Craig B. Pearl, DDS, MsD, FCMFOS, specializes in Oral and Maxillofacial Surgery, and is an Associate Professor at the University of Texas, Texas Medical Center in Houston. He’s also one of the doctors working with MedCAD’s 3D virtual surgical planning and patient-specific implants.
He’s an open and honest partner to us, and he’s always ready to offer suggestions on ways we can improve our process and product. We’re always happy to listen—even if, as he says, “his ideas sometimes may seem completely ridiculous.”
Dr. Pearl took some time out of his busy teaching and surgical schedule to talk to us about his life in maxillofacial surgery—and his life beyond it.
Q: What led you into maxillofacial surgery?
A: I went straight from school into dentistry, and straight away I knew that maxillofacial was what I wanted to do. As a kid I would take things apart pretending to operate on them, and to my parent’s dismay most of the electronics never worked again, so I earned the nickname “trouble.” Maxillofacial was the undergraduate subject that I enjoyed the most, the one that I felt I was the best at, and it gave me everything that I wanted out of a career. It had me working with my hands and doing the kind of work that I felt could make a difference.
I’ve always preferred working in a hospital environment rather than in a private practice setting, which I always found very lonely. I did private practice for a number of years in South Africa, but it never gave me the same sense of job satisfaction. There, I joined a practice where the other surgeon didn’t want to do TMJ, so I inherited a huge number of TMJ patients. My sister is a neurologist, so she also sent me a number of chronic tension-type headache patients, so in some ways TMJ found me.
As my TMJ practice grew, I decided to expand my knowledge in TMJ surgery. I spent a year with a TMJ and facial pain surgeon, and he taught me all the surgeries that you hear about as a resident but wouldn’t necessarily feel comfortable doing. TMJ and chronic facial pain patients are generally an underserved part of our specialty, with the vast majority of OMS surgeons preferring not to treat these cases.
Q: How did you find your way to the US?
A: In 2008 I was fortunate enough to meet the Chair of the OMS Department for the University of Texas, Texas Medical Center, Dr. Mark Wong, and give a lecture to the Department of Oral and Maxillofacial Surgery here in Houston in the impressive Texas Medical Center. Fortunately, he and Dr. Jim Wilson remembered me, that when I reached out in 2017, they offered me an interview and finally a position. It took me a year to get here with visas and logistics but professionally, it’s been the best decision I’ve ever made.
My kids absolutely love it here; although all born in South Africa, they are truly integrated into the American way of life. They’ve got the accent and all of the Americanisms; I could not imagine them growing up anywhere else.
Immigrating is definitely not easy and over the six years I’ve had my fair share of visa ups and downs, from delays in work permit renewals, to an error that got me denied entry in Germany and deported back to South Africa during Covid. Fortunately, Dr. Wong stood by me, and in February of this year we all got our permanent residence, and in about five years we’ll be eligible to apply for citizenship.
Q: You worked as a firefighter for 13 years, even after you became a surgeon. Can you tell us a bit about that?
A: I’ve probably always had this adrenaline junkie side of me, and so when I started dental school, I also did the firefighting course and the BLS course. On weekends and evenings, I worked at the fire station, where I enjoyed working on Squad Company, doing extrications with the jaws life for injured people trapped in their cars after motor vehicle accidents as well as structural fires. As I developed more medical knowledge deeper into my training, I moved into medical response and was part of an organization that would respond in the community to victims of trauma and medical emergencies. Even after I qualified as a maxillofacial surgeon, I was still doing it. I think the turning point for me was after the 2004 Boxing Day Tsunami in Southeast Asia. The day after the tragedy, I went to Phuket, Thailand on a rescue mission, after it became apparent that there were a number of injured, missing, stranded, and deceased South Africans on vacation there. We went in to find the South Africans and bring back the injured and, unfortunately, bring back as many of the dead as we could find and identify. After a very tough emotional and sleep-deprived trip, I got back and was absolutely mentally exhausted. My wife was heavily pregnant with our first kid. The day I got back, I resigned from the fire services because I was just absolutely emotionally and physically drained.
I actually have thought about going back as a volunteer so many times. I miss it a lot, and I would love to join a volunteer service here in Houston. Maybe one day when I have some free time.
Q: How did you discover MedCAD and work it into your practice?
A: In South Africa, the company that I worked with the most was Biomet, which was really my go-to for all my trauma and TMJ cases. In South Africa, you can get the Biomet stock joint, as well as the custom joint made for the patient with a wait of about two to three weeks. When I came here, I was surprised to find that I could only get the Biomet stock joint, since the custom joint in America is not FDA approved, and at the time the manufacturer of custom joints had a nine month wait.
MedCAD was already working with Biomet for 3D planning, so the Biomet rep put me in touch with MedCAD. The thing that I found with MedCAD is that it’s big enough that they can do deliver on whatever I needed, but it’s small enough that they can take the time to speak to you and give you that one-on-one service.
Working with them, we came up with a way of customizing cases even though we were using stock joints. Fast-forward two and a half years, and we’ve done well over 40 cases like this, and thankfully they’ve all worked out unbelievably. Now we are constantly evolving and coming up with new and better ways — not only to help the patients but to teach our residents to be effective and competent TMJ surgeons.
One of the things that I like about working with MedCad most is if I have a question or have a concern, our MedCAD rep Jonathan Vasquez will get in the car and drive from Dallas and come see me in the OR. He will spend hours observing my surgery and hopefully leave with a better understanding of my needs as a surgeon.
One concern that most surgeons express is a fear that the technicians don't understand fully the surgical aspects, the nuances. And as a surgeon, I don't fully understand the software and planning. So as soon as I expressed that, on more than one occasion, Jonathan came to the OR here and watched what I do, and then had a better understanding of why I say certain things or ask for certain things. They have also invited me to go up to Dallas, to sit with them in the planning and manufacturing department and to see what they can do. MedCAD has been very, very willing to listen to me and take my suggestions, even if they sometimes made no sense to the technicians. We’ll sit together for a few hours and we’ll knock it out, and from these meetings our surgery and planning has evolved and grown.
There are quite a few companies doing patient matched implants now, and that’s wonderful. We were doing this surgery long before there was 3D planning and patient specific guides, but it took much longer because you were doing it in the OR, and it was trial by fire. Now it’s saving two, three hours of operative time, and with this added increase in accuracy and efficiency, it really takes all the guesswork out of doing complex surgery like a total joint replacement.
Together with plating companies and their planning partners, maxillofacial surgery has been at the forefront of this evolution in facial surgery. I’m fortunate that the University of Texas, in the Texas Medical Center as well as our Department of Maxillofacial and Oral surgery where I teach, is very supportive of these new techniques. Our department, under Dr. Wong and Dr. Young who leads all research in our department, is very supportive of us exploring these new technologies and delivering meaningful and relevant research.
I think that all of these companies who offer virtual surgical planning and patient specific implants have allowed us as surgeons to offer our patients a more reproducible and consistent result that we’re able to achieve in a much more efficient manner. Operative time is calculated per-minute billing, so if we can reduce operative time without compromising patient care then that would result in significant reduction in cost. That is how you offset the cost of the 3D planning and printing — with the amount of time that you save in the OR.
Q: How do these technologies benefit you day-to-day?
A: I think that for me, one of the most rewarding parts of doing clinical teaching is getting our residents interested in TMJ and trauma surgery, seeing that they will in the very near future be doing what we taught them in their own practices, and then surpassing us. In their lifetimes, they’ll be doing things that are way more impressive than what we do now. Seeing these residents grow and develop, and watching them do cases that historically have been neglected, gives me a huge sense of satisfaction.
Maxillofacial is where MedCAD and the other planning and printing companies have made their mark. Here at Memorial Hermann in the Medical center, which is the busiest Level 1 trauma hospital in the country, my job on a daily basis is just dealing with the sheer volume of severe facial trauma. Working with companies that can help people be restored to an almost pre-injury state is huge, and I think we’ll see MedCAD and all these companies’ roles increasing as turnaround times decrease, and they come up with new designs and maybe even biologic
printing.
This is such important work. Because you’re dealing with the face, you can’t hide your errors under clothing. You can’t hide a poor result or asymmetry. The patient wears whatever you do, right in the open for all to see.
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2024 | MedCAD