April 26, 2022 • 22 mins
Jaw-in-a-Day accomplishes in one surgery and one day what used to take three surgeries or more. Prior to this revolutionary procedure, the process to get dental implants could take months, or even years, forcing patients to live without teeth. Using virtual surgical planning, a team of doctors can not only pre-fabricate teeth to implant on the day of surgery, they can improve the accuracy and efficiency of this difficult process. On this episode of 20-Minute Health Talk, we speak with the pioneers of Jaw-in-a-Day:
- David Hirsch, MD, DDS, FACS, senior vice president of the dental medicine service line for Northwell Health, and chair of the newly established Department of Oral and Maxillofacial Surgery at Lenox Hill Hospital.
- Lawrence Brecht, DDS, a specialist in maxillofacial prosthetics
They discuss how this new approach to jaw surgery came to be, evolving the technology behind it over that last 10 years, and expanding access.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Host (00:00):
Welcome to 20-minute Health talk.
(00:04):
I'm your host, Rob Hoell. A problem with your jaw is tough to hide
while certain tumors of the jaw can be disfiguring.
Left untreated traditional, surgical treatments can have a similar
impact.
That is where our guests come in today.
Dr. David Hirsch is senior vice president of the dental medicine service
line for northwell health and chair of the newly established
Department of oral maxillofacial surgery
(00:24):
at Lenox Hill Hospital.
Dr. Hirsch pioneered Jaw-in-a-Day, which accomplishes in one surgery
and in one day
what used to take three surgeries over the course of months, if not
years.
Dr. Hirsch, welcome
Dr. Hirsch (00:36):
Thanks for having me
Host (00:39):
Over the past decade our second guest today.
Dr. Lawrence Brecht has worked with Dr. Hirsch
to develop and improve and now expand access to this
revolutionary procedure.
He is the director of maxillofacial prosthetics for Lenox Hill
Hospital, lij Medical Center and North Shore.
University Hospital.
Dr. Brecht thanks for joining us.
Dr. Brecht (00:55):
Yeah. Thanks for having us
Host (00:57):
Repairing, a jaw can involve multiple procedures
and leave patients
not feeling whole.
Dr. Hirsch, tell us how Jaw-in-a-Day came to be.
Dr. Hirsch (01:05):
Jaw-in-a-Day was
Dr. Brecht and I's kind of brain child.
We had been doing a lot of reconstruction for patients with cancer
motor vehicle accidents or any infectious process.
And we just weren't satisfied with the Reconstruction and we thought
that we could deliver a better product.
(01:28):
Originally when we would see patients.
like this it would take us about a year from their initial surgery,
having removal of their jaw to getting them new jaw as well as
implants and finally teeth.
And so we set out to figure out, is there a way we can do this in one
(01:49):
operation, in one day?
Host (01:52):
We talk about a jaw in a day.
What kind of surgery is this?
Is this an all-day surgery or how many hours does it take?
Dr. Brecht (01:58):
First one was what?
Dr. Hirsch (02:00):
Yeah, used to be a Jaw-in-a-Day-and-a-half.
And now it's probably I probably re-term it Jaw-in-half a day.
Yeah, I think we could probably do this procedure in about six hours.
And with that being said, you know, it takes about an hour to get set
up before you even start surgery.
(02:20):
And then when you're done, probably takes another 45 minutes when
you're done, so we're very efficient.
Host (02:26):
It's awesome.
What about the if it's taken from
Different part of the body, say the the bone is taken from the leg.
What kind of effect does that have on the person's walking?
Or is there any effect at all?
Dr. Hirsch (02:38):
Yeah, I mean, when we take the bone from the leg, it's there's a
there's two bones in the leg.
The the larger bone is the tibia and the smaller bone is the fibula.
We use the fibula and the patients in the initial post operative
period it is like they've had a broken leg but
(03:00):
We've had we've done this on athletes, we've done this on basketball
players.
We've done this, some people who ski and for the most part they go
back to their normal physical activity.
It takes a little bit of time, but patients do remarkably well missing
their fibula.
Host (03:16):
Now, this is so successful that you're expanding on Long Island.
What does this mean for the people in Long Island?
Dr. Hirsch (03:23):
Well, more jaws in a day.
Dr. Brecht (03:26):
Yeah, It gets more jaws in a day.
I think, you know, we were sitting around here before talking about
what it was like to have to travel into the city, you know, you don't
need to necessarily travel into the city to get this done.
I mean procedures, we've done a number of them now out at Long Island Jewish Medical Center
So yeah, I think patients of Long Island win by having this team out
(03:51):
there.
Providing the service.
After we've refined it for 10 years.
I mean, as the, the dental person on this, I mean, I have the
privilege to watch.
Dr. Hirsch operating in usually our plastic surgery or ENT surgery,
colleague working down on the leg and harvesting the leg bone.
(04:13):
If that's the bone that we're going to use as opposed to some other
sites and I am amazed to watch how this whole thing kind of
choreographs and comes
together and, you know, David's really the leader of the team in the
operating room and he kind of sets the standard for everybody and that
kind of leads to Great results.
You know, nobody wants walk out of there feeling disappointed.
(04:35):
So it's a wonderful orchestration of an extremely complicated set of
procedures that kind of, makes it look easy when it's all pulled together
Host (04:48):
And this is kind of amazing procedure and it's very we've
talked before a little bit as is very well-choreographed.
There's actually a couple of different surgeries happening at once
tells walk us through the day of the surgery.
What it's what goes on in a day, a Jaw in a day.
Dr. Hirsch (05:04):
Yeah, it is.
It's well choreographed and the entire procedure really is planned
prior to us, going to the operating room
Dr. Brecht (05:15):
Right, right. It all happens before
Dr. Hirsch (05:17):
So, we'll spend a couple of sessions online with
Dr. Brecht, myself.
And usually another surgeon. One that, as I'm removing the tumor will be
harvesting
from another area of the body that allows us to cut the surgery time
(05:38):
in half, but the planning is about an hour, long, planning session,
and we sit there and we look at the geometry of the jaw.
The areas that need to be removed.
What are the important anatomical landmarks?
We have to respect and basically do a dress rehearsal prior to going
to the OR. And so that's where the big thing is.
(05:59):
And then once we do,
That when we go to the OR, we already know what each each of us are
going to do and it just goes much smoother in that we thought about it
We've thought about what each of our parts should be and then, you
know, the easy part is actually going and doing the procedure.
Host (06:22):
Tell me how technology plays a role virtual.
Surgical planning, tell us about that.
And how are you able to really get a great grasp of what's going on?
Through the the use of very fine
Finally cuts cat-scans that are very accurate.
We can translate that to a 3D image and then on a computer program we
(06:45):
can actually plan the surgery, plan the cuts of the surgery,
everything can be planned to the millimeter.
Once that's done that's translated to physical product by sending all
That information to 3D printers and then 3D printers will make guides
for us to take to surgery.
(07:06):
They'll make specialized plates that are custom fit to the patient's
jaw and even things down to the prosthesis and the teeth.
Dr. Brecht is planning that virtually.
So the entire surgery is planned on a computer and translated to the
operating room using all 3D printers and that's that's pretty nice.
(07:29):
Oval good thing about it is it can be replicated and so it's not just
limited to our patient population.
This is something now that has been brought to the masses in the
United States and in Europe and virtual surgical planning can be done
anywhere.
So we will be planning, Larry be planning in his office.
(07:52):
I'll be in my office will have an engineer that we might be working
with in Colorado.
So
All of the technology that's humanly possible.
Is brought to these cases.
Tell me who the ideal patient is for this procedure.
Dr. Hirsch (08:12):
That's a great question.
I mean when we initially started doing this we thought we could do
this, only on select patients.
So a young patient with a benign tumor that probably wasn't going to
get radiation.
We thought would be a good ideal patient.
But at this point in time because we've been able to fine-tune
(08:33):
everything we do there were we can do it on almost any patient that
that needs a
resection of their jaw.
We used to think we couldn't do it because patients were going to get
radiation.
But again, as we've gotten better at doing the technique and we've
learned the intricacies of what works and what doesn't work.
(08:55):
I think the really there's no limitation on who we can do it on.
Host (08:59):
That's awesome.
Dr. Brecht, tell us about how you fabricate teeth.
Dr. Brecht (09:06):
Again, technology is really the driving force here, you know, your leg
bone, the fibula really looks like your jaw bone, your lower jaw bone
without teeth.
Like, you know, somebody wearing a denture.
If you took their lower jaw out
It looks just like a leg bone.
Except now we have the ability to attach the teeth - a denture - to
(09:30):
A leg bone through these implants, we fabricate them from a very
aesthetic, acrylic material, that's milled by computer starts out.
As a looks like a big hockey puck, except it's tooth-colored and
computer off of our planning, and our design mills out what the teeth
(09:52):
should look like.
We put those in in the operating room.
We attach them to the implants.
We let the patient go through.
Probably want a bit about like a three-month healing period, fine-tune
it, maybe get them a second set of teeth to refine
any changes that the patient really wants to have.
Maybe they started out with crooked teeth.
(10:12):
We gave them crooked teeth in the OR and they're like, you know, I
really wish my teeth were straight.
We make them a second set when the person is really happy with the new
set of temporaries.
Then we go off and make a final set.
Instead of Milling it out of acrylic.
We Mill it out of this material called zirconia, which is
we're familiar with their zironica as an artificial diamond
(10:33):
and it's the same material.
It's just in a different crystal structure.
Instead of it being clear
it has a tooth color shade or gradation between, you know, having
an opacity to it to maybe as the top of your teeth, have some
transparency, the very, very aesthetic, very durable.
(10:55):
Those are long-term teeth.
We put those in patients that we've treated 10.
years ago.
They still have those those teeth in place.
Host (11:03):
It's amazing.
And how long does it take before?
A person is back to, you know, a hundred percent, you know, eating
talking back to work, all this stuff
Dr. Hirsch (11:14):
Depends on the patient, their age, but I think typical patient
probably spends about five days to seven days in the hospital and then
we start them eating while they're in the hospital.
We start Physical Therapy when when they're in the hospital.
So, usually the first post-op visit
we're trying to get them moving towards more normal everyday
(11:38):
activities, but it does, it does take time.
It's a big operation.
But typically, you know, I think by three weeks we have them eating
most Foods.
Dr. Brecht (11:51):
Yeah.
I think the remarkable thing is, you know, we started out pretty much
uh, on younger patients that had a
really aggressive benign tumor
that was really destructive
and the only way to eradicate it was to take out the entire portion of
the jaw that was affected by then.
And then a little more right, make sure you've got it all out. And over
(12:15):
time as David said, realized that this the technique is applicable to,
you know, even even older patients.
I'm trying to think.
But the oldest patient we've done is and
Dr. Hirsch (12:30):
I probably early 80s.
Dr. Brecht (12:32):
Yeah, and you know, people are remarkably.
In a grateful, it's humbling on our side.
These are these are people.
You know, in the dental side.
I'm doing
We're both doing follow-up.
I tend to see people, you know, regularly probably every six months
making sure everything is okay for, for a few years and then kind of
(12:56):
like after the five-year mark.
I'm probably still the person seeing the people because I want to make
sure the prosthesis is okay.
I want to make sure the implants are okay, that everything is tight
and you develop.
A very long-term relationship with people that we put them through
this experience.
It's really life-transforming for them and they go about life, pretty
(13:19):
much as normal afterward.
And it's, it's very humbling on our end to do this.
I mean, you know, every time I see one of these done, I'm, I'm still
amazed.
I still get a rush.
I'm so happy in what I've chosen to do
for my life's avocation.
(13:42):
I'm happy to be around colleagues who are really great at what they
do.
And after 20 years
they still want to push the envelope.
That's, that's the definition of being a professional.
Host (13:56):
It's great.
Speaking of moving out to Long Island.
Your first patient was Tara Singh, and she had an amazing result and you
did something a little bit different on this.
Tell us a little bit about how that procedure went.
And what was the new process there.
Dr. Brecht (14:09):
Well, you know, my incredibly humble surgical colleague here, is I
find it fascinating.
I've got this picture up here on the computer screen and there's this
plate here that holds all the pieces of the leg bone together to form
a jaw bone.
And one of the things we did on the march from a simple operation to
(14:31):
the operation we're at now
is David really was able to perfect the technology.
And the surgery, we're not just taking the leg bone and maybe breaking
it into three pieces to make it look like a jaw, but maybe somebody
had a bigger native jaw and needed to have more height in their leg,
(14:53):
bone forming, their jaws.
So, what he was able to design with the
surgical colleagues that put it all together, but they were able to do,
is they would split the leg bone put it on top of itself in.
Come up with a bar design that again is custom made by computer.
You couldn't do this before that technology was around and it's called
(15:16):
a double barrel technique.
And what it is able to do is give a remarkable resemblance to a
patient's, you know, pre-surgical jaw form.
Dr. Hirsch (15:27):
We do that quite frequently depending on where the defect in the
in the jaw is.
Host (15:34):
Yeah.
And the outcome is so amazing because you would never think that she
had surgery.
And I'm hoping that my producer, Brian Donnelly will be able to link
that video in there because I think you should people should see that
video and see the success that that was able to be done for her.
Dr. Hirsch (15:46):
Yeah, and lastly, you know, when you make the comment that they don't
look like they had surgery.
So one of the nice things about the virtual surgical planning, is it
allows us to do somethings blindly
The plate usually fits very well.
And so we used to have to get access to the entire mandible, to make
(16:07):
sure everything was exactly where we wanted it.
Now when things fit, I'm able to make smaller incisions make really
small incisions in the patient's face, make the majority of my
incisions inside the patient's mouth.
And so when you can make more incisions in the patient's mouth and
have less scars on the face
patients then really start to look like they don't have surgery,
(16:33):
you know, if you can make a three-centimeter incision instead of a 10
centimeter incision in somebody's neck.
It's a huge benefit, especially to a young patient who does not
have wrinkles.
Host (16:45):
You'd mentioned before that you two pioneered this, and now it's being
replicated all over the country.
What about, are other
Where does this go from here?
Are there other applications for this?
Maybe in other types of surgery.
Are other people looking at your work here and seeing how they can
maybe help somebody else.
Maybe not a jaw, or something else?
Dr. Hirsch (17:05):
Yeah, I mean it's been so it has been replicated and in the field of
Orthopedics.
The first oral surgical planning... they started to use it
after we were doing a lot of head and neck stuff, were always asking
ourselves
what can we do next?
And what's the next thing?
(17:27):
We're always trying to look to to make things more efficient and come
up with new ways of doing these things.
That's what that's what makes all of this very
I think exciting to us.
Host (17:37):
What does it look like when you do these 3D images, right?
And you do these, these scans of the mouth and you're going to do this
surgery.
You want to go right to the letter.
You want to make it perfect.
And that's why you do this
virtual surgical planning.
When you're done you go back and look and see how exact it is?
Dr. Hirsch (17:54):
Yeah.
Host (17:54):
And how exact is it?
That's a very insightful
question. So when we first started doing it, we wanted to know.
Are we accurate?
Are we doing this right
So every patient that we did it on, we probably did it for the first
20 patients is we got a post-operative CAT scan, and then overlay
(18:16):
the images that we planned with what we turned up with after the
operation just to see, are we close?
What can we do better?
And it was remarkably accurate
The overlay was always within one with actually within one
millimeter of what we planned and you know, that would just kind of
(18:39):
proof of concept to us.
And that that type of accuracy, you know, we needed to prove I think
in the beginning to make sure that we were doing the right things here.
So we always like to end on a positive note here, on 20-Minute Health Talk
And so I like to ask both of you and I'll start with you.
Dr. Brecht, just tell me.
What gives you hope?
What gives you optimism going forward?
Dr. Brecht (19:01):
I'm incredibly optimistic when I see young people being excited about
techniques like this and wanting to learn and just kind of soak it up
because they're the repositories for the next Innovation that's going
to drive this forward.
I remember when David and I started this person who trained just ahead
(19:25):
of us and kind of was one of the pioneers of leg-to-jaw surgery
we were at a talk and he came back and we asked him.
why he stopped doing the operation and he said, he couldn't figure out
what the next iteration to the operation was and, you know, David and
I looked at one another like, 'wow, that's, you know, how could you not see..."
(19:46):
Right? Technology came along at the same time.
So, I'm excited about technology and I do remember, when a, when a
younger Dr. Hirsch came to me and said, hey, I have this idea and people told me
you're the guy i need
to come find.
I remember that day
so clearly, and after he told me what his vision was, I said, 'this is
(20:08):
at, this is great.
I'm happy to do this with you.'
So I think I'm hopeful that we've got great teachers in this system.
We've got motivated, young people, and between young people and
energy and technology
I think things will be good
Fantastic. Dr. Hirsch
(20:30):
what gives you hope and optimism?
Well, that once hard to follow
For me, Northwell Health has given me a platform to do
what I want to do
professionally. Allowed me the autonomy and Leadership role that I can
(20:56):
recruit and surround myself with people
who I think are great. And if I couldn't surround myself that people
that are better than me and that are very bright and Excel then they
make me look good.
And so I'm really optimistic of what we're growing here throughout the
(21:21):
Northwell system, at Lenox Hill, at LIJ, at North Shore.
And so for me the future
is really bright because I love what I'm doing and I love who
I'm doing it with.
So it's pretty hard, not to be excited to come to work when when you
have that situation set up for yourself.
Host (21:43):
That's awesome.
Well, Dr. Hirsch, Dr. Brecht
Thank you so much for joining us here on 20-Minute Health Talk.
And for you, the listener
thank you so much for tuning in.
Have a great day and stay safe.
Dr. Brecht (21:53):
Thanks, Rob
Get more expert Insight from some of the leading voices
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podcasts.
Welcome to 20-minute Health talk.
(00:04):
I'm your host, Rob Hoell. A problem with your jaw is tough to hide
while certain tumors of the jaw can be disfiguring.
Left untreated traditional, surgical treatments can have a similar
impact.
That is where our guests come in today.
Dr. David Hirsch is senior vice president of the dental medicine service
line for northwell health and chair of the newly established
Department of oral maxillofacial surgery
(00:24):
at Lenox Hill Hospital.
Dr. Hirsch pioneered Jaw-in-a-Day, which accomplishes in one surgery
and in one day
what used to take three surgeries over the course of months, if not
years.
Dr. Hirsch, welcome
Dr. Hirsch (00:36):
Thanks for having me
Host (00:39):
Over the past decade our second guest today.
Dr. Lawrence Brecht has worked with Dr. Hirsch
to develop and improve and now expand access to this
revolutionary procedure.
He is the director of maxillofacial prosthetics for Lenox Hill
Hospital, lij Medical Center and North Shore.
University Hospital.
Dr. Brecht thanks for joining us.
Dr. Brecht (00:55):
Yeah. Thanks for having us
Host (00:57):
Repairing, a jaw can involve multiple procedures
and leave patients
not feeling whole.
Dr. Hirsch, tell us how Jaw-in-a-Day came to be.
Dr. Hirsch (01:05):
Jaw-in-a-Day was
Dr. Brecht and I's kind of brain child.
We had been doing a lot of reconstruction for patients with cancer
motor vehicle accidents or any infectious process.
And we just weren't satisfied with the Reconstruction and we thought
that we could deliver a better product.
(01:28):
Originally when we would see patients.
like this it would take us about a year from their initial surgery,
having removal of their jaw to getting them new jaw as well as
implants and finally teeth.
And so we set out to figure out, is there a way we can do this in one
(01:49):
operation, in one day?
Host (01:52):
We talk about a jaw in a day.
What kind of surgery is this?
Is this an all-day surgery or how many hours does it take?
Dr. Brecht (01:58):
First one was what?
Dr. Hirsch (02:00):
Yeah, used to be a Jaw-in-a-Day-and-a-half.
And now it's probably I probably re-term it Jaw-in-half a day.
Yeah, I think we could probably do this procedure in about six hours.
And with that being said, you know, it takes about an hour to get set
up before you even start surgery.
(02:20):
And then when you're done, probably takes another 45 minutes when
you're done, so we're very efficient.
Host (02:26):
It's awesome.
What about the if it's taken from
Different part of the body, say the the bone is taken from the leg.
What kind of effect does that have on the person's walking?
Or is there any effect at all?
Dr. Hirsch (02:38):
Yeah, I mean, when we take the bone from the leg, it's there's a
there's two bones in the leg.
The the larger bone is the tibia and the smaller bone is the fibula.
We use the fibula and the patients in the initial post operative
period it is like they've had a broken leg but
(03:00):
We've had we've done this on athletes, we've done this on basketball
players.
We've done this, some people who ski and for the most part they go
back to their normal physical activity.
It takes a little bit of time, but patients do remarkably well missing
their fibula.
Host (03:16):
Now, this is so successful that you're expanding on Long Island.
What does this mean for the people in Long Island?
Dr. Hirsch (03:23):
Well, more jaws in a day.
Dr. Brecht (03:26):
Yeah, It gets more jaws in a day.
I think, you know, we were sitting around here before talking about
what it was like to have to travel into the city, you know, you don't
need to necessarily travel into the city to get this done.
I mean procedures, we've done a number of them now out at Long Island Jewish Medical Center
So yeah, I think patients of Long Island win by having this team out
(03:51):
there.
Providing the service.
After we've refined it for 10 years.
I mean, as the, the dental person on this, I mean, I have the
privilege to watch.
Dr. Hirsch operating in usually our plastic surgery or ENT surgery,
colleague working down on the leg and harvesting the leg bone.
(04:13):
If that's the bone that we're going to use as opposed to some other
sites and I am amazed to watch how this whole thing kind of
choreographs and comes
together and, you know, David's really the leader of the team in the
operating room and he kind of sets the standard for everybody and that
kind of leads to Great results.
You know, nobody wants walk out of there feeling disappointed.
(04:35):
So it's a wonderful orchestration of an extremely complicated set of
procedures that kind of, makes it look easy when it's all pulled together
Host (04:48):
And this is kind of amazing procedure and it's very we've
talked before a little bit as is very well-choreographed.
There's actually a couple of different surgeries happening at once
tells walk us through the day of the surgery.
What it's what goes on in a day, a Jaw in a day.
Dr. Hirsch (05:04):
Yeah, it is.
It's well choreographed and the entire procedure really is planned
prior to us, going to the operating room
Dr. Brecht (05:15):
Right, right. It all happens before
Dr. Hirsch (05:17):
So, we'll spend a couple of sessions online with
Dr. Brecht, myself.
And usually another surgeon. One that, as I'm removing the tumor will be
harvesting
from another area of the body that allows us to cut the surgery time
(05:38):
in half, but the planning is about an hour, long, planning session,
and we sit there and we look at the geometry of the jaw.
The areas that need to be removed.
What are the important anatomical landmarks?
We have to respect and basically do a dress rehearsal prior to going
to the OR. And so that's where the big thing is.
(05:59):
And then once we do,
That when we go to the OR, we already know what each each of us are
going to do and it just goes much smoother in that we thought about it
We've thought about what each of our parts should be and then, you
know, the easy part is actually going and doing the procedure.
Host (06:22):
Tell me how technology plays a role virtual.
Surgical planning, tell us about that.
And how are you able to really get a great grasp of what's going on?
Through the the use of very fine
Finally cuts cat-scans that are very accurate.
We can translate that to a 3D image and then on a computer program we
(06:45):
can actually plan the surgery, plan the cuts of the surgery,
everything can be planned to the millimeter.
Once that's done that's translated to physical product by sending all
That information to 3D printers and then 3D printers will make guides
for us to take to surgery.
(07:06):
They'll make specialized plates that are custom fit to the patient's
jaw and even things down to the prosthesis and the teeth.
Dr. Brecht is planning that virtually.
So the entire surgery is planned on a computer and translated to the
operating room using all 3D printers and that's that's pretty nice.
(07:29):
Oval good thing about it is it can be replicated and so it's not just
limited to our patient population.
This is something now that has been brought to the masses in the
United States and in Europe and virtual surgical planning can be done
anywhere.
So we will be planning, Larry be planning in his office.
(07:52):
I'll be in my office will have an engineer that we might be working
with in Colorado.
So
All of the technology that's humanly possible.
Is brought to these cases.
Tell me who the ideal patient is for this procedure.
Dr. Hirsch (08:12):
That's a great question.
I mean when we initially started doing this we thought we could do
this, only on select patients.
So a young patient with a benign tumor that probably wasn't going to
get radiation.
We thought would be a good ideal patient.
But at this point in time because we've been able to fine-tune
(08:33):
everything we do there were we can do it on almost any patient that
that needs a
resection of their jaw.
We used to think we couldn't do it because patients were going to get
radiation.
But again, as we've gotten better at doing the technique and we've
learned the intricacies of what works and what doesn't work.
(08:55):
I think the really there's no limitation on who we can do it on.
Host (08:59):
That's awesome.
Dr. Brecht, tell us about how you fabricate teeth.
Dr. Brecht (09:06):
Again, technology is really the driving force here, you know, your leg
bone, the fibula really looks like your jaw bone, your lower jaw bone
without teeth.
Like, you know, somebody wearing a denture.
If you took their lower jaw out
It looks just like a leg bone.
Except now we have the ability to attach the teeth - a denture - to
(09:30):
A leg bone through these implants, we fabricate them from a very
aesthetic, acrylic material, that's milled by computer starts out.
As a looks like a big hockey puck, except it's tooth-colored and
computer off of our planning, and our design mills out what the teeth
(09:52):
should look like.
We put those in in the operating room.
We attach them to the implants.
We let the patient go through.
Probably want a bit about like a three-month healing period, fine-tune
it, maybe get them a second set of teeth to refine
any changes that the patient really wants to have.
Maybe they started out with crooked teeth.
(10:12):
We gave them crooked teeth in the OR and they're like, you know, I
really wish my teeth were straight.
We make them a second set when the person is really happy with the new
set of temporaries.
Then we go off and make a final set.
Instead of Milling it out of acrylic.
We Mill it out of this material called zirconia, which is
we're familiar with their zironica as an artificial diamond
(10:33):
and it's the same material.
It's just in a different crystal structure.
Instead of it being clear
it has a tooth color shade or gradation between, you know, having
an opacity to it to maybe as the top of your teeth, have some
transparency, the very, very aesthetic, very durable.
(10:55):
Those are long-term teeth.
We put those in patients that we've treated 10.
years ago.
They still have those those teeth in place.
Host (11:03):
It's amazing.
And how long does it take before?
A person is back to, you know, a hundred percent, you know, eating
talking back to work, all this stuff
Dr. Hirsch (11:14):
Depends on the patient, their age, but I think typical patient
probably spends about five days to seven days in the hospital and then
we start them eating while they're in the hospital.
We start Physical Therapy when when they're in the hospital.
So, usually the first post-op visit
we're trying to get them moving towards more normal everyday
(11:38):
activities, but it does, it does take time.
It's a big operation.
But typically, you know, I think by three weeks we have them eating
most Foods.
Dr. Brecht (11:51):
Yeah.
I think the remarkable thing is, you know, we started out pretty much
uh, on younger patients that had a
really aggressive benign tumor
that was really destructive
and the only way to eradicate it was to take out the entire portion of
the jaw that was affected by then.
And then a little more right, make sure you've got it all out. And over
(12:15):
time as David said, realized that this the technique is applicable to,
you know, even even older patients.
I'm trying to think.
But the oldest patient we've done is and
Dr. Hirsch (12:30):
I probably early 80s.
Dr. Brecht (12:32):
Yeah, and you know, people are remarkably.
In a grateful, it's humbling on our side.
These are these are people.
You know, in the dental side.
I'm doing
We're both doing follow-up.
I tend to see people, you know, regularly probably every six months
making sure everything is okay for, for a few years and then kind of
(12:56):
like after the five-year mark.
I'm probably still the person seeing the people because I want to make
sure the prosthesis is okay.
I want to make sure the implants are okay, that everything is tight
and you develop.
A very long-term relationship with people that we put them through
this experience.
It's really life-transforming for them and they go about life, pretty
(13:19):
much as normal afterward.
And it's, it's very humbling on our end to do this.
I mean, you know, every time I see one of these done, I'm, I'm still
amazed.
I still get a rush.
I'm so happy in what I've chosen to do
for my life's avocation.
(13:42):
I'm happy to be around colleagues who are really great at what they
do.
And after 20 years
they still want to push the envelope.
That's, that's the definition of being a professional.
Host (13:56):
It's great.
Speaking of moving out to Long Island.
Your first patient was Tara Singh, and she had an amazing result and you
did something a little bit different on this.
Tell us a little bit about how that procedure went.
And what was the new process there.
Dr. Brecht (14:09):
Well, you know, my incredibly humble surgical colleague here, is I
find it fascinating.
I've got this picture up here on the computer screen and there's this
plate here that holds all the pieces of the leg bone together to form
a jaw bone.
And one of the things we did on the march from a simple operation to
(14:31):
the operation we're at now
is David really was able to perfect the technology.
And the surgery, we're not just taking the leg bone and maybe breaking
it into three pieces to make it look like a jaw, but maybe somebody
had a bigger native jaw and needed to have more height in their leg,
(14:53):
bone forming, their jaws.
So, what he was able to design with the
surgical colleagues that put it all together, but they were able to do,
is they would split the leg bone put it on top of itself in.
Come up with a bar design that again is custom made by computer.
You couldn't do this before that technology was around and it's called
(15:16):
a double barrel technique.
And what it is able to do is give a remarkable resemblance to a
patient's, you know, pre-surgical jaw form.
Dr. Hirsch (15:27):
We do that quite frequently depending on where the defect in the
in the jaw is.
Host (15:34):
Yeah.
And the outcome is so amazing because you would never think that she
had surgery.
And I'm hoping that my producer, Brian Donnelly will be able to link
that video in there because I think you should people should see that
video and see the success that that was able to be done for her.
Dr. Hirsch (15:46):
Yeah, and lastly, you know, when you make the comment that they don't
look like they had surgery.
So one of the nice things about the virtual surgical planning, is it
allows us to do somethings blindly
The plate usually fits very well.
And so we used to have to get access to the entire mandible, to make
(16:07):
sure everything was exactly where we wanted it.
Now when things fit, I'm able to make smaller incisions make really
small incisions in the patient's face, make the majority of my
incisions inside the patient's mouth.
And so when you can make more incisions in the patient's mouth and
have less scars on the face
patients then really start to look like they don't have surgery,
(16:33):
you know, if you can make a three-centimeter incision instead of a 10
centimeter incision in somebody's neck.
It's a huge benefit, especially to a young patient who does not
have wrinkles.
Host (16:45):
You'd mentioned before that you two pioneered this, and now it's being
replicated all over the country.
What about, are other
Where does this go from here?
Are there other applications for this?
Maybe in other types of surgery.
Are other people looking at your work here and seeing how they can
maybe help somebody else.
Maybe not a jaw, or something else?
Dr. Hirsch (17:05):
Yeah, I mean it's been so it has been replicated and in the field of
Orthopedics.
The first oral surgical planning... they started to use it
after we were doing a lot of head and neck stuff, were always asking
ourselves
what can we do next?
And what's the next thing?
(17:27):
We're always trying to look to to make things more efficient and come
up with new ways of doing these things.
That's what that's what makes all of this very
I think exciting to us.
Host (17:37):
What does it look like when you do these 3D images, right?
And you do these, these scans of the mouth and you're going to do this
surgery.
You want to go right to the letter.
You want to make it perfect.
And that's why you do this
virtual surgical planning.
When you're done you go back and look and see how exact it is?
Dr. Hirsch (17:54):
Yeah.
Host (17:54):
And how exact is it?
That's a very insightful
question. So when we first started doing it, we wanted to know.
Are we accurate?
Are we doing this right
So every patient that we did it on, we probably did it for the first
20 patients is we got a post-operative CAT scan, and then overlay
(18:16):
the images that we planned with what we turned up with after the
operation just to see, are we close?
What can we do better?
And it was remarkably accurate
The overlay was always within one with actually within one
millimeter of what we planned and you know, that would just kind of
(18:39):
proof of concept to us.
And that that type of accuracy, you know, we needed to prove I think
in the beginning to make sure that we were doing the right things here.
So we always like to end on a positive note here, on 20-Minute Health Talk
And so I like to ask both of you and I'll start with you.
Dr. Brecht, just tell me.
What gives you hope?
What gives you optimism going forward?
Dr. Brecht (19:01):
I'm incredibly optimistic when I see young people being excited about
techniques like this and wanting to learn and just kind of soak it up
because they're the repositories for the next Innovation that's going
to drive this forward.
I remember when David and I started this person who trained just ahead
(19:25):
of us and kind of was one of the pioneers of leg-to-jaw surgery
we were at a talk and he came back and we asked him.
why he stopped doing the operation and he said, he couldn't figure out
what the next iteration to the operation was and, you know, David and
I looked at one another like, 'wow, that's, you know, how could you not see..."
(19:46):
Right? Technology came along at the same time.
So, I'm excited about technology and I do remember, when a, when a
younger Dr. Hirsch came to me and said, hey, I have this idea and people told me
you're the guy i need
to come find.
I remember that day
so clearly, and after he told me what his vision was, I said, 'this is
(20:08):
at, this is great.
I'm happy to do this with you.'
So I think I'm hopeful that we've got great teachers in this system.
We've got motivated, young people, and between young people and
energy and technology
I think things will be good
Fantastic. Dr. Hirsch
(20:30):
what gives you hope and optimism?
Well, that once hard to follow
For me, Northwell Health has given me a platform to do
what I want to do
professionally. Allowed me the autonomy and Leadership role that I can
(20:56):
recruit and surround myself with people
who I think are great. And if I couldn't surround myself that people
that are better than me and that are very bright and Excel then they
make me look good.
And so I'm really optimistic of what we're growing here throughout the
(21:21):
Northwell system, at Lenox Hill, at LIJ, at North Shore.
And so for me the future
is really bright because I love what I'm doing and I love who
I'm doing it with.
So it's pretty hard, not to be excited to come to work when when you
have that situation set up for yourself.
Host (21:43):
That's awesome.
Well, Dr. Hirsch, Dr. Brecht
Thank you so much for joining us here on 20-Minute Health Talk.
And for you, the listener
thank you so much for tuning in.
Have a great day and stay safe.
Dr. Brecht (21:53):
Thanks, Rob
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