Interview: ‘enhancing oral health globally’

Dental Tribune America: Please introduce yourself to our readers. What is your background, and where do you work?
Michael R. Norton: I graduated from the University of Wales, School of Dental Medicine, in 1988 and trained to become a registered specialist in oral surgery. From the earliest time in my career I had the good fortune to be introduced to the concept of osseointegration, and so from those early days I began to immerse myself in the field, undertaking both research and clinical practice at The Royal London Hospital.

After a period of work within industry I opened a private surgical practice in London’s famous Harley Street, dedicated to implant and reconstructive dentistry. This is where I continue to work today.

By the late 1990s I was well published, including one of the earliest Quintessence textbooks on the subject published in 1995. I was also lecturing internationally and very involved with the Academy of Osseointegration (AO). I chose to become involved with AO because it is the premier international association for professionals interested in implant dentistry.

In 2007 I was awarded the fellowship of the Royal College of Surgeons, Edinburgh, for my contribution to the field of implant dentistry, and recently I was appointed to the position of adjunct clinical professor to the Department of Periodontology at the Ivy League Dental School at the University of Pennsylvania.

Today I am secretary, board member and fellow of the AO and past president (1999-2001) and honorary life member of the Association of Dental Implantology (ADI) in the UK. I am past editor of the AO’s Academy News and associate editor of the International Journal of Oral & Maxillofacial Implants (JOMI).

The Academy of Osseointegration has some well-established guidelines for implant dentistry and patient care. How have these guidelines influenced the way implant dentistry is practiced today?
The guidelines are a very important document, as there are no formal guidelines for training or education in implant dentistry. In 2008 AO decided to try to fill this void, and in 2010 I chaired a task force to update these guidelines (Norton MR, Ganeles J, Ganz SD, Stumpel LJ, Schmidht JM. 2010 Guidelines of the Academy of Osseointegration for the Provision of Dental Implants and Associated Patient Care. Int J Oral Maxillofac Implants 25;3:Suppl).

With the increasing number of general dentists involving themselves in implant dentistry as well as sub specialization by periodontists, prosthodontists and oral surgeons, it was felt that there needed to be a structure by which all could adhere. It is important that treatments follow a clear and concise pathway, whether patients are being treated in a team environment or by a single-handed clinician.

The structure of the guidelines was strongly influenced by a parallel endeavor undertaken by the Specialist Advisory Board of the Royal College of Surgeons in Edinburgh. This standard itself was based on a document produce by the General Dental Council of the United Kingdom for Training Standards in Implant Dentistry. The basic tenet being that such guidelines should steer the clinician down a safe path of treatment execution or referral when recognizing ones limitations.

Whether we like it or not, there is an increased risk of and exposure to litigation when carrying out this type of surgery, particularly in light of the cost implications to the patient. These guidelines are there to ensure that while unforeseen events might occur which lead to treatment failure and/or litigation, a clinician should place him/herself in a strong position by adhering to the basic principles that underpin the Guidelines document. I encourage my peers to download them at www.osseo.org.

What is AO doing to expand its global reach?
The AO has always been an international organization, but due to its strong North American emphasis and headquarters in Chicago many have quite mistakenly seen it is an American organization with foreign members. Today AO is working really hard to change this perception, with global outreach and the formation of a global Charter Chapter program that has seen meetings organized in the UK, Israel, Spain, Italy and Japan.

In January 2015 the AO will run its first major outreach program in India, a country where it currently has little exposure. This not only helps to establish AO as a global organization, but it helps to ensure that the board is fulfilling the mission statement of the AO, ‘enhancing oral health globally,’ by advancing the science, practice and ethics of implant dentistry and tissue engineering.

In addition to the above, we successfully ran our first International Symposium within the AO annual congress earlier this year in Seattle. The symposium was in Japanese and specifically targeted our large Japanese membership. At AO’s 2015 Annual Meeting next March in San Francisco, the plan is to run a Korean symposium, with preliminary discussions to focus on China the year after that.

On a personal note, who influenced you most in your career?
I have been strongly influenced by a number of individuals at different stages of my career, but I will set apart three individuals.

First and foremost my dear friend and father figure Harvey Sevitt, who recently passed away, was simply the most consummate general dental practitioner. Harvey inspired me with his passion and love of dentistry, and it was he who enthused me to follow dentistry as my chosen career.

Secondly, Mike Simpson, consultant oral surgeon, who taught me how to be a good surgeon and who strongly encouraged me to follow a career in implants when most people hadn’t even heard of them.

Lastly, I would have to say Dr Stig Hansson. Stig is in my view probably responsible for some of the greatest advances in implant design since Brånemark discovered osseointegration. His clarity of thought, his biomechanical polemic and its importance to bone response around implants has shaped my career-long view of how implants work and how we can get the very best out them in clinical practice.

Is there something that people might be surprised to know about you?
Although I love my work, I love not working more!

Implant therapy seems to be one of the most exciting and dynamic areas in dentistry, with constantly improving techniques and technologies. What do you think the future holds?
In so many respects I think that today we are in the epoch of tinkering. I look at the implant that I was working with back in 1991 and the implants I work with today and sometimes I wonder what has really changed or improved since that time. The flip side to this is the sheer volume of research and development I see week in week out, especially in my role as associate editor of the Journal or Oral & Maxillofacial Implants and in my own work in the development of the Astra Tech implant.

So I know there is still a lot more to be done. However the real future must be in the realms of tissue engineering. I am sure it will not be too long before we will look at radiographs of metal screws and consider such things as crude and archaic. Although, perhaps not during my working lifetime.

Do you have anything you would like to add?
I would like to see an injection of honesty on the major podia about what can really be achieved in a predictable, day-to-day manner, long-term. I understand the desire for colleagues to showcase their best work, and indeed I am not immune to the same pressure, but I think we do a disservice to and mislead colleagues when we present un-tried and tested clinical techniques that have only short-term follow-up.

At the very least we need to emphasize that such cases are an example of our best outcomes, the exception rather than the rule — and leave delegates in no doubt that they should not expect to be able to replicate such results in a predictable manner, at least until such time as we have long-term proof that such outcomes are sustainable. This too would help fulfil the AO mission statement to promote ethical implant dentistry.