Dr. Ori Platner
Head of the Periodontal Service, Sheba Medical Center
DMD (Dental Medical Doctor), Tel-Aviv University
Periodontology specialist
[email protected]
What led you to specialize in Periodontics?
At the beginning of my studies, I wanted a surgical profession in which I could work with my hands, and also a profession that would allow me a balance between work and home life. In addition, I wanted to help people who suffer from severe pain, and toothache is one of the worst. Therefore, I chose to study dentistry. I started in 1998 and received a Dental Medical Doctor degree in 2004, upon completion of 6 years of study at the School of Dentistry at Tel Aviv University.
Following the completion of my medical studies, in 2005, I began an internship in maxillofacial surgery for two years at Tel Aviv Sourasky Medical Center. While it is a beautiful profession, over time I realized that the main, and more interesting part for me, of oral and maxillofacial surgery, is performed in a hospital. Since I did not intend to stay in a hospital at the end of the internship, I understood that, at the end of the day, I would not engage in the more interesting part of the profession.
That’s why, after two years, I changed my specialization track and started a new internship from scratch in Periodontology and Dental Implants. I chose periodontics because it does allow a private clinic and still involves performing a wide variety of dental procedures. . And so, after 5 years of specialization in periodontics at the Department of Periodontology and Dental Implants at the School of Dentistry, Tel Aviv University, I became a specialist in periodontology in 2013.
After becoming a specialist in periodontology, I expanded my horizons at the University of Southern California (USC) in the USA, where I did a fellowship in periodontics, and at the same time my wife, who is an ophthalmologist, did a fellowship in Vitreo – Retinal surgery at UCLA. We returned to Israel in 2017, and I returned to the academy as a lecturer. Then, in 2020, I sought affiliation with a hospital. I wanted to be exposed to complex systemic cases and to special populations, which are very common in hospitals, where treatments can be performed in a more controlled environment, including for example methods like sedation and general anesthesia. So now, over the last three years, I have been managing the periodontics department at Sheba Medical Center.
What drives you in your profession?
Periodontics allows me to do two things that I truly enjoy and that motivate me, giving me strength: working with my hands and communicating with people. In addition, it is a fascinating field with many innovations. Periodontology is a field in dentistry that is at the forefront of science and research, as it involves surgical tools with the booming research of tissue regeneration.
What fascinates me in the field of periodontics is that many things are still unknown and not well understood. What causes inflammation to appear in a specific site in the gums and not elsewhere? What causes such inflammation to develop and grow in certain individuals but not in others? What is the reciprocal relationship between periodontal diseases and systemic conditions, such as pregnancy problems, Alzheimer’s, diabetes, and heart disease? These are all fascinating questions that are not fully answered yet, and that spur me on at work.
Periodontics enables an improvement in patients’ quality of life, as it is related to both aesthetic aspects and concern for the patient’s overall well-being. In fact, there is hardly any dental treatment plan that does not have some periodontal aspects.
I am happy that I chose to specialize in periodontology, to learn and develop with the field, and the more I am engaged in it, the more my motivation and pleasure grows.
Can you share with us a clinical case that you consider fascinating or unusual?
I come across many esoteric cases that can serve as interesting anecdotes, but I prefer to outline a more routine case here, which can teach something important and of interest to dentists. The case I will bring up deals with peri-implantitis, a problem that frustrates dentists because it is widespread on one hand, and the ability to treat it is very limited on the other hand.
A Prosthodontic referred to me, for evaluation and treatment, a patient with Peri-Implantitis. Around one of the implants in his mouth, there was acute inflammation (with very advanced bone resorption), but the clinical signs (bleeding, swelling, pus, pain) were very limited. The tissue was pink (and not red), stiff, did not bleed and had no pus. Around other implants in the patient’s mouth, inflammations developed with clear and strong clinical signs, and only this implant, was distinct. After I removed the implant there (as the bone around it was nearly completely resorbed), I decided to look into it more deeply. Hence, I also took a biopsy from the surrounding tissue and sent it for a histopathological evaluation. It turned out to be a metastasis of renal cancer.
As a periodontist, I am not used to informing patients of metastatic malignancy, and it was difficult for me to do so. Therefore, I arranged for the patient, in advance, an appointment with an oncologist that specializes in renal cancer. This way, when I met with the patient, I could guide him on what to do next, instead of just giving him the discouraging news.
The lesson from this case is that when something doesn’t make sense, when there is a gap and contradictions between different findings (for example, acute radiological signs of inflammation but weak clinical signs), it is important to pay attention and to investigate it in depth. As doctors, we must get out of the day-to-day routine and dig deeper when the findings do not add up.
For a deeper understanding in this context, you are invited to read an article of which I am one of the authors:
The Importance of Histopathological Diagnosis in the Management of Lesions Presenting as Peri-Implantitis; Ilana Kaplan, Avraham Hirshberg, Benjamin Shlomi, Ori Platner, Avital Kozlovsky, Ronen Ofec, Devorah Schwartz-Arad; Clinical Implant Dentistry and related research, Vol. 17, Issue S1, p. e-126-e133; First published – 26 August 2013
Link to the article: link
Can you recommend a scientific article that dental professionals should read?
Oral health’s inextricable connection to systemic health: Special populations bring to bear multimodal relationships and factors connecting periodontal disease to systemic diseases and conditions; Yvonne L. Kapila; Periodontol 2000. 2021 Oct; 87(1): 11–16.
Link to the article: link
This article describes the interdependence between the health of the gums and the health of the body, and between diseases in the gums and systemic diseases in the body. Evidence shows that a patient’s general health is reflected in and affected by their oral health. Many systemic diseases manifest in the mouth, sometimes for the first time, and are, on the other hand, aggravated by dental conditions. For example, treating inflammation of the gums and balancing the gums makes it easier to balance sugar levels in diabetics. And on the other hand, in balanced diabetics, gum inflammation decreases. Similarly, an interdependence has been found between the condition of the gums and many other systemic diseases: respiratory diseases, cancer, cardiovascular and heart diseases, pregnancy complications, and more.
Since there is an interdependence between the health of the mouth and the health of the rest of the body, we must not treat only the mouth. Dentists should look at their work in a wider perspective, considering the well-being of the patient as a whole, and not just their teeth and gums. The treatment must be holistic; this is an important part of our responsibility towards patients. In this context, it is also important to understand that we are in a strategic position, where it is possible to motivate patients to change their unhealthy lifestyle and habits, in areas such as nutrition, smoking, balancing diabetes, and more.
What advice would you give to dentists?
As mentioned before, it is important to treat dentistry as a holistic profession, which includes much more than just caring for teeth. The quality of life is related to the teeth, and vice versa. It is important to look at the bigger picture, and to examine the mouth and jaw in a systemic view, as part of the overall health of the patient’s body and mind.
How do you keep yourself professionally updated?
During my fellowship at USC in the USA, I was exposed to the best doctors and research in the field of periodontics.
At the University, we hold regular meetings with interns, dedicated to presenting the latest professional literature and discussing the research presented. In addition, the interns present cases, including the review of relevant literature, which enables me to be in a constant learning process.
Additionally, as part of my work at the hospital, I come across special and complex cases on a monthly basis, which broadens my horizons. When patients arrive with a unique medical condition that I am not familiar with, I read literature on the topic and also talk to the doctors from all medical disciplines who treated the patient until they came to me. From the dialogues with their doctors, I learn the most.
There are also many professional courses in the world, for example, courses about specific surgical procedures, taught by world leading periodontists. I recently returned from such a week-long course in Germany. Surgery requires hands-on experience, so it is important to get trained in such courses on how to actually perform different and new approaches. Such study cannot be done via zoom or correspondence. Learning how to perform surgeries can only be done by actual practicing under the supervision of experienced surgeons.
And finally, of course, I participate in professional conferences in Israel and around the world, and I read professional literature to stay updated.
Medicine requires constant learning, but I love doing it. It’s fascinating.
How do you see the future of your Periodontics?
Currently, as mentioned, we do not truly understand all the reasons and factors involving the formation and development of periodontitis. Much is still unknown regarding periodontitis and peri-implantitis. Gum infection is diagnosed as a chronic disease today, and we have no treatment that cures the problem from its root. Progressive destruction in furcation is hard to repair, and vertical tissue resorptions are a major challenge. I believe that in the future we will learn more about periodontitis, and we will be able to provide definitive treatments for the inflammation and highly predictable regeneration modalities.
Another field that will probably evolve is implants made of biological substance. I predict that the day will come when we can implant teeth from engineered biological tissues, instead of titanium implants.
Which technologies or developments, in your opinion, will shape the future of Dental Implantology?
Recently, there has been an increasing interest in the treatment of a toothless area by auto-transplantation. This is a therapeutic approach where a tooth that needs to be extracted from a certain site in the patient’s mouth, is implanted in another area of the patient’s mouth where teeth are missing.
This approach is very relevant, for example, for children who lost tooth due to trauma or tooth agenesis for example, and need to restore that site. An extracted tooth from crowded area can be transplanted at that site. Current literature shows new methods of auto-transplantation with highly improved success rates.
In two cases that I have recently performed, I used an innovative technology that allows precise planning and preparation of the implant site for the tooth implanted with this approach. The results look very promising, and I plan to deepen and perfect the method in my daily practice.
Time will come when we will be able to grow teeth in the lab, and use them as dental implants. We are just at the beginning of the road, and the future is exciting!
What are your thoughts about the future of dental radiology?
The field of dental imaging is changing rapidly. The imaging capabilities of CBCT continue to improve, providing sharper and more accurate imaging with reduced radiation to the patient. I predict that micro-CT methods will also gain popularity in the field of dental imaging, allowing for more detailed scans of individual teeth in the mouth. With this technology, we may be able to identify vertical cracks, a major diagnostic challenge that current imaging technologies cannot identify.
In addition, computerized planning of implant placement using CBCT, and the creation of surgical guides will become simpler and faster, becoming the gold standard for implant surgery. This will allow more dentists to perform implants, and at a higher accuracy, in complex cases, anywhere in the world.
You said you decided to specialize in Dentistry, and later on in Periodontics, in order to keep a good Work-Life balance. Did it pay off?
Luckily, I think I have reached the optimum. At work – I have a nice balance between working at my clinic and working at the hospital. This leaves me time to spend with my children some afternoons and to enjoy free weekends. I even find time to volunteer occasionally for some community activities and have participated in several humanitarian expeditions with other fellow doctors. Life is really beautiful!
