Scroll down to see all article references in the order they appear in this issue.
Academy News interview with Dr. Hans-Peter Weber, Osseointegration Foundation president
By: AO Fellow Mehrdad Favagehi, DDS, MS, Academy News editor-in-chief; and Paul A. Fugazzotto, DDS, Academy News Editorial Consultant
Note: This is the continuation of an article published in Volume 34 No 04 2024 of Academy News
AN: Dr. Weber, please tell us about your early dental career in Switzerland. Did you go into academics, private practice, or a combination of both after you graduated from dental school? What motivated you to leave Switzerland, and re-enter dental school in the USA?
HPW: I graduated in 1976 from the University of Berne School of Dental Medicine in the beautiful city of Berne, Switzerland. My intent at that time was to move back to the eastern part of the country, where I grew up, to take over the rural general dentistry practice of our family dentist there. To prepare myself for private practice, I had a few associate positions lined up with private practitioners in Berne, who were known to be great clinicians and mentors.
As I was about to start my first job, I received a call from the chair of the Department of Removable Prosthodontics at the Dental School, Dr. Alfred Geering, offering me a junior faculty position in his department. I had done very well in my final exam in prosthodontics and had probably gotten on his radar because of it. I consulted with my first private practice mentor, who told me that there was no better place to become proficient with making removable prostheses than the dental school. So, I decided to take the job at the school. The rest is sort of history. I quickly realized how much I liked the educational environment and how enjoyable it was to work in a team of colleagues, whose duties were teaching, patient care, scholarship and service. We continued to learn from each other and with that were able to enhance our knowledge and skills in each of the academic domains.
The problem with removable prosthodontics at that time before dental implants was that it was often difficult to treat patients, who suffered from advanced alveolar ridge resorption with satisfactory dentures. Amazing news came from Sweden, where Professors Jan Lindhe and Sture Nyman in Gothenburg had successfully treated patients with severely compromised dentitions involving tooth loss and advanced periodontal disease with fixed full arch prostheses. They were able to maintain enough teeth, often only roots, with non-surgical and surgical periodontal and endodontic means to serve as anchors for these prostheses. After completion of treatment, patients were enrolled in a rigorous long-term care program, and the authors were able to show astonishing long-term outcomes.
This excited a young clinician like me, and I was determined to get involved in this kind of treatment. Dr. Niklaus Lang, chair of the Department of Crown and Bridge Prosthodontics and Comprehensive Dentistry in Bern, had started a postdoctoral program in perio-prosthodontics, in which I was able to enroll in 1982. Dr. Lang was an excellent mentor and motivator. He was ultimately the one who convinced me to continue my career in academic dentistry.
During my time in his department, I also met my future wife, Cheryl, a dental hygienist from Boston, MA, whom Dr. Lang had hired in the early 1980’s. Having grown up on Cape Cod, she was (and still is) an avid sailor; and although we tried to convince her that sailing on the Swiss lakes was a beautiful thing, it did not quite cut the mustard for her. She often stated that she preferred being on top of a mountain than sailing alongside them.
One of the requirements on the path to promotion to professor was to spend a year or more abroad, with the purpose of having time for research and scholarship and being exposed to a different educational system. Through Dr. Lang’s connections, I was given the opportunity to work as a visiting assistant professor in the Department of Periodontology at the University of Texas Health Science Center in San Antonio, TX with Dr. Kenneth Kornman as chair.
This was also my chance to find out how living and working in the U.S. would suit me. Cheryl and I enjoyed a great year from 1987-1988 in San Antonio, personally and professionally, and it became an easy decision for me to continue my career in the US. With Cheryl being from New England, we decided to move back North and to pitch our tent in Boston. And with the help of some friends, I landed a position as research associate in Prof. Ray Williams’ Department of Periodontology at Harvard, which also allowed me to enroll into a DMD in Advanced Standings program, from which I graduated in 1990. Dr. Williams was another important mentor with a defining influence on my career. He opened the doors wide to enable the type of academic career in dentistry I have been able to enjoy.
AN: What were the similarities and differences of the dental school experience in Switzerland and the U.S., from both a student and faculty perspective?
HPW: From a student perspective, the educational components were at my time similar between Bern and Harvard. Both had a five-year curriculum, of which the first two years were spent together with the medical students, followed by about one year of primarily pre-clinical dental training before spending the last two years in patient care. Furthermore, both curricula required dental students to get involved in research.
A major difference on the educational side was that there were major exams along the way in the Swiss curriculum, the first after two semesters (1st Propaedeutic Exam), the second after four semesters (2nd Propaedeutic Exam), the third after six semesters (3rd Propaedeutic Exam), and the final exam at the end (Federal Exam). The latter consisted of oral and chair-side clinical examinations in each discipline of dentistry arranged over a period of about six months. Another major difference was/is of course the cost of dental education. Whereas it is almost tuition free in Switzerland, most dental students in the U.S. must carry a substantial tuition burden, which has steadily increased over time to astronomical numbers today.
From a faculty perspective, both systems are quite similar. To build a successful academic career, involvement in teaching, patient care, research/scholarship, and service are required of a faculty member. Research and scholarship that lead to publications, presentations at meetings, and ultimately recognition in the field, are important in both systems. In Switzerland as in the U.S. and many other countries, research, scholarship and publication as well as preparing for lectures are a labor of love and often require extra work beyond the usual office hours.
AN: Please briefly describe your research/academic career after you graduated from the Harvard School of Dental Medicine.
HPW: After receiving my DMD from the Harvard School of Dental Medicine in 1990, I accepted a position as instructor in periodontology at Harvard under Prof. Ray Williams. In 1992, I was promoted to assistant professor in periodontology and named director of the newly created Division of Implant Dentistry. In 1994, I switched departments and became chair of the Department of Restorative Dentistry and Biomaterials Sciences in the rank of associate professor. In 2002, I received my promotion to Professor with Tenure without Limit of Time as the Raymond J. and Elva Pomfret Nagle Professor of Restorative Dentistry and Biomaterials Sciences at Harvard. In early 2010, I followed a call to take over the vacant chairmanship in prosthodontics at the neighboring Tufts University School of Dental Medicine and became Professor with Tenure and department chair in prosthodontics at Tufts. I held this position until my retirement from academia in 2018 as a professor of prosthodontics emeritus.
AN: What were the areas of focus of your research as it relates to dental implants?
HPW: My interest has always been in translational and clinical research in a team approach. A major focus has been on peri-implant tissue healing and behavior over time, including placement and loading protocols. Most important were several studies with Dr. Daniel Buser and colleagues from Harvard and Bern in the 1990’s, where we could demonstrate in animal and human studies that dental implants did not have to be submerged for uncompromised osseointegration. It was quite a breakthrough at that time, because it meant that patients in many instances did not have to undergo a second surgery before the implants could be restored. This opened a lot of doors for us in our early academic careers. Later, prospective and retrospective clinical studies with a more prosthodontic focus became the mainstay of my scholarship, addressing questions of esthetics and function, long-term stability of treatment outcomes with dental implants, conventional and digital workflows and techniques, as well as complications with dental implants and implant prostheses.
AN: From your perspectives as an insightful researcher and a comprehensive clinician with more than four decades of both “pre and post implant explosion” experience, how has your perspective changed over the years regarding:
1) hierarchy of treatment selection for replacement of a single tooth? of multiple contiguous missing teeth?
HPW: For the replacement of a single tooth, the dental implant is for me the number one choice. However, systemic or local anatomical or pathological conditions may change that.
AN: definitions of therapeutic success
The definition of success of implant treatment should include the stability of the implant, the stability and integrity of the prosthesis, peri-implant hard and soft tissue health, and patient satisfaction with function and esthetic appearance in a long-term perspective.
AN: Why did you become a member of the Academy of Osseointegration? Has it been worth it? Is it still worth it?
HPW: I joined the Academy of Osseointegration in 1990 because I saw it as THE organization in the U.S. that brought all the specialties involved in implant dentistry under one roof. It has not disappointed. The programs were and still are stimulating, and the meeting allows one to connect in person with colleagues from various disciplines and from all over the world. Membership has absolutely been worth it for me and still is.
But like other academies, the COVID-19 epidemic has also affected the Academy of Osseointegration. Traveling to a meeting and interacting with colleagues in person has diminished substantially because many have become comfortable with virtual meetings. The increasing cost for attending a conference in person has not helped either. To quote a young colleague, the attractiveness to attend a meeting in person is directly related to the number, content, and quality of hands-on workshops and interactive discussions offered. The leaders of the Academy are fully aware of this and are developing new programs and opportunities as we speak. One of the offerings already in existence are the regular online lectures, which are available at no cost to members.
AN: How has the specialty of prosthodontics been impacted by osseointegration?
HPW: In a most positive way! It has given prosthodontists a tool to restore patients’ function and appearance with stable prostheses, which was often not possible prior to osseointegration. Knowing how negatively missing or bad teeth (including dentures) affect patients’ self-esteem, social ability, and overall health, it has been a fantastic addition to our treatment options. If I think back of my time in removable prosthodontics in the late 70’s and early 80’s, it still amazes me how far we have come in the field thanks to osseointegrated dental implants!
AN: What are your current roles in research and/or clinical practice?
HPW: Around the time of my retirement from academic dentistry, I received a call from my good friend Dr. Stephen Eckert, a key contributor to the Academy of Osseointegration’s mission for many years, to explore my interest in leading a ClearChoice Dental Implant Center in Quincy, MA that was soon to open. After some soul-searching and several meetings with colleagues within and outside of ClearChoice, I decided to take this unique opportunity, which allowed me to finally have my own private practice under the umbrella of ClearChoice Management Services.
To be able to restore esthetics, function, self-esteem, and better overall health for patients, who totally neglected their teeth for various reasons and were in despair because of it, has been a most gratifying experience. Since the beginning of 2023, I have been reducing my practice time at ClearChoice Quincy to one day. Two prosthodontists and two oral surgeons, all excellent young doctors, take care of most of the patients while I have been serving in the role of director of research and clinical development for the network. We have quite a few clinicians in the network, who are interested in research and have come up with some great ideas for studies.
We also have an incredibly large pool of patients. But as it goes, everybody is extremely busy in their practices, and it is not easy to find time to execute a project. In addition, performing prospective clinical trials in a corporate private practice setting is a difficult hurdle to jump. At this time we are engaging in retrospective or cross-sectional studies, for example, one on changes in tissue volumes of edentulous arches between time of surgery and different time points of healing (two-to-four months), and another on the correlation of Zirconia prostheses design and dimensions and prostheses fractures.