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ZurichDental Podcast

Podcast with Dr Jakob Müller and Dr Olivier Schicht

Dentistry of the last 30 years

Looking back on 30 years of dentistry: Why tooth preservation and composite repair characterise today's dental practice

In this episode of ZurichDental, Dr Jakob Müller and Dr Olivier Schicht look back on their many years of professional experience. The focus is not only on technical milestones such as microscopes, nickel-titanium instruments or DVT, but above all on a common thread: Tooth preservation as an attitude and as a craft.

"You don't have to brush all your teeth - just the ones you want to keep."

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From ring cap crowns, amalgam and gold inlays: what has disappeared from the study programme

A good example of the change is what you had to learn in the past but hardly see today: Ring cap crowns with wax modelling, casting and soldering techniques seem like something from another world from today's perspective. At the same time, Dr Schicht explains that amalgam and cast gold fillings, including gold inlays and overlays, were still taken for granted during his training. Even back then, dentistry was characterised very differently depending on the university, and much of what was once standard is now marginal knowledge or history.

Tooth preservation as a core concern: endodontology and periodontology as the key

Both guests share a clear position: dentistry is defined by tooth preservation. Dr Olivier Schicht came to Zurich to specialise in endodontology and honestly describes how he hated root canal treatment as a student, mainly because of the tedious preparation with steel instruments. It was only later that it became a game changer: nickel-titanium instruments, automated preparation and, above all, the operating microscope made endodontics more precise, easier to control and ultimately more attractive. Dr Jakob Müller, on the other hand, describes the switch from resective procedures to regenerative procedures, for example with enamel matrix proteins such as Emdogain and other materials for bone augmentation, as a turning point in periodontology. His guiding principle is reconstruction instead of degradation.

Implants, DVT and templates as standard, but peri-implantitis remains the construction site

In implant therapy, the predictability of treatment has changed significantly: CBCT and digital 3D technologies, as well as drilling templates, now enable implant planning that would previously have been unthinkable. At the same time, the issue that preoccupies many in their day-to-day practice is being addressed openly: peri-implantitis. Although rougher implant surfaces have significantly improved healing, they can become a pitfall in the event of inflammation, as bacteria persistently colonise the microporosities. Dr Jakob Müller notes, by way of guidance, that according to the WHO, approximately 15 to 25 per cent of implants worldwide may be affected by peri-implantitis. Implants can now usually be managed very effectively for 10 to 15 years, but it is not realistic to promise a genuine guarantee of longevity spanning many decades. This makes the sentiment underlying the discussion all the more relevant: implants replace missing teeth, but not existing ones.

Root canal treatment: high success rate, but fracture remains the most common risk

The strength of root canal treatment lies in its predictive power, but not in a guarantee. Dr Olivier Schicht cites root fractures as the most common long-term problem: a tooth can be perfectly endodontically and prosthetically treated and still fracture later. The decisive factor for the prognosis is not only the foundation of the root, but above all how much healthy tooth substance is still present above the gums to provide a stable restoration for the tooth later on. It also explains why devitalised teeth are more frequently overloaded: The fine protective reflex of the vital pulp is missing, tactility and overload warning are reduced. A cusp-spanning restoration or crowning can reduce the risk, but not eliminate it completely.

Composite restorative therapy: lots of new things on the market, but the core remains the same

It is fascinating to look at what has hardly changed at all: composite filling therapy. Whilst there are countless adhesive systems and material variants, tried-and-tested systems are still in use today and deliver long-term results that remain impressive even after 20 to 30 years. Bulk-fill composites are cited as a real simplification, as they allow for greater layer thicknesses and thus make day-to-day treatment easier. And one point is clearly emphasised: repairing composites is not a stopgap solution, but often the better, more tooth-preserving choice. If a marginal ridge or cusp breaks off, an otherwise sound filling can often be repaired in a stable and aesthetically pleasing manner, rather than having to replace the entire filling.

Anterior aesthetics without veneers: Non-invasive with composite and adhesive bridges

Dr Olivier Schicht describes the goal he has pursued since his student days: restorations should look so natural that they are imperceptible. This is particularly evident in the anterior region, where the shape and position can be optimised using composite without sacrificing tooth structure. Dr Jakob Müller puts the veneer hype into perspective: yes, there are indications for them, but they are rarer than many people believe. Aesthetic problems can often be resolved in a way that is gentler on the teeth and more natural using composite. Adhesive bridges are also viewed positively, particularly given the understanding of modern concepts such as single-wing restorations and a meticulous approach to refixation. And typical of today’s dental practice: simulating and visualising beforehand, rather than preparing blindly.

Quality-orientated dentistry: perfection as a compass and photo documentation as a teacher

Towards the end of the conversation, the discussion turns to the fundamentals: pride does not stem from quick successes, but from long-term results that still hold up years later. The advice to young dentists is therefore clear: aim for perfection, check every step, and master the basics. After all, precision is not first learnt through major restorations, but through seemingly small things such as a perfect cervical filling. One practical tool for this is photographic documentation: if you regularly photograph your work and examine it critically under magnification, you’ll see your mistakes in black and white and improve more quickly. Or to put it another way: practice makes perfect, but only if you look closely.

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