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Microscope-Assisted Peri-Implant Reconstruction with Dr. Yi-Chen Chiang
129 Plays1 month ago
Listen as Dr. Flavia Pirih interviews Dr. Yi-Chen Chiang on using a microsurgical approach to offer more predictable outcomes in peri-implant defect reconstruction. Read the full article here. https://aap.onlinelibrary.wiley.com/doi/10.1002/cap.10265
This podcast is produced by the American Academy of Periodontology. To learn more visit perio.org.
The views expressed in this episode are those of the participants and not necessarily those of the AAP.
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Transcript
Journal Updates & Editor Introductions
00:00:00
Speaker
Whether you are in training, in practice, or in research, the Journal of Periodontology and Clinical Advances in Periodontics have something new for you. Hello, everyone. I'm Dr. Efio Anido, and I'm the editor-in-chief of the Journal of Periodontology and Clinical Advances in Periodontics.
00:00:35
Speaker
All right. Hello, everyone. I'm Dr. Flavia Pidi. I'm the associate editor of the journal of periodontology and clinical advances in periodontics. I'm here with
Podcast Introduction & Listener Engagement
00:00:44
Speaker
you at Probing Perio, the podcast that explores and dives into clinical and translation work in periodontology and implant dentistry. This is a side note. If you have enjoyed probing perio, please help us by rating the podcast on Apple Podcasts, Spotify, or whatever you're listening. And please leave us a review. It will help us continue bringing you great episodes and guests.
Dr. Jo Chang's Journey & Study Introduction
00:01:09
Speaker
We'll kick off today's podcast with a special guest, Dr. Jo Chang. She's the first author of the study
00:01:16
Speaker
um on microsurgeries in perian pontitis. So, Dr. Cheng, can you tell us a little bit about yourself and your work? Hello, Dr. Peier, and hello everyone. I am Dr. Oh, my formal name is Yichen Chang. I'm originally from Taiwan.
00:01:33
Speaker
and everybody calls me Joe and I just graduated from University of Michigan grad period in 2024 and I relocated to Seattle in the Tacoma area to to be a periodontist in private practice.
Study Insights: Ultrasound in Periamentitis
00:01:50
Speaker
Okay, so can you tell us a little bit about this study? Yes, so the this project originally is actually like a side project of my master's thesis, which is um using ultrasound and ah just to detect the bony structure around the periamentitis patients.
00:02:12
Speaker
And some of the patients in our study originally were doing reconstruction, reconstructive procedure, and we're also doing implantoplasty, or we're doing resective, or even implant removal. So when i when we did those clinical procedures, I found that that the hardest procedure to do those ah surgeries was actually the reconstructive methods. So Dr. Chen, who is my thesis mentor, he helped me out with starting this project. And then we started by basically ah as a side project of my
00:02:55
Speaker
thesis, but in the end, it actually gave me a lot of fun just to dig into the knowledge and all the opportunities and challenges but behind this this hot topic, which is very interesting and I learned a lot from it. Awesome, great.
Benefits of Microscopes in Surgery
00:03:13
Speaker
So how did they use of operating microscope enhance the precision of the treatment in this case series?
00:03:21
Speaker
Yeah, so um the microscope actually gives a lot of visualization because it has the a coaxial illumination. And also ah the magnification ranges from 5 to 30 times of the ah the magnification, which compared to the regular dental loop, we usually use 2.5, 3.5, or the maximum 4.5.
00:03:51
Speaker
So in using the um the good visualization and also the magnification, we were able to see a lot of ah things that we cannot ah using we cannot see using just bare eyes or a dental loop, especially oh like the deposits, calculus, or the bacteria, or any even residual cement that we saw in some of the cases in my master thesis that it's just very easily to be, uh, detect and basically identify the etiology, uh, using the microscope. And then we were able to use it using micro instruments to remove the etiology, uh, by using the operating microscope. All right. So I think if we were to talk about the 30 X, which for us, I think it's quite interesting. And as you've mentioned, and
00:04:46
Speaker
Loops, usually we use loops up to 4.5, even though there are other loops. So you think really the main advantage of using the microscope was really to identify and help with surface decontamination? Do you think that was the biggest advantage for your study? Yes, at least from all the cases that we've done. um I originally, when we were doing some cases in my master thesis, there are some projects, there are some patients that we didn't use operating microscope at all.
00:05:16
Speaker
And just because maybe the microscope is not really available during that time. um But in the end, once I started to use microscope treating, at least the reconstructive methods. After that, I try my best to use the operating microscope to treat the perimatitis because then I know um the ones, if I don't use, I probably miss something else, especially um not in just reconstructive. If if we're doing like implantoplasty, there's some titanium particles that's very easily just leave in the soft tissue or even on the bony structure.
00:05:54
Speaker
um Just by bear eyes or a loop, sometimes it's harder to see. But with microscope, it's actually very easy. You'll see the shiny particles. Okay, I need to get rid of this in your order to getting some good outcomes for the procedure. So ah basically the visualization and in order for the micro instruments to be ah used under the microscope is also very, and very important because any movement under the microscope seems massive. So you are more tender, you're more gentle in order to not create any additional um bruises, tears, anything that sometimes under the microscope, you see a big tear, but when you move the microscope away, so how it's nothing.
Challenges & Learning Curve with Microscopes
00:06:45
Speaker
But under microscope, it's so obvious that you will you are actually forced to be more gentle because you can see what you're doing basically. Yeah. And how long do you think was the learning curve to use the microscope? so Um, I am very glad and also in the beginning is kind of tough as well, because, um, because of my thesis, Dr. Chen and Dr. Velasquez, they, um, they're the, basically the experts in using microscope. So Dr. Chen actually kind of forced me in the beginning that he will just pull over a microscope and said, okay, let's try this today and start from very beginning to in the end of my third year.
00:07:27
Speaker
I definitely feel more and more comfortable. um He used to tell me that even he as a master clinician in microscope, he still at least practice 10 minutes or 15 minutes every day just to make sure that he gets the feeling of the hand, like the sense of the touch basically. um I am not as diligent as he is, but I tried that um for example, sometimes once a week I will um have the microscope over and try to practice on the rubber dam just to practice some suturing and I started
00:08:06
Speaker
Some easier procedure like the just a easy flap on the lower interior area which is the most the easiest part to start microscope and Then gradually adding one more challenge into every single procedure like later doing um calf CTG or doing tunneling sometimes it's a little bit harder because of the position and then we shift it to the posterior teeth which I We also require some patient compliance as well because it's harder for the patient to move back and forth using microscope. But um I think constant um practicing and also get a feeling of how to use it prevents the barrier from getting even like bigger gap. And that was something that I'm really grateful during the residency. I was able to get this training and it helped me a lot to appreciate
00:09:02
Speaker
how a more gentle touch of the surgery can provide good one healing for the patient. The post-op care for the patient is actually really nice. that they um they just There's less pain and they don't really need that much of the pain meds.
00:09:21
Speaker
Usually they're really happy that I'm doing microscope on the patient because I mean they see the big setting as a how you guys are doing something big and then they get there. They're actually happy. That's all they're proud of the research. So ah Yeah, it's there's definitely a barrier for using microscope, but I think the key is that just to practice and not be afraid of accepting the challenges and then after a you um over the curve. It's actually something that, oh, I want to use it because it's beneficial instead of it's all preventing me bye from getting this procedure done. So it's a different mindset.
00:10:06
Speaker
And I know we have just started your practice. And so are you using the microscope are you or are you planning to use the microscope in your practice?
Incorporating Technology in Practice
00:10:14
Speaker
Yeah, so I just started in a private practice a month ago. So recently, there's a lot of stuff that we need to buy because there's something that um ah Basically my boss used to use that and I'm more preferred doing the other way so there's I I am trying to convince my microscope um but it probably needs some more time, but I am I really see the the benefits of doing this for the patient and even just for myself so that I can have a peace of mind and that I know I see better and
00:10:50
Speaker
So yeah, I am actually planning to use microscope in the practice. So I think since we're talking about the difficulties in actually you know maybe purchasing a microscope or changing your practice towards a practice that uses the microscope, ah why do you think this is not more readily adopted? Do you think it's the cost of the microscope? Is it adjusting the practice? Or what are the barriers that are out there for the use of the microscope?
00:11:18
Speaker
So i think I think mainly two reasons. The first one is definitely cost. That if we want a private practice to adopt to a new method, on the surgeon will need to feel like it's ah making profits or more beneficial than what they already have worked in their hand.
00:11:40
Speaker
So ah first of all, the cause is that I was adding some more cause. Am I going to use it? And is it going to delay my treatment timing? So those are the thoughts that, of course, is one of the obstacles that might lead to not using microscope in the clinic.
00:11:58
Speaker
And the other one should be because of the learning curve that we were just talking about. ah Usually, it's a little bit harder during when you're in private practice already because ah those patients, they're not supposed to be used for practice. I mean, in residency, the patients, they're more tolerable because they know that we're residents, we're learning, so it's okay to Not okay, but it's more acceptable and tolerable that it takes longer for us to prove to do the procedure But in private practice everything is kind of faster so it probably require more time that you need to practice and outside of the ah the clinic time. So then everybody is busy and everybody wants to go home after work and have fun and rest. So this is possibly also an obstacle that adopting microscope into private private practice if um the surgeon has never used it before. But there are also like some kind of live workshops going on that you can get used to practicing. but
00:13:04
Speaker
a lot of it is just behind the scene that it's really needed that to get yourself used to how you see the instruments and get a feeling of the ah instruments under the microscope. Oh, I also think of one more thing. ah I think the training of the ah surgical assistant is also very difficult as well because when you're working under the microscope, your field is very narrowed and it's kind of limited. So whatever bigger gesture under the microscope makes a surgeon kind of
00:13:41
Speaker
dizzy a little bit. So the surgical assistant kind of needs to know where and how they should deliver the instrument to you. ah And basically the training for this part is also kind of difficult as well.
00:13:57
Speaker
But it's all doable. If we can do in residency, which we are not really experienced surgeons, I think it's also doable for a master clinician. Maybe the learning curve will be even less because they already know most of the ah skills that they need to do. They just need to adopt to a new technique, basically.
Study Impact & Future Research Plans
00:14:21
Speaker
Is there anything else you would like to say about about the project, about the cases?
00:14:28
Speaker
that we haven't covered so far. So I think overall I really like this paper because it was part of the master thesis project and I learned a lot from just ah seeing those cases and learn from Dr. Chen and Dr. Velazquez. They are really great in ah using microscope and and I had this opportunity to learn from them and then ah basically improve my surgical techniques as well. And also the by biology behind all these reconstructive and the to help the patient and also to possibly do some contribution to the period field, which I'm very honored to be part of it this project.
00:15:20
Speaker
Sounds good. All right. So could you tell our listeners how they can find out more about you, about your work and also to follow you online? So yeah, I'm currently working as a periodontist in private practice in the greater Seattle area in Washington state. So you can find me on Instagram. My Instagram account is called that period philosopher. The philosopher is floss instead of philosophy by using floss. And or you can email me at dr.chiaeng at periodphilosopher.com.
00:15:59
Speaker
Sounds great. Thank you very much for being here with us and good luck setting up the microscope in your practice, hopefully in the near future. And I think to end, if you like this episode, share it with your friend and subscribe to this podcast to get the latest episodes wherever you're listening. You can also rate it, write a review and follow us on social media.