Best perio programs for implants & thirds. Is there such a thing?

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avitlu

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Hello everyone,

I'm a gp, been in practice for a few years. I'm young, and I want to go to residency to specialize and "become an expert in dentoalveolar surgery" (implants, grafting, thirds, alveoloplasty, etc.). I've been debating between omfs and perio. Based on what I know, there are drastic differences in the two residencies. OMFS obviously steps way outside of "just dentistry" and is very hospital based, takes a lot of facial trauma call, head and neck infections, cancer, etc. I'll be honest, I don't really want to do that; it's not for everyone. I like the idea of a perio residency more. My fear, however, is that I'll spend way more time than I'd like measuring perio pockets and scaling than doing actual involved dentoalveolar surgery (I mean no offense to anyone, seriously).
So, my question is, are there perio programs in the US that have a much heavier focus on dentoalveolar and complex implant surgery? Such as you place hundreds of implants, sinus lifts, involved grafting, even thirds experience. Or I am wasting my time and should just apply to omfs? Yes I know I can go do externships, but before I start down that path, I am just trying to get honest feedback before I commit one way or the other. Like which perio programs do you guys recommend I look at? Do they exist?
Thank you!
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My 2 cents before all the OS guys see this thread and jump down your throat... Don't even think about OMFS if all you are interested in is dentoalveolar surgery. OMFS scope and lifestyle is completely different from the other dental specialties.

All perio residencies involve a significant amount of literature review and seminars so be prepared for that. You will spend a lot of time at least initially doing the traditional perio procedures (S/RP, maintenance, osseous, pocket reduction, crown lengthening, gingivectomy etc.) which still forms the clinical foundation of the specialty. I think you are unlikely to take out many thirds in any perio program. I would look into the few VA residencies (tons of implant placement) and programs that fosters perio and prosth collaboration.
 
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Svart Aske said:
My 2 cents before all the OS guys see this thread and jump down your throat... Don't even think about OMFS if all you are interested in is dentoalveolar surgery. OMFS scope and lifestyle is completely different from the other dental specialties.

All perio residencies involve a significant amount of literature review and seminars so be prepared for that. You will spend a lot of time at least initially doing the traditional perio procedures (S/RP, maintenance, osseous, pocket reduction, crown lengthening, gingivectomy etc.) which still forms the clinical foundation of the specialty. I think you are unlikely to take out many thirds in any perio program. I would look into the few VA residencies (tons of implant placement) and programs that fosters perio and prosth collaboration.
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Thank you for the reply. By VA residency, do you mean GPR/AEGD?
 
The question is do you have high enough class rank and CBSE score for OS residency? If yes, then apply for OS. And another question is will you be willing to go door to door to meet the referring GPs? If no, then you shouldn’t specialize in either specialty. I know some periodontists, who perform all the things that you listed in their practices: implants, sinus lift, chin/ramus grafts, and 3rd molar extractions etc. If you want to know where these periodontists did their residency, send me a PM. However, it’ll be much easier to convince the GPs to refer their patients to your office for you to perform these procedures if you are an OS. It’s much harder for periodontists to get referrals from the GPs. If you can’t get the GPs to refer patients to you, then all the procedures that you learn from your residency go down the drain….and that’d be a waste of your time and money.
 
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avitlu said:
Thank you for the reply. By VA residency, do you mean GPR/AEGD?
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No, there are a few perio residences that are VA-based. They are more competitive as they pay a stipend.
 
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Va, San Antonio, Texas A&M Alabama are good
 
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Svart Aske said:
My 2 cents before all the OS guys see this thread and jump down your throat... Don't even think about OMFS if all you are interested in is dentoalveolar surgery. OMFS scope and lifestyle is completely different from the other dental specialties.

All perio residencies involve a significant amount of literature review and seminars so be prepared for that. You will spend a lot of time at least initially doing the traditional perio procedures (S/RP, maintenance, osseous, pocket reduction, crown lengthening, gingivectomy etc.) which still forms the clinical foundation of the specialty. I think you are unlikely to take out many thirds in any perio program. I would look into the few VA residencies (tons of implant placement) and programs that fosters perio and prosth collaboration.
Click to expand...

Agreed. UT San Antonio and UW have a strong relationship with the prosth departments
 
Svart Aske said:
My 2 cents before all the OS guys see this thread and jump down your throat... Don't even think about OMFS if all you are interested in is dentoalveolar surgery. OMFS scope and lifestyle is completely different from the other dental specialties.

All perio residencies involve a significant amount of literature review and seminars so be prepared for that. You will spend a lot of time at least initially doing the traditional perio procedures (S/RP, maintenance, osseous, pocket reduction, crown lengthening, gingivectomy etc.) which still forms the clinical foundation of the specialty. I think you are unlikely to take out many thirds in any perio program. I would look into the few VA residencies (tons of implant placement) and programs that fosters perio and prosth collaboration.
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Nobody’s jumping down anybody’s throat.

As long as you’re comfortable managing your own complications you can do anything you want. That’s your license on the line. Not mine. Most of the OMFS guys I know think the same way. That’s how we can rationalize moonlighting during residency.

However, if you’re not giving your patients the option of referral for higher-level anesthesia (different story if you’re bringing in an anesthesiologist), or if you’re punting your complications to one of us on a regular basis, or you’re taking out uppers and sending us the lowers, then you’re acting irresponsibly.

I’m sure there are some GPs who are referring thirds to periodontists, but I have to think they’re not all that common. OP is a GP, so he or she knows who he or she refers to for thirds. Residency is on your time and you have every right to choose how you spend it. And you get to spend it on things that are typically referred to that specialty, or maybe you’ll spend it on things that aren’t, and you’ll miss out on the skills that turned out to be more important.
I’ve done apicoectomies and crown lengthening and all sorts of stupid stuff during omfs residency that we are either not GPs’ first choice for or not really thought of as doing at all. But i had fun and knew full well I could handle and had access to the resources for any complications including anything all the way up to a big neck infection.

I, and most other OMFS residents/attendings, am not satisfied with not being the best option around for doing anything I do. And if other people don’t think that way, then that’s okay with me.
 
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There’s lot of perio programs where residents spend a lot of time trying to take out third molars
 
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If you want to be a surgeon, have the drive and the dedication, and you have the necessary credentials then apply to OMFS. We are the best in dentoalveolar surgery but you should know that it's about 1/4 of what we do. Implants and especially 3rd molars are OMFS scope. So is facial trauma, benign and malignant pathology, orthognathics, anesthesia, facial cosmetic surgery and TMJ.

If in addition to implants you are interested in soft tissue management, crown lengthening, pocket reduction, SRP and treating periodontal disease than you should go for perio.

But to be clear, there's only one surgical specialty in the dental field and it's Oral and Maxillofacial Surgery.
 
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maxFax2020 said:
If you want to be a surgeon, have the drive and the dedication, and you have the necessary credentials then apply to OMFS. We are the best in dentoalveolar surgery but you should know that it's about 1/4 of what we do. Implants and especially 3rd molars are OMFS scope. So is facial trauma, benign and malignant pathology, orthognathics, anesthesia, facial cosmetic surgery and TMJ.

If in addition to implants you are interested in soft tissue management, crown lengthening, pocket reduction, SRP and treating periodontal disease than you should go for perio.

But to be clear, there's only one surgical specialty in the dental field and it's Oral and Maxillofacial Surgery.
Click to expand...

Wowzers homie, relax
 
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maxFax2020 said:
But to be clear, there's only one surgical specialty in the dental field and it's Oral and Maxillofacial Surgery.
Click to expand...
BD392C56-7A13-4EBD-BE7D-E1E5879456E1.gif


Big Hoss
 
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parkinglottoilet said:
Ok but he's not wrong? Lol
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He’s wrong and we do a lot of things better than them actually, that’s why they constantly bash us.

OS just jams implants in anywhere and everyone is finding out.
 
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There are a lot of good, as well as bad OS and perios out there, but theres no room for "I'm better than you" talk. A lot of OS today are doing soft tissue work. A lot of perio is doing thirds. Quite simply it boils down to: Do you want to spend 4-6 years in a hospital setting or are you mostly into dentoalveolar surgery. If its the former, OS, if its the later, perio. Thats all. We (OS and perio) are good at removing teeth, grafting, and placing implants. The problems is most OS are all up in themselves and put others down. We all need to be respectful of the professional choices we've made for ourselves and carry on accordingly.
 
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periopocket said:
He’s wrong and we do a lot of things better than them actually, that’s why they constantly bash us.

OS just jams implants in anywhere and everyone is finding out.
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To think that periodontists are surgeons is laughable. There is a connotation that OMFS aren't surgeons by the medical field. To even say periodontists are surgeons when some physicians don't consider OMF to be so is just not true
 
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parkinglottoilet said:
To think that periodontists are surgeons is laughable.
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Are Mohs surgeons real surgeons? Or are they still pimple poppers with a scalpel? How much cutting must one do to be called a surgeon? I will draw a line at endodontists calling themselves dental neurovascular surgeons.

Big Hoss
 
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Big Time Hoosier said:
Are Mohs surgeons real surgeons? Or are they still pimple poppers with a scalpel? How much cutting must one do to be called a surgeon? I will draw a line at endodontists calling themselves dental neurovascular surgeons.

Big Hoss
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Lol it's a good point. Within medicine there is a lot of discussion about this gray area (interventional cards, interventional radiology). They mostly are called proceduralists and not surgeons. I understand that is splitting hairs. All I am saying is if you told a lay person you were a surgeon/ surgical sub-specialist and then went on to say you were a periodontist I think a lot of people would roll their eyes.

At the end of the day, people can call themselves whatever they want. I see plenty of "cosmetic dentists" signs out there even though that isn't recognized by the ADA.
 
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parkinglottoilet said:
To think that periodontists are surgeons is laughable. There is a connotation that OMFS aren't surgeons by the medical field. To even say periodontists are surgeons when some physicians don't consider OMF to be so is just not true
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Do periodontists do surgical procedures? What defines them as surgeons vs OMFS, the fact that OMFS belong to FACS? 1 additional year of residency? Or that OMFS conducts procedures under GA?
 
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A surgeon is defined by training. The training includes inpatient care, general surgery and general anesthesia rotations. A periodontist is a dental specialist who performs surgery. This is not disparaging the periodontal specialty.

Will you guys be ok if dental therapists started calling themselves dentists? Or NPs calling themselves physicians?
 
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To clarify, orthodontists don't count as surgeons?
 
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Linking some useful resources
www.facs.org

What are the surgical specialties?

Read up on frequently asked questions about surgical specialities and choosing your residency.
www.facs.org www.facs.org

Surgical Specialties — Royal College of Surgeons

There are ten recognised specialties within surgery, all of which will provide you with different challenges and rewards throughout your career.
www.rcseng.ac.uk www.rcseng.ac.uk

Oral and Maxillofacial Surgery is an internationally recognized surgical specialty by both the American College of Surgeons and Royal College of Surgeons ... not so sure about our periodontal colleagues ;)
 
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C.elegans said:
Linking some useful resources
www.facs.org

What are the surgical specialties?

Read up on frequently asked questions about surgical specialities and choosing your residency.
www.facs.org www.facs.org

Surgical Specialties — Royal College of Surgeons

There are ten recognised specialties within surgery, all of which will provide you with different challenges and rewards throughout your career.
www.rcseng.ac.uk www.rcseng.ac.uk

Oral and Maxillofacial Surgery is an internationally recognized surgical specialty by both the American College of Surgeons and Royal College of Surgeons ... not so sure about our periodontal colleagues ;)
Click to expand...

It is because they do orthognathic surgery. Are ENTs on there? Curious.
 
P7898 said:
It is because they do orthognathic surgery. Are ENTs on there? Curious.
Click to expand...

Yes of course ENTs are on there. They're also known as otolaryngology.

I can't express how stupid many of the above comments are. OP asked about training programs that are going to help him/her learn how to take out thirds and instead of getting answers and everyone whipped out their dicks and rulers. I may be guilty of this myself.

Here's an answer for you, OP. If you want to go to a perio program that does a lot of thirds, find one at a dental school where the OMFS program is loosely, rather than tightly, associated. I went to a dental school where the OMFS program was holier than thou, had no presence at the dental school, and the only way to get your patients thirds out or implants placed in a timely manner was to refer to the perio residents. It had a heavy influence in my decision in going to an OMFS residency that was tightly associated with its dental school.

Admittedly OMFS has shot itself in the foot by disassociating itself with dental schools. This is what has allowed perio to make a space in the implant game.

For you OMFS's out there who can't stand the thought of someone else making a patient bleed, get involved at a local dental school to show our future referral base what we're capable of and what we can offer. Talk to your former (or current) program director about the concerns you have that dentists don't think of us as the only go-to for certain procedures and encourage them to involve their respective dental schools as well.
 
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Anonymomfs said:
Yes of course ENTs are on there. They're also known as otolaryngology.

I can't express how stupid many of the above comments are. OP asked about training programs that are going to help him/her learn how to take out thirds and instead of getting answers and everyone whipped out their dicks and rulers. I may be guilty of this myself.

Here's an answer for you, OP. If you want to go to a perio program that does a lot of thirds, find one at a dental school where the OMFS program is loosely, rather than tightly, associated. I went to a dental school where the OMFS program was holier than thou, had no presence at the dental school, and the only way to get your patients thirds out or implants placed in a timely manner was to refer to the perio residents. It had a heavy influence in my decision in going to an OMFS residency that was tightly associated with its dental school.

Admittedly OMFS has shot itself in the foot by disassociating itself with dental schools. This is what has allowed perio to make a space in the implant game.

For you OMFS's out there who can't stand the thought of someone else making a patient bleed, get involved at a local dental school to show our future referral base what we're capable of and what we can offer. Talk to your former (or current) program director about the concerns you have that dentists don't think of us as the only go-to for certain procedures and encourage them to involve their respective dental schools as well.
Click to expand...

Speaks the truth. Which school were you at? ;)
 
Anonymomfs said:
Yes of course ENTs are on there. They're also known as otolaryngology.

I can't express how stupid many of the above comments are. OP asked about training programs that are going to help him/her learn how to take out thirds and instead of getting answers and everyone whipped out their dicks and rulers. I may be guilty of this myself.

Here's an answer for you, OP. If you want to go to a perio program that does a lot of thirds, find one at a dental school where the OMFS program is loosely, rather than tightly, associated. I went to a dental school where the OMFS program was holier than thou, had no presence at the dental school, and the only way to get your patients thirds out or implants placed in a timely manner was to refer to the perio residents. It had a heavy influence in my decision in going to an OMFS residency that was tightly associated with its dental school.

Admittedly OMFS has shot itself in the foot by disassociating itself with dental schools. This is what has allowed perio to make a space in the implant game.

For you OMFS's out there who can't stand the thought of someone else making a patient bleed, get involved at a local dental school to show our future referral base what we're capable of and what we can offer. Talk to your former (or current) program director about the concerns you have that dentists don't think of us as the only go-to for certain procedures and encourage them to involve their respective dental schools as well.
Click to expand...


what dental school did you go to?
 
At my dental school I remember scrubbing in with my PG perio resident taking out tooth #14, it was a 2 hour surgery! Glorious!
 
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WannaBeDentist said:
At my dental school I remember scrubbing in with my PG perio resident taking out tooth #14, it was a 2 hour surgery! Glorious!
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Wow, and you are probably pure talent that gets everything done perfectly within the first try, very impressive.

So much hate and judgement in this thread.
 
This thread...lawdd have mercyyy
 
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The difference between God and an Oral Surgeon is that God doesnt think hes an OS.
 
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Lol.... who knew this thread was going to be this juicy?

I'll just leave my opinion here. I refer out to both oral surgeons and periodontists. I've noticed (from MY referral sources. I'm not talking on behalf of everyone), that the periodontists I've worked with tend to be be more artistic in their approach to an implant placement. Small details are more likely to be taken into consideration (keratinized gingiva/position in regards to prosthetics. etc.). If I were to have an implant placed on myself, I'd likely go to a periodontist because I've found they're usually a little more detail-oriented. Imagine a painter making fine adjustments to his work. If I needed wisdom tooth out, an orthognatic surgery, anything cancer-related, maybe a very complex bone-regeneration procedure involving having to harvest bone from another part of my body, then i'd go to an O.S. I think they're a little more "big picture" or a "lets gett-er done" approach. I do think an O.S. is more likely to bail out a periodontist from something going wrong than vice-versa but both serve their purpose. I have tremendous respect for both specialties but it really pisses me off when O.S.' bash periodontists.
 
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Utdarsenal said:
Lol.... who knew this thread was going to be this juicy?

I'll just leave my opinion here. I refer out to both oral surgeons and periodontists. I've noticed (from MY referral sources. I'm not talking on behalf of everyone), that the periodontists I've worked with tend to be be more artistic in their approach to an implant placement. Small details are more likely to be taken into consideration (keratinized gingiva/position in regards to prosthetics. etc.). If I were to have an implant placed on myself, I'd likely go to a periodontist because I've found they're usually a little more detail-oriented. Imagine a painter making fine adjustments to his work. If I needed wisdom tooth out, an orthognatic surgery, anything cancer-related, maybe a very complex bone-regeneration procedure involving having to harvest bone from another part of my body, then I'd likely go to an O.S. I think they're a little more "big picture" or a "lets gett-er done" approach. I do think an O.S. is more likely to bail out a periodontist from something going wrong than vice-versa but both serve their purpose. I have tremendous respect for both specialties but it really pisses me off when O.S.' bash periodontists.
Click to expand...

In my brief experience, I've seen that OS in practice are much more realistic and down to earth. Its the residents that have a big head that constantly bash other specialties.
 
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avitlu said:
Hello everyone,

I'm a gp, been in practice for a few years. I'm young, and I want to go to residency to specialize and "become an expert in dentoalveolar surgery" (implants, grafting, thirds, alveoloplasty, etc.). I've been debating between omfs and perio. Based on what I know, there are drastic differences in the two residencies. OMFS obviously steps way outside of "just dentistry" and is very hospital based, takes a lot of facial trauma call, head and neck infections, cancer, etc. I'll be honest, I don't really want to do that; it's not for everyone. I like the idea of a perio residency more. My fear, however, is that I'll spend way more time than I'd like measuring perio pockets and scaling than doing actual involved dentoalveolar surgery (I mean no offense to anyone, seriously).
So, my question is, are there perio programs in the US that have a much heavier focus on dentoalveolar and complex implant surgery? Such as you place hundreds of implants, sinus lifts, involved grafting, even thirds experience. Or I am wasting my time and should just apply to omfs? Yes I know I can go do externships, but before I start down that path, I am just trying to get honest feedback before I commit one way or the other. Like which perio programs do you guys recommend I look at? Do they exist?
Thank you!
Click to expand...

Periodontists don't extract third molars as a common treatment modality they offer, and I do not believe that is even in the scope of their training or specialization. If you want to do perio and oral surgery then obtain advanced training as a general dentist. I do lots of implants and lots of impacted third molars as a general dentist, but I had additional residency level training so I am very comfortable doing what I do, but have the knowledge to know when I need to refer patients to perio/OS.
 
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in reality you can do whatever you want in private practice as long as you feel prepared to do the procedure and handle complications. After that its a matter of making the local GP's aware of what you do, what you like to do and what you're good at.

in other words, its not unreasonable for OP to want to specialize in perio and then seek referrals for third molars and implants in private practice. If thats what they want to do then by all means go for it. An oral surgeon could advertise to GP's and seek out referrals for implants, gum grafting, crown lengthening, and other perio procedures if they really wanted and theres nothing wrong with it.

But what you see in the real world outside of a residency or dental school setting is the majority of patients being referred to oral surgeons for the thirds. And the gum grafting, crown lengthening ect being sent to the periodontist.
The GP decides who to send implants to by what is the easiest option for the patient and personal relationships with that omfs or perio office.
 
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Why? I would imagine DSO's are being hit hard with being leveraged by private equity firms and all. And with no profits from opened offices and decrease gains they are all pulling out of DSO's to consolidate their assets.
 
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I think a lot of people need to remember that they are not defined by their career choice. I am an OMFS resident but I am also an avid hiker, photographer, and just want to have a good life with my friends and family in the future. Who cares if I am a surgeon or not - it doesn't change what I do, how I care for my patients, or the amount of respect I get from my friends, family, or colleagues. If a periodontist wants to call themselves a surgeon, that's fine. In general, it might confuse the layperson, or even incite criticism from certain groups of people, but as long as they are prepared to deal with these issues, who cares? I will respect someone a lot more if they are a good person, honest, and are good at their trained specialty regardless of their preferred title.

Just my shower thoughts on the subject.
 
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P7898 said:
Why? I would imagine DSO's are being hit hard with being leveraged by private equity firms and all. And with no profits from opened offices and decrease gains they are all pulling out of DSO's to consolidate their assets.
Click to expand...

Interesting view point. I seem to remember during the financial crisis 2008-2009 that many private dental offices were going bankrupt and the number of DSOs owned by private equity firms were increasing. This new crisis just signals another buying spree for those with deep pockets. I predict you will see MORE DSOs after this crisis, not less.
 
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