From facial reconstruction to transplantation: Prosthodontist to discuss importance of teamwork

When people working at the top of their professions make a concerted effort to know what their colleagues need, the whole represents the greater outcomes of the parts and exceptional things can be created. In other words, teamwork can accomplish so much more, especially in the field of prosthodontics and dentistry in general.

That’s the idea Lawrence E. Brecht, DDS, hopes to convey in his lecture “Facial Reconstruction to Facial Transplantation: Success Through a Team Approach” at CDA Presents The Art and Science of Dentistry in San Francisco in September. Brecht is the director of maxillofacial prosthetics at New York University College of Dentistry and has a joint appointment in the Hansjörg Wyss Department of Plastic Surgery of New York University Langone Medical Center, where he also serves on the cleft palate, craniofacial, ear anomalies and facial transplant teams.

Brecht’s presentation will review and stress the importance of the surgical-prosthetic-industrial team approach in reconstruction, from the simplest examples to the most complex, including facial transplantation. In his lecture, he will also discuss how the culmination of the team concept can be seen in the advances in composite tissue allograft surgery (facial transplantation) for the severest of facial deformities.

“We’ll begin with how a team approach can benefit children with a cleft palate and the simplest of ‘reconstruction’ of a smile for a baby and move up through jaw reconstruction for cancer and trauma patients — utilizing the ‘Jaw in a Day’ procedure — and move outside the oral structures, to the orbit, nose and ear, and the technology that is used to create those prostheses,” he said. The lecture will end with a discussion of what Brecht calls the “worst-case scenario” — when facial transplantation becomes necessary.

Brecht’s interest in prosthodontics and its subspecialty, maxillofacial prosthodontics, began when he was a student at New York University, where he earned his DDS. “You’re dealing with reconstituting portions of the face beyond the oral structures and it seemed to me that it was not a difficult thing to reconstruct a tooth as a tooth,” he said. “I enjoy the challenge and the fact that you have to work with your colleagues to get the best possible result for a patient.”

After completing a residency at Boston’s Brigham and Women’s Hospital and a fellowship at the Harvard School of Dental Medicine, Brecht went on to earn certificates in both prosthodontics and maxillofacial prosthetics from the Department of Veterans Affairs Medical Center in New York, NY. He maintains a practice in New York City limited to prosthodontics and maxillofacial prosthetics.

Restorations to transplants

Many previously unimagined reconstructions are now possible and achieved following fewer and more efficient surgical procedures that also facilitate improved prosthetic restorations and functional outcomes. While facial transplantation may be an option in some cases, it should not be the “first thing you go to,” according to Brecht. He said many problems are associated with facial transplants, such as the need for lifelong antirejection medications that increase the potential for various cancers and the procedure’s extreme cost. Often, reconstructions are successful and make facial transplants unnecessary. Case in point: A successful reconstruction of one of his patients who was originally a facial-transplant candidate.

“There’s a boy we’re taking care of who had a gunshot wound and was considered to have a face transplant but was able to be reconstructed” Brecht said. “Using leg bones, we made dental implants and were able to make dental prostheses to restore him to a fairly whole status.”

When facial transplants do become necessary, Brecht and a team of professionals plan out what structures to remove from the donor to be accepted in the recipient. But the team also strives to maintain a level of dignity for the donor throughout the procedure, including making molds of the donor’s face, Brecht said. The molds are used to create a lifelike silicone replica of the face to be draped over the donor’s remains. “That keeps a sense of there being a humanity of the donor,” he said.

Brecht credits a team approach and advances in digital technologies for the success of reconstructions and facial transplants. He enjoys the intellectual stimulation of being part of a team, which in his field may include computer engineers, microsurgeons and dental laboratory specialists. He says one person does not have all the answers to provide the care that patients need. But with the team approach, everybody pulls together, teaches each other and becomes amateur experts in their teammates’ specialties.

“With the onset of some really new and creative technologies, we’re able to do things that we could not have done five years ago and it’s constantly evolving,” Brecht said. “Embracing technology and being part of a team that’s greater than just myself have led to great personal growth and satisfaction. And that gives me a different perspective on what I do.”

“Facial Reconstruction to Facial Transplantation: Success Through a Team Approach” takes place from 11:30 a.m. to 1 p.m., Thursday, Sept. 6, and is open to the entire dental team. (See page 32 on the online program.)

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More than 150 courses and workshops will be offered at CDA Presents The Art and Science of Dentistry in San Francisco Sept. 6-8, and attendees are encouraged to register early to take advantage of early-bird pricing, in effect through Aug. 9, and to secure their spot at popular events. “Facial Reconstruction to Facial Transplantation: Success Through a Team Approach” by Lawrence E. Brecht, DDS, is the San Francisco convention’s featured lecture. Read about more highlights of the San Francisco convention.