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VIDEO - Kwang Bum Park - HSP #84
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AUDIO - Kwang Bum Park - HSP #84
Dr. Park talks about the origins of MegaGen, the first revolution of implantology, and why a second one has already happened.
Dr. Kwang Bum Park graduated Kyung Pook National University, School of Dentistry of Korea in 1985. He finished his residency in periodontics in 1988. After three years of academic teaching and research at Kyung Pook National University, he has been practicing periodontic and implant surgery since 1993. He founded a private dental institute ‘Perio-Line,’ and trained hundreds private practitioners on the topic of clinical perodontics and implant dentistry. He was a visiting scholar at the UCLA School of Dentistry, Department of Periodontics in 2000. In 2001, as a founding member, he started a dental hospital network called ‘MIR Dental Network’ which now compises of 21 large multidisciplinary dental hospitals throughout the Korea. He is presently CEO and Chairman of an implant manufacturing company ‘MegaGen’ which he started in 2002. He is the director of MINEC Dental Education Center which provides continuing education to practicing clinicians on the topics of implant dentistry. He is an international member of AAP, an active member of AO and an honorary member of Japanese Society of Gnathology and Occlusion.
472, Hanjanggun-ro, Jain-myeon, Gyeongsan-si Gyeongbuk, Korea
Howard: It is an honor to be in downtown New York City at the Grand Hyatt at the 11th annual MegaGen Implant Symposium with the founder of the company Dr. Kwang-bum Park. Did I say that right?
Dr. Park: Yes, exactly.
Howard: I'm sorry I have ... they say if you speak multiple languages, you're European or an Asian or Latin American but if you only speak one language, you're an American and I don't know any other foreign words and I think it's amazing that you can give an interview in a second language.
What I am so impressed about you ... I remember the first time I saw you lecture in Scottsdale with some of my best friends Tom Mattern, who is one of your biggest fans. It is just so amazing ... many implant companies they are just corporations whatever, but you're a real live dentist from Seoul, Korea and your dental office that you showed, it's like eight, nine stories tall with all the specialties, and I mean you are an amazing person and I feel sorry for the people who look at the word MegaGen and think it's just a name. That name is you.
My first question to you is what made you want to start an implant company?
Dr. Park: Yes, in 1990 I placed my first implants and ... in the United States, of course, and then we had quite the group of study, education team and we depleted the use of American and European random implants, we found that something is not mentioned with Korean patients because Koreans a little bit special, especially in terms of food, the distance of food and the chewing patterns. We had more failures than expectations then on the literatures ... so we started to think, "Oh, we have to change something from current design and current shape of implants," so we asked her to ... especially 3i, I was big 10 of 3i Implants and we requested the 3i to change the design, especially for Korean patients, but it was denied, of course. At the time Korea was very small, very tiny country and the number of implants placed at the time was nothing now, so they didn't listen.
After that we contacted with some European companies also, but they had no ideas. We started to think how we can make an implant company in Korean but we were just a dentist. No ideas on the engineering and the oppression of company. Anyway, our team decided to make a company in 1998. Sometime, when we have chance, let's make a company. We decided name of company already and when I was in United States in 2000 to study more with Dr. Tom Mattson and the professors of USLA. Then two guys flagged from Korea, one was engineer, one was business man. They told me they can help me, our team, to make a company. That was the start. Why I made the implant company, the answer is, yes, I didn't like the design of implants at the time.
Howard: Now, at 2015, do you believe that Koreans have a different diet or chewing factor that was different than the rest of the world?
Dr. Park: Yes.
Howard: What is that from? Is it more chewing, or different types of food, or less ... what do you think it was?
Dr. Park: It's quite strong, it's more wears on the tooth with the Korean patients. Chewing pattern it's different kind of food. You Americans and the Europeans eat food like chop, chop, chop, just enough, but Koreans, they're more grinding. [inaudible 00:04:48] It's totally different. The ways of communication of the stress, I had a lot of failures ... broken failures, fractures. Even two unit breach or three unit breach with the 3 implants was cut. It's unbelievable. You cannot imagine.
Howard: I'm going to give you three words, and then have you talk about each one of those words. On Dentaltown, I look at the words that dentists are searching and when they go to implants, the top three searches are going to be, "Should I cement this or screw it?" Number two, I don't think anybody knows what platform shifting is, and of course the big one, immediate load. Can you talk about all three of those subjects?
Dr. Park: Yes, which one is the first?
Howard: Cement or screw.
Dr. Park: Cement or screw. I started my implant practice with a screw retained prosthetics mainly. At the time, of course my mentor, my teachers had taught me to make that kind of prosthetics because of retain-ability ... so 99% of prosthetics I made my implants was screw retained prosthetics. External hexed implant has some limitations, [inaudible 00:06:13] is good with the screw retained, but not easy to make precise precisions ... so we developed that combination of cement and screw retained. We named, as a one Korean guy named it, as SCRP, screw cement retained prosthetics, SCRP, combination techniques. The most of Korean dentists use the [inaudible 00:06:44] steel bar.
It's good, but recently with the help of Kadiken Technology ... I usually make cement retained prosthetics and ... because we can control the cement space. It's much more retentive. Even if we use very flexible temper cement it can be maintained in the mouth, very stable. If we want to take it out, you can take it out. The returnability with temper cement and the customize abutments and the [Geconia 00:07:23] crown. It matches very well. Now, this, I'm using almost 100% with the screw retained. Cement retained, yeah.
Howard: What cement are you using, specifically?
Dr. Park: There are many different kind of implant cement. I'm using CEM Implant Cements, CEM Implant Cement. It's good.
Howard: Who makes that?
Dr. Park: It's made in France.
Dr. Park: I think other implant cement is similar.
Howard: Okay, and you said CAD/CAM. What specific CAD/CAM system are you using?
Dr. Park: We call this as [inaudible 00:08:08] Implant Technology, right? Most the people are using CT, that is a one part [inaudible 00:08:17] and to make we are using CAD/CAM machines to make customize abutments and CAD/CAM made prosthetics. I like to use Geconia customize abutments mainly and I usually make monolithic Geconia crowns on top of customize abutments.
Howard: What machine brand name CAD/CAM are you using?
Dr. Park: In my clinic we are using three different machines. One is Imes iCore ...
Dr. Park: Imes iCore. It is a German company.
Howard: Okay, so it's called IMS? How do you spell it?
Dr. Park: IMES COR. It was good. I met the machine as a first. I am using it and for the mass productions ... I forgot the name ... Geconia ... I need to ask him.
Howard: That's okay.
Dr. Park: The one for the titanium products, I like the Korean CAD/CAM. It's really good.
Howard: What's the name of that one?
Dr. Park: Adam Company.
Howard: Okay, and what about ... a lot of dentists are confused about can we immediate load or not. Will you talk about when it's good to immediate load and when it's good not to and just talk about your thoughts on immediate load?
Dr. Park: We have lots of articles on image and loading. Maybe 20-30 years ago, many doctors started immediate loading, but most of the articles from what's made for ... from [inaudible 00:10:11], and full mouth case. Why we had to ... we cannot do immediate loading more often on the upper arch is because of stability and implant design. When the implant stability goes down after implant placement for the third and fourth week. The third and fourth week. The first month, actually can be said as the weakest point of the implants, so we have to wait until six to eight week when we recover the implant stability with the [inaudible 00:10:53]. We follow with them through almost 20 years. I thought our team starts to thought, "Why we don't make a special implant system which doesn't show the decrease of implant stability?"
We tried many experiment, and then finally we found a very knife threaded implants ... it does make a big stress on the bone. Just cut the bone, and then ... during the implant placement and it has a wide sub-piece, and it doesn't push bone that much ... because of the pressures during and after implant placement, the sub-piece of the implants ... not sub-piece, the bone against the implant's sub-piece have some amount of nickel at the beginning, not big. That's why we have a decrease on the [ISDU 00:12:09] and implant stability. If we can maintain the first initial stability forever, or the stability goes up always, yes, we can start immediate modeling, we can start loading immediately after surgery. We got it. With the first design was finished in 2008 and we measured ISDU several hundred implants and found okay, this is really good.
In 2009, 2010, we started lecture to our colleagues and dentists in Korea and many people think, "Oh, I don't want today," because why? They still want to ... be just stay at their current implant treatments. They don't need to fasten. Just place implants, wait several months, and some guys told me, yes, it looks a bit scary. If some patient has implant failures, who will get that? You can guarantee it? No, so we tried to modify the ... the goal was to fix how to educate people, what kind of instrument we need to convince them. Originally, it was the first, and then we tried to make very convenient IS machines and [inaudible 00:13:53] machine or so and somebody who was to load very safely, even though there are some mistake as we made fuse abutments for immediate loading. Then when they repeat to use fuse abutment, and they repeatedly try immediate loading, then they'll realize, "Oh, this is much better and this is very safe." Then I can try immediate loading with definitive customized abutment crown. There was our five years history.
Howard: I want to ask you ... In the United States, most of the implants are placed by oral surgeons and periodontists, would you agree?
Dr. Park: Mmm-hmm (affirmative).
Howard: Probably 9 out of 10 general dentists, family dentists, have never placed an implant. Is that the way it is in Korea, too?
Dr. Park: No.
Howard: Explain the difference in general dentists and specialists in Korea versus the United States.
Dr. Park: I think, in Korea from the beginning, we didn't have strong specialties. Of course we have specialties in the university. I'm a periodontist, I trained for three years, but nobody defer the [inaudible 00:15:12] patients to me. I have to finish my prosthetics on my patients also. Everybody do surgery. Everybody do prosthetics. Even orthodontists.
Howard: Is that the way it is in most of the world? Is the United States kind of isolated in the fact that it has nine specialties that have 30,000 dentists in nine specialties, seven of which are clinical, two of them are non-clinical public health and oral radiology, but seven clinical ... and then 120,000 general dentists? Is that kind of unique to the United States? Does most of the rest of the world not have the in-specialties?
Dr. Park: I think so. The trend is going to the general dentist. I believe every dentist should be the super general dentist.
Howard: When you think of implants in Korea, what percent of implants ... okay, like in the United States, when impressions go to the lab, 95 out of 100 are for one tooth at a time. Only 5% are for big cases. Is that the way it is with implants in Korea? What is there, 40,000 dentists in Korea? Is it 40,000?
Dr. Park: 15.
Howard: How many?
Dr. Park: In total, we have 20,000 and among them, 15,000 dentists place the implants.
Howard: You have 20,000 dentists in South Korea, and 15,000 of them place implants.
Dr. Park: Yes.
Howard: Three out of four place implants, and here it's only 1 out of 20 ... so you got a lot of growth here. My question specifically was when those 15,000 dentists are placed in implants, what percent of the time ... is it just for replacing one missing tooth?
Dr. Park: It's becoming smaller and smaller. When I started the implant was not very popular and the patients didn't know what is implant ... so we need to educate the patients. At that time, about 20, 25 years ago, I had a lot of full mouth cases, but now people were educated. They know how to treat and whenever they lose one tooth, they think implants now. In most case I do surgery on the single missing case.
Howard: Most of your implant cases, they are just one at a time?
Dr. Park: In most cases.
Howard: I want you to talk now to these general dentists who have never placed an implant. How could a general dentist ... we want to go to the next floor, there are several steps. Talk about the first couple of steps. What training would you recommend? Somebody is listening to this podcast, driving to work, and they're like, "Well, first question is what would be an ideal case?" What would be your favorite tooth? Obviously a first molar might need a sinus lift. What would be the easiest first case and how could that person get trained, well, as much training to do that first. What tooth would you recommend first?
Dr. Park: Of course, the height of the reach, and the hardly bone. Hardly any bone and within the height of bone.
Howard: Where around the mouth? Lower enter?
Dr. Park: Lower molar.
Howard: Lower molar?
Dr. Park: Lower molar is the best place. The first molar and the second ... second one isn't quite difficult to approach. First and the second free molar and first molar would be the best candidate.
Howard: The lower second pre-molar and the lower first molar. That'd be easiest ... so number two, would you want a 3D x-ray of that? Would you want a CBCT?
Dr. Park: Of course. I usually work with a panoramic digital printer at the beginning, but with the CBCT, I could open my eyes. I could imagine where I can encounter with a surgery. Images, you can minimize that, images if you have CBCT.
Howard: Do you like any particular CBCTs? Any systems you like?
Dr. Park: No, I believe most the CBCT companies make a very, very nice quality of CBCT machines.
Howard: On this implant, would you recommend a surgical guide? If it's only for one tooth, and there's a tooth in front, there's a tooth in back. Are those two teeth enough to guide you?
Dr. Park: Yes.
Howard: Or would you recommend a surgical guide?
Dr. Park: Yes.
Howard: For your first 100 implants.
Dr. Park: For the first 100 implants, actually I don't recommend to use a surgical stand. They have to understand. It's really, really, really good to make minimal and basic surgery, but if he want to learn implant procedure, he need to know how to make ... how to handle the soft tissues ... so if you, just to rely on the surgical guide, they don't know how we can make tissue, how we can feel the bone density with the shape of the rigid [inaudible 00:20:40]. During the last few cases, 20-50 cases, I hope they can make incisions, open flap, place implants.
Howard: Without a surgical guide.
Dr. Park: With or without a surgical guide.
Howard: With or without a surgical guide.
Dr. Park: At the understanding of the bone quality and the soft tissue management, they can minimize the surgical complications.
Howard: What training would you recommend?
Dr. Park: As a general dentist?
Howard: Who's never placed an implant and wants to add this treatment.
Dr. Park: In my mind, I'm a periodontist. I think in the implant treatments the soft tissue is the most important. Of course, we have to know how to handle bone, how to regenerate the bone deficiency, but without excellent soft tissue skill, it's very difficult to make bone. I hope they can try to make a plate and try to make sutures as accurate as possible and with minimal [tengions 00:21:53]. They have to understand the soft tissue first. Incision and suture is the first priority to me.
Howard: I would love it if someone like yourself could provide an implant curriculum from A-Z online. One hour courses, diagnose and treatment planning, how to do a CAD/CAM ... I would love that. I wish someday they could log onto Dentaltown and have 25-50 one hour classes on implants from A-Z. I think that would be fantastic for dentistry ...
Dr. Park: I think so. Not just ... we are dentists, we need very nice handle skills. Not only the knowledge.
Howard: What would you say to a dentist who's looking out there and there's 50 different kinds of implant systems and now they get to talk to you, the dentist, periodontist, owner who started MGen, if this man is driving his car and is probably wondering ... Tell me what's different about your implant than another system. Why should a dentist use MegaGen?
Dr. Park: We still tiny company. Most of the university teach the major implant systems. There's Nobel and Strummen and some European implant systems, but in my mind, it's kind of perceptions. Many big companies made a lot of articles. They rely on the articles. They think this articles and this company is trustable. In my mind, it's not. Most articles I found ... most articles were made with the guidance of company. I don't like it. Even, we are trying to make a more scientific articles. Why they have to use MegaGen implant? I cannot say. It's very, very special. They need to ... if somebody want to switch from this implant system to other implant systems, it will not be easy because they are used to theirs. They are stuck, their brain is stuck with this implant systems. If they have new implant system, which can give different characteristics, different numbers, they are skilled. They feel skilled. Even if it's better, they don't have the experience. After several years, usually they can start to change their mind, their systems. It's a problem of perceptions.
Howard: I want to ask you another question. I want to get back on the third search word, platform switching. So many dentists are searching for that term, so obviously they want more information. What is platform switching? Is that ... What is that?
Dr. Park: Platform switching is when we started the implant system with the ... especially with the [inaudible 00:25:17] system, the platform of the implant was exactly meshed with the platform of the abutments. There was no upsets, it was connected straight. Then we found that some amount of bone loss around the implants. We call it [inaudible 00:25:39]. We accepted it's just normal, but with limited studies, we found it's because of a period. Ulterior products, ulterior toxins. Some scientists and some doctors tried to make a smaller platform and smaller connections against the implant platforms. Even at the placement of 5mm diameter implants, they tried to place 4mm diameter of abutments. On single side, they had .5mm gap. Then it means the bone is that much far from the bacteria products. They found the bone loss was reduced. Then with the development of internal connections the precision became much better and that means the space where bacteria's can survive was minimized. Then ulterior products was much, much less than external fixed implants. Then we found, oh, bone was much better because the bone was very well maintained with internal connections.
If we use internal connections, there is automatically some amount of platform switching.
Howard: Let me ask you another question, since you are a periodontist, of the implants that fail, do you think that's more failures are caused by the operator than the dentist error in drilling the bone too hard or fast or burning the bone or do you think more implants fail from bacteria because they had periodontal disease, the tooth had an abscess, failed root canal? What do you think is a bigger factor ... is bone burning a big issue in placement?
Dr. Park: It depends on the stage of the failure. If we have a failure at two weeks after implant placement, yes, we can think it's mainly because of overheating. If we have a failure several years after implant placement, we have to think it's because of bacteria than the overloading.
Howard: Bacteria and force.
Dr. Park: Yes, that is the two keyword.
Howard: Do you think it's more ... if an implant fails five years later, do you think it's more bacteria or more force?
Dr. Park: It's combined. When I used the 3i implant system, at that time they had machined surface, but ITI had TPS surface. TPS is obviously very easy ... it's very easy to be contaminated with bacteria, but machining surface was very clean and we had a strong debate which surface is better. Then they said ...
Howard: I want to also ... I also want to congratulate you. You just came out with a first edition of your book From A to Z Implantology and it is an amazing book. Everyone at the convention ... we've all been looking at it and reading it last night, today, this morning. Tell us about your new book.
Dr. Park: Actually our group published many books on the soft tissue management and he regeneration and our previous implant systems. This is focused on our future projects, mainly [inaudible 00:29:30]. We are trying to make a second revolution in implant dentistry.
Howard: What was the first revolution and what is the second revolution?
Dr. Park: First revolution is from Dr. [Brenmark 00:29:45] in 1985 to the start of this eueka project.
Howard: Explain what you mean by eureka. Eureka's ...
Dr. Park: Eureka is kind of interjections when we find something. As you know, eureka's one of the words that he said, "Eureka, I found it," stuff like this. When we made the plan for one of the implants, which will be the future, very soon. When the implant mean place implants that deliver the definite to the crown to any kind of regenerations, at the same time with the surgery. Doing everything at once and just ... [crosstalk 00:30:36]
Howard: You know what my fantasy is for that book? Do you know what my dream is? Talk about a second revolution. I started Dentaltown in 1998, and you started MegaGen in 1998, we're both dentists. When I started Dentaltown, it was on a personal computer. Of the 2 million dentists around the world, only 500,000 had a personal computer and Dentaltown got 200,000 of those 500,000 dentists as members. Then the mainframe went away, the Pcs went out, and now it's the smart phone. We came out with the Dentaltown app and over 50,000 dentists have downloaded it. Our podcast is going to be on the app under podcasts where they can watch us. Dentists are ... what's really popular is they go to their settings and they hit Bluetooth and they're listening to it in their car, but guess what our new section is that we're going to have. We're ... next month, we're launching books.
There's a lot of kids who don't want to carry around a five pound book in their purse and go on an airplane, and it would be the greatest honor for me ever if our first digital book was by the man himself, a real dentist who's starting his second revolution of implants so if you're thinking about that, I would love it ... because then they could read it on their iPhone, their Samsung. You're from Korea, so I'm embarrassed I have an iPhone. I should have a Samsung. I do have an LG TV, so [Hyundai 00:32:16], LG, Samsung. Hyundai? Samsung, LG ... those are the three biggest consumer brands in Korea?
Dr. Park: Kia.
Howard: Kia? Is Kia Hyundai?
Dr. Park: Kia and Hyundai is the same company.
Howard: Kia and Hyundai is the same. Samsung. I want you to think about that, because if you put your book on our new Dentaltown app I think it would be read more times than ...
Dr. Park: We are preparing the digital book, also.
Howard: Okay, but I just want to tell you, it was an honor to meet you three years ago in Scottsdale. I wish everybody could see ... How could dentists out there see a picture of your dental office in Seoul, South Korea?
Dr. Park: It's on the website, but ...
Howard: Is it on your website? MegaGen?
Dr. Park: No, we have a different company and there's Mir Dental Network. Mir, M-I-R Dental Network.
Howard: We have a magazine that goes to 125,000 dentists. I wish you would someday write us a story of you, an autobiography, showing your clinic because me and Tom Mattern were mesmerized by your lecture in Scottsdale. What you're doing there is just phenomenal. You're an amazing man. I would like to share your story with more Americans ... so if you ever have time to write an article that has pictures of you and your clinic and your facility ... That's just amazing. One of my lifelong dreams is actually lecture to the Korean Dental Association, so if you have any contacts there, I'd sure like to come over there and lecture it and see your clinic in person. I would love that.
Dr. Park: Why not?
Howard: Thank you so much for your time. You're an amazing man.
Dr. Park: Thank you.
Howard: Thank you very much.