PEOPLE: EFP founder Jean-Louis Giovannoli reflects on how European perio has changed in last 25 years

Jean-Louis Giovannoli, one of the founders of the EFP, stood down earlier this year as chair of its congress committee. At the end of this 25th anniversary year, he looks back on the evolution of the federation and of European perio.

Twenty-five years ago, in December 1991, a meeting took place in Amsterdam at which the aims, constitution, and by-laws of a new international dental organisation were adopted. Thus was born the European Federation of Periodontology, which has just celebrated its 25th anniversary.

But the real beginnings of the organisation date from six years earlier and a discussion over dinner between periodontists Jean-Louis Giovannoli from France and Ubele van der Velden from the Netherlands about the possible creation of a united body of European societies of periodontology.

“When Ubele van der Velden suggested to me the idea of bringing together all European national perio societies, I immediately felt seduced by this vision and did not hesitate for a moment in deciding to support him in this initiative,” says Jean-Louis Giovannoli.

Despite the common goal, the Dutch and French perio societies – among the 11 national societies in the original EFP – had different objectives in creating a European organisation.

“When I met Ubele, I immediately appreciated that his goal as an educator was the exportation of the Dutch model, with the purpose of offering his compatriots who were ready to go abroad a nice future,” recalls Dr Giovannoli.

But his own interest in the project came from different motives. “I was interested in a European project mainly because it would prevent French periodontists from becoming isolated from other countries and would give them the opportunity to exchange with them,” he explains. “In France, language has long been a major obstacle to participation in international scientific debates, and even today we struggle to overcome it.”

For Giovannoli, there was also a visionary political dimension to all this and, in these days of Brexit and of populist voices raised against the European Union, it is refreshing to hear someone stress the fundamental value of a common Europe.

“As a European citizen, I’ve always been convinced that the European project is the only possible way to guarantee the future of our children, as well as peace and prosperity in our continent. Others clearly think otherwise, but I still hope that reason will prevail over national inertia.”

He says that European periodontology and the EFP itself face similar challenges to those faced by the European Union regarding disparities and differences between countries.

“Every country identifies with its culture, its history, its education system, its health system,” he comments. “Without giving up its identity, every country must evolve towards a European harmonisation. We may have different reasons to take part in that harmonising process, but the final goal is still the same for all of us – promoting periodontology and making sure that the periodontal health of patients across Europe improves, and that periodontal education is increasingly well-taught and well-learnt.”

After being involved in the meetings that led to the setting up of the EFP at the end of 1991, Jean-Louis Giovannoli became the federation’s first president and over the following 25 years served the organisation in a variety of roles.

Giovannoli was the president of EuroPerio 1 in 1994 and since then he has been involved in the organisation of all EuroPerio meetings. The Perio Master Clinic, which takes place between editions of the triennial EuroPerio, was his idea and he chaired the first Perio Master Clinic, which took place in Paris in February 2014 (the second edition takes place next March in Malta).

The model of the federation

For Jean-Louis Giovannoli, who became the EFP’s first president in 1992, it is important that the organisation is a federation of national societies where decisions are made by the general assembly made up of the member national societies.

He says that the system of electing an executive committee to run the EFP is “rather effective but, because of the search for simplicity, there is always the temptation of a centralised decision-making process. Just as in politics, it’s not always easy to reconcile efficacy and ‘democracy’.”

“I’ve spent 25 years, together with other founders such as Pierre Baehni, reminding my cherished colleagues that this federal trait should be preserved and I’ve always thought this is the key of our success,” he continues. “If you compare the EFP to other large organisations such as the AAP or the EAO, it is clear that the influence of the EFP comes from the fact that the EFP is a pool of societies with the sole objective of promoting our discipline, improving education, and defending our interests.”

He notes that most members of the executive committee are full-time educators and contrasts this with the wider membership of the national societies, who include “practitioners, academics, researchers, clinicians, students – and even hygienists in certain countries.”

As a non-academic, he says that he has sometimes felt “isolated” in executive committee meetings alongside “eminent professors” and that he has often “reminded them that a vast majority of individual members of the EFP are practitioners who feel largely apart from academic issues.”

What the EFP has achieved

Looking back over the last 25 years, he says that the EFP can be proud of many “beautiful” achievements, particularly in the field of education and continuous training.

“The EFP has succeeded in providing a European speciality education framework and has created an ‘EFP accreditation’ for university institutions that voluntarily agree to respect the suggested curricula and the guidelines. I am proud and delighted that two French universities – Strasbourg and Paris VII – have finally been awarded with this recognition, so today they keep pace with the best periodontal centres in Europe.”

Another great achievement, he feels, is the Perio Workshop – first held in 1993 under the chairmanship of Niklaus Lang in Ittingen (Switzerland) and now held annually in La Granja (Spain) – which he describes as “an essential meeting place for the best European researchers, putting European perio science at the highest global level.”

He adds that while “the way of recruiting participants can be debated,” there can be nothing but praise for “the brilliant job done by [Perio Workshop chair] Mariano Sanz in organising these events. The conclusions of the Perio Workshop are received as authoritative and, together with the Journal of Clinical Periodontology, are currently the benchmark in perio. Compared to other dentistry fields, we can be proud of being the only organisation to have reached these levels.”

The Journal of Clinical Periodontology, the EFP’s flagship publication, has gained its high impact factor (3.915) “thanks to the very solid work of the editor-in-chief [Maurizio Tonneti] and the editorial board, whose members come from our ranks.” Citing his 20 years of experience of working with the publisher Quintessence in France, he believes that the EFP should set up its own publishing house and publish the JCP itself.

Turning to EuroPerio, Giovannoli recalls the day he proposed to the other EFP founders the idea of organising a European perio congress: “At the time, everybody thought I was a megalomaniac! But then everybody followed me and trusted me so much that I needed to succeed.”

EuroPerio1 was held in Paris in May 1994 and since then there have been seven more editions of the triennial congress, and Jean-Louis Giovannoli has been involved in all of them. “In 25 years, our congress has established itself as the most unmissable meeting in dentistry. In 2015, at EuroPerio8 in London, we registered 10,000 attendees from 90 countries and it is now the biggest global scientific congress in dentistry.”

He attributes the event’s success to the interest shown in the discipline of periodontology and the “great work done on a daily basis by researchers, academicians, and clinicians.” He adds that the strength of the organising committees and the fact that EuroPerio – which has gained a reputation for “rigour, integrity, and reliability” – takes place only every three years have also helped contribute to its success.

“As the person in charge of the EFP’s congress committee, I took part in all organising committees from EuroPerio1 in 1994,” he explains. “I spent a lot of energy and hours in meetings. I’ve visited almost all European congress venues and I’ve discovered some quirky places for all kinds of events.”

Dr Giovannoli talks about the challenges faced along the way, including negotiations with industry partners to provide funding and the “endless debates” with the professional conference organisers.

He describes his former role as chair of the congress committee as consisting mainly of “making sure that the organising committee respected the rules approved by our general assembly.” He says he used his influence “to make sure that organising committees were always well balanced and made up of competent and representative members.”

The growth of EuroPerio has meant that there are few venues in Europe big enough to host the event, so not all national societies are able to host future meetings. For Giovannoli, this is a shame. “I regret this change, which disengages national societies and excludes a large part of Europe. I’m not convinced we need to keep growing, as 10,000 participants are more than enough to turn EuroPerio into a worldwide event. The quality of the content and free sessions must remain our main priority.”

He praises the EFP’s industry partners for their support and says that “conference after conference, they have proved their loyalty.” But he is worried that implantology now has “such a prominent place within our programmes, and an important part of our funding comes from implant companies.”

He urges organisers of future EuroPerio congresses to achieve the best possible balance, “while preserving their independence from the industry, which is key for our credibility.”

Evolution of perio

Looking back on his long career, Jean-Louis Giovannoli describes how dentistry has evolved considerably, often through the influence of periodontology.

“I became a dentist because my father was a dentist and then I became a periodontist – somewhat by chance, but I’ve never regretted it,” he recalls. “I love this practice, which has allowed me to earn a decent living and which has provided me every day with a great pleasure when working. I still enjoy daily contact with patients a lot. That’s why I hesitate so much to retire.”

He tells of how he has performed many surgical procedures and how, as time progressed, these became less invasive. “I’ve tried all the fixing and regenerative techniques that have been proposed over the years and I’ve done a lot of muco-gingival surgery,” he says. “I love surgery, but what I love the most is treating patients with severe periodontitis and helping them keep their teeth. Nothing is more rewarding for us than acknowledgement expressed by our patients after we have succeeded in saving their teeth.”

Giovannoli argues that the most important development over the last 40 years is probably the advent of osseointegration and he states clearly: “We need to admit that implantology has turned our practice upside down.”

He says that while implants cannot be presented as an effective alternative to techniques aimed at conserving teeth, “nobody can deny that they are today the most effective treatment for dental gaps.” But he worries that it is increasingly difficult, if not impossible, to run a profitable private practice without doing implants and notes that students attracted to periodontology are often looking ahead to the chance to become implantologists.

“We can only deplore this evolution and yearn for the time when the essential aspect of our activity was to provide periodontal treatments,” he complains. “The long-term outcomes of implants are often disappointing and studies show that the rate of complications is very high.”

He says that “despite the progress of modern implantology, I hope that non-invasive dentistry able to preserve all dental pieces will be available for the greatest number of patients.” But he fears the tendency to put “aesthetic or functional aims ahead of health aims, which must remain the priority.”

Looking ahead, he says that prevention of periodontal diseases needs to be developed further and that there is a need for more specialists to treat patients with complex problems.

“Above all, we need to strengthen the education of all dental-surgery students in the biological principles of periodontology, to qualify them to identify all their therapeutic needs, to take care of the majority of patients effectively within the limits of their competence, and to refer the most severe cases to specialists.”

Jean-Louis Giovannoli has “only excellent memories” of his time working for the EFP and admits to feeling sad to leave. “These 25 years have been for me an exceptional adventure which has allowed me to forge links with many European colleagues. That is the strength of the EFP too: powerful links, sometimes based on affection, binding together all this nice family of European periodontology.”

Dr Jean-Louis Giovannoli is a Paris-based periodontal specialist, one of the founders of the EFP, and a former chair of the federation’s congress committee. He is the joint author, together with Stefan Renvert, of Peri-implantitis (Quintessence Publishing Company, 2012).