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21 July 2021

The Pandemic and the Future of Dentistry: Interview with Prof. Markus B. Blatz

Prof. med. dent. Markus B. Blatz is Chairman of the Department of Preventive and Restorative Sciences, and Assistant Dean for Digital Innovation and Professional Development at the University of Pennsylvania School of Dental Medicine in Philadelphia, Pennsylvania, where he also founded the Penn Dental Medicine CAD/CAM Ceramic Center, an interdisciplinary venture to study emerging technologies and new ceramic materials while providing state-of-the-art esthetic clinical care. Dr. Blatz graduated from Albert-Ludwigs University in Freiburg, Germany, and was awarded additional Doctorate Degrees, a Postgraduate Certificate in Prosthodontics, and a university professor.

Dr. Blatz is co-founder and immediate past President of the International Academy for Adhesive Dentistry (IAAD) and a founding member of the European Academy of Digital Dentistry (EADD). He is a Board-certified Diplomat in the German Society for Prosthodontics and Biomaterials (DGPro) and a member of multiple other professional organizations, including the American Academy of Esthetic Dentistry, the European Academy of Esthetic Dentistry, the International College of Prosthodontists, the American College of Prosthodontists (honorary member), Academy of Osseointegration, and O.K.U. Honor Dental Society. He is the Editor-in-Chief of Compendium of Continuing Education in Dentistry, Associate Editor of the Journal of Esthetic and Restorative Dentistry and of Quintessence International, Section Editor for the International Journal of Prosthodontics, and serves on the editorial boards of numerous other recognized scientific dental journals. He is co-author of the international bestseller “evolution – contemporary protocols for anterior single-tooth implants,” which has been translated into over 8 languages.

Before joining Penn Dental Medicine as Chairperson of the Department of Preventive and Restorative Sciences in September 2006, Dr. Blatz was at Louisiana State University (L.S.U.) Health Sciences Center School of Dentistry in New Orleans, where he served as Chairman of the Department of Comprehensive Dentistry and Biomaterials and Assistant Dean for Clinical Research. During his tenure at L.S.U., Dr. Blatz also directed the Master of Science in Oral Biology Program and was a senior faculty member in the Department of Prosthodontics. From 1994 to 1998 he was an Assistant Professor and from 1998 to 1999 a senior faculty member in the Department of Prosthodontics at Albert Ludwigs University Freiburg School of Dentistry in Freiburg, Germany.

A widely published and internationally respected lecturer, Dr. Blatz’s primary focus within clinical practice and research is esthetic dentistry, emphasizing implantology and dental materials, particularly ceramics and adhesion. Dr. Blatz is the recipient of multiple teaching and research awards and has published and lectured extensively on dental esthetics, restorative materials, and implant dentistry. He was recently named one of the “World’s Top 100 Doctors in Dentistry”.

How deeply do you think the pandemic affected dentistry here in the U.S. and worldwide, and what advice can you give to your colleague both on the clinical and University sides?
There's no question that it was very, very impactful to everybody, at every level. However, the actual impact was greatly defined by the response of respective governments and regulatory agencies, which varied greatly, not just by country but also by region. So that’s why it's difficult to generalize it.
Some countries closed all dental practices for a specific time. We also were under lockdown here and had to close all our dental clinics except for emergency care without rotating instruments. After the lockdown, we were among the first dental schools in the U.S. to reopen their student clinics completely in early June 2020, following all required precautions and personal protection equipment guidelines.
Not everybody seems to understand the importance of oral health and its effect on general health. That understanding, however, made us want to get back on track as quickly as possible to serve our patients and the greater community. While some had questioned the willingness of patients to seek dental care after the lockdown, the response from patients has been tremendous and made our clinics busier than before.
Colleagues in private practices have reported the same response. Patients are seeking more dental treatment than before, which is interesting. However, like our own dental school clinics, many colleagues are booked out long in advance. Besides possible oral health neglect for the months of lockdown and no regular dental treatment, one other factor for that phenomenon may have been patients’ change in spending habits. Without the ability to spend resources on travel or luxury items, some may feel compelled to invest more in their personal and oral health.
While serving our patients and community, our key mission as a dental school is to educate and graduate competent dentists. When the “total lockdown” was enforced with only short notice, one of our greatest challenges was related to patients in the middle of complex dental care procedures. The transition to exclusive online teaching was relatively smooth since we already had a very robust online training, learning, and exam platform in place. For years, our students have been equipped with mobile tablet devices, which contain course information, manuals, instructional videos, lecture links, exam software etc. Online and blended learning concepts have long been part of our teaching portfolio. The missed clinic time by dental students was substituted with life online seminar presentations. In addition, we developed novel virtual “clinical” examinations to teach and evaluate students’ ability to connect foundational knowledge with clinical applications. 

How did technology change the way dentists work, and how ready were you to adopt this innovation so fast? 
We focused on digital dentistry for many years, first mostly in respect to laboratory procedures and now increasingly for chairside digital dentistry. We have taught intraoral scanning and delivered CAD/CAM restorations for many years. Still, We recently placed greater emphasis on chairside digital technologies, a development further accelerated by the pandemic. We are now producing roughly 80-90% of all single-unit indirect restorations in our in-house Chairside CAD/CAM Design and Milling Center. We have employed dedicated dental laboratory technicians who assist faculty and students in designing, fabrication and finishing their CAD/CAM restorations. We still work with external dental laboratories for all other restorations, especially complex and multi-unit reconstructions.
I believe that the need to have longer patient appointments and perform more procedures in one seating, which limits the frequency of having to change personal protection equipment and cleaning treatment areas, has vastly accelerated the trend towards chairside digital dentistry. We were somewhat lucky that we were already prepared for that. Our intensified online teaching efforts during the lockdown were also instrumental in building on already existing training courses on digital dentistry for our students and faculty, which allowed us to vastly increase the application of CAD/CAM technologies to record heights after the lockdown.

Just a little more question on the academic side - how was it for a new grad in dentistry that graduated during the pandemic?
From a social aspect, I am sure it had tremendous effects. Not celebrating this milestone in your life with family and friends in person is simply sad and unfortunate. From an academic standpoint, the timing was such that the lockdown was towards the end of their dental student career. By that time, I believe we had them prepared well enough. This is aided by the comprehensive care model we teach our students in. Students start seeing patients from very early in their careers. The courses where they perform most of their clinical general dentistry treatment stretch over two years. This allows them to provide dental care in a comprehensive and phased manner, starting with periodontal treatment and caries management and, after reevaluation, completing the necessary restorative and prosthodontic treatment. Therefore, dental students in their last year had already completed most if not all their requirements by the lockdown time. Plus, they had to complete virtual clinical exams to demonstrate competency.
Interestingly, after the lockdown has been so great, the demand for dental care has been so great that students in our clinics are providing care at record numbers with significantly more clinical experiences than any class before. There is always a nice relationship between the dentist's role and his team and the ability to adapt to new technology.
What's your thought about this relationship, and how far can we push it? Analog dentistry will not go away, and we teach it both ways. In fact, I believe that one cannot be a good “digital” dentist without being a good “analog” dentist. Technology, at this point and in the foreseeable future, will not take over completely everything that we do, but it can help us in very specific ways. We're not trying to be fancy and “jump on every train that leaves the station”, but, integrate digital technologies where they make sense and properly prepare our students for their dental careers.
Current digital workflows, including intra- and extraoral scanners and chairside and laboratory-based CAD/CAM systems, have reached a level of quality as good as or even better than conventional ones. Another key argument is the enhanced patient experience, for example, through intraoral scanning, digital smile design, or in-office restoration fabrication.
For our dental students, digital tools are second nature to them, and they adapt to a virtual and digital environment with ease. First-year students are already learning how to use intraoral scanners and digital design in the preclinical simulation laboratories. They embrace digital technologies with enthusiasm.
There is already a significant shift in the use of digital technologies in dentistry. Besides digital impression making and restoration fabrication, they are increasingly used in the diagnostic and treatment planning stages. This includes technologies that detect caries, automatically read radiographs, and collect patient information from CBCT, intra- and extraoral scans, and photographs to develop an individual treatment plan. Artificial intelligence and machine learning tools are becoming more prevalent in automating many of these steps while removing subjective operator-related bias. AI will soon become critical in esthetic and functional planning and design and material selection, customized for each patient. We will also use information technology to track and compare general and oral health data to better understand the pathology and prevalence of certain diseases. Merging these data sets and applying AI will enable us to understand diseases like never before. This will also improve preventive measures and allow us to treat our patients better.

Obviously, you have an incredible career both in the academic and clinical size and as a professor and educator. So what kind of advice can you give to your young colleagues?
First of all, do the right thing for your patients. Make top-quality care your goal, not financial gains! Help patients keep their teeth as long as possible, be minimally invasive, understand each patient’s specific needs, and treat them accordingly. Make every single restoration the best you can. And keep learning from your mistakes. When something fails, don’t start blaming the lab or the material or the patient, evaluate yourself first and think about what you can do better next time.
Careers in academia are quite different from private practice and have to be built step by step over many years. While they come with some sacrifices, they provide opportunities to move dentistry forward through technologies, education, and research and positively impact the people who listen and the patients they care for.

“My request to you is to not settle with what we teach you today but to continue to learn. So keep the curiosity, challenge yourselves as well as others, and remain innovative thinkers for the advancement of our beloved profession and the benefit of our patients.”

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