In this podcast, join Dr. Reza Ardalan and Dr. Tommaso Ghedini as they discuss everything from the importance of cadaver courses to digital dentistry and what the future of dentistry may look like for new dentists. Plus, learn more about Dr. Ghedini’s innovative technique using surgical stents for guided tooth sectioning.
Dr. Tommaso Ghedini is a highly accomplished dentist from Milan, Italy specializing in oral surgery, prosthetics, and restorative work. Dr. Ghedini works in his private practices in Milan and its province and currently teaches in the Humanitas Research Hospital, with a focus on oral and implant surgery.
During this interview, Dr. Ghedini shares insights into his diverse clinical practice, his teaching experiences focusing on oral surgery, and the importance of hands-on learning through cadaver courses. Tune in to learn about Dr. Ghedini 's innovative approach to tooth extraction, combining technology and precision to improve outcomes.
In addition to his professional achievements, Dr. Ghedini sheds light on his personal interests outside of dentistry, such as playing football, enjoying fine wines, and spending quality time with his family. He also touches on the evolving landscape of dentistry in Italy, emphasizing the role of digital dentistry as a vital tool for enhancing patient care and treatment planning.
Key Highlights Include:
The benefits of cadaver courses and understanding anatomy
Dr. Ghedini’s technique for using surgical stents for guided tooth sectioning
The importance of continual learning as a dentist
Digital dentistry and its expanding role
How will corporate dentistry impact future generations of dentists in both the US and Italy
The significance of maintaining work-life balance and staying grounded
Listen to the full podcast on DentalSlang.com, or read the recap below.
______________________________________________________
For those who would rather read than listen, explore the full transcript capturing the valuable insights shared by Dr. Tommaso Ghedini
Dr. Ardalan: Tommaso, thank you so much for joining us on the Dental Slang Podcast. I spent some time doing my research and going through your background. And to say that I'm impressed would be an understatement.
I know that you have an advanced degree in oral surgery, but you seem to also do a lot of restorative and prosthetic work. Can you describe your clinical practice to us?
Dr. Ghedini: Yes, of course. I started my practice as a general practitioner, and I have two clinics with my father, so I deal with the patient from zero, from the first recall. So, for me, it's really important to know dentistry in all the aspects.
At the beginning of my career, I treated all kinds of patients from endo to restorative, (except for orthodontics), but then I specialized in oral surgery and now I deal more with dental implants and oral surgery, but I also love to do the restorative and the prosthodontic part.
Dr. Ardalan: Yeah, that’s interesting because that's not really the norm. This probably gives you a good opportunity because you understand so many different aspects, and it gives you the opportunity to also be able to teach. When you're teaching dentistry, what is the range of topics that you cover?
Dr. Ghedini: I don't cover everything, just because I do everything. I try to cover as a teacher, of course, the oral surgery part, so wisdom teeth, radiolucent lesions, cysts or tumors, because I work in a hospital, so I deal a lot with these kinds of patients.
And I am an adjunct professor at Humanitas University, so I have the privilege to teach to future doctors at the medical school, and it's something really interesting. And I teach dentistry and endodontics also there. it’s interesting that I have this mastery in cadaver courses, and it's something I really like to teach because I think it's important to have this kind of opportunity when growing as a young dentist.
Dr. Ardalan: I know that you do a lot of traveling with your teaching as well. So, what have you learned about yourself, and your own style of dentistry, from the teaching aspect of it, especially when you've taught as far as Bulgaria? How does that relate back to the clinical style of how you practice?
Dr. Ghedini: An aspect that I really like about teaching is having the opportunity to also meet esteemed colleagues during their lectures. So, I have my little part, I teach my things, but I am in an environment where I have the opportunity to learn from the best. For example, Tiziano Testori, and he's one of my mentors, and it's impressive that every time he's at the Congress, he's always in the first row taking pictures of every lecture.
So, I'm there and I say, okay, if Tiziano Testori does that now, after 40 years of an incredible career, why can I sit on my throne to be the king of nothing? It’s incredibly inspirational for me.
Dr. Ardalan: Yeah, that continual part of learning. Earlier, you mentioned your cadaver courses, I want to focus on that for a minute. Teaching cadaver courses has to be especially challenging. How do you think your students respond to that type of hands-on learning and where do you think cadaver courses fit in the larger dental curriculum? I know we did a ton of those when we were in dental school.
Dr. Ghedini: For sure, because in Italy, we don't have the cadaver course in our formation during university. So, it's really important for a young dentist, a young surgeon to know all the anatomical structures and to touch and have the sensitive feedback of what they are doing during surgery.
I found in every course, every student's really eager to work on the cadaver because they can experiment, they can try different things without the fear of making mistakes that can be huge mistakes when we talk about nerves and vessels. And you can see the limits. So, you know where you can work, but you can also see where the borders are and the limits of the surgery. I think it's important for the growth of an oral surgeon at the beginning. Of course, then you have to work on patients, but always with a mentor there with you at the beginning.
Dr. Ardalan: I think that gives a tremendous background—to actually be able to tangibly touch, feel, and see it without the fear of making a mistake. I thought that was an invaluable part of my dental school education. And listen, I made plenty of mistakes, but it was on a cadaver. I’m like, “I can’t find this nerve,” and they’re like, “Doc, you dissected it. It’s over on this side.”I’m like, “Oh, okay, I should probably practice this a little more.”
Dr. Ghedini: But also, you can feel how you can stretch the nerve. Because when you open with the blade, when you stretch the tissues, you see the nerves that it's not interrupting, it's not cut. So, you can see how hard you can play in that scenario.
Dr. Ardalan: Yeah, you start to learn some of the limits. One thing I like to ask folks is, when I talk to doctors that have such a diverse background in their education, I'm always curious, when you're not in clinical practice or teaching, are there any particular activities that you like to do outside of dentistry? Because it seems like you're pretty busy doing a lot of this, but there's got to be a little bit of downtime. What’s your escape?
Dr. Ghedini: I have very little time, but when I can, I'm a typical Italian. So, I play football, or as you say, soccer, and that's one of my passions. And I’m a typical Italian, so I love drinking wine and am also a food lover, I love going to restaurants with my wife. She is also really passionate about it.
But the most important thing for me is to spend some time with my kids. They are really young now, so when I have time, my focus is on them 100% if possible.
Dr. Ardalan: I love asking this because listeners often hear guests at the top of their field discussing all they do. I always ask to remind everyone that we’re still human and make time for family. I think we get along well because I’m also into food and wine—though my wine taste may not be as refined as yours. I’ll have whatever! But yeah, family, wine, kids—it all fits together nicely.
And, you know, I gotta say, your mastery of English is pretty incredible, as I know that it isn’t your initial language. Where did you learn to master the English language and how do you keep up with it, being that it's not necessarily part of your daily routine living in Italy?
Dr. Ghedini: I think that I'm not mastering English, but I try my best. And what I do is to try to speak or listen as much as I can. So, I do an English lesson once a week, one hour, that's like 7pm till 8pm. My wife is not really happy with that, but that's okay. That's an hour during the week. And another thing that she doesn't like a lot is like I now watch all the movies, TV series in English, and she just wants to, I don't know, have a rest during the evenings, and I'm always there focused on that. Because I think it's really important to listen, speak a little bit every day, so I try my best to do this and to practice a little bit, because during the day, of course, with my patients, I speak just Italian.
Dr. Ardalan: I got to tell you man, you know, don't sell yourself short, your English is impeccable. It is excellent and you can tell that you're actually putting the time in, you've made a commitment to it. The same way you would with your dentistry, you've actually planned this out that this is a scheduled thing. I commend you for that.
You do so much and I always like to people who teach who are also in clinical practice, are there any particular types of clinical cases that provide the technical challenges that you might appreciate?
Dr. Ghedini: Of course, as a dentist, we like to change the patient's smile. And then the patient's life, we think that we can change a little bit the patient's life through the smile. And so, the patient that like suffers of worn dentition or maybe a missing tooth and so they have to do a reshape of their smile, I think these are the cases where they are the most challenging because you have to do a proper diagnosis.
So, knowing the patient, what's the aspects and the factors that have led to that problem, and then trying to solve it from a prostho point of view with the aid of course, of maybe ortho. So, these multi-specialization cases, I cannot do everything. Maybe the ortho is done by another colleague, but I like to treat these kinds of patients.
Dr. Ardalan: I think you end up seeing the biggest start to finish change in those patients, and I think those oftentimes make the biggest impact on the patient. That gives you a sense of appreciation.
Dr. Ghedini: I've seen a patient yesterday just with two teeth. She had a broken incisor. I've done an injection technique, one appointment. She was crying. So that's the thing, OK, technically it was not a big issue, but it was really effective. So OK, we don't have to change the whole smile to make people smile again, but maybe a couple of things can make a huge difference in a patient.
Dr. Ardalan: I always tell folks, I would never be where I am without mentors along the way. Do you have specific mentors in clinical practice of dentistry, teachers or lecturers that when you go forward, you're like, I kind of want to emulate that, I kind of want my style or my practice to be like that person. Is there anybody that stands out for you?
Dr. Ghedini: Yeah, I have a lot of mentors. I was really lucky to have a lot of esteemed colleagues that showed me the path and the way to do our job.
But if I have to pick one, I would say Eric Van Dooren. he's an incredible surgeon from Belgium. I can tell you a story that's funny because when I was young, I'm still young, but when I was younger, when I was 22 or 23, I just graduated and one of my mentors told me, okay, Dr. Van Dooren is coming for our congress, can you pick him up at the airport and bring him to the hotel? Okay, of course, I go, sure, no problem. I went there and we have this little journey and we talk about football because he was a football player when he was young, blah, blah, blah. And the day after, the congress he says, “oh, Tommaso, how was everything? If you want, you can come to my practice for a week to see me finalizing the cases with my Brazilian dental technicians.” I was like, “okay….whenever you want!” So, I went there for a week. It was like Disneyland, a super high level of dentistry, everything was perfect.
So, imagine I was 23 years old, I was like, “ah, I want to be like that guy.” One night while I was there, he said, “oh, Tomasso, it is the birthday of my daughter, if you want to come out with us.” So, he is also a family man. A family man, plus a super high level of dentistry and a humble guy. He was always writing me on Instagram, “Nice case, Tommaso.” I think that being humble and being around his family, and feeling that he is a good father, it’s something that inspires me a lot.
Dr. Ardalan: That's excellent because you could tell, it seems like that your style is emulating that and you're gonna be that for the next generation of dentists coming up and if we can keep having more of that, it just makes the profession better as a whole. So that's outstanding that you had a great experience like that.
I wanted to ask you this, because obviously I see what's happening with dentistry in the States, because obviously, this is where I live. How do you see dentistry changing in your home country of Italy over the course of say, the next decade?
Dr. Ghedini: It's a difficult question, because it's, it's not that easy to predict what will be our field in the next 10-15 years. But of course, we have an idea. And I think, it will be difficult for the next generations, because of the bureaucracy and the cost of opening your own clinic, and dealing with the chains, and with the networks of companies that run the big clinics.
The idea of not having all the problems of the bureaucracy, not having all the problems of dealing with the daily administrative part of your clinic, makes me think the new generation will choose the idea of being part of a bigger clinic.
Of course, this is not helping them to choose their treatment plans, it's not helping them to have their own individuality, so maybe they will need to operate like others want. I don't know, I'm not really optimistic about the future in Italy, about the independence of dentists in the future, because I think that there will be issues related to money and so the treatment plans can be diverted to money-related treatment plans, that is of course not the best thing, or the best solution for the patient.
Dr. Ardalan: I mean it seems like your description of where you see dentistry in Italy is not that much different from what it's like in the States. I think that's just becoming what we call corporate dentistry or dental service organizations, bigger groups and if it's anything like us, these young dentists are coming out with such a tremendous amount of debt. They owe so much money, they borrow so much money to go to school.
It's hard to maybe do what I did and just say, well, I don't care, I'm going to open my own practice. The hope is that there's still really good clinicians, and that the corporate structure finds a way to combine that. Like, we're going to take away the bureaucracy but still give you that independence with clinical dentistry. So yeah, like you in Italy, we have that same issue in the States. We're keeping our fingers crossed and trying to follow that path.
Dr. Ghedini: I also see in the next generation, they're not that eager to build their own practice. It's not just a question of money. Of course, in the US, probably you have a debt that is much more than we have after graduating. But also, I don't see the fire in the eyes of new dentists. I may be wrong, but it's what I see.
Dr. Ardalan: Well, it is interesting. I sometimes look at it with the opportunities that they had. When I came out, there was nobody offering me this big pot of money to go and work. It was like, well, I guess I have to do it on my own. It might have been different if somebody's like, come work at this clinic and here's six figures of dollars being thrown at you.
It’s interesting, especially with technology changing. It also gets challenging in private practice. So, for us, the term “digital dentistry,” gets tossed around a lot at various meanings. And there are different, I don't know, definitions attached to those. And a lot of times I think it depends maybe on the agenda of the speaker, what their version of digital dentistry is. So, I’m curious, in Italy and in your opinion, how would you define “digital dentistry” and the advances that are going on in Italy and in Europe?
Dr. Ghedini: I think that digital dentistry has to be seen as a tool to enhance the level of dentistry because it can help raise the level of dentistry. If it's done properly, it can help a lot in implant positioning, but you can also use it in other branches, and you can pre-visualise the things, having a better communication with the patient.
In my opinion it’s a tool. We have to know how to treat patients with digital dentistry in a digital way. I think it's compulsory. There's no other option I think for us.
Dr. Ardalan: I love the idea of it being a tool, but as technology advances, we can't overlook the importance of hands-on experience. It's great hearing you talk about this because, on one hand, you have cadaver courses with hands-on learning, and on the other, we have digital tools—sometimes with AI—that can do some of the work. But it's the combination of understanding what’s happening and using these tools in practice that helps create great clinicians. It’s just one more tool in the toolbox, another piece of equipment to enhance your skills.
Dr. Ghedini: Yeah, you cannot think about doing an implant without having done a lot of analogic. So doing your flap, implant position, normal drilling sequence, you have to pass through that. You have to master that procedure. After that, you can use the digital approach to help with planning, positioning, and other aspects. During implant planning, you can also plan the prosthetic part and determine if you need any augmentation, whether soft tissue or hard tissue.
Dr. Ardalan: It just gives you more success. Now, you were mentioning implants, so I heard that you spent some time in London watching the work of Dr. Nick Fahey. I had the privilege of having Nick on the podcast. Every time I get to see and meet Nick, it's just a fantastic conversation. It usually ends up over a pint of something and the conversation goes a different direction.
But, I'm curious, he's such a great clinician, he has his book out. How did those over-the-shoulder sessions go, and did it impact your daily practice when you're able to go and see how another great clinician does things?
Dr. Ghedini: It was an incredible opportunity and an incredible experience. Meeting him and his wife, Sarah, and seeing their clinic, the Woodborough House, it's an incredible thing and really run perfectly. I learned a lot about how they run the clinic, but also much more from Nick as a surgeon. We had some debriefs before the surgeries and he would explain to me every detail why he chose one prosthetic solution, why another one, because of the bite of the patient etc. So, he had a broad sense of what he was doing. And, the patient was not treated as a number, but as a person. And it's like how I try to treat my patients. So, I got along really well with him and Sarah, because I think we have lots of things in common. I found this super master who is doing things like I tried to do, so it was another thing that I really loved from him. And also, of course, we spent the evening with a couple of pints.
Dr. Ardalan: You know what I find, and it really fits, Nick, he's incredibly humble. The fact that you can come in and watch and he's here to teach. But I think for anyone listening, because I do the same thing, even though many people look at you, Tommaso, and say you are the expert and so great, you’re never too big or busy to acknowledge that there are still opportunities for you to learn. The fact that you're this continual learner and there's people like Dr. Fahey who's also willing to go and teach. I think this is what you're going to be doing for others in the future, and kudos to you for continuing to enhance your clinical skills as well.
Dr. Ghedini: Yeah, for sure.
Dr. Ardalan: I know that, like many in dentistry, you come from a family of dentists. Did your family’s involvement in dentistry help shape your goals in practice?
Dr. Ghedini: I have to say that my father is a dentist, so of course he helped me in the decision. He didn't convince me at the time, he just showed me the clinic and said, “Oh, that's a path you could follow if you want. If not, the world is yours, you can do whatever you want.” But I was, of course, fascinated by the work of my father, so I decided to do dentistry.
He gave me the opportunity to follow my own path. And he gave me time to follow my mentors, to do the specialization in surgery, all the other things with the university, and also with the course and congresses. For me, it was really important to have a father with a broaden view of dentistry, saying you need to know more. You need to learn more techniques and skills for our patients. So, at the beginning, you should spend some time outside the clinic, then come back with your own skills to help with the growth of our clinics. That was the idea, and I think it was correct.
Dr. Ardalan: That's just another aspect of your dad being a mentor because he’s saying, “I want your personal growth. It’s only going to make our practice better; it’s going to improve our clinic and benefit the patients.” I think it's fantastic that you have such a supporter of education. And that commitment has continued for you because it’s like, 'Okay, I’m going to keep learning. I’m always at the meetings,' and I feel the same way.
Bringing all this full circle, I understand that you've invented your own clinical technique. Can you tell us more about that and what's involved?
Dr. Ghedini: Yeah, I was looking at the subicity for tooth extraction, we're talking about wisdom teeth surgery, and I was there with the 3D reconstruction, I was trying to understand where to cut the tooth, and I thought it would be perfect to cut it like that. So, I asked, “Why are we not guiding the tooth sectioning?” I then began to make a surgical stent for guided tooth sectioning, which provides depth control and width control for the length of the cut.
And it's really interesting when you have teeth that you can reach easily, so not really in deep impaction. It can help you when you have roots on the alveolar nerve and you have to do a proper separation, because if you do the wrong tooth sectioning, you are in trouble, because it will last much longer. The intervention that will cause much more postoperative complication, and also it prevents any neurological damages in case that if you don't do a proper tube sectioning.
Dr. Ardalan: That's brilliant. I mean, when you think about it, not everyone does this—since I’m a pediatric dentist, I don’t—but dentists like you use technology to create a stent and guide implant placement. It's really ingenious to sit there and say, instead of relying on guesswork or using a drill or elevator to separate tissue based on what you visually see on an X-ray, “Oh, I’m probably five or ten millimeters deep.” Instead, you can use your CBCT scan and say, “No, it’s exactly this amount. This is the precise depth I’m going to achieve.” It’s just another way to use technology as a tool.
Dr. Ghedini: Yeah, and in fact, I think that AI will help because making the tooth extraction in the software, you can see the segmentation of the tooth in the software easily with the AI.
Dr. Ardalan: And especially what you're doing, you think about how many oral surgeons, how many surgeons, how many doctors are out there doing that exact procedure, and you can take a little more of the guesswork out of it and just get a higher percentage of success rates. So, if somebody wants to learn more, whether it's about the technique or just to be able to follow you, what's the best way either for them to contact or reach you.
Dr. Ghedini: Of course, of course. I am on Instagram, where it will be easiest to message me. My profile is @dr.ghedinitommaso. If you have any feedback, advice or you just want to get in touch with me, I'm more than happy.
Dr. Ardalan: Tommaso, I so appreciated our conversation today. It's exciting to meet somebody that is so proficient in what they're doing and is just a continual learner. And I really do believe that you're going to be setting the standard for generations and there's so many young doctors, old doctors like myself, that are going to be able to learn from the things you're doing. I appreciate you taking the time to be on the Dental Slang Podcast.
Dr. Ghedini: It was really a pleasure for me. Thank you, thank you, thank you. It was really nice to have this talk with you.
Dr. Ardalan: I did and it's just gonna be an excuse for me to have to make a trip over to Italy so we can talk more about family and we'll do it over some food and some wine.
Dr. Ghedini: Whenever you want wine and food here are perfect and you have a friend in Italy. I love it, that's all I need for an invite. I appreciate it.
Dr. Ardalan: Tomasso, thanks for being on the Dental Slang Podcast. Make sure to follow us on all the socials at Dental Slang. And feel free to follow me too at Dr. Reza Ardalan. Until next time, we'll see you on the Dental Slang Podcast.
