The Jerusalem Post - The Jerusalem Post Magazine
Tooth Magic
How long does it take to have a tooth implant, and can the process be shortened? You may be surprised, but implants today are much less scary and complex than they used to be. As a boy in New York, Dr. Gedaliah Mordechai Stern dreamed of becoming a magician and also of making aliyah. Now, living in Israel, he does perform a kind of magic, as the head of a large, internationally known implant center in Jerusalem.
As a child growing up in Boro Park, Dr. Gedaliah Mordechai Stern had two dreams: to be a magician, and to make aliyah. He has fulfilled his second dream in spades, with all his many children and grandchildren living in Israel. Along the way he built a world-famous dental clinic, which some say is “magical” in its accomplishments.
Dr. Stern studied in yeshivos and universities, beginning with Kamenitz in Brooklyn and continuing with academic studies in Brooklyn College (psychology), NYU (dentistry), Pittsburgh and Boston (dental implants and oral reconstruction). After completing his training at the Department of Surgery in Maimonides Medical Center, he made aliyah, combined his Torah and professional accomplishments, and opened a dental clinic based on the finest principles of both. In 2007 he was chosen as one of the top dentists in the United States thanks to his achievements, innovations and skill in dental implants and lasers.
Dr. Stern’s clinic is located in the heart of the Rechavia, Shaarei Chessed and Nachlaot neighborhoods in Jerusalem, on Ussishkin Street near Bezalel Street. The entrance to the clinic passes through a beautiful, relaxing garden, replete with a fishpond and a little waterfall. The reception area is marked by a beautiful aquarium, lending an aura of serenity that is not generally expected in a dentist’s office. A variety of dentists — including his own son, Dr. Chanania Stern – provide a range of services: implants, gum treatments, root canals, laser treatments, fillings, whitening, surgical extractions, aesthetic treatments, children’s dentistry and more. Dr. Stern as well treats patients in the U.S. once a month, in N.J. and N.Y.
We met with Dr. Stern to discuss the questions that bother anyone who might be facing dental implants.
For one thing, how long does a dental implant take?
“Thanks to modern technology, great experience, proper organization, and a large inventory, it can truly take a very short time. The situation in our clinic for the last 20 years has been that we no longer speak in terms of days, or even one day, but rather just one hour. Thanks to laser technology, only one hour-long appointment is needed to extract teeth from an entire jaw, place the implant implant posts — usually with no surgery or stitching. In most cases one can then immediately eat all types of food — hot, cold, hard, soft— with no restrictions. After three to four months, the permanent ‘teeth’, or ‘restoration,’ is placed, generally without anesthesia; it is usually made of a porcelain or ceramic material, and the patient helps choose the color, shape, and other aspects. The entire process is truly miraculous and magical, thanks to much help from Above.”
What is the single most important thing for successful implants?
“After having placed and restored tens of thousands of implants over the past decades, I can say with certainty that what is most needed is siyatta diShmaya. Implants are wonderful when they are done responsibly, but they are not a game. One must definitely turn to the best doctor, the one with the most experience and the best materials and most advanced technology. There are, of course, experts who have been blessed with special skills by the Creator, but even the best doctor needs constant siyatta diShmaya in order to do the best job possible. As is often said, a great doctor comes with a great angel.”
Asked about the considerations involved in deciding whether to do an implant or a root canal/ post/crown, Dr. Stern says: “We used to have various theories on how to raise children — but now we have grown children and no theories. Having placed and restored tens of thousands of teeth on implants over the past 30 years we can safely say that there’s no experience like experience. Every situation is different, but we have learnt what generally works best in which situation. At the same time, just as we have professional guidance, we also have spiritual guidance from our Torah guides, Gedolei Yisrael, who accompany us every step of the way to success.”
What exactly is a dental implant? How has it developed over time?
“Dental implants have been around for a while, but have evolved significantly over the past 30 years. A natural tooth is comprised of three parts: the root — in the bone, under the gum; the tooth, above the gum; and the neck, which connects the tooth above the root. The implant replaces the root, while the crown, generally primarily porcelain, takes the place of the tooth and is fitted above the implant. The third part, the “post,” connects between the implant and crown. The implant and post are made of a natural element called titanium (Ti). Like other metals, it oxidizes in the presence of air, much like your silver at home that tarnishes. Amazingly, this natural “tarnish” is microscopically identical to bone. The bone feels so comfortable with it that it is stimulated to grow and fuse to the implant — even more strongly than bone to a natural tooth.
“We prefer implant-post systems today with no screws, no parts, and no gaps between parts, minimizing or even eliminating loosening, breakage and biologic-gap contamination. These are faster and easier, and we’ve found them to provide better results. It does require more experience and larger inventories, but it’s more than worth it.”
Dr. Stern is a member of the Academy of Laser Dentistry and a Diplomate of the American Board of Oral Implantology. He brings with him over 30 years of experience in performing implants and restoration of myriads of teeth — an accomplishment likely unequaled anywhere. His worldwide lectures center on the person behind the teeth – for he is not only a dentist, but also a psychologist and a sensitive Torah scholar.
“Our clinic is different than the accepted norm,” he says. “We believe that the patient deserves more than just standard dental treatment. I am especially proud of my team – a mixture of incredible people who have an especially positive approach and who strive to give the best and most pleasant treatment. We have professional dentists and experienced hygienists, experts in all types of treatment for adults and children.”
People who work with Dr. Stern say that he is in fact a very unique personality, a rare combination of various worlds, who “dedicates his life to treating people, not teeth.”
Is there a “best” implant?
“Really not. An experienced dentist has many different types of implants in his inventory, and he is prepared for surprises and different eventualities. Some bone is very dense, like marble, and cannot be compared to bone of cherry wood quality or bone that is even softer than that. Anyone who has made aliyah from the U.S. knows that you can’t bang the same type of nails into a wooden wall as into the concrete walls. As the Rambam says, ‘We don’t know how it will be until it will be.’ We can’t know how deep a puddle is until we step into it. Regardless of suggested technological ‘substitutes,’ there’s no substitute for a doctor with many years of experience and a proper inventory of sometimes over 100 different implant types, sizes and shapes to attain optimal results.”
Is it better that the implant process be executed by one doctor, or two?
“Both can work well when the dentists have much experience and knowledge in all the stages, and are coordinated with one another, there is less room for misunderstandings, and ideal results can be attained.”
Which is better, a bridge to save the teeth, or an implant?
“Dealing with this question is one of our hardest challenges. On the one hand, with all our ‘brilliance’ and knowledge, there is nothing like the natural teeth given to us by our Creator. On the other hand, there’s no question that when reconstruction is necessary, it is often much faster, easier, stronger and more economical to remove problematic teeth. It takes extensive experience to know when to remove and when not to. As the Gemara says, ‘Chacham adif minavi — a wise [experienced] person knows better than a prophet.’ We disagree with those who say that teeth are always better than implants and should be saved at all costs. It may sound kinder and more conservative to preserve teeth, but this often ends up being a poor decision. Today we look back regretfully on many teeth that we should have removed. Long-term experience outweighs theories.”
Is there any reason not to look for “bargains” in tooth implants?
“I think we all know the answer to this one. Would one look for the cheapest bypass heart surgery, G-d forbid?! Money is an issue for most of us, but we’re talking about an investment toward years of comfort, function, and health. Is it worth taking a chance on causing irreversible damage? When you pay less for implants, it has to mean compromising the level of care and service. The real question to ask is how expensive today’s cheap price will be tomorrow. When flying overseas, you can choose first-class or economy based on financial considerations — but would you ever consider taking a cheaper airline that compromises on safety and security?!
“Implants are not something you do every day, so when you finally do it, do it right, and do it responsibly! Too many people have paid heavy prices for trying to do it cheaper. It hurts us to have to redo past money-saving attempts, leading to added costs and anguish. This also applies to attempts to place fewer than necessary implants. Did the Creator skimp on tooth roots to save? The best idea is to consult a dentist with experience and long-term success. People who have done it right are usually not sorry.”
Getting a second opinion is always a good idea. Ask for names of patients who did similar treatments 5 to 10 or more years ago.
Are there “specialists” in implant dentistry?
“Oral surgeons do wonderful work in the field of surgery, and periodontists do amazing things for gums — but this alone does not make them certified oral implantologists. The Israel Dental Association has so far not officially recognized oral implantology as a separate specialty. Years ago in the U.S., serious organizations such as the American Board of Oral Implantology and the American Academy of Implant Dentistry were established to institute rigorous testing and recognize genuine expertise and competence in this field. Oral implantology requires advanced knowledge in surgery, prosthetics, gums, lasers, and more, as well as a ‘responsible captain’ to oversee and bring it all together.
“People choose to have implants so that they can look good, feel good, and be done with their dental needs as quickly and efficiently as possible. This requires advanced training, knowledge and experience to get the best possible short- and longterm results. Expertise on this level definitely exists — even if not officially recognized in Israel — and should be sought out, if one wishes to do it the best way possible.”
What’s new in implant dentistry?
“Modern technology has definitely brought new developments to the field. We are now able to do things we never dreamed of, faster, easier and better than before. Until a few years ago, it used to take many hours to prepare for the implants and to execute them, with much cutting, stitching, CT radiation and discomfort. Today, thanks to laser technology, there is usually no cutting or stitching, and almost no bleeding or swelling. Piezosurgery (a form of advanced ultrasonics) enables the removal of teeth more quickly and comfortably, without destroying the gum and bones that are so important for implants. Teeth are practically identical, biologically, to natural bone. In the rare cases that it is necessary, we can convert the patient’s own teeth into “bone grafting” material, instead of using donor bone from someone else or even from an animal — which even today is still often done by others. This is an amazing and exciting development. We continue to be as excited as ever, and even more so, to be able to help our patients faster and better than ever before.”
What’s the secret?
“Dental implants change people’s lives. Each case is a new creation. Behind every implant is a person, someone in dire need of regaining lost comfort, function, health or aesthetics — not feeling ‘whole.’ Many people desperately wish to restore the quality of life they gradually lost over the course of years, often because they were too occupied with daily life to take care of themselves.
“But the past is in the past, and we can now only look forward to the future. We need to focus on what can be done now and what must be done. The miracles of today’s science and medicine enable us, with siyatta diShmaya, to effectively restore our long-lost health and peace of mind, and help us look good, feel good, and be done with necessary care. People can be helped today faster and easier than ever before, and they are often sorry they didn’t do so sooner. What’s happening is truly fascinating, and a real gift from G-d to be able to help others in this way. We celebrate every success and every day that we can help people and change their lives. We are forever indebted to Hashem, and to our thousands of patients throughout the world who have given and give us the opportunity and the privilege to continue with our holy work.”