Quality is everything: Catching up with Prof. Anton Sculean

Professor Anton Sculean is chairman of the Department of Periodontology and currently the Head of Research at the School of Dental Medicine, University of Berne, Switzerland. His research interests focus on periodontal wound healing, regenerative and plastic-aesthetic periodontal surgery, use of antibiotics, antiseptics and novel approaches such as lasers and photodynamic therapy in the treatment of periodontal and peri-implant infections. While presenting at Osteology Barcelona, we caught up with Dr Sculean to hear about the specialised instruments he has designed together with STOMA.

Thank you very much for your time. I was fascinated to hear that you've designed a range of instruments with STOMA that support the clinical procedures you've pioneered. Can you please tell us more about these.

Of course. So I'm doing a lot of soft tissue surgery around teeth and also around implants.

In doing so, I'm trying to preserve as much soft tissue as possible. For this, of course, you need instruments that are tiny and sharp.

At the same time, I need a way to lift the papillae and prepare the flap, the so-called tunnel flap, because usually, I don't have any vertical releasing incisions in order to get access to the defect.

Therefore we need instruments that are designed in a specific way. With the different shapes of tunneling instruments, for example, which look like small periosteal elevators, but in a very tiny design, straight or bent, or even a novel type of instrument that is designed to lift a papilla.

With these instruments, I can manage the soft tissues in a way that is less traumatic for the tissues, and of course, it increases the chances of successful regeneration.

The clinical techniques you've developed obviously came before the instruments, so you used other instruments at first?

Of course, in the beginning, we didn't have "tunnelling" instruments or mini tunnelling instruments. So I used larger periosteal elevators or even a modified Orban knife.

I realised quite early on that these instruments traumatise the tissues because of their size. It is very difficult to work in the depth of the defect, to reach the depth of the residual with larger instruments. For two decades now, I have had an excellent collaboration with STOMA and together, we have developed new designs. And we’re still in the process of improving everything and we learn every day - but the idea is always the same. We try to traumatise the tissue as little as possible and be gentle with the tissues, because the defect will then heal by itself. In this way at least, the chances are much higher for this to occur.

Why did you choose to partner with STOMA?

It's difficult to remember that far back because we've known each other for 20 or 25 years. I think we originally met at a dental meeting and just started discussing how we could cooperate. We started the collaboration by running some courses together and I would also try out some of their instruments on my patients and provide feedback. We realised that certain instruments needed modifications. Now we have new tweezers, for example, and tissue pliers and needle holders in specific designs that allow for more gentle handling of the tissues and more precise suturing techniques.

And you've developed three kits with STOMA?

Yes. So the "basic surgery set" contains the curettes, the periodontal probes, elevators, retractors and periotomes. We have the "micro surgery kit" with a micro periosteal elevator specifically designed to maintain the papilla and also to harvest connected tissue, for example, from the palate. And we have the "plastic esthetic surgery kit" that contains the tunneling instruments in various shapes.

Are these kits specifically for periodontists or are they being used by general dentists?

They are mainly used by specialists - periodontists and oral surgeons - but also by GPs who are trained in certain procedures. It's a range of instruments that are used in all kinds of indications where we need gentle handling of soft tissues.

With so many instruments on the market, what factors should clinicians and surgeons think about when they're choosing instruments?

That's a very good question. In periodontology, generally, if you want to be gentler with the soft tissues, try to avoid using very large instruments. It's obvious that if you're working with tiny areas of tissue, you do not use a large instrument because the chance that you will destroy the tissue is higher. So, coming from this way of thinking, we try to decrease the sizes of the instruments to make them more tissue-friendly and at the same time, with specific angulation for specific areas of the dentition. If you work, for example, in the maxillary area in the anterior front or in the lateral area or maybe on lingual defects, the access is different. And we have even developed some specific instruments for the so-called lingual tunneling that is quite demanding from a technical point of view.

So how do STOMA instruments excel?

One word – quality. I have STOMA instruments from over 15 years ago that I still use today. So from that point of view, it's excellent because it's like a Mercedes. You buy it one time and in most cases, you have it for decades. I think that that's maybe the most important value and characteristic of STOMA - high quality. STOMA instruments are a little bit more expensive than some other instruments, but it's a very good investment because if you take care of the instrument, you can have it for decades. Some other instruments you have to throw away after a few months. So, that's very important.

And how does the process of developing new instruments with STOMA work?

Another good question. If we take the example of the tunneling instruments, in the beginning, we only had large instruments. I realised that it would be useful to have smaller sizes for use in the interior area of the mandible. The tissue is very thin. So, if you have a very large instrument, you have a higher chance of tearing the tissue majorly and distally. So I said, "Okay, let's try to develop a narrower one". Through this process, I realised that a small change can make a big difference.

We also modified the needle holder. In the old design, you don't get the thread when you make the knot. This was very annoying because sometimes, you make the knot and it didn't have this oblique groove. So, the suture stays stuck in the needle holder. Then you had to repeat the procedure. It was very annoying. Now, with this oblique groove, this never happens. With this groove, in fact, the suture is sliding over the instrument. So, this is excellent.

So these are the kind of small improvements we make.

So, do they hand make a prototype and give it to you to test?

Usually, yes. We discuss it and then I have an idea about a novel instrument. Martin Mazzeo from STOMA is very good at designing or bending different kind of metals. Then he shows it to me and I try it. I say, "Oh, this is nice, but you could do it better here or there". So, he's improving it and then I try it again and then at a certain moment I tell him, okay, that's perfect.

Thank you very much for your time and insight.

Thank you very much.