“I was 20 years ahead”- Dr. Patrick Palacci in conversation with three perio- implantologists
Dr Patrick Palacci, a name that is synonymous with 'Palacci Technique,' is known for creating several novel techniques in Periodontics & Implantology with regard to optimal implant positioning, papilla regeneration and esthetic implant dentistry. Dr Palacci is an inspiring and influential figure in the world of dentistry, a researcher who has worked in close association with Professor Per-Ingvar Brånemark and contributed so much to Perio-Esthetics and Esthetic Implant Dentistry. Dr Palacci will answer the questions and share his expertise in an interview with three Perio-Implantologists from India - Drs. Sudhindra Kulkarni, Neel Bhatavadekar, and Akshay Kumarswamy
Dr Patrick Palacci graduated at the University of Marseille in 1975. He continued his postgraduate education in periodontology at Boston University (USA), where he received the title of Post-graduate. He was appointed Consultant Professor at Boston University in 1982.
In 2004 he received the title of Associate Professor at the University of Santiago de Chile and the University of Buenos Aires in 2006. He maintains a private practice in Marseille. His centre is one of 12 Brånemark Osseointegration centres in the world, working closely with Professor PI Brånemark.
Dr Palacci has developed many surgical techniques concerning optimal implant positioning, plastic surgery techniques and papillae regeneration. He received the Nobelpharma Award in 1995 on the most important advances in surgery over the past 30 years.
He is the author of numerous scientific articles written over the last twenty years in international journals. He is also the author of two books dealing with esthetic and implant treatment. These books have been written in English and published in nine different languages. The third book in conjunction with the technique NobelGuide was written in 2008 jointly with Prof. Peter K. Moy (Los Angeles) and Ingvar Ericsson (Sweden), also translated into Japanese. He wrote at the request of Professor PI Brånemark, a chapter on aesthetics and soft tissue management in the book “The Osseointegration Book: From Calvarium to Calcaneus” considered the bible of implantology.
Dr Palacci currently provides many courses in his clinic in Marseille, advanced courses for experienced practitioners. Groups from many countries (Sweden, Denmark, Chile, Italy, USA, Japan, Australia New Zealand…) could receive his teaching. He continues to give guest lectures and training around the world.
Dr Palacci will answer the questions and share his expertise in this interview with three Perio-Implantologists from India - Drs. Sudhindra Kulkarni, Neel Bhatavadekar, and Akshay Kumarswamy.
Neel Bhatavadekar: Given your extensive clinical experience in soft tissue modelling around implants, do you feel allogenic soft tissue graft substitutes work as well around implants, as connective tissue (CT) grafts do?
Unfortunately, my feelings are that autogenous soft tissue grafts work better (at least in my hands) than allogenic grafts. Maybe this is due to my extensive experience using autogenous, but I have always found faster, better healing reactions with this type of material.
Sudhindra Kulkarni: Does Connective Tissue Graft (CTG) function better as a pedicle graft or as a free graft?
Connective tissue grafts are my treatment of choice in terms of final esthetic results, predictability long term results but in soft tissue reconstruction, the surgeon should be able to use all alternative surgical procedures to obtain the best final results. I, personally, present 28 years of old cases using CT grafts.
Akshay Kumarswamy: In your experience, do synthetic tissue graft substitutes containing collagen have good long-term success compared to autologous soft tissue grafts from the palate?
I have performed thousands of autogenous bone grafts for ridge augmentation, sinus lifts since 1988 (date of my first sinus lift) but stopped eight years ago. I am now using biomaterial with collagen with an extremely high success rate and definitely much less morbidity. Esthetic cases, as well as extreme cases, will be presented during my training program Dr Sandeep Singh's academy.
Sudhindra Kulkarni: What is more critical - vertical soft tissue thickness or horizontal bulk of soft tissue in the periodontal or peri-implant soft tissue stability and function?
Both are important; it depends on the clinical situation and specific requirements.
Neel Bhatavadekar: How long do you usually wait until suture removal after peri-implant mucogingival procedures?
I usually wait 8 to 10 days; however, I use resorbable sutures, and the rate of resorption varies according to the patient.
Akshay Kumarswamy: The world knows you through the “Palacci technique”. What other techniques do you have in the vast repository of knowledge, that all of us can expect to learn in the near future?
I got the 1st Nobel Pharma award in Gothenburg in 1995, celebrating the best improvements of the last 30 years of osseointegration with this concepts: Soft tissue manipulation and the papillae regeneration technique + Precision in implant positioning (including the use of implant positioning guides). Over 20 years later, these two concepts are the main topics developed in today’s implantology. I was 20 years ahead then.
Neel Bhatavadekar: What are your thoughts regarding socket grafting post-extraction, versus socket shield with graft? (Both scenarios referring to delayed implant placement)?
There are several ways to obtain a good result, and each technique has its applications. In fact, this depends on the type of lesion and degree of infection of the tooth to be extracted. However, every time I think I can simultaneously extract and place the implant(s), I do it, especially in case of immediate loading.
Akshay Kumarswamy: What, in your opinion, is more critical around implants for long term success? A good envelope of bone or a good envelope of keratinised soft tissue?
One question we can ask is, Do we need more bone or more titanium? In the ’90s, wide implants were extensively developed, and a lower success rate was observed. I, personally, started to use, over 15 years ago, narrow implants in any type of case, from a single tooth to full arch and from incisors to molars, with a very high and predictable success rate. This concept will be presented during my conference in India.
Sudhindra Kulkarni: Do you think PRF and its ilk have any significant role in improving soft tissue biotypes?
I have been using PRF for more than 15 years, working in close relation with Dr Joseph Choukroun, and I really think that PRF boosts soft tissue healing and has a significant role in improving soft tissue biotypes.
It will be a great opportunity for the periodontists and implantologists from India and all the South Asian countries to watch Dr Patrick Palacci in his 3-day Augmentation Workshop with Dr Sandeep Singh (Masters in Implantology, UCLA, California, USA) from 30 Aug- 1 Sept, 2019 at Sahaj Dental Academy, Prayagraj (Uttar Pradesh, India)