18 January 2023

Dr. Nick Fahey: ‘My book is a love letter to guided surgery’ Part II

Mary Guiden

In this second part of a two-part interview, Dr. Nicholas Fahey talks about his new book that offers practical applications and solutions for simplifying dental implant cases. He is a specialist in prosthodontics and an expert in all aspects of implant dentistry, practicing in Woodborough House, located in Berkshire in Southeast England.

“Guided Surgery: Making Implant Placement Simpler” provides an overview of virtual surgical planning, offering a path for clinicians to learn more about the fascinating world of computer guided implant surgery. Fahey is the lead clinician for a team that practices a multidisciplinary approach to patient treatment and care. He is involved in all aspects of digital dentistry, in particular, using CBCT scans in conjunction with virtual implant planning software for computer-guided surgery. Also, more recently, Fahey has become interested in guided surgical navigation, 3D facial scanning and digital analysis of jaw movement in real-time using MODJAW. He has lectured worldwide on topics such as computer-guided surgery and virtual implant planning.

Q: What’s the future in digital dentistry – what do you see taking place in the next five years?

Fahey: There are several technologies I’ve been eagerly awaiting but haven’t quite seen them come to fruition. One is optimal coherence technology (OCT), which we’re beginning to see being used in the ophthalmological field.

I believe OCT could be a great tool in dentistry for intra oral scanning. This is because OCT is somewhat like a combination of infrared scanning and ultrasound. The big advantage with this tech is that just like Superman’s x-ray eyes, you would be able to see through tissue, including fluids like blood and saliva. Conventional intra oral scanning technology is limited in the fact that you can only scan what you see. To be able to scan through tissues, or saliva or blood containing fields — that would be an absolute game changer.

Using OCT, you could even potentially scan through the tissue and see where the implants and healing abutments are underneath the tissue. These healing abutments could then even have all the information encoded on them to be read by the scanner and to improve the speed of treatment for our patients. I’ve been quite excited about the thought of a device like this.

Another thing I’m looking forward to seeing is affordable 3D printing of ceramic, which I believe will replace milling technology in the next few years. They are available now, I believe but are very expensive. Like everything new, once the R&D is recouped, and this technology becomes mainstream, I believe the cost should rapidly come down.

The holy grail would be chairside 3D printing of tissue, i.e., being able to print new bone and soft tissue for a patient. We are using more and more autologously derived biologics like PRF, PRGF and growth factors like BMP-2. The best situation would to be able to create some form of matrix to go in a 3D printer that would allow for us to print out new hard and soft tissue specific to the individual patient. Ideally this would be possible from a simple blood draw prior to the surgery.

I also firmly believe that robotics will become increasingly important in the next five to 10 years. You just have to look at neurosurgery and the way surgeons used to remove brain tumors; 90 percent of brain tumors were removed using a stereotactic technique. The surgeon would just cut away what they felt needed to be removed by eye. Nowadays, most brain surgery is done utilizing computer assisted neurosurgical robotic units. That does not mean that the surgeon is replaced, as we are still necessary (at this stage) to plan the surgery and to control the robot, but inevitably implant surgery will change from the surgeon being the person doing the actual cutting during the surgery.

Q: Tell us about your book – what are some of the high points and topics you are proud to highlight for your colleagues and students?

Fahey: My book is unashamedly a love letter to guided surgery. Guided surgery and getting the most out the 3D information we collect from our patients has been a magnificent obsession for me for many years. In the book, I talk about my philosophy of how being a somewhat ‘ordinary’ dentist using these tools have made it easier for me to be better at my job.

The book is also a clinical handbook that informs on how we use guided surgery to deliver predictable and safe results for our patients. It’s a little bit like saying: ‘If I can do it, using guided surgery, anyone can.’

I am self-taught in this realm. I’ve been involved in guided surgery for over 20 years now. A number of us pioneered this work. Twenty years ago, there just weren’t people to go to for mentoring, help or advice.

This is changing, but if you read my book, you will save yourself 20 years of learning. Effectively, the book is aimed at people who want to avoid the pitfalls of trying to find this stuff out for yourself.

Some dentists might say: Guided surgery adds too much additional cost, my patients couldn’t afford that. But can your patients afford for you not to use it? Especially as guided surgery increases the predictability of your treatment.

By the time you see the patient for surgery, you have effectively, virtually carried out the surgery twice. Once, when you plan the case and a second time, on the day of surgery when you review the planning. It means for most people that surgeries become much more straightforward, predictable, and low stress. This is a win for both you and your patient. I’m a type A personality and I want to do the best job for my patients. I’m easily able to recognize the difference in stress for me, if for some reason I do a surgery without following the systems and processes required to utilize my guided approach.

Q: What’s the audience you’re hoping to reach?

Fahey: I’m very passionate about educating dentists, not just in guided surgery but in many educational aspects of dentistry. That doesn’t just mean educating young dentists, it could be people that are new to the field.

I would like to help people get very good at their implant surgery without having to have the steep learning curve I experienced. There’s no need to suffer or try to do it all on your own. Other people have done the work to help make you better at what you do.

There’s 20 years of knowledge in the 361 pages in my book and it’s not all just for beginners. It’s also for advanced clinicians who want to find out about guided surgery. Even for those experts in guided surgery, there are still lots of gems, tips, gold in terms of advice and guidance.

The book really has three constituents of people it is aimed at: clinicians getting into guided surgery, clinicians who want to consolidate their knowledge around guided surgery and expert clinicians looking for tips and tricks to make their life and work easier.

One of the things I’ve heard in the past is that you need to have done 50 surgical cases before you explore guided surgery. If I was getting started in this field today, I would start with guided surgery. Do 50 cases with guided surgery, get good at it and you’ll easily have a simpler career in implant dentistry.

Q: What else would you like to share with the Dentistry33 audience?

Fahey: We run courses on guided surgery through the Fitz-Fahey Academy. In addition, in 2023, I’ll be speaking at conferences, symposiums and master classes not just in the U.K. but globally. If dentists see me out and about, just come up and say ‘Hi’ because I’m approachable and I’d love to meet you and welcome more conversation on guided surgery and dentistry. Perhaps even share a glass or two of fine wine – another of my magnificent obsessions.

Learn more about the Academy on Facebook: https://www.facebook.com/fitzfaheyacademy/

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