Implant failure is a failure for both the dentist and the patient

@AEEDC 2017; Interview by the Dental Tribune. Dentistry magazine.

From left to right: Dr Iyad Estoiny with Safwan Nached, Director of Pharmaphal. (Photograph: Marc Chalupsky, DTI)

Originally from Syria, Dr Iyad Estoiny obtained his master’s degree in fixed and removable prosthodontics in France before moving to Dubai in 1997. An implantologist and general dentist at GMCClinics in the heart of Dubai, Estoiny also focuses on prosthodontics and aesthetic and laser dentistry. In an interview with Dental Tribune Online, the implant specialist spoke in favour of proper oral hygiene and individual prophylaxis training, two areas of dental care that are essential for long-term implant success.

Dental Tribune Online: You are originally from Syria. How was the dental training at your school? Dr Iyad Estoiny: I received my DDS in 1991 from Tishreen University in Syria. There are four dental schools in Syria, along with many practitioners. A number of Syrian dentists have moved to the UAE because of their good dental knowledge. The dental education is still excellent in Syria.

Can you summarise the state of oral health in Dubai? As Dubai is a multicultural city, one sees problems from all over the world. Some patients are highly motivated in terms of their oral hygiene, while one has to put in a great deal of effort with some others. In terms of oral hygiene, I have seen that people have started to become aware of dental problems and products. In the last five years, people have become more focused on beauty and aesthetics, which in turn has led to a higher interest in healthy teeth.

We also have an overwhelmingly young population in this country; consequently, there are only a few older dentists here. Eighty per cent of expats are young. This means that one does not see any advanced periodontal problems, but one does increasingly see stress-related bruxism, which in turn leads to periodontal problems.

How would you evaluate the market for oral hygiene in this region? The market here is competitive and small. We do not sell the products, but give it to patients. If they like it, they can buy it at the pharmacy. This has worked well. For us, it is important to ensure that patients have the correct interdental brush size. This means that we tell them what size they need. A dental hygienist or periodontist usually gives instructions and explains everything. One always needs to determine the correct sizes and give proper instructions.

As an implant specialist, what do you think about prevention? There does not seem to be a strong connection between implantology and prevention at first, but just look at the problem of peri-implantitis. One needs to treat peri-implantitis as a bacterial problem and thus one must give clear instructions for cleaning, which involves interdental brushes and mouthwashes. Prevention is always the golden rule for any implant. If I do not see good oral hygiene in my patient’s mouth, I do not place the implant. I wait for a couple of months for the oral hygiene to improve. If I consider it acceptable, then I place the implant.

How do you deal with implant failure? Implant failure is a failure for both the dentist and the patient. It is a headache for dentists, and in the worst case, patients will not be able to enjoy a beautiful smile. Periodontal treatment and oral hygiene are important before and after every implant placement. Before and after surgery, I usually explain oral hygiene and motivate my patients. Just recently, I placed an implant in an 84-year-old patient. Six months after placement, I have seen improvement owing to interdental brushes. Oral hygiene treatment is mostly taken care of by dental hygienists. Most larger clinics employ at least one dental hygienist and it seems that Dubai citizens make extensive use of them. Is there a good partnership between hygienists and dentists? There is very good cooperation. I am not interested in cleaning and my dental hygienist is not interested in placing implants. We are both happy to do our work. The profession of dental hygienist does not exist in some countries, such as in France, where I lived for a long time. There, the dentist cleans and polishes for 10 minutes. Here, our appointments last for 45 minutes. We explain to the patient how to perform the necessary post-operative care.

How do you explain it usually? We simply show them how to brush their teeth and interdental spaces properly. If one just prescribes a certain toothbrush to patients on a piece of paper without instructing them, they will likely go to the pharmacy and buy a different one. If you give it to them, let them try it and help them use it correctly, the possibility of the patients buying the correct brush is higher. You completed a programme on individually trained oral prophylaxis (iTOP). What was your impression? I did the iTOP programme a year ago. Although I liked the programme a great deal, we have still seen that not all patients take the time and really apply what they have learnt. Some patients are really motivated and sit down with us to learn more about the system. The dentist and dental hygienist then work together. In today’s fast-paced world, we need to convince patients that they have to take care of individual prophylaxis. For dental hygienists and dental students, iTOP gives dental professionals a gradual awareness of how to provide oral hygiene for their patients. I think that iTOP for students will work well for future dentists.

Thank you very much for the interview.