Are there any procedures a general dentist cannot learn unless they attend a residency program?

[DallasDentist]

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I understand that OMS is an exception to this, but are there any procedures a general dentist cannot learn unless they attend a residency? I am leaning towards being a GP, but would like to learn as much as I can from CE. Mostly just curious about the level of autonomy a GP has to learn and practice on their own without needing to attend a residency program.

 

[DustFreeEraser]

Yes, the ones that are not worth doing as GPs (e.g. apicoectomy, gum grafts, papoosing a child, etc). Sure you’ll find some that do it but in general, I’d expect low return on investment on becoming proficient at them as a GP when they can invest the time on learning implants or sedation.

 

[yappy]

In theory, nothing. In practice, you will be limited by the flow of a GP office.

 

[D1Bound]

Technically I think a dentist could do a lefort but the amount of hoops to jump through and trying to obtain that knowledge without a residency would be pretty amazing. Also, I know for a fact in some states a dentist cannot receive an anesthesia permit like an OS or Dental anesthesiologist can.

 

[Pablo Sanchez]

Yes, the ones that are not worth doing as GPs (e.g. apicoectomy, gum grafts, papoosing a child, etc). Sure you’ll find some that do it but in general, I’d expect low return on investment on becoming proficient at them as a GP when they can invest the time on learning implants or sedation.

I agree! I work at a practice where they are very talented GPs who do pretty much every procedure under the sun, and they are set up to do it efficiently. I was in watching the one doc do an apico and thought “wow, this is so cool and he is so talented. He must be making a fortune off of this since he’s doing an apico!”

I then saw the fee and it was absolutely not worth it from a financial standpoint. Sure, the patient probably appreciated being able to have his general dentist do the procedure, and that in of itself probably brings patients into the practice which in turn creates more revenue, but to spend all the time learning it, and all of the years practicing it before you’re very good at it…just not worth it to me. A GP would definitely be more productive doing an implant, root canal, Invisalign case, or crown in that time.

 

[Allsmiles!]

Well, it’s all fun and games until someone does a procedure…it goes terribly wrong…and they quickly realize their ambitions over shot their training!

 

[princeafrica]

Also, good CEs ain’t cheap and you need to take into consideration time away from clinic to do those CEs

 

[FutureDent020]

I agree! I work at a practice where they are very talented GPs who do pretty much every procedure under the sun, and they are set up to do it efficiently. I was in watching the one doc do an apico and thought “wow, this is so cool and he is so talented. He must be making a fortune off of this since he’s doing an apico!”

I then saw the fee and it was absolutely not worth it from a financial standpoint. Sure, the patient probably appreciated being able to have his general dentist do the procedure, and that in of itself probably brings patients into the practice which in turn creates more revenue, but to spend all the time learning it, and all of the years practicing it before you’re very good at it…just not worth it to me. A GP would definitely be more productive doing an implant, root canal, Invisalign case, or crown in that time.

Yea, apico’s would absolutely not be worth it as a GP. There is strong, evidence that microscope, ultrasonics, and bio ceramic cements are making a significant difference is surgical results. Microscope less than the other two, but still. So investing in all that, and obviously a CBCT scan, plus the courses to learn how to do them, to do maybe 1 a month, for maybe $1,000? Plus several follow up appointments and you can’t leave the room during the procedure and it can take 30 min to an hour at times. No clue why a GP would do them.

 

[PerioDont]

Yep just because you can do something doesn't mean you should.

 

[0Mik3cho]

Yea, apico’s would absolutely not be worth it as a GP. There is strong, evidence that microscope, ultrasonics, and bio ceramic cements are making a significant difference is surgical results. Microscope less than the other two, but still. So investing in all that, and obviously a CBCT scan, plus the courses to learn how to do them, to do maybe 1 a month, for maybe $1,000? Plus several follow up appointments and you can’t leave the room during the procedure and it can take 30 min to an hour at times. No clue why a GP would do them.

Adding on to that, my endo professor talked about a meta analysis indicating pooled success rates of 59% and 94% for traditional root end surgery and endodontic microsurgery.

Outcome of endodontic surgery: a meta-analysis of the literature--part 1: Comparison of traditional root-end surgery and endodontic microsurgery - PubMed

The use of microsurgical techniques is superior in achieving predictably high success rates for root-end surgery when compared with traditional techniques.

pubmed.ncbi.nlm.nih.gov

 

[Thehighwind87]

At the end of the day, doing speciality procedures doesn’t make sense with

1) limited patient pool means limited proficiency- if you do one molar rct a month- then you are wasting your time. Your competency will always be subpar.

2) litigation aspect. If you don’t place enough implants do enough endo do enough omfs- you will probably screw up one day and end up sued. It’s inevitable that even specialists screw up- but if you do one molar rct a month- your chance of screwing up is higher then the endodontist that does it everyday. Literally lets say you do screw up one day, and the expert witness is an endodontist who does 10 root canals a day- and the lawyer asks you about your background and how many you do "oh your honor I do 1 a month." yeah good luck with that defense- it ain't worth it.

3) financially it doesn’t make sense. You can run a 1 million dollar practice on bread and butter fill drill clean dentistry on 50-60% overhead. That's a 400-500k take-home. The average bread and butter practice does 700k on 50-60 overhead which is 300k give or take take home. That is more than enough money that adding speciality procedures makes no sense- but instead add liabilty and or stress.

4) finally at a certain point in a dentist's career- they just want to make things "cruise." When I was young, I was hungry to grow the practice etc. Right now? I want to do the lowest stress dentistry, do what I know is straightforward, and spend time with my family. When I first took over the practice, I wanted my schedule full and busy. Today, the last thing I want is a full schedule but rather a schedule that lets me get out early to get home to the family. Every dentist practice goes through that phase. Regardless- I don't want to stress about specialty procedures that I have no proficiency in.

I do only bread and butter and stopped doing all specialty a long time ago and I’ve been much happier ever since

 

[FutureDent020]

Adding on to that, my endo professor talked about a meta analysis indicating pooled success rates of 59% and 94% for traditional root end surgery and endodontic microsurgery.

Outcome of endodontic surgery: a meta-analysis of the literature--part 1: Comparison of traditional root-end surgery and endodontic microsurgery - PubMed

The use of microsurgical techniques is superior in achieving predictably high success rates for root-end surgery when compared with traditional techniques.

pubmed.ncbi.nlm.nih.gov

Yea, that study looks specifically at (microscope and bio ceramic retrofills) vs (either no magnification or maybe loupes and amalgam retro retrofills). Results were significantly in favor of microsurgery like you said. They’ve also looked at bio ceramics with loupes (not microscope) and those success rates were also significantly higher than TRS. So bioceramics are playing a big part. I’ve done surgeries each way and man, you see SO much more with the microscope. You also can create such a more accurate/ clean retro prep. Aim small, miss small.