In the specialized world of craniofacial orthodontics, it’s not uncommon for clinicians to see 6-day-old infants and 60-year-old adults in the same day. After two decades in practice, Pradip R. Shetye, DDS, BDS, MDS, has come to expect the variety, while learning to thrive in an environment filled with significant challenges.

Shetye’s office at the New York University Langone Medical Center’s Department of Plastic Surgery regularly sees “the tough cases,” such as a recent patient with a diagnosis of cleidocranial dysplasia.

Pradip_Shetye_7

A 20-year-old patient with cleidocranial dysplasia. Top: Left, a pre-surgical pan generated from CBCT shows overretained primary teeth and impacted permanent and supernumerary teeth. Right, a post-surgical pan shows extraction of overretained primary teeth and supernumerary teeth and orthodontic bonding of impacted permanent teeth. Bottom: Left, extracted overretained primary teeth; right, extracted supernumerary teeth.

“The patient had all his baby teeth [18] and all his adult teeth were not erupted, other than the first molars,” says Shetye, director of the Craniofacial Dental Center at Langone. “In addition, he had 12 supernumerary teeth in the upper jaw, and an additional 10 supernumerary teeth in the lower jaw. He almost had three sets of teeth at age 20.” After three-dimensional imaging, Shetye and members of the NYU interdisciplinary team took extra care to properly identify which teeth were supernumerary, and which were adult. After careful planning, all baby teeth were removed.

“After that, we took him to the operating room and removed 22 supernumerary teeth in the upper jaw and lower, then orthodontically bonded those adult teeth that had not erupted [22],” explains Shetye, who also serves as an assistant professor of Plastic Surgery (Craniofacial Orthodontics) and an assistant professor of Orthodontics at NYU College of Dentistry.

“Now we are applying orthodontic traction to bring these teeth in occlusion. This was one of the most challenging cases in terms of orthodontic treatment, and it’s part of the appeal of craniofacial orthodontics.”

Pradip_Shetye_2Expert in Cleft Lip and Palate

According to Shetye, about 4,400 babies in the United States are born every year with a cleft lip, with or without a cleft palate. The diagnosis is made prenatally—usually detectable via sonogram at around 20 weeks gestation (80%). Early detection usually yields a referral to Shetye’s office, where the 48-year-old clinician can begin outlining an initial series of corrective steps.

The treatment is multi-disciplinary, and Shetye’s team members will sometimes sit with a family for 2 to 3 hours explaining various treatment options, as well as what it takes to raise a child with cleft lip and palate. “If they decide to stay with the NYU Cleft Palate Team,” says Shetye, “they will bring back the baby about 6 to 10 days after birth. I will take an impression of the gum pads and fabricate a Nasoalveolar Molding Appliance (NMA).”

With an impression of the palate in hand, the eventual molding appliance helps to reshape the palate, lip, and the nose before surgery, particularly in the first 3 months. “Then the baby undergoes surgery with the plastic surgeon,” says Shetye. “This treatment system was invented at NYU by my former boss, Dr Barry Grayson. We also teach a course on this twice a year at NYU. Many people come from overseas to take the course, and the next one will have 16 people.”

Specialized training and excellent outcomes have fueled a stellar reputation for Shetye in the highly competitive New York market. Many parents don’t hesitate to make the lengthy trip from New Jersey or Connecticut to Langone Medical Center, where they visit on a weekly basis for the first 3 months—spending about 30 to 45 minutes per session with Shetye and his team members. After 3 months of treatment and consultation, Shetye shares his wisdom with a plastic surgeon, and the child has his first surgery.

While the surgical intervention may represent the first physical change for patients, the “art” comes in the planning stage. “When you are treating children with facial differences or craniofacial deformities, you are not treating them for merely their current age,” says Shetye, a past recipient of the Henry Kawamoto Award from the American Society of Craniofacial Surgeons. “You are treating them with an eye toward skeletal maturity, and how your treatment is going to affect them long term. Understanding the long-term growth of children with facial differences is important, because you may get an excellent result at a particular age, but if you don’t properly consider growth and development, then all that is done may have to be undone at a later stage.”

Pradip_Shetye_4Inspiration in India

Shetye grew up in Goa, India’s smallest state by area in the southwest portion of the country. His uncle was a successful orthodontist in the region, and Shetye went to his office as a patient. During these visits in the late 1970s, the first seeds of a possible profession took root.

With encouragement and mentoring from his uncle (who still practices in Goa), the young Shetye explored orthodontics, ultimately doing master’s research on patients born with a cleft lip and palate. After 2 years studying the deformity and its long-term effects, he knew pediatric work would fill a major portion of his professional life.

“Another reason I pursued craniofacial orthodontics is because I love working in interdisciplinary settings,” he says. “Now I work with plastic surgeons, prosthodontists, speech pathologists, neurosurgeons, oral and maxillofacial surgeons, otolaryngologists, and psychologists, so it’s interesting to see and examine these patients, and plan their treatment with other specialists.”

About 12 years ago, Shetye came to the United States specifically for the Craniofacial Orthodontic Fellowship Training Program at NYU. He was already a trained orthodontist, but the state of New York required an additional 2 years of dental training, so back to dental school he went. In 2007, the state changed its licensing policy yet again, which Shetye says caused him to be “in school longer than I expected.”

After fellowship training at NYU, and retraining to be licensed to practice in the United States, NYU offered a full-time faculty position that would allow Shetye to treat patients, teach fellows and residents, and conduct additional clinical research in craniofacial orthodontics. It was the “perfect combination” and an offer he could not refuse.

These days, about 80% of Shetye’s patients fall under the umbrella of advanced craniofacial orthodontics, with the remaining 20% in the routine orthodontic care category. Most craniofacial cases stem from genetic abnormalities, but a small percentage involve facial injury/trauma, which also involves reconstructive surgical planning in conjunction with plastic surgeons.

Shetye offers all phases of orthodontic treatment for children, teens, and adults, including early interceptive orthodontics; phase I and II orthodontics; Invisalign; adult orthodontics; dentofacial orthodontics; presurgical infant orthopedics; and presurgical orthodontics.

Pradip_Shetye_8In craniofacial orthodontics, as well as more routine care, Shetye favors advanced technology and does not hesitate to acquire the latest equipment. With the help of an adequate NYU budget, for example, the interdisciplinary team installed the latest cone beam CT scanner about 3 years ago when they moved to a brand-new, state-of-the-art office, just half a block from the NYU Hospital.

Sophisticated 2D and 3D images are possible, and a digital intraoral scanner aids clinicians on the team. Low-radiation 2D and 3D digital x-ray units, and 2D and 3D digital photography, help the interdisciplinary team to diagnose and treat a range of orthodontic problems. The 3D CBCT technology allows for 3D x-ray images that are similar to a medical CT, but with far less exposure to radiation.

“With this device, we can isolate the exposure to just the area that we want to see, greatly reducing radiation,” enthuses Shetye. “Highly accurate and detailed digital dental impressions are obtained using the 3D intraoral scanner, which eliminates the need for traditional dental impressions. Computer terminals at each treatment chair allow the doctors to view complete treatment records and images with the click of a mouse.

“Patients’ records can therefore be made available immediately when needed for consultation with family dentists or other specialists,” he continues. “Each of the six dental operatories is equipped with a flat screen television for exclusive use by patients during their visit. Our office is also able to show patients via 3D surgical simulation how their face is going to look after the jaw surgery. Finally, we also use technology to fabricate in-office aligners. I’m an early adaptor of technology, and I like to be ahead of the curve.”

Pradip_Shetye_6

Practice Profile

Practice Name: New York University (NYU) Langone Medical Center’s Department of Plastic Surgery (Orthodontics)

Location: New York, NY

Number of locations: 1

Number of chairs: 6

Staff size:  7

Years in practice: 20

Average patients per day: 35

Number of days worked per week: 5

Education: DDS Degree (Dentistry) from NYU College of Dentistry; Residency (Orthodontics) at St. Barnabas Hospital; Fellowship (Craniofacial and Advanced Orthodontics) at University of Illinois at Chicago and NYU Langone Medical Center

Top 5 products used: RMO—Versa T metal brackets and all wires; Ormco—Damon and Ice brackets clear; Reliance—bonding system; 3Shape—Trios intraoral digital scanner and software; Dolphin—imaging and practice management solutions

Websites: craniofacialorthodontics.com; nyulangone.org 

All that technology costs money, but about half of all Shetye’s patients pay nothing for treatment. Thanks to the charitable mission of an organization called My Face, pro bono work is a reality that lets the world’s finest experts share their expertise with those who would be otherwise unable to pay.

Shetye explains: “Most children born with cleft lip and palate or other craniofacial conditions need very expensive treatment from infancy through adulthood, and orthodontic insurance is inadequate to cover the expenses of a child who needs multiple interventions throughout their growing period. My Face helps patients who need support.”

A New Yorker Now

Type “craniofacial orthodontist” into yahoo.com and Shetye’s name is at the top of the list on page one. The prominent placement is a testament to a sought-after URL (www.craniofacialorthodontist.com) and a bustling practice in the heart of the Big Apple that sees about 125 patients per week.

The pace is fast, stress can be high, and the beat of New York pulses just outside the walls. It’s a long way from Goa, but Shetye is a confirmed New Yorker and has no regrets. The Langone Medical Center office is just a couple of blocks from the East River, and a 15-minute cab ride to the world’s finest theater district—facets of life that he has come to love and appreciate.

Cycling,  hiking, photography, and travel are beloved hobbies away from the office, with favored destinations of London, Paris, Hawaii, and New Orleans. “I do miss India,” muses Shetye. “Goa is beautiful—the sand, the sea, the sun, and the excellent seafood—but I am happy working in the United States. New York is such a vibrant city. I couldn’t think of living anywhere else.” OP

Greg Thompson is a freelance writer for Orthodontic Products. He can be reached at awerner@allied360.com.