Dr. Glenn Gorab is an Oral and Maxillofacial surgeon practicing in Clifton, New Jersey. A 1981 graduate of Fairleigh Dickinson University School of Dentistry, Dr. Gorab completed two residencies at The Jersey City Medical Center and recently celebrated 20 years of private practice. He practices with fellow oral surgeon, Dr. Jason Lustig. He is Director of Dentistry and Chairman of the Oral and Maxillofacial Surgery department of PBI Regional Medical Center and Saint Mary’s Hospital, both in Passaic, New Jersey. Of special interest to Dr Gorab is bone grafting and dental implantology. Recently, Dr Gorab volunteered his services to the Healing the Children Foundation, helping with the placement of extra oral implants for use in supporting prosthetic ears.
Dental1: When did you know you wanted to become a dentist?
Dr. Gorab: I seriously considered the profession while in high school. I had visited a number of dental offices in my immediate area. I enjoyed seeing the work that was done and the interaction of the doctor with the patients. Finally, I enjoyed working with my hands. Dentistry seemed like the perfect fit.
Dental1: How did you pick your particular area of expertise?
Dr. Gorab: After dental school I did a general dental residency for one year at the Jersey City Medical Center. There was a tremendous amount of exposure to trauma and oral surgery and that really interested me. So, after my general practice residency I continued with additional years in an oral surgery residency.
Dental1: You’ve been in practice just over 20 years now, what do you consider the biggest change in your field?
Dr. Gorab: The biggest change that I see in our field is the use of materials and techniques for bone grafting and the availability and adaptability of dental implants to restore patients’ function and cosmetics.
Dental1: What do you enjoy most about your field?
Dr. Gorab: What I enjoy most is helping people by restoring function, comfort and esthetics and hearing patients say at the end of the procedure "that wasn’t as bad as I thought.”
Dental1: What is one of your biggest challenges?
Dr. Gorab: As a specialist, we don’t typically get involved with people on a long-term basis. We are usually seeing people on a referral basis for one or two visits and then usually do not see them again. It’s sometimes difficult to see a patient on a consultation, gain their trust, establish a rapport, diagnose the problem and explain how you are going to treat it all within 45 minutes to an hour. You have to overcome a tremendous number of patient’s preconceived notions of what is going to happen.
Dental1: How in particular has bone grafting changed?
Dr. Gorab: The techniques used for grafting autogenous bones have become very adaptable and available to people. The ability to do these procedures in an office-based setting is certainly much more convenient for patients. As such, patients generally accept treatment more readily. With regard to the materials, the science of bone-grafting material has been advancing at a very quick pace.
Dental1: Are people expecting more from dentistry because of the new technology?
Dr. Gorab: I think technology has allowed us to do more, especially in the field of dental implants. We are getting so close to being able to duplicate what was placed there naturally. So, in that regard, we can expect more from technology. We all know that implants work. The challenge now is to make them as esthetic as possible and make the restoration process simple.
Dental1: Dental implants seem to be less painful than root canals and more permanent that bridgework. Is this part of their appeal?
Dr. Gorab: Yes. On countless occasions, I’ve had patients tell me that placement of an implant was more comfortable than an extraction of a tooth. In fact implants are more reliable on a long-term basis than preparation of the teeth and placement of crown and bridgework.
Dental1: How do you balance having a busy practice with the need to learn new the technology?
Dr. Gorab: Dr. Lustig and I attend a great number of continuing education seminars every year. In addition we attend the national meeting for the American Association for Oral and Maxillofacial Surgeons (AAOMS). At these annual meetings and continuing education sessions, new techniques are presented, along with the scientific basis and clinical evidence. From these sessions, we can decide what new techniques we would like to pursue in our office.
Dental1: Do you have a favorite piece of equipment or technology that you couldn’t do without that makes your job easier?
Dr. Gorab: I think CT scans, denta scans and the various computer programs that are used for placement of implants and some of the instrumentation for the placement of grafting or implants really make our jobs and lives a lot easier.
Dental1: How did you come to work with Healing the Children Foundation?
Dr. Gorab: I was approached by a friend, Dr Allen Rosen, who asked me if I wanted to get involved with two upcoming cases. Dr Rosen is a plastic surgeon and for years has been involved with the Healing the Children Foundation. He told me about two adolescents he had been seeing since they were children who had some bad burn injuries.
Dental1: How old were the children at the time of the implants?
Dr. Gorab: They are 17 and 18.
Dental1: Were you part of the diagnostic team that determined that the best course of treatment for the adolescents was an ear prosthetic?
Dr. Gorab: Yes. Much of reconstructive work was done on previous visits to the United States by Dr. Rosen. A year ago we met one of the children who had lost an ear and had planned to do this surgery for him sometime in the future. This year the planning came to completion and we had not only one patient but two – a boy and a girl.
Dental1: Why do you need oral implants for a prosthetic ear?
Dr. Gorab: Prior to use of extra oral implants, the only way to attach any type of prosthesis was by using various types of adhesives or glues. With implants you are able to make either a mechanical or magnetic attachment to the prosthesis, which provides a more positive and secure method of attachment
Dental1: Where exactly does an extra oral implant go?
Dr. Gorab: The extra oral implants are placed in a semi-circular type of arrangement in the area where the ear would normally be. The implants themselves are placed in the temporal and/or mastoid area. In both cases, we used three implants with three magnetic attachments.
Dental1: It must be almost lifelike then.
Dr. Gorab: Yes. The ear itself will be skin tone and color matched. It will be made of silicone that most accurately simulates the texture of the natural ear.
Dental1: Would that have even been possible five years ago without advancements in bone grafting?
Dr. Gorab: I don’t think the advancement has been in bone grafting but with the application of dental technology to the extra oral skeleton. The use and modification of the various types of implant systems have been done so that they can be utilized outside the mouth. The Straumann Corporation is been a leader in the industry of dental implantology. So it was natural for them to develop a system useful for extra oral prosthesis, either the replacement of an ear, eye or a nose.
Dental1: How did the surgery change their lives?
Dr. Gorab: As you can imagine missing one of your natural structures gives you an unusual appearance. At this point in their lives, even though they have a tremendous amount of facial scarring, the replacement of an ear gets them one step closer to a more natural appearance and their original appearance prior to their devastating accidents. When the children come to the office they are very excited and grateful. Even though they have gone through a tremendous amount of surgery to correct their scarring and deformities, they are very appreciative of what is being done for them.
Dental1: It must have been really gratifying for you.
Dr. Gorab: Yes, it is extremely gratifying. It is a gift to be able to help these children. Each day in the office we make small changes in many patients’ lives, whether it be relieving them from pain or restoring a function. But in these cases, being able to do the surgery for them that will allow them to regain their appearance, self-esteem and sense of well-being is a tremendously rewarding feeling.
Dental1: When you were interviewed Channel 4 news in New York there was mention about two sets of ears for the different seasons. Why is that?
Dr. Gorab: In certain circumstances we will make two sets of ears. It depends on the seasons. They may use one set, which is a little lighter for the winter months, and another one that is a little darker for the summer months, to account for tanning.
Dental1: Are they going to need any more surgery for their ears?
Dr. Gorab: We are seeing them for follow-up and there may be some minor tissue revisions that we may do in the area but for the most part their major surgery is complete.
Dental1: Do you think you will start doing more of this kind of surgery in the future?
Dr. Gorab: Absolutely! The system that we used is from Straumann and their system is such a versatile system that we are contacting a number of surgeons who perform these types of ablative surgeries of the ears, eyes or nose to make them aware that we have a new modality to help their patients. This has been a new technique for us, which we hope to expand upon.
Dental1: It must be very exciting to be part of this pioneer team.
Dr. Gorab: It is. After doing oral surgery every day for 20 years, I still look forward to coming to work every day. Oral and maxillofacial surgery is a dynamic specialty that is constantly evolving. I enjoy learning and developing newer techniques to help my patients. It is an exciting and challenging profession. Most of all, I find it extremely rewarding by improving the lives of our patients.
Dental1: What other kinds of breakthroughs do you think we are going to see in the next five to 10 years?
Dr. Gorab: I think dental implantology is nearly perfect. The greatest development we can hope to see is in restoration of bone height and width using bioengineered material versus patient’s natural bone. By that I mean using various types of genetically-engineered products to reliably and cost-effectively enhance bone growth and volume.
Dental1: Do you think we are going to see implants replace the more classic forms of treatment such as root canal and bridges?
Dr. Gorab: I think that the natural tooth is always the best option. If it can be saved without any tremendous amount of effort and surgery, it should be done. But with regards to extensive procedures trying to save the tooth or prolong the health of the tooth, I think we can rely more on dental implants because of their success rate and ease of use.
Dental1: Any words of advice for those starting out in the field?
Dr. Gorab: I think dentistry is an amazing field for someone who would like to help people, work with their hands and do procedures while being part of the advancements in the field. Oral and maxillofacial surgery is an ever-expanding specialty where our scope and types of procedures have become more and more numerous. There are many more exciting things that are going to happen in the next 20 years.
Dental1: Do you have any more plans to work with Healing the Children Foundation?
Dr. Gorab: I look forward to volunteering my services to them whenever they need my help and expertise.