12:04: healthy periodontal status is crucial.

00:12:08: And for sure, maintaining the healthy period ontal status.

00:12:11: it's something that should be maintained along with the healthy soft tissue and also aesthetic because for me differently from past in which the periodontial treatment was performing a quite aggressive way Reduce the probing pocket depth without taking care of the recession increase is something that nowadays it's completely changed.

00:12:36: We have to treat periodontal disease But at the same times we have to provide as much as possible a final aesthetic result To our patient reducing the risk of gingival recession.

00:12:46: and so What has changed?

00:12:50: So imagine you started your studying or your PhD.

00:12:55: You learned certain principles, what are the three of five key principles that have changed and we need to highlight today

00:13:05: for sure?

00:13:06: The soft tissue management is one of the most important thing that change during this year.

00:13:12: when I started We were focused on the soft tissue Management around these and the treatment of gingival recession.

00:13:23: But now what has completely changed is that role, it's important in the soft tissues around implant.

00:13:30: when I started was completely lacking this aspect completely also in the treatment of periodontal disease, in the treatment of infrabony defect.

00:13:43: When you have an infraboney defect and you have to solve this type of defect.

00:13:51: when I started The goal was just to obtain the radiographic bone-defect feel And probing pocket closure but nowadays is along with a soft tissue improvement.

00:14:09: For sure, another important aspect that changed completely from the beginning is the patient reported outcome.

00:14:16: when I started we didn't care about the patient opinion but nowadays we realize it's not details and This really changed a lot in the

00:14:30: last ten years.

00:14:31: And what are key points that change to show attention towards patients?

00:14:36: What things have become important now?

00:14:39: I try to understand what is important from our perception as dentists, as acclimations and periodontist.

00:14:47: And what's important in the patient perspective?

00:14:51: Because maybe for a patient perspective pain is more important than for the dentist!

00:14:58: The post-operative courses are also very important.

00:15:02: Also the aesthetic perception isn't always similar because, for example I can be really focused on some soft tissue details.

00:15:14: For example a little scar...for me it looks very bad but maybe the patient didn't even realize that there is a scar in his alveolar mucosa.

00:15:24: so its something we need to better understand which is the difference of perceptions and our treatment.

00:15:36: Maybe it's an obvious question, but what is the patient most interested in when he comes to you?

00:15:44: For sure nowadays patients.

00:15:47: and this is another important concept because The patient wanted to have something fast.

00:15:54: And easy.

00:15:55: yeah they saw on TikToks, someone saying that you can... Yes.

00:16:00: In the majority of the case patient Harai and this is completely different from the beginning.

00:16:05: Harai's knowing many things From social media, from AI platform.

00:16:11: So they know They come to me And said I know That You Can Do This And This?

00:16:17: No!

00:16:18: This Is Not Scientific Supported.

00:16:20: I Cannot do that.

00:16:21: I have To Do Something That Requires More Step More Time.

00:16:25: And this is another important difference with respect to the past in which the patient was used to come and say what's possible, but there were no doubts on that.

00:16:42: Do you think because I said scientific evidence put it together for patients who are reading some stuff intraceptivity?

00:16:51: So

00:16:52: how

00:16:53: do convince or show the patient that scientific evidence and clinical evidences are fundamental for their approach we're going to take with them.

00:17:03: This is a different quest because, you know since I work at university my patients know do research, so they know that what I say is based on an evidence.

00:17:23: But maybe for other young colleagues who did not work at the university anymore it's more difficult to let them to trust, instead of trusting TikTok like my daughter.

00:17:36: She wanted a piercing on her tongue and I said you cannot have a piercing in your tongue because that is going create a recession on the lingual aspect which was very difficult for

00:17:45: me.".

00:17:45: And she said no it's not true!

00:17:47: On Tiktok there are some differences where they say come if go on Puppet you can find an article published by your mom.

00:17:53: That said, you can have gingival recession on the lingual aspect wearing piercing in your

00:17:58: tongue.

00:17:59: Okay that's a very good practical tip I did with all this!

00:18:03: You probably... yeah okay make sense because i mean i guess The

00:18:07: trauma?

00:18:07: Yes

00:18:09: but then so let say uh you know i'm a clean clinician and then i don't have so much access to university or academia And i want to update myself.

00:18:20: what is the ...and im gonna read latest articles, what is you think the most misunderstood topic about?

00:18:29: let's say soft tissue around implants?

00:18:31: So are there things that we need to highlight or stress that I'm misunderstood.

00:18:39: The fact it people believe that soft tissues something.

00:18:45: if they want You can deal with them, but it is not so important.

00:18:50: Which isn't true at all because now we realize that We need both born and soft tissue.

00:18:57: It's not a matter which is more important.

00:19:00: I always said to my student if i ask you wearing a trouser or t-shirt.

00:19:07: You cannot go outside without the T-shirt, you have to wear your trousers and in the right position.

00:19:16: The same is for the bone of the implant and the soft tissue For the implant!

00:19:21: You can not have proper implant supported restoration Without taking care both bones and soft tissues.

00:19:30: That's it

00:19:31: And so let's go a little bit more practical.

00:19:33: Let's say that you are in situation where you have to augment the soft tissue on an implant, what of things do they look like?

00:19:40: So...let us see what we can see!

00:19:45: It is always about planning.

00:19:48: This is another crucial aspect for me when I perform surgery or whatever type of surgery.

00:19:56: When i arrive at the day of my surgery I already know exactly the plan from the beginning to end.

00:20:05: So I always make a visit and take all of that information.

00:20:11: in relation with case, if it is around tea or implant...I need different types of information.

00:20:20: but once i collect everything carefully evaluate everything regarding soft tissues The timing of the soft tissue is crucial, so you have to decide.

00:20:38: It's difficult to make a summary... Of course!

00:20:40: ...of my decision but is in relation, if you are in the ascetic area or in posterior areas.

00:20:47: If you want to place an immediate implant a delayed implant... ...if you're in an elci-patient and periodontal patient.

00:20:54: so these all aspects that should be taken into consideration.

00:20:57: but when I have to evaluate for example an edentulous area You need to evaluate it for sure.

00:21:05: The born amount But the quality of the soft tissue, these two parameters should be taken into consideration at the same time in order to decide if you need to increase both.

00:21:17: The timing... You first start with a soft tissue to facilitate the bone regeneration in second step or maybe have started with the bone regeneration and then on the second stage place the implant and deal with the soft tissues.

00:21:30: so this are all aspects that should be carefully evaluated based on a presurgical documentation that you have to carefully study.

00:21:40: So let's do our...

00:21:41: It takes time, sorry to interrupt but this is important for me because it takes time and seems like part of the job.

00:21:52: we don't ask patients to pay in which they study!

00:21:57: the case.

00:21:58: But this is crucial, especially if it's a multidisciplinary case.

00:22:02: I never study alone because i have not the competence to discuss about the crown or the abatement.

00:22:11: so I really like to discuss with all my team in order take that right decision.

00:22:17: and let us make specific example.

00:22:20: So lets say you are in aesthetic area.

00:22:23: Naively, I would say you remove a tooth.

00:22:25: Naively i would say your decision to place an implant immediately or not strongly depends on bone.

00:22:32: but what is the role of soft tissue in that here?

00:22:36: In that decision making

00:22:40: So...I may decide.

00:22:43: The first important thing it's that perform an immediate implant only if I am in a healthy patient.

00:22:50: If i'm treating periodontal patients, it's another story and we are not speaking about that.

00:22:56: but for sure the amount of remaining bachal bone is crucial.

00:23:04: And what about the soft tissue?

00:23:05: For me, immediate implant in the ascetic area always need an increase of soft tissue thickness.

00:23:13: At the same time!

00:23:14: Yes if I'm placing the implant... ...I am placing for sure a connective tissue graft and going to increase the soft tissues thickness.

00:23:25: because If i wanted to have two millimeters of soft tissues thickness around peri-implant supported restoration in the aesthetic zone, I can tell you that in ninety five percent of patients don't have two millimeters soft tissue thickness on their own soft tissues.

00:23:47: So they need to increase them.

00:23:48: Basically we could say every time at least in a spatic zone yes you needed to increase your soft tissue and it's not just about the thickness but also about the keratinous tissue around.

00:24:02: No, in the aesthetic area it's a matter of soft tissue thickness because the keratinization is an external characteristic which depends on the position of the mukhojinjival junction and you can get an increasing keratinized tissue with realignment of the Mukhojinjival junction.

00:24:25: So speaking about single-implant restoration.

00:24:29: I'm not talking about the dental frontal area in which you need GBR, this is another story.

00:24:37: but when i'm speaking about a single implant replacement uh...I am NOT worried about keratinized tissue in these areas.

00:24:46: it's a matter of sub-tissue thickness

00:24:49: one thing that we haven't mentioned especially for students who are watching me.

00:24:54: so..i think have paper clearly studying the effect of soft tissue management.

00:24:59: You have many papers, but where you see a higher survival rate of the implant and lower risk of perimplantitis?

00:25:09: So why is soft tissue in the thickest around the implant so relevant besides aesthetics?

00:25:18: because they are capable to create the soft tissue seal preventing bacteria contamination and maintaining the peri-implant health stability in the long term, providing an area that is easier to clean for the patient.

00:25:40: To maintain the healthy quality of the soft tissue in this area.

00:25:45: so it's crucial both frontal and also aesthetic areas.

00:25:49: And we've been talking about single implant.

00:25:52: What are more complex cases?

00:25:55: For example, we need to do a GBR first.

00:25:58: how is the big picture workflow in that case?

00:26:04: I can tell you that i'm mainly periodontist as you know and dealing with majority of my daily practice periodontal procedure and let's say single implant rehabilitation or small implant rehabilitation.

00:26:25: I'm not the one who made big bone regeneration, this is in my feel of... In the head of my confidence it outside my confidence area My confidence zone.

00:26:44: But anyway if we have patient that needs this type of bone regeneration.

00:26:55: Again, it depends if in the aesthetic area or in the distal areas.

00:26:59: because in the gestal area differently from the frontal area we need to have keratinized tissue.

00:27:08: but because Because in the posterior area, when you have a trophic ridge.

00:27:18: You have complete absence of vestibule death that does not allow patient to maintain proper way for future peri-implant restoration because they cannot brush and so on this area The idea is to deal with keratinized tissue increase deepening the vestibules dead end creating condition, anatomical conditions that can be more comfortable for the patient to maintain in a healthy way.

00:27:48: So

00:27:48: one thing I want to say is by doing the podcast i'm learning so much!

00:27:53: It's good as a crash course of a sufficient monitor.

00:27:57: now Of course we are both... We have biomaterials and one of our star bi-materialists Mukoderm a collagen matrix, derma collagen matrix.

00:28:10: So the idea is of course for us it's very interesting... ...the situations where a substitute can support your work.

00:28:20: so and Of course The tissue of the patient this local standard.

00:28:25: but what do you think at the key aspect?

00:28:27: of the Tissue that the patients that make it a gold standard?

00:28:33: Yes For sure.

00:28:34: as a researcher and since the patient reported outcomes are nowadays becoming so important, we're trying to investigate possible alternatives for connective tissue grafts which is now a day the gold standard.

00:28:54: but that presents some disadvantages.

00:28:57: And first disadvantage is for sure the postoperative morbidity of patients low postoperative morbidity.

00:29:06: because especially when you become more familiar with the harvesting technique and When you are dealing With small rehabilitation.

00:29:17: Because again, it's different if I'm dealing with an entire upper arch in which i need a huge increase In both soft tissue Soft and hard tissue.

00:29:28: but But for sure trying to find something that can be an alternative is part of our research job.

00:29:41: And the idea, you know... The most important mechanical properties that connective tissue grafts present are capability to stabilize the flap in the coronal position and this something which we still need to work with the soft tissues, because I think that nowadays... ...the most important role of the soft tissue alternatives for the collagen matrix is to be capable of creating a scaffold, to incorporate the blood clot remaining completely covered and protected by the covering flap.

00:30:29: A covering flap that should be completely passive and coronally advanced without any tension which remains stable in its final position will allow the blood clot that remain into the scaffold of the collagen matrix to mature and become, with time new connective tissue.

00:30:53: So I think this is most important role for the collagen matrix nowadays And maybe in future the collagen should become capable to stabilize the flap in the coronal position.

00:31:07: I think that the flap remains stable when it contains a band of keratinized tissue, or at least one millimeter because of the disapitalialized anatomical papilla.

00:31:29: And this is something that with a collagen matrix we should work to obtain the same capability.

00:31:36: Yeah, taking... The tip?

00:31:38: We are working on it!

00:31:39: So since I'm back and going back to conferences in Congresses have been hearing several times—I was very surprised about talking about this overgrowth that has been seen, also Giovanni Zucchelli was talking about it in one of the previous episodes.

00:32:04: So what is it?

00:32:05: Why happens and... What's your take on it?

00:32:10: Giovanni now he's obsessed with overdraws!

00:32:14: I'm not!

00:32:24: It can be a possible adverse effect of the connective tissue graft, but on the other side it's positive effects.

00:32:34: It depends which indication you are using the connectative tissue graft and it depends on many factors some of them related to patient palatal fibromucosa characteristics And sometimes it's something that we perceive as a non-esthetic condition, but maybe the patient not.

00:32:58: Sometimes It is true and real complication.

00:33:03: So for sure one of most important things to learn recent years is that we are trying to see as much of possible the connective T-sugar that we harvest from the palate.

00:33:20: Because if you use a thick, connected T-Sugar that derives from the desepitalization of a free gingival graft these can have tendency to grow over time too much

00:33:33: and

00:33:34: And when it is too much, can be to much also for the patient because It provides an area which she's excessively prominent and convex that can deserve a surgical treatment For correction of the overglow.

00:33:54: This very difficult.

00:33:57: So we are trying to reduce as much as possible the thickness.

00:34:02: What is the thickness you're aiming at?

00:34:05: roughly?

00:34:06: Around these, nowadays I apply connective T-sugar graph that are around zero point eight to zero point nine for sure less than one millimeter of thickness after this epithelization.

00:34:19: So very thin layer a little bit thicker when i'm dealing with implant rehabilitation because aim to obtain two millimeters of soft tissue thickness between the flap and the graft.

00:34:36: In that case, two millimeters is good enough?

00:34:38: Yes

00:34:40: not more

00:34:41: because then you can experience an excessive overgrowth with time.

00:34:46: And um...is this predictable?

00:34:49: I mean You are harvesting.

00:34:51: Can you predict in some way That This will happen?

00:34:53: or

00:34:54: Yes, when this type of technique with the free gingival graph techniques and desipitalization you harvest a connective tissue graph which is immediately subepithelial without any fatty and glandular tissues so that entire amount thickness that you fix during surgical procedure will remain stable.

00:35:15: We didn't experience any shrinkage if we experienced something where time is further growth which is exactly the opposite, so it's very predictable.

00:35:27: Good!

00:35:28: So in terms of soft tissue management this is a very wide topic.

00:35:34: I want to narrow that little bit also because roughly one week ago there was an initial study paper with Ilham Munsif on the use of Cerebon Plus shield and Mukodarm in stocking management.

00:35:55: Can you tell us a little bit about objective of protocol before talking to them over their results?

00:36:02: Yes, this was let's say we can say that it is kind pilot study, a preliminary study to evaluate the effect of this new magnesium membrane that is aimed at reducing the post-extraction socket and rebuilding it in case of need for rich reconstruction.

00:36:36: Since it's a new material with new chemical properties, we wanted to always be very as a researcher.

00:36:48: Very careful and start with the kind of pilot study to evaluate safety And also patient reported outcome The effect on soft tissue due to the chemical properties material and basically if I can go to the preliminary result we have a very positive results in terms of patient reported outcome, soft tissue healing.

00:37:29: We are still waiting for clinical outcome on the bone regeneration and also from an histological point of view.

00:37:38: Because again, since it's a preliminary study we wanted to have full pictures of these combinations.

00:37:47: but in terms of soft tissue We are having very good results without the need for connective tissue graft covering with collagen matrix not to provide the first intention closure, because when you try to obtain a first-intention closure after tooth extraction.

00:38:08: The amount of coronal advancement it's allowed and you can reduce the vestibule depth which is something that we tried to avoid as much possible.

00:38:19: so if we don't completely cover the biomaterial with soft tissue The idea is to place collagen matrix that can remain a little bit exposed, to protect the biomaterial into the socket and avoiding the risk of an excessive vestibule depth reduction due to the coronal advancement of the flap.

00:38:46: And so we are satisfied with soft tissue healing and the patient reported outcome after this

00:38:59: procedure.

00:39:00: Yeah, what is struck me besides the results on a soft tissue was they reported pain from the patients which were very low?

00:39:09: Yes exactly as I was saying to you uh...I think that the soft tissue manipulation it's something when we become familiar with these types of of manipulation is related to low pain, because it's a very gentle surgical procedure.

00:39:34: This is why I like this type of surgical procedure which is delicate that require microsurgical instrumentation, microsurgical suture and so the pain usually for the patient is always very low.

00:39:52: in these types surgical procedure that is not only related to the soft tissue, but the way you open the flap.

00:40:02: The way your suture...the way you take care of the soft tissues and how you handle the entire surgical procedures are performed in order to reduce as much as possible the morbidity and also this case what we observe almost Nothing.

00:40:20: Yeah,

00:40:21: that's very good.

00:40:22: So before we go to our favorite topic

00:40:25: yeah

00:40:26: let's do a series of Rapid questions.

00:40:29: so yes no okay?

00:40:31: Okay first I will start with.

00:40:33: Let's say you've done the surgery after surgery Coffee or nice campfire spritz?

00:40:39: It depends if it's a morning surgery, or late evening surgery.

00:40:43: So in the morning campfire Spritz!

00:40:45: Exactly In the evening coffee because the night is still young

00:40:50: Very good.

00:40:51: And If you were not in Perio what would you do?

00:40:53: Or What Would You Be Doing?

00:40:55: Probably Psychology

00:40:57: Ah Nice.

00:40:59: Then another silly question Strachino o burrata

00:41:02: Burrata?

00:41:03: Very Good.

00:41:05: That requires a long explanation, but we're not going to do this.

00:41:09: And let's say that you go into a Congress.

00:41:13: would you prefer big city or small beautiful town?

00:41:19: It depends on the probably big cities and I can visit new place.

00:41:26: Okay

00:41:27: very good.

00:41:27: so rapid question done for the marketing department.

00:41:32: So, but one thing that we definitely need to talk and we save this for last is the following.

00:41:38: We've been having in Botez and I think people who follow us have seen it a beautiful event with twenty women coming from around the world including Ilham Munsef.

00:41:47: We already mentioned her And was about...

00:41:50: And also Valentina.

00:41:52: Valentin

00:41:52: Benioff exactly!

00:41:53: Another relics of mine.

00:41:55: Did they like them?

00:41:57: Yes They were really, really happy about the event.

00:42:03: They enjoy it a lot and yes... The atmosphere I think was really nice.

00:42:12: Nice to hear!

00:42:13: I saw pictures on Instagram.

00:42:15: they said was a pity.

00:42:20: Next time we do it together!

00:42:22: But what is surprising, maybe not surprising but you know I was talking to the organizer or my colleagues who organized their event and they had a little bit of statistics.

00:42:32: so for example in Germany the percentage of women doing a PhD in dentistry pretty high like almost seventy percent and similar that this maybe is not the key data point.

00:42:47: You know, in Italy it's the same.

00:42:49: we have seventy percent of students at the dentistry school who are women.

00:42:58: but if you then look into their career We think only twenty or thirty per cent of full professors in academic areas were women.

00:43:13: In the at the base there are a larger amount of female but in the apical position we still have The majority of men.

00:43:26: and then the question is what happens in between?

00:43:30: There were so many problems in between.

00:43:32: some of them probably belongs to To that, too.

00:43:38: The tradition today history of women condition because the politics around women, support of women in job are still linked to the past.

00:43:56: But things and situations change very fast.

00:44:03: if I think about my grandma... She was at home, she was taking care of the kids.

00:44:11: She was taken care of her nephews and that's life for women.

00:44:17: so nowadays it is completely different.

00:44:20: my daughters grown up with a mother who works a lot trying to obtain their I would say freedom.

00:44:29: because you know job for women especially not in...I can't say we live let's say, lucky part of the world.

00:44:38: But in many countries to have a job is to have freedom and I think there is strong unbalance globally in the world.

00:44:50: then we have some countries which are more developed We're more Let's see In advanced in this right women rights but we still many countries in which we have a lot of problems.

00:45:07: I think Italy, We are in between

00:45:11: and you're doing a lot to change this?

00:45:13: I'm trying but...I am trying because as the mother of three four daughters And as women As um..as i would say also A little bit role for my younger colleagues, because now I have a lot of colleague.

00:45:31: A lot of.

00:45:31: Hilem is my PhD student she's women and she has a mother Valentina Bentivoglio.

00:45:38: She's a woman an oral surgeon And the year struggling to have good balance between family life career.

00:45:51: So...I try not do as much possible to improve women's condition, at least in our field which is a small field.

00:46:04: Let us say that what would you say for young students who want become a dentist?

00:46:10: A woman student or female student... What do we just say there?

00:46:20: They have to find it difficult because Nowadays, if you are a woman.

00:46:30: You have still to demonstrate much more than men To obtain together the same position to get those the same visibility If your good is not enough and And so they have to be really focused.

00:46:46: but on the other side it's also I saw.

00:46:50: they asked me So how can i have family?

00:46:52: if I wanted to be a mother, and in Italy it's still difficult.

00:46:55: If you have family or kids politics are not supporting women that want to maintain their job... I had my daughters when they were young with lots of energy!

00:47:12: And I was lucky because there is a family and husband who supports me on this.

00:47:22: I was privileged.

00:47:23: I have a privilege in my life to be able to raise my daughter and at the same times, try to work as much possible.

00:47:33: but this is not for everybody.

00:47:37: so if you are women or want it get higher position then know that you need to work alot.

00:47:46: Ok!

00:47:48: Let's close on a positive optimistic note.

00:47:53: What was for you a woman role model?

00:47:58: Woman role model?

00:48:02: in dentistry is not easy to say because there are very few women that were quite well known when I started.

00:48:16: There're lot of women that are of my age, so we're almost middle-aged women.

00:48:25: That I was admiring a lot all around the world.

00:48:31: Let's say Magda Fares, Charlotte Steelwood, Isabella Rocchetta, Irina Seiler...I have lots of colleagues who I admire but they were at about same age.

00:48:43: So in our field it is difficult to say role model And for sure, I have in my family.

00:48:57: grandma was a role model for me because she was as i was saying mother of six.

00:49:04: She was working at home but she was really open-minded and during my life some suggestion that I still have in my mind and she was really always supporting me, even if it's from the beginning of the nineteenth century.

00:49:28: So completely different mentality but she has an open mind And this is something which i try to take into my mind also when we get older to learn from the young.

00:49:47: Nice, an open mind.

00:49:48: I learned and this is great!

00:49:51: Thank you Martial.

00:49:52: What

00:49:53: a pleasure for me.