Prosthodontics

[Johnson22]

I have heard some mixed feelings about doing a residency in prostho. What does the future of prostho look like and what kind of scores are needed to get in? Is it competitive? Is it true that many prostho programs are integrating implants? Is it worth the 3 years of extra schooling? Thanks!

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[12YearOldKid]

Prosth is not really one of those residencies you do because the "future of the specialty" looks good.

Prosth is something you do because you love it and/or want to teach. Money is about the same as a GP. In fact, many prosthodontists end up working as GPs. Some programs are fairly competitive, but many others are begging for qualified applicants.

Most prosth programs are now placing at least a few implants, but so are most GPRs. The main implant focus for prosth is really restoring rather than placing.

 

[GQ1]

I have heard some mixed feelings about doing a residency in prostho. What does the future of prostho look like and what kind of scores are needed to get in? Is it competitive? Is it true that many prostho programs are integrating implants? Is it worth the 3 years of extra schooling? Thanks!

Johnson22, 12 year old kid is wrong. For the last 4 years pros has had increasing applications, its tougher than perio to get into, has more american applicants and residents than perio. money in the ACP survey is 150% that of a GP. theres many diffreences to a gp its just how you want to practice. with increasing technology, an ageing populations with heavily restored mouths, cosmetic dentistry being within our field, a requirement to place implants - the no. always increasing - the next 30 years is repeatedly described as the golden period of pros.

 

[Johnson22]

A dentist I talked to said it could be extremely lucrative. What kind of scores are needed to get into the good programs...and scores for the bad. Do any programs offer stipends? Do general dentists not like prosthos because they feel like they can do the same work?

 

[GQ1]

A dentist I talked to said it could be extremely lucrative. What kind of scores are needed to get into the good programs...and scores for the bad. Do any programs offer stipends? Do general dentists not like prosthos because they feel like they can do the same work?

when you dont work with a specialty you dont know what they do. dentists work less with prostho than other specialists. eg most of your referrals as a good prostho will come from perio, not gps - who send some but not as many cases. board scores can vary but now that they have more applicants - not like endo but still a lot 50 -60 for 3 not stipended places 100 fro 2 stipended places they can be choosey. some want a gpr so you have an appreciation of all the specialtieswhich is what you need as a prostho as you control and direct the tx plan of pros perio, endo and ortho. programs on the 2 coasts and then ones like chicago, minnesota and the texas schools are most competitive.

 

[archer123]

Johnson22, 12 year old kid is wrong. For the last 4 years pros has had increasing applications, its tougher than perio to get into, has more american applicants and residents than perio. money in the ACP survey is 150% that of a GP. theres many diffreences to a gp its just how you want to practice. with increasing technology, an ageing populations with heavily restored mouths, cosmetic dentistry being within our field, a requirement to place implants - the no. always increasing - the next 30 years is repeatedly described as the golden period of pros.

I agree somewhat with 12 year old kid. A prosthodontist is in no better position to get a job than a GP, and the salary is not much more. Of course the average yearly salary is higher, it's not by much, and considering that pros is at least 3 additional years is it really worth it. As the kid said, you have to love doing lab work and thorougly enjoy the work. I would actually say that a GP is in more demand than a prosthodontist. I don't believe in the golden age, but if you want to go into something and hope that the "golden age" will spring up in the next 30 years, it's a risk that you will have to take. I believe in the golden age of nanotechnology, but not the golden age of pros. There are a few difficult pros programs to get into, however, most with a pulse and average 85 boards will get in, which means that the average dental student will have little trouble gaining admission. And it is true that pros has a large number of foreign grads as does perio. I still think perio is more difficult to gain admission than pros. endo>ortho>omfs>pedo>perio>pros>omfrad=oralpath
A lot of prosthodontists are struggling and end up working in a dental school, of course there are exceptions to everything, but you get the idea. If you think you are going to graduate pros and start making 200K a year you are mistaken, but very possible with the other specialties.

 

[simpledoc]

I agree somewhat with 12 year old kid. A prosthodontist is in no better position to get a job than a GP, and the salary is not much more. Of course the average yearly salary is higher, it's not by much, and considering that pros is at least 3 additional years is it really worth it. As the kid said, you have to love doing lab work and thorougly enjoy the work. I would actually say that a GP is in more demand than a prosthodontist. I don't believe in the golden age, but if you want to go into something and hope that the "golden age" will spring up in the next 30 years, it's a risk that you will have to take. I believe in the golden age of nanotechnology, but not the golden age of pros. There are a few difficult pros programs to get into, however, most with a pulse and average 85 boards will get in, which means that the average dental student will have little trouble gaining admission. And it is true that pros has a large number of foreign grads as does perio. I still think perio is more difficult to gain admission than pros. endo>ortho>omfs>pedo>perio>pros>omfrad=oralpath
A lot of prosthodontists are struggling and end up working in a dental school, of course there are exceptions to everything, but you get the idea. If you think you are going to graduate pros and start making 200K a year you are mistaken, but very possible with the other specialties.

am so confused i always had an itch to specialize in prosth if i ever decide to specialize, simply cuz i wanted to be the supreme authority in rehab or restoring the whole mouth.... i didnt know prosth is so undervalued..the funny thing is, all the general dentists i know, do nothing but amalgams, composites, RPDs, dentures etc and make atleast 125K and whenever they end up with a high end client who needs to get a crazy implant related reconstruction, they immediately get on phone with their prosthodontist buddy for ideas.. i personally would hate to do that! i cant be out there in the real world and feel insecure about myself when i see a crazy mouth!! how could I possibly prevent myself now from making a wrong decison? having said this, i still think that perio is the most insecure specialty among all and they just want to venture into almost anything in dentistry, ranging from implants to restorations to 3rd molars! i would hate to be called a periodontist!

 

[simpledoc]

programs on the 2 coasts and then ones like chicago, minnesota and the texas schools are most competitive..

GQ1, looks like you are in a good program...which program are you in? why dont you ever say? would help some people like us to get a good idea of "what is really out there"!

 

[archer123]

am so confused i always had an itch to specialize in prosth if i ever decide to specialize, simply cuz i wanted to be the supreme authority in rehab or restoring the whole mouth.... i didnt know prosth is so undervalued..the funny thing is, all the general dentists i know, do nothing but amalgams, composites, RPDs, dentures etc and make atleast 125K and whenever they end up with a high end client who needs to get a crazy implant related reconstruction, they immediately get on phone with their prosthodontist buddy for ideas.. i personally would hate to do that! i cant be out there in the real world and feel insecure about myself when i see a crazy mouth!! how could I possibly prevent myself now from making a wrong decison? having said this, i still think that perio is the most insecure specialty among all and they just want to venture into almost anything in dentistry, ranging from implants to restorations to 3rd molars! i would hate to be called a periodontist!

I'd rather be called a periodontist than a glorified GP. There are a wide range of cases that a GP will treat, some will do full mouth reconstruction including implant placement and will do a good job, sometimes the results are a nightmare. The key to all things in dentistry is to do what you are capable of doing, and not more. To be a supreme authority in oral rehabilitation means that you understand all aspects of many disciplines including omfs, perio and pros. Why would a GP refer a full rehab case to pros when they can do the case themselves. some will refer, others will do it themselves. Personally, I would rather go to a prosthodontist for a single crown rather than a GP, but this is not true of the majority of Americans who seek dental care. You say that perio ventures everywhere---well the same holds true for pros. placing implants. I'd rather be in the care of a periodontist doing an implant than a prosthodontist, but the bottomline is that if we get in over our head the OMFS will come in to save us from a medical nightmare that I might be able to handle and that you likely won't be able to handle. My point is that each specialty should stay in the scope of what they are capable of and if nothing else, do no harm. If you truly love pros go for it.

 

[GQ1]

I agree somewhat with 12 year old kid. A prosthodontist is in no better position to get a job than a GP, and the salary is not much more. Of course the average yearly salary is higher, it's not by much, and considering that pros is at least 3 additional years is it really worth it. As the kid said, you have to love doing lab work and thorougly enjoy the work. I would actually say that a GP is in more demand than a prosthodontist. I don't believe in the golden age, but if you want to go into something and hope that the "golden age" will spring up in the next 30 years, it's a risk that you will have to take. I believe in the golden age of nanotechnology, but not the golden age of pros. There are a few difficult pros programs to get into, however, most with a pulse and average 85 boards will get in, which means that the average dental student will have little trouble gaining admission. And it is true that pros has a large number of foreign grads as does perio. I still think perio is more difficult to gain admission than pros. endo>ortho>omfs>pedo>perio>pros>omfrad=oralpath
A lot of prosthodontists are struggling and end up working in a dental school, of course there are exceptions to everything, but you get the idea. If you think you are going to graduate pros and start making 200K a year you are mistaken, but very possible with the other specialties.

REALLY GOOD ANECDOTAL ADVICE THERE
you re a trawler we ve never seen you here before so get back to where you came from. heres the ada EVIDENCE - pros makes 1.5 x more than a GP.



Private Practice and the Economic Rate of Return for Residency Training as a Prosthodontist
Nash, Kent D. [1], Pfeifer, David L. [2]
Jada 2005; 136:1154-1162.

Abstract


Background. The authors used survey data to estimate the economic rate of return from undertaking an investment in residency training to become a practicing prosthodontist.

Methods. The authors estimated earnings of practicing prosthodontists using results from a survey of 2,500 U.S. prosthodontists. Survey data were used to assess the total costs of prosthodontic residency and earnings of practicing general practitioners. The authors applied statistical methods to estimate the internal rate of return (IRR) for prosthodontic residency training.

Results. The estimated IRR ranged from 8.23 percent for private practitioners with no financial assistance during residency training to 12.18 percent for full-time private practitioners with stipends and loans. Total costs of residency ranged from $271,835 to $441,321, depending on the amount of forgone earnings, time in practice and how soon practice began after the residency.

Conclusions. All of the estimates of IRR in this study were positive, indicating that prosthodontic residency is a financially attractive investment.

Practice Implications. The positive IRR for prosthodontic residency indicates that the demand for advanced education in prosthodontics will continue, and that the amount of time spent in practice increases the rate of return.

Key Words. Lifetime earnings; economics; internal rate of return; prosthodontic residency.

 

[Johnson22]

What scores are needed to get into the tough programs? Research needed?

 

[archer123]

REALLY GOOD ANECDOTAL ADVICE THERE
you re a trawler we ve never seen you here before so get back to where you came from. heres the ada EVIDENCE - pros makes 1.5 x more than a GP.



Private Practice and the Economic Rate of Return for Residency Training as a Prosthodontist
Nash, Kent D. [1], Pfeifer, David L. [2]
Jada 2005; 136:1154-1162.

Abstract


Background. The authors used survey data to estimate the economic rate of return from undertaking an investment in residency training to become a practicing prosthodontist.

Methods. The authors estimated earnings of practicing prosthodontists using results from a survey of 2,500 U.S. prosthodontists. Survey data were used to assess the total costs of prosthodontic residency and earnings of practicing general practitioners. The authors applied statistical methods to estimate the internal rate of return (IRR) for prosthodontic residency training.

Results. The estimated IRR ranged from 8.23 percent for private practitioners with no financial assistance during residency training to 12.18 percent for full-time private practitioners with stipends and loans. Total costs of residency ranged from $271,835 to $441,321, depending on the amount of forgone earnings, time in practice and how soon practice began after the residency.

Conclusions. All of the estimates of IRR in this study were positive, indicating that prosthodontic residency is a financially attractive investment.

Practice Implications. The positive IRR for prosthodontic residency indicates that the demand for advanced education in prosthodontics will continue, and that the amount of time spent in practice increases the rate of return.

Key Words. Lifetime earnings; economics; internal rate of return; prosthodontic residency.

All of dentistry is "finacially attractive"--and your point is? If you didn't get caught up in the minutiae, you would realise that I'm trying to convey the understanding that pros is on the lower rung of the ladder in terms of $$$, and just as important is that many prosthodontists have trouble getting started in private practice because GPs have a greater demand and at the same time do much the same treatment as a prosthodontist would. I personally know prosthodontists who tell me this. A trawler--how ominous

 

[NewNameForGoogleBot]

Private Practice and the Economic Rate of Return for Residency Training as a Prosthodontist
Nash, Kent D. [1], Pfeifer, David L. [2]
Jada 2005; 136:1154-1162.

I thought this article was kinda funny when I read it in JADA. I have yet to see a scientific study to prove that endo, ortho, omfs, etc are good financial investments; the prosthodontists must be a little defensive. That said, I have no reason to disagree with the authors, although the increase in salary from GP to pros is clearly lower than that of other specialties. Once again it comes down to doing what you like the most.

 

[Johnson22]

You guys make it sound like it's not worth pursuing. Thanks for the input.

 

[archer123]

You guys make it sound like it's not worth pursuing. Thanks for the input.

It is worth pursuing if you like it. Don't take what I say or what anyone else says on this forum as gospel. Dentistry is a good profession if you like it. Some people can't stand GP and that's fine, others like it. Everyone has there own reasons--the bottom line is that if you really enjoy pros then you will do well. People who don't like what they do tend to not do as well, this applies to everything, not just dentistry. And just because it may not make as much $$ as endo is not a reason not to pursue it. For me it wouldn't be worth pursuing because I don't like doing it. I like it conceptually and the treatment planning considerations, but not clinically. I think a lot of what people end up going into is what they enjoyed in dental school. For example, I do not like my pros department faculty so it turned me off, but I do like the perio faculty so I was around perio people more and I was influenced that way. And there is nothing wrong with doing a GPR first if you are unsure at this point. Even if there is no golden age you will stay make a good living doing what you like doing.

 

[GQ1]

It is worth pursuing if you like it. Don't take what I say or what anyone else says on this forum as gospel. Dentistry is a good profession if you like it. Some people can't stand GP and that's fine, others like it. Everyone has there own reasons--the bottom line is that if you really enjoy pros then you will do well. People who don't like what they do tend to not do as well, this applies to everything, not just dentistry. And just because it may not make as much $$ as endo is not a reason not to pursue it. For me it wouldn't be worth pursuing because I don't like doing it. I like it conceptually and the treatment planning considerations, but not clinically. I think a lot of what people end up going into is what they enjoyed in dental school. For example, I do not like my pros department faculty so it turned me off, but I do like the perio faculty so I was around perio people more and I was influenced that way. And there is nothing wrong with doing a GPR first if you are unsure at this point. Even if there is no golden age you will stay make a good living doing what you like doing.

Perio is the only area that you wont find a shortage of faculty, why because theyre not making much outside. The ACP is attempting to fix the faculty shortage in pros as most go into practice. hence perio is now on the bottom rung, its a specialty that relies on refferrals not like pros. but the procedures are more expensive than eg endo referrals and gps can do these procedures. so its the toughest specialty to start up in. maybe endo being the easiest. perios (leachodontists) are not as respected as omfs as omfs do what you treatment plan. perio due to a lack of work like to think theyre also the architects of the tx plan so start adding procedures until prostho slaps them down. perio has more international students as US grads have realized if you want to place implants (where the $ is) do omfs or pros.

 

[drhobie7]

Here is what I have seen with pros: other specialties will take you more seriously than if you are a GP. OMS has greater respect for your decisions (and rightly so). Other GPs look to you for the final say. Pros is the ultimate in restorative dentistry. If you like restorative dentistry and don't mind doing 3 years post-grad, do it. You'll be happy you did. Every prosthodontist I've talked to is very pleased with their decision to do pros. They say they have a level of understanding they would not have otherwise gotten. It's a level of confidence that differentiates you from a GP, much like OMS is differentiated from perio.

There was some stuff about perio in this thread as well. I can't imagine periodontists are going anywhere. There will always be pockets to reduce, roots to flap and scale, and soft tissue to graft.

I think if you do pros you'll end up doing more big cases. These bring in more cash and most seasoned dentists find these the most interesting/enjoyable. After you do a hundred or so crowns it just isn't that challenging anymore.

So, my advice is do pros.

 

[brock010]

As a third-year resident in prosthodontics I have really enjoyed reading these posts. There is a lot of truth on this thread. Firstly, let's start with the money, since that seems to be an important factor to some. Prosthodontists on average make more money than GPs on average. But they won't tell you that 10% of prosthodontists make over $1M. Of course, this is assuming that the prosthodontist chooses to do prosthodontics. I make this statement because many prosthodontists start out in general. Eventually, they make a transition to a full-time prosthodontics practice. This change will probably occur in the mid thirties to early forties of his life. Hence, it is true that a prosthodontist must really enjoy what he does. He must take pride in his work and take on the role of the architect. Implant placement is now an accepted procedure among prosthodontists. We are qualified to place them. If fact, soft tissue management is best applied with simultanious placement and restoration. If the dental papilla (or mucosa) is best preserved this way, then how feasible is it for a patient to undergo implant placement by a periodontist or OMFS and then get in his car and go the GP or prosthodontist to get the restoration? It makes more sense for the surgeon to place the provisional. Prosthodontist tend to place implants in prosthodontically favorable sites, which makes the final prosthesis and occlusion easy to handle. It is risky bussiness to start a prosth practice from scratch. It takes time to earn referrals and a respectable reputation. Prosth is a journey. It describes the human condition. It is philisophical. And it is difficult. Every once in a while it is truly magical and that's what brings us back for more.

 

[Doggie]

Implant placement is now an accepted procedure among prosthodontists. We are qualified to place them.

I am just curious because I would have gone into Prosth if I hadn't chose OMS.

In your program (or any other programs), do they train you to tackle the more challenging cases where bone grafts are involved? Are prosthodontists trained to handle complications of implant placements (ie: floor of mouth hematoma, IAN paresthesia, sinus perf, infection, etc)?

 

[simpledoc]

I am just curious because I would have gone into Prosth if I hadn't chose OMS.

In your program (or any other programs), do they train you to tackle the more challenging cases where bone grafts are involved? Are prosthodontists trained to handle complications of implant placements (ie: floor of mouth hematoma, IAN paresthesia, sinus perf, infection, etc)?

ive heard that programs like UCONN, Washington and Bethesda Naval DC have their residents most of their implants..but I could be wrong..

 

[simpledoc]

As a third-year resident in prosthodontics I have really enjoyed reading these posts. There is a lot of truth on this thread. Firstly, let's start with the money, since that seems to be an important factor to some. Prosthodontists on average make more money than GPs on average. But they won't tell you that 10% of prosthodontists make over $1M. Of course, this is assuming that the prosthodontist chooses to do prosthodontics. I make this statement because many prosthodontists start out in general. Eventually, they make a transition to a full-time prosthodontics practice. This change will probably occur in the mid thirties to early forties of his life. Hence, it is true that a prosthodontist must really enjoy what he does. He must take pride in his work and take on the role of the architect. Implant placement is now an accepted procedure among prosthodontists. We are qualified to place them. If fact, soft tissue management is best applied with simultanious placement and restoration. If the dental papilla (or mucosa) is best preserved this way, then how feasible is it for a patient to undergo implant placement by a periodontist or OMFS and then get in his car and go the GP or prosthodontist to get the restoration? It makes more sense for the surgeon to place the provisional. Prosthodontist tend to place implants in prosthodontically favorable sites, which makes the final prosthesis and occlusion easy to handle. It is risky bussiness to start a prosth practice from scratch. It takes time to earn referrals and a respectable reputation. Prosth is a journey. It describes the human condition. It is philisophical. And it is difficult. Every once in a while it is truly magical and that's what brings us back for more.

hey brock...which program are you in? can you provide us some insight about your program and some good ones out there?

 

[StarGirl]

You guys make it sound like it's not worth pursuing. Thanks for the input.

i hope you're not relying on sdn to make your decision....



.....i'm still trying to find my pulse... maybe i still have a chance.

 

[umkcdds]

i just don't understand how a prosthodontist can make a living outside of teaching in a dental school, or running a denture mill.
the bread and butter money-maker for the gp is, universally, crown and bridge. so why would a gp want to send anything other than dentures and partials to a prosthodontist? i've never met a dentist, outside of the school, that has referred anything to a prosthodontist. actually, the only prosthodontists i know of, outside of the dental school, run denture mills.

 

[drhobie7]

i just don't understand how a prosthodontist can make a living outside of teaching in a dental school, or running a denture mill.
the bread and butter money-maker for the gp is, universally, crown and bridge. so why would a gp want to send anything other than dentures and partials to a prosthodontist? i've never met a dentist, outside of the school, that has referred anything to a prosthodontist. actually, the only prosthodontists i know of, outside of the dental school, run denture mills.

A lot of pros cases are redos from GPs. This is more common as cases get more complex. I think many GPs are in the situation where 'they don't know what they don't know'. This is a dangerous predicament because it means you don't understand your limitations. Doing a full mouth rehabilitation is more complicated than a 3 unit bridge. When you combine implants and fixed pros things get even more complex. Then add in some TMJ or muscle pathology and things get more confusing. Pros does the biggest cases and fixes the screw ups of GPs. I think it's a great specialty. I just wish it wasn't 3 years.

 

[simpledoc]

I think it's a great specialty. I just wish it wasn't 3 years.

me too!

 

[brock010]

In your program (or any other programs), do they train you to tackle the more challenging cases where bone grafts are involved? Are prosthodontists trained to handle complications of implant placements (ie: floor of mouth hematoma, IAN paresthesia, sinus perf, infection, etc)?

The more challenging cases are almost always referred out. Complications are best avoided by meticulous planning and effective diagnosis and treatment. 3-D imaging is the standard of care for me, so the margin of safety is increased when compared to placing implants with the help of a PA and panoramic radiograph. Therefore, IAN paresthesia, sinus perf and FOM hematoma are extremely uncommon. If I was not able to handle a particular complication, I would refer the patient to OMFS. The key is to have and maintain a good working relationship within the specialties. When needed, others ask for my help, and I ask for theirs.