by Greg Thompson
When they’re not teaching, the Fabers prefer to tackle the tough cases
For a young girl stricken with a malignant tumor in her lower jaw, the long medical journey began years ago with oncological specialists doing everything they could to save her life. After vanquishing the cancer, her problems were far from over. In the ensuing years, she would cross paths with dental specialists across the oral health continuum.
While the girl may not have fully understood the talents of the many dental experts who helped her, the road to a happy, confident, and healthy young woman ultimately ran straight through the office of Faber Orthodontics in Melville, NY. The father-and-son team of Richard D. Faber, DDS, MS, and Zackary T. Faber, DDS, MDSc, specializes in these types of complex surgical cases, which often represent up to a third of their work at any given time.
Far from being intimidated, the Fabers express an enthusiasm for the inherent technical and intellectual challenges of tough cases. “It is gratifying when you help people get good aesthetic and functional results,” says Richard Faber, co-owner of Faber Orthodontics and program director of the Advanced Education Program in Orthodontics at the State University of New York (SUNY) Stony Brook School of Dental Medicine. “These cases are all challenging. For example, some kids have juvenile rheumatoid arthritis with a significant deficit in the bone, and we have to not only do bone grafts to lengthen the jaw, but also get their occlusion together.”
Syndromes, anomalies, and anatomical differences all conspire to make each case diabolically different. Considering the amount of variability, the Fabers rely on their considerable experience to effectively coordinate care with their interdisciplinary team, which includes other specialists and maxillofacial surgeons.
Name: Faber Orthodontics
Location: Melville, NY (Long Island)
Owners: Richard D. Faber, DDS, MS; and Zackary T. Faber, DDS, MDSc
Specialty: Complex surgical and interdisciplinary cases
Patients per day: 95
Starts per year: 300
Days worked per week: 4, plus every other Saturday
Office square footage: 1,850
Web site: faberortho.com
Technical skill is required, but Richard Faber believes the real challenge—and even the art—is in the diagnosis and treatment of complex cases. “Most of the time, the patient is seeing the orthodontist more than anybody else,” Faber says. “In these complex cases, we wind up being the quarterback of the case. We direct the patient where to go, and everybody does their part.”
The Fabers work closely with oral and maxillofacial surgeons, first setting up the cases orthodontically, then performing a model surgery. With the help of a dental articulator, they simulate the surgery and blueprint the procedures using x-rays. The oral surgeon eventually receives the indexes (splints) that govern where to put the teeth. This level of detail is critical to ensure that the surgeon manipulates the jaw with complete precision.
In the case of the girl with the malignant jaw tumor, radiation treatment had destroyed many of her tooth buds, and she did not have enough teeth in her lower jaw. The radiation also stunted growth in her lower jaw, creating a large discrepancy between her upper and lower face.
The Fabers consulted with surgeons, who ultimately performed a distraction to move the mandible forward a considerable 15 mm. “We wound up having to do bone grafts in the lower jaw to build up the bone,” says the elder Faber, past president of the North Atlantic Component of the Edward H. Angle Society. “Consequently, she had some implants placed there. She was just in recently, and now has a complex prosthetic replacement of the teeth on the lower jaw. And we orthodontically aligned her teeth on the upper jaw.”
Youth and the Tooth
|Zackary (right) says that he and his father (left), “still go out to dinner every Friday night.”|
For Zackary Faber, orthodontics is in the blood. A third-generation graduate of the University of Maryland’s Dental School, Faber has now been in practice for 8 years and also works as an associate clinical professor at the SUNY Stony Brook School of Dental Medicine. With two professors in the clinic, days are parceled out based on teaching schedules, with Richard Faber manning the practice every Monday, Wednesday, and Friday, and Zackary Faber attending every Monday, Tuesday, and Friday.
Both Fabers acknowledge that family practices can be more painful than an infected abscess if both parties don’t get along. While it helps to have similar treatment philosophies, the Fabers are able to transcend the father/son dynamic and view each other as respected colleagues. “I have heard many nightmare stories of siblings working together, and other relationships, but we get along really well,” the younger Faber says. “And we still go out to dinner every Friday night.”
When Zackary has the run of the practice, the elder Faber does not blink. In addition to his duties at SUNY teaching residents, the younger Faber works in close partnership with his father to come up with treatment plans for children with craniofacial problems such as cleft palates. Many adult patients require treatment plans involving orthodontics, periodontics, implants, and orthognathic surgery.
With a slightly more upbeat chairside manner, Zackary provides the yin to his dad’s more world-weary yang. “Zack has a good chairside manner,” Richard Faber says. “The patients are your customers, and we want them happy and sending other patients here. A lot of our referrals are patient referrals.”
In the competitive Long Island environment, where 600 orthodontists duke it out on a 100-mile-long, 35-mile-wide stretch of land, referrals are the lifeblood of the operation. At Faber Orthodontics, satisfied customers, contacts in the academic world, and expertise in the latest techniques all contribute to solid word of mouth.
While they are known for their success with complex cases, the Fabers acknowledge that the majority of cases they treat are uncomplicated. They use sophisticated technology, but ask either Faber about the latest gadgets, and you get the same answer: Wait for the bugs to show up. “As far as adapting technology early, we are not on the bleeding edge,” Zackary Faber says. “We usually adapt technology at the end of the first generation. There is no reason to get out in front, burn yourself, and not learn from other people’s mistakes. But if we can get our patients a better result in a faster or more efficient way, we are going to jump on it.”
The second mantra of Faber Orthodontics is “show me the evidence.” As professors, both Fabers have a healthy respect for orthodontic literature, a respect not always shared by eager residents. “Some of the techniques that people are hearing on the lecture circuit are not backed up with evidence,” Richard Faber cautions. “And the techniques violate some of the rules set up by the research of the past. People jump on it because they think it is easy, and they get in trouble later on when they can’t do what the lecturer has done. There are a number of bracket systems on the market designed to simplify things, and these systems ignore some of the real basic science.”
When it comes to hardware and techniques, the Fabers use “everything that moves a tooth” in their quest to find technology that suits patients both physically and mentally. Metal, ceramic, lingual, Invisalign, and removable functional appliances are all viable options.
For a 13-year-old girl with no past orthodontic work, the Fabers recently suggested Invisalign, but the girl’s mother warned that her daughter would likely lose any removable appliance. The solution turned out to be the iBraces line of lingual braces. “We have done lingual braces for a long time,” Richard Faber says. “The first generation of the brackets and wires were a lot more difficult than they are now. New brackets with computer-aided placement are better. When it comes to finding solutions, we are not closed-minded, and that is one of the great things about working with my son.”
When out of the clinic and in the classroom, Richard Faber advises students to first look for evidence-based treatment, an endeavor that resolves most problems. With a laugh in his voice, he laments that most students will only engage in literature searches that go no further than 1975, the limit for Medline, and coincidentally the same year he first got into practice.
Passing along this wisdom to students is a joy that Richard and Zackary relish. Full-time devotion to their practice could undoubtedly boost their relatively modest 300 starts per year, but neither father nor son has any desire to give up the classroom anytime soon. “The residents are intellectually stimulating, and teaching is a lot of fun,” Richard Faber says. “You get a lot of satisfaction out of it, and I have been teaching at Stony Brook for more than 30 years.”
|Most of the women on staff at Faber Orthodontics have been with the practice for 20 to 25 years.|
Increasing Efficiency in a Down Economy
Recent economic hardships have dampened some of the residents’ enthusiasm, but the downturn can also be turned into a teachable moment that emphasizes solid practice management. “Most of the time, students are pretty realistic about what is going on,” Richard Faber says. “But I think in the last year or 2, they are a little bit unrealistic about what the job opportunities are out there in the real world. The economy has certainly hindered people hiring young orthodontists straight out of school. They struggle at the beginning trying to find jobs.”
For practices that are established or just beginning, the Fabers agree that low staff turnover and focused technology can eke out the savings that turn an average year into a good year. Most of the women on staff at Faber Orthodontics have been at the practice for an amazing 20 to 25 years. One receptionist, who now works on an as-needed basis, has been with Richard Faber since the day he started 34 years ago.
Adults receive care from hygienists only, not dental assistants. Meanwhile, workers at the front desk use OrthoChart, a comprehensive software program that organizes many elements of the practice. “We also use VistaDent for all the cephalometric stuff, digital photography, and digital x-rays,” Richard Faber says. “And we just got the new VistaDent 3D to work with cone beam CT, which will help diagnosis move into three dimensions.”
To capitalize on the texting phenomenon so popular among teens and many adults, Zackary Faber recently introduced OrthoSesame into the office. “We are texting the patients for their appointments and sending them e-mails,” Faber says. “They can go on the Web sites, see their pictures, and pull up their charts. For the kids, it is terrific. And the adults like to get the reminder on their phone that they have an appointment. So you text the kid and the mother, and they appreciate that.”
Patience with Patients
Like watching grass grow or paint dry, the whole concept of moving teeth requires a commitment to patience. Clinicians who require instant gratification need not apply to orthodontics. What sport translates well to the inherently patient nature of an orthodontist? Golf.
As avid golfers, the Fabers use the concept of patience to improve their game, their profession, and their teaching. Just as each golf shot requires a different approach, so, too, does each case, whether it be surgical in nature or otherwise. “You take each shot one by one,” says Zackary Faber, who occasionally breaks 80 on the course. “In golf and orthodontics, sometimes there is a better time not to do something.”
For newly minted orthodontic graduates, patience applies to success, especially in today’s world. “Walking out the door with an orthodontic certificate, some students think you have the ability to print money,” Zackary Faber says. “But it takes so much time to build a referral base and build your practice so that you are a member of the community. Orthodontics does not build like a general practice or a periodontist practice. You build on referrals and relationships, and it takes years to develop those roots in the community.”
When Zackary Faber came to the practice 8 years ago, he immediately sought to rejuvenate the referral base. Now doctors from the tip of Long Island, Manhattan, and even Pennsylvania and Connecticut, are sending patients to Faber Orthodontics. One of those referrals was the young girl with the tumor in her lower jaw. What became of her? “Last spring, that same girl was elected homecoming queen for her high school,” Richard Faber says. “That really brought a smile to our faces, and satisfaction to the team of specialists who worked on delivering her care.”
Greg Thompson is a contributing writer for Orthodontic Products. For more information, contact