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Close-up: Joel Berger & Ian Aires

Leading dental implant office provides innovative approach to new smiles

The dentist's chair has always been known for its ability to incite anxiousness. But the founders of San Diego-based PermaDontics are changing that.

Founded by oral surgeon Joel Berger, DDS, MD, and prosthodontist Ian Aires, DDS, PermaDontics' process of providing full-mouth dental implants is unique in its approach and in its procedure time -- just a day.

"In the middle '90s, there was data at Columbia and NYU that people were looking into restoring or replacing teeth immediately on dental implants, and we were one of the first to do those procedures in Southern California and to publish results in the region," Berger said. "And the development of PermaDontics is an extension of that interest. To do need it, you have to have a very close working relationship between the lab, the prosthodontist making the teeth and the oral surgeon. Our concept was to have all three in one facility so the patient can be treated much more easily than jumping between all three facilities."

Now Berger and Aires, who've been working together since the early 1980s, are recognized as leaders in the field for this inclusion of all three elements of the implant procedure under the same roof. They are asked to speak across Europe and Canada about about their research and innovation in what Berger calls "immediate loading dental implants."

"There are hardly any pain incisions," Aires said. "It is very precise and delicate, and there's no pressure on the gums. We try to do it within the morning. The surgery itself takes about two hours, and then putting the teeth on top takes me about an hour and a half. So, all inclusive, it's about a morning to finish -- and then patients can be home by lunch."

Aires got his start in dentistry at age 18 in the army in his native South Africa. He said that seeing the dentistry field not as a patient but from the other side made him realize that it was the type of hands-on work he would enjoy. Aires started practicing in 1981 in California -- drawn to San Diego for the California lifestyle that's similar to where he grew up.

Berger's interest in the field goes back to undergrad, where he was inspired during a lab by a physician who was also a dentist and plastic surgeon. Berger followed that track, relocating to San Diego after obtaining his degrees.

"Having grown up in Montreal and trained in Seattle, I was tired of cold, freezing weather and tired of wet, freezing weather and was looking to move to an area that removed cold, wet and freezing from my vocabulary," Berger said.

The PermaDontics protocol is that everything is planned on a medical model of a 3-D scan of the patient before work is begun on the patient.

"We do surgery on that model first and know what we're going to. That means we use a dummy that's an exact duplicate of Mrs. Jones. Previously, we would have had to go to Mrs. Jones, cut her gums open, and see what is the best angle, the best sizing, and then put implants in using clinical judgment," Aires said. "Now, with the exact duplicate of Mrs. Jones, we go in and do drilling into a plastic model and can see where the nerves, sinuses and gums are, staying away from all critical spots."

While insurance typically does not cover the approximately $20,000-$30,000 dental implants, PermaDontics has seen a steady patient demand from those wanting to undergo its leading procedure -- and a strong interest from industry colleagues to learn about it as well.

The PermaDontics Institute gives other professionals the chance learn how to do the procedures, via a large conference room for watching the high-tech video cameras in the lab, prosthodontics center and oral surgery rooms. In addition to this informal teaching component, PermaDontics also hosts two half-day seminars per month. Berger said this idea of sharing knowledge for the advancement of the industry as a whole is just part of the industry.

"In our field, you're never driven by money -- you're driven by vision and commitment," he said. "Dr. Aires and myself believe that dental professionals have a commitment to teach and share knowledge with our colleagues. It's a natural, ingrained commitment when you go through the professional and post-graduate training: You're inculcated with the desire to share knowledge and teach your colleagues. Money isn't the motivator at all."

Beyond its forward-looking approach to procedure, technology and knowledge sharing, the PermaDontics office space is designed with a non-clinical, holistic ambience as soon as you walk in the door -- a departure from many current dental offices. As for the next innovation for both PermaDontics and the industry as a whole, Berger sees significant developments a few decades down the road.

"I think the future of implantology is exciting in the development of biologically active plants. Now, we put the implant into bone and the implant surface is titanium. The movement is to cover the surface of the implant with protein that stimulates bone formation to the implant via a BMP (bone morphogenetic protein).

"We're probably 20 to 50 years away from that being a reality on a clinical basis. For me, you're always looking for the next mountain to climb, and at a certain point you look back at your life and think, 'I'm running out of time to climb any more mountains,'" he added with a laugh. "Right now, I am focused on PermaDontics and the teaching component and being successful in that."

Blackford is a Los Angeles-based freelance writer.

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JEAN WALDEN 2:57pm December 19, 2009