|“Team Atlanta” (left to right: Drs. Maurice Salama, David Garber, and Ronald Goldstein) reviewing a complex case utilizing modern 3-D technologies.|
You’re a partnership that has endured in excess of 30 years in the case of Drs. Ronald Goldstein and David Garber, 23 years since Dr. Maurice Salama joined you, and 18 years since Dr. Henry Salama joined the team in Atlanta. That’s an amazing record in any field, and certainly reason enough to talk to you about your practice, your teaching, and also what you see as the future for dentistry. Let’s start with the beginning of your practice, and then how your partnership and “Team Atlanta” developed.
Dr. Goldstein: The predecessor to Goldstein, Garber, and Salama (GG&S) was initially founded in 1929 on the rather progressive vision of my father, Dr. Irving Goldstein. I joined the office in 1959, and while working with different specialists individually in Atlanta, as well as being exposed to the periodontal-prosthetic philosophies of Dr. Morton Amsterdam, I came to recognize how effective and beneficial it would be to incorporate virtually all these dental specialties under one roof. I initiated the process of implementing this vision by recruiting Dr. David Garber from the faculty of the University of Pennsylvania, who had postdoctoral expertise in both periodontics and fixed prosthodontics.
How did your practice then develop into the comprehensive team that you have today?
Dr. Garber: In 1992, we specifically sought out Dr. Maurice Salama for his dual-specialty training in orthodontics as well as periodontics, which along with his implant residency secured our vision of having a “one-stop,” cross-disciplinary, interactive practice.
As the practice continued to grow, we realized the need for someone with more significance and expertise in the burgeoning realm of dental implants. Dr. Henry Salama, who was the director of the Implant Research Center at the University of Pennsylvania, was the optimal candidate, as well as also having dual prosthetic and periodontal postdoctoral specialty training. In 1996, Henry joined the practice and, along with Maurice, subsequently became partners. In addition, as a high-level interdisciplinary practice, we always incorporated an in-house dental laboratory team to better ensure quality control and efficiency, especially in cases involving a ceramist. Throughout the years, we have worked hand in hand with some of the most talented international ceramists such as Drs. Gui Cabral, Christian Coachman, Murilo Calgaro, as well as Pinhas Adar; all of whom joined Mark Hamilton with his 36 years of providing outstanding technical laboratory expertise in our facility. Throughout time, we were often asked to lecture together on the same podium at various symposiums and conferences emphasizing multidisciplinary dentistry, and, therefore, eventually became known as Team Atlanta.
Dr. Goldstein, explain to our readers how your primary concern, which is patient care, benefits from the teaching endeavors in which all the team members are actively involved.
Dr. Goldstein: Teaching requires one to constantly stay up to date with the latest science and technology, which has accelerated dramatically during the last 30 years. The team’s teaching, as well as research initiatives, have made them leaders in the field and constantly on the cutting edge of comprehensive therapy. This prominent profile has generated professional and patient inquiries; and interest from all over the world, including industry. Our combined comprehensive experience and acumen in the fields of periodontics, prosthodontics, orthodontics, and oral surgery gives us the ability to effectively treat most of our patients’ oral health needs as well as those especially complex challenges that are likely to elude many individual practitioners; specifically those complex clinical cases that normally require multiple patient consultations at multiple locations. We have tried to pattern GG&S as the dental equivalent of the Mayo Clinic and, especially, as a dental resource center. A case to make the point follows in Figures 1 to 6.
|Dr. Maha El-Sayed using the TRIOS intraoral scan (3Shape) to scan an implant for immediate loading.||Drs. Garber and Maurice Salama examining a Carestream 9300 (Carestream) CBCT scan.|
|Dr. Wendy Clark studies Dr. Salama’s virtual implant placement prior to surgery.||More eyes, more ideas: Drs. Maurice Salama, Henry Salama, and David Garber review a surgical plan using SimPlant software (Materialise Dental).|
|Dr. Goldstein uses DenMat’s NV Microlaser, the world's smallest cordless laser.||Dr. Nadia Esfandiarinia uses a GG&S wall art decoration to explain proportion to a patient.|
|Thirty-seven-year GG&S laboratory technician Mark Hamilton completing a Nobel Biocare scan.||Using laser therapy is Dr. Maurice Salama and dental assistant, Lori Gettinger.|
Dr. Goldstein, you are often recognized by many as the “father” of aesthetic dentistry. The initial realm of dental aesthetics involved only restorative modalities that were at first limited to crowns, then composite bonding, and eventually to veneers. How has the “team” concept changed your perspective(s)?
Dr. Goldstein: Dr. Adams, it was evident that “complete” aesthetics really involved much more than the restorative procedures alone. There was a need to satisfy the newly developing subjective cosmetic needs of patients, and to mold together the collective knowledge of different aspects of dentistry. I think that, while we were initially focused primarily on the restoration of teeth, this “team approach” allowed us to be the first to go beyond, and to plan the restorations within the context of the lip framework and the smile, and relating them to the patient’s face and persona.
Drs. Maurice and Henry Salama, in today’s evolving dental arena, what do you see as the developing trends in dentistry?
Dr. Maurice Salama: During the last 25 years, it’s clear that the trends in clinical dentistry have been propelled by aesthetic and implant dentistry. I believe that the ever-increasing public awareness of our profession’s capabilities to enhance smiles and function continues to propel the present trends in dentistry; in part, this may be due to all the media and social exposure addressing everything from “all-on-4” to the single-unit implant replacement. The public is also requiring that the smile enhancement and implant processes be done more rapidly, simply, less expensively and, at the same time, with greater predictability.
Dr. Henry Salama: This is exemplified by the trend for minimally invasive and biomimetic dentistry. The exponential technological advancements in bioengineering, adhesive, ceramic, and digital dentistry has empowered clinicians to more predictably meet their patients’ expectations.
Digital dentistry allows dentists to better document, diagnose, and design patient specific treatment to obtain digitally pre-visualized restorative outcomes through 3-D printing and CAD/CAM technologies that are often accessed through digitally empowered laboratories. In effect, it is creating a more level playing field in dentistry. It is allowing a higher level of aesthetic and implant dentistry to be delivered to more patients by more clinicians.
|Dr. Goldstein using the iTero (Align Technology) scanner to take a digital impression for a porcelain veneer.||GG&S lab technician Jennifer Preston confers with Dr. Garber on the newest patient scan using the Zimmer Zfx lab scanner.|
|GG&S ceramist Nigel Letren places a porcelain crown in the oven (Programat P510 [Ivoclar Vivadent]) for final bake.|
Dr. Goldstein, you’re from an older generation—isn’t there a huge cost factor as well as learning curve that seemingly makes this digital practice vision prohibitive?
Dr. Goldstein: The short answer is yes, it is challenging at this stage in one’s career to incorporate new methods. However, I don’t believe clinicians of any age group can afford to avoid this digital revolution in dentistry and maintain their practice’s competitive relevance in the marketplace. We’ve seen the costs of CBCT scanning and other digital technologies and therapies rapidly decreasing into more manageable price ranges. I believe this trend will continue as it has in many other areas of technology. In addition, the software is becoming progressively more user friendly. As opposed to proprietary architecture, the open source paradigm in software is permitting the efficient sharing of information and data across the board.
Today, digital technology in all its different forms is essential to making dentistry, in general, and implants, in particular, safer and more accessible for a higher percentage of the population. Similarly, most dental laboratories are also on aboard, with about 80% now using in-house scanners and, just recently, metal-free crown and bridge restorations have exceeded metal-based restorations for the first time ever.
You’ve all been lecturing for years, writing textbooks and articles. So, how did the DentalXP educational concept evolve?
Dr. Garber: Just as we suggested earlier that clinical practice today must embrace the digital revolution to remain relevant and competitive, so it is with continuing dental education. The Web site dentalxp.com initially began from a philosophy to create access to new, timely, and relevant information; to and from the global dental community by sharing cases, opinions, and feedback on a Web-based forum. Throughout time, videos and lectures on cutting-edge surgical and restorative modalities from Team Atlanta were featured. It progressively evolved with leading clinicians and educators from around the globe being invited to also share their knowledge and expertise with the fast-growing DentalXP community. From the beginning, what members particularly appreciated is that the site was totally inclusive and never exclusive to any one type of philosophy of therapy or brand. The subscriber base and demand quickly outstripped our resources, forcing us to make DentalXP into a more robust entity. Most of all, we realized it could no longer be a hobby. It eventually required someone with the vision, expertise, and combined business/dental acumen to develop and manage it on a day-to-day basis. We were fortunate in being able to convince Eddie Salama, brother of Henry and Maurice Salama, to assume this responsibility as chief executive officer. This made a significant difference in the further progress of Dental XP to where it is now: the number one dental continuing education provider on Google search with multinational servers and a sophisticated and customized software that handles the needs of about 128,000 doctors in 168 different countries. Globalization in dentistry is no longer just a vision; it is here, and it is now.
Dr. Maurice Salama, as the youngest representative of 4 generations of educators, do you believe that this is the future for dental education?
Dr. Maurice Salama: There is no doubt that Web-based continuing dental education is going to play a critical role in future access to knowledge and expertise. However, we also believe Web-based learning is most effective when supplemented with hands-on courses and timely access to the educators themselves in live courses. Therefore, we have developed customized hands-on courses that deliberately enhance the didactic experience accessed online. To further achieve this goal, DentalXP also organizes Global Symposiums as well as partnering in an online implant externship (implantexternship.dentalxp.com) to provide clinicians with a multitude of options to access continuing dental education in a way that addresses their unique requirements.
I noticed when visiting dentalxp.com that you have nearly 300 different speakers from all over the world. How did this come about?
Dr. Garber: As previously mentioned, our team has always felt very fortunate to lecture all over the world and even more fortunate to discover the incredibly creative and talented clinicians whom we have met along the way. Not only have we been able to impart some knowledge to our audience in the process, but we, in turn, also have learned and gained even more. Most of all, this exposure as well as the relationships developed allowed us to identify rising talents in dentistry, young local speakers with incredible ability and remarkable results, whom were open and gracious enough to generously share their knowledge with their peers and the DentalXP community. In effect, DentalXP embraces the role of being a vehicle to expose these diverse new talents and their techniques to the rest of the world. So, throughout the years, Team Atlanta grew to incorporate other speakers who, in turn, became their own “World Teams,” often brought together by different academy’s meetings and publications. “Team New York,” “Team Brazil,” “Team Japan,” “Team Israel,” “Team Ukraine,” “Team Italy,” “Team United Kingdom,” and “Team South Africa” are a few that come to mind and have been featured on the site as well as a special issue of the The American Academy of Cosmetic Dentistry Journal that was in partnership with DentalXP, and, had Maurice as the editor.
In February 2013, DentalXP had their first “brick and mortar” Global Symposium in Las Vegas. As someone who has attended many meetings throughout the years, what made this one stand out for you?
Dr. Henry Salama: Combining the different forms of education—“seeing,” “hearing,” and then “supervised doing,” followed by long-term interactions on the forum has resulted in an online community that demands to periodically get together and share information and experiences in an open annual symposium. In my opinion, this meeting was a game changer in dental education. For the first time, the numbers that are all too often highlighted by online educational sites were translated into attendance by real clinicians who took the next step from viewing videos and lectures online to coming and choosing from almost 30 hands-on workshops while examining and accessing products directly from vendors.
Dr. Garber: Many of these attendees would encounter peers at the meeting and then recognize each other from their virtual world, particularly the online forum. We would then see them at the meeting, sharing a drink and recollecting one another’s questions and case reports, and then reflecting on their different solutions to a problem previously posted on the online forum.
These previous “virtual connections” facilitated an enormous amount of enthusiasm, excitement, and developing relationships not usually encountered in the typical one-time or even annual symposium. So, we were initially physically bringing together their “dental lives” from an interactive online community who were now also sharing personal philosophies.
Dr. Maurice Salama: It’s strange, Dr. Adams, but when we think traditionally about being online, we imagine this world where we never really meet. However, the first DentalXP symposium has shown us that there is a very definite need for the additional personal contact, not only between the speaker and the attendees, but also with industry and vendors.
What are your long-term hopes and visions for DentalXP?
Dr. Maurice Salama: It appears that DentalXP serves a very diverse panoptic role in the ever-growing demand for quality continuing dental education. Dentistry is rapidly changing and DentalXP makes all the necessary information readily available, almost as it’s evolving across the world. On the DentalXP Web site, you can source out most any topic, from bleaching, to veneers, to crown and bridge and direct composite restorations, to different surgical techniques for sinus lifts, regenerative procedures, and all aspects of “digital dentistry”—and it’s constantly available, 24 hours a day, 7 days a week, from most anywhere in the world and also in different languages such as Japanese, Spanish, and Portuguese. We even had Russian translation at the recent Global Miami Symposium.
On a different topic, you recently affiliated with Heartland Dental Care, a large dental service organization. I believe that our readers would be curious to know why you made the decision to do this.
Dr. Maurice Salama: It was an interesting decision, Dr. Adams, indeed!
Throughout the years, we often reviewed the options for the continuity of our practice, the commitments we felt to our patients, our staff (some who have been there 20 to 35 years), the community at large, as well as to our ongoing teaching endeavors. We found in Heartland Dental Care not only a company but also a group of individuals with the same strong commitments to dentistry, education, and people. What makes this affiliation a unique fit is the commitment to education by Heartland Dental Care, GG&S, Team Atlanta, and DentalXP. Heartland’s press release states, “Like Heartland Dental Care, Goldstein, Garber and Salama and team also understand and value the importance of continuing education and leadership, combined with clinical expertise.”
This has allowed us the ability to concentrate on the practice of dentistry, and then education beyond the business. The transition has been remarkably smooth and we continue to operate in the same way, with our same staff and products. They have also been a remarkable resource for us in many different areas such as technology, human resources, insurance, financial management, and dental practice acumen.
What do you see as the future for Team Atlanta and DentalXP?
Dr. Maurice Salama: We see security for the practice to continue to move forward with us, Team Atlanta, all being able to continue providing high-level, quality dentistry in the same environment while maintaining our role as educators and as a resource for other educators via DentalXP. In response to our members and dentistry at large, we are looking at our next global symposium in February 2015 in Las Vegas. A big focus of the 2015 symposium will be to make sure we also address the needs of young dentists entering the profession and desiring to expand their knowledge base as well as their technical capabilities. Therefore, we will have new selections of hands-on courses as well as speakers covering the most requested and relevant topics in dentistry today. In addition, as stated previously, we are excited about the new online implant externship, a 300-hour program directed by a board of leading educators and clinicians in the field. This program will lead to certification and access to specially designed advanced hands-on training in DentalXP affiliated teaching institutes located around the globe for easy and efficient access to subscribers. We have also started organizing smaller regional or local ClubXP meetings in collaboration with DentalXP’s leading educators, designed to fit the individual club’s specific needs in any topic using a platform that combines both live speakers as well as online follow-up. It is also exciting to see so many effective teachers using dentalxp.com to constantly add ideas, tips, or new techniques daily. We hope even more clinicians will utilize this mode of sharing, teaching, and learning together, and enjoy being part of a global community with personal relationships that can be started simply with a click on any computer, tablet, or smartphone.
Dr. Garber: Dentistry is evolving far more rapidly than we anticipated, and to remain a part of it, you cannot manage on your own. We, GG&S, are fortunate to be part of Team Atlanta and now part of DentalXP globally—which allows us to be in constant contact, sharing information and friendships 24/7. We feel that even though we are an older partnership, built on traditional values, we are continuing as an active part of the community, probably to an even greater extent in the most contemporary way by virtue of DentalXP, and the strength of Digital Technologies. We are very excited about the future of dentistry and dental education!
Disclosure: Dr. Goldstein has a financial interest in DentalXP; however, he has received no compensation for this article.
Disclosure: Dr. Garber has a financial interest in DentalXP; however, he has received no compensation for this article.
Disclosure: Dr. Maurice Salama has a financial interest in DentalXP; however, he has received no compensation for this article.
Disclosure: Dr. Henry Salama has a financial interest in DentalXP; however, he has received no compensation for this article.