Through The Keyhole – Dr. Martin D. Levin

Dedicated to improving endodontics through stewardship, teaching and innovation.

Please describe your early years in the dental profession.

My lifelong enthusiasm for the profession really began in earnest when I arrived at Penn Dental Medicine as a first-year student. The program was all-inclusive, and head and neck anatomy, physiology, dental morphology, and occlusion were just a few of the subjects in the curriculum I most enjoyed. I was inspired by my teachers, particularly Drs. Louis I. Grossman, Israel Bender, Morton Amsterdam, Leonard Abrams, and D. Walter Cohen, all of whom left indelible impressions on me regarding both the art and the science of dentistry. They spent their careers advancing knowledge while challenging the status quo and always emphasizing the patient benefit associated with high quality treatment. From them, I learned to pursue excellence and innovation, and this pursuit became the driving force of my professional career.

Tell us about your international involvement on behalf of endodontics.

My global perspective began the summer of my junior year at Penn. Dean D. Walter Cohen found summer positions for my roommate, Michael Cobin, an endodontist currently practicing in Westlake Village, California, and me at the Royal Dental College in Aarhus, Denmark, through the assistance of their Dean, Jan Lindhe. We made technique models — it was a great summer. Michael and I drove around Denmark in a somewhat run-down Volkswagen Beetle we purchased in Amsterdam from another student for $300. I even tried my new pilot’s license often flying around the Baltic and landing at some Danish islands for a day at the beach with our new dental student friends. In those days, their air traffic controllers communicated mostly in Danish, so I never knew exactly what the other aircraft were doing. I just listened for my call sign in the King’s English and responded as best I could.

Our European dental colleagues were performing very sophisticated research, and I very quickly learned that there was a whole world of dentistry to be discovered outside of Philadelphia! This broadening experience helped set the course for my future engagement with dentistry with a worldwide perspective.

Since then, it has been my honor to lecture internationally, to learn about the practice of endodontics in other countries, and to make friends from among the global community of endodontic practitioners. One such friend is Dr. William Cheung, a Hong Kong resident, who annually volunteered to serve the underprivileged at a hospital-based program in Western China. In 2000, most Chinese dentistry was institutional, with only the beginnings of private practice in Beijing. Bill and I had met at a Penn Dental Medicine Board of Overseers luncheon, and intrigued, I immediately jumped at the chance to be a part of this effort. Shortly thereafter, his invitation in hand, I was packing a microscope, courtesy of Global Surgical, digital sensor, laptop, other equipment and supplies — and heading for the airport. Of course, I had almost no room for clothes, so there were a few wardrobe challenges along the way. It was a privilege to work side-by-side with Bill, providing endodontic treatment, and teaching modern techniques to local dentists who were struggling with interrupted power, water, and antiquated equipment. Much of their treatment was carried out with local anesthetic delivered with endlessly reused needles and syringes. While I developed much respect for these clinicians and patients who struggled under less than ideal conditions, I was relieved to have brought my own supply of anesthetics.

China was changing rapidly, upgrading healthcare, and adopting modern infrastructure and conveniences. This visit was a life-changing experience for me. My operating microscope was affixed to an old table by a steel frame created by hospital mechanics, and stabilized by sandbags positioned across the table legs. It worked, and we were able to introduce the microscope and digital radiography to that region of China. I have since returned to China many times, including visits to several major cities to lecture and demonstrate advanced endodontic procedures and CBCT technology.

Other lecturing engagements have allowed me to visit more Asian countries, South America, Europe, and Africa. One rewarding aspect of my travels that I am particularly fond of has been the opportunity to include my family and introduce the wider world to them as well.

On a recent trip to Russia, I served as Scientific Co-chairman of the Quintessence Radiology Congress in Moscow. I was joined by my associate, Anastasia, whose native command of Russian helped us tremendously. Through so many generous invitations, I have been given the opportunity to contribute to the delivery of patient care in the broadest manner possible.

What is your philosophy on new technologies?

Both now and in the future, we have a duty to our patients to pursue and deliver the best care possible. Endodontic disease adversely affects our patients’ quality of life and can produce significant morbidity. Developments in technology promise to advance diagnosis and treatment, and each step in the process requires experimentation and proof that these initiatives will improve treatment outcomes. But in order to succeed, we have to be willing to participate.

Since the discovery of X-rays by Roentgen in 1895, film-based imaging has been the predominant radiographic technology used in dentistry. Digital radiography, invented and championed by Dr. Francis Mouyen, has been gaining acceptance among dental practitioners and has recently seen increasing popularity in the medical imaging world as computers and software have improved. The earliest system was demonstrated to me in Paris in the mid-1980s by Dr. Mouyen in the endodontic office of Dr. Jean-Marie Laurichesse. It consisted of a digital detector and a stand-alone proprietary computer based on the early Intel 8086 chip and disk operating system (DOS)-based software. This system, which was truly state-of-the-art for that time, produced images that were revolutionary. I was spellbound, and our future plans to collaborate were agreed to over a lunch with plenty of wine. Dr. Mouyen arranged for a technician to bring his early system to Washington for me to use, and that was the beginning of my fascination with digital radiography.

Another advancement has been cone beam computed tomography (CBCT). Since endodontic therapy depends on diagnostic radiographs and image-guided treatment, the adoption of 3D technology, especially limited field of view, high-resolution CBCT, has been transformational for endodontics. I can now assess odontogenic and non-odontogenic lesions, root canal morphology, revision treatment, root and alveolar fractures, and resorptive lesions in three dimensions, as well as anatomy prior to surgery. I cannot overemphasize the value that this technology is having on our profession, and I look forward to continued enhancements. Here again, major manufacturers like Carestream (Carestream Dental, LLC) have played a pivotal role in the development and further enhancements to this technology, with a special emphasis on endodontic use.

I enjoy being an early adopter of new technologies. One such innovative product is the CPoint™ (EndoTechnologies, LLC), an obturation technology that was introduced in England 3 years ago to replace gutta percha. Gutta percha is a formulation that is more than 150 years old, and there have been only a few, mostly unsuccessful, attempts to replace it. CPoint is a novel obturation product that is being introduced to the U.S. market. The material is based on soft contact lens polymer chemistry. It is FDA registered and undergoing testing in the best academic laboratories in the world. An analysis of biocompatibility has already been completed and the findings submitted to the JOE for publication. In short, we will only improve our treatment options by innovation and experimentation, and the contribution of companies like these cannot be overestimated.

Innovations like these require constant evaluation and testing, and by participating in these processes, I can see firsthand the potential for these advancements and to provide improved outcomes. This is the basis for my continuing interest in new technologies.

What are your interests outside of dentistry?

I am surprised at how many hobbies I have had. As a child growing up in Chevy Chase, Maryland, I began tinkering with electronics in my father’s garage workshop in an effort to devise a way to communicate with my best friend around the corner without using the phone – dial-up service in those days. My father bought me a how-to book on amateur radio, and I jumped in with both feet and became a radio ham while in in sixth grade. I even remember building my transmitter, burning myself with solder, and ultimately listening to Sputnik on my ham receiver, all the while wondering how technology would change our lives forever.

While I was home from college one summer, my father asked my twin brother, Charles and me what we wanted for our 21st birthday. In unison, we proclaimed “flying lessons.” His response was, “Get in the car; we’re going to the airport.” With instructors at our side, we were flying around the airport within an hour. Becoming a pilot began with a simple wish, and continues to satisfy my need for adventure and to expand my understanding of the physical world. It was a perfect fit — weather, physics, lots of radios, and travel, all in one neat little package.

My interest in flying continued through dental school. While assuring my parents that I was devoting every waking moment pursuing my first year of dental education, I was able to complete my flight training. Once licensed to fly, I needed a plane to use, so I joined a flying club at Philadelphia International Airport. Many of the members were controllers, so it was relatively easy to learn the ropes and feel at home in a large plane environment. In those days, things were a little less regimented. I remember reporting inbound on the approach control frequency only to hear, “Marty, you are clear to land runway 35, hold short runway 27R,” followed by an inbound airline pilot on the frequency asking, “Who is this Marty?” About 25 years ago, I bought a Cessna 182 and completed my instrument rating so I could fly in more limited weather conditions. I still enjoy using the plane for East Coast business and recreational flying.

My 25 years of sailing on the Chesapeake with my family is probably the hobby that my family and I hold dearest. Spending weekends aboard the boat with my wife and three daughters brought us many years of shared family memories.

What is your involvement in dental education?

Many of us remember those special teachers who took the initiative to foster our personal and professional growth. They insisted on high standards that would endure throughout our lives. Just like my mentors, I wanted to help students grow into curious and confident clinicians, so I became an adjunct faculty member at Penn Dental Medicine. I have since had the opportunity to teach at numerous endodontic residency programs, including the University of Maryland and Nova Southeastern, and to share my experience and insights about both clinical procedures and operations management. It has been gratifying to share my knowledge and to hopefully pass on the same values that my professors gave to me.

I eventually became more involved in Penn Dental Medicine’s volunteer activities and was invited to join the school’s Board of Overseers. After a number of years on the board, I was appointed Chair and had the pleasure of serving the dean and the university to help support the dental school’s educational mission. I now serve Dean Denis Kinane as the chair of the Dean’s Council. In this role, I continue on the Board in an ex officio capacity and as a steward of Penn Dental Medicine’s legacy with a dedicated group of volunteers.

Writing also has become an interest of mine. It has been an honor to have contributed to Pathways and Ingle’s textbooks over the years, and join other colleagues in an attempt to conceptualize material. Lately, I have completed a chapter in Cone Beam CT: Oral and Maxillofacial Diagnosis and Applications, and will help Drs. Uma and Madhu Nair update a chapter in the next edition of Pathways.

For years you have been sharing your knowledge of practice management. Can you elaborate on this interest?

When we were young, I spent many weekend and summer hours working with my father at his business. I learned the importance of creating a business plan and operating strategy, which would later allow me to grow my practice and enjoy what I was doing. I learned how to establish a brand and how to create a value equation, skills which are integral to the mantra of success in any business course. I also learned that customer loyalty and trust are essential elements in any business. Sadly, this necessary aspect of a professional practice was never addressed in dental school.

When I opened my first office in 1975, I was able to put my business knowledge to good use, and sharing this knowledge with endodontic residents and other endodontists became a passion. I recognized from the beginning that applying basic business skills and using the newest technology would provide the best results for my patients and referrers. Experiencing both successes and failures along the way, I have pursued these goals to the best of my ability. Who would have guessed, from looking at our first handwritten appointment book, that one day we would be using an electronic oral health record, microscopes, 2D digital radiography, and 3D computed tomography? A lot has changed.

What can you tell us about your current practice?

My practice view is best expressed by the mission statement we have developed: “To improve healthcare in our community by setting the standard of excellence. We support innovative, patient-centered care to prevent, diagnose, and treat endodontic disease.” This statement reflects our collective belief in the value of shared knowledge and allows for the greatest impact on the improvement of dental care and overall health.

You can see that our core values are improvement and innovation, always guided by the patient benefit and the legacy of my mentors at Penn Dental Medicine. Today, my team includes Drs. Anastasia Mischenko and George Jong, together with a dedicated clinical, technical, and administrative staff. Anastasia graduated with a Master’s Degree from the University of Maryland’s endodontic residency program, headed by my good friend, Dr. Ashraf Fouad, a world-class microbiologist and educator. With a special interest in microbiology, Anastasia collaborates on best practices and acts to facilitate our adoption of new treatment protocols.

George has just joined our practice after completing a one-year GPR at the Baltimore Veterans Affairs Medical Center and an endodontic residency at NYU under the guidance of another world-class educator, Dr. Paul Rosenberg. George’s focus is surgical intervention, including apical microsurgery, exodontia, and bone preservation procedures. He is already utilizing our CS 9000 3D and has embraced our culture of adopting the newest instrumentation and obturation technologies.

The operational focus of our practice is always driven by the patient benefit and stays under constant review. We seek to provide a safe and highly efficient environment that provides an extraordinary patient experience. For this reason, we strive for a very friendly and collegial atmosphere. The interaction of our staff, the design of our office, and the refinement of our treatment protocols all combine to continuously improve the quality of patient care. We are constantly changing.

My journey from my first days in dental school to today has been enormously satisfying and has allowed me to fulfill many of my personal and professional goals. I certainly could not have managed alone and am very grateful to my family, friends, staff, faculty mentors, and professional colleagues.

Dr. Levin receives honoraria and/or serves as a scientific advisor to Carestream Dental, LLC and EndoTechnologies, LLC.

Top Five Favorites

1. Carestream Dental: CS 9000 3D™ and CS 6100™ digital sensors

2. EndoTechnologies: CPoint™

3. Henry Schein Dental: EndoVision™

4. Atlantic Design Solutions: Websites

5. ReDent Nova: SAF

About the Author
Dr. Martin Levin is an endodontist in Chevy Chase, MD. Connect with him on Google+