Clear a few things up about OMS vs. PERIO

[north2southOMFS]

In light of a recent post about perio programs which eventually turned OMS vs. perio and led to the demise (banning) of my co-resident, I would like to start an informative and non-demeaning or derogatory post surround who does what and why one can be better than the other in performing certain procedures.

Here is my take on the subject:

In regards to implants I believe Oral surgeons feel their territory is being stolen from them, when afte all the Oral surgery profession pioneered the practice. Oral surgeons went through the trial and error of all the failed methods before our now tried and proven endosteal type implant. Oral surgeons struggled through the subperiostial types, the blade type, and those goofy bicortical type implants that lets face it, sucked. But eventually we learned and now have perfected the implant, the endosteal small diameter implant fixture that lets face it, is easy to place unless there is ridge augmentation or sinus modifications to make. So what happened when implants got easy, all the other specialties decided to jump on them like bulldogs on a meat truck. I don't think it has anything to do with "gingival esthetics" or "gingival scarring" what ever those are. Gingiva heals pink, period. Gingival recession is a different story. So can periodontists place implants as well as oral surgeons, sure, when they are simple; but so can a general dentist.

Now, I do want to give the gum docs their due credit though, they have made research advanced with our current implant types with strides in osseointegration techniques and the roughened type implant surfaces, biological width preservation with depth of implant placement, epithelial attachment to the implant surface, so yes they have put in their due research on the topic, but I think the angst comes from the fact that the OS profession feels like the procedure/treatment they pioneered is being stolen from them, kinda like invisalign with the orthodontists vs the gen. dentists.


OK next topic:

Perios taking out teeth:

????????
I almost have no comment, it is so absurd. Do you think periodontists would raise a stink if oral surgeons started doing APF's on all their pt's, or better yet even hired their own hygenists and raised flaps and billed for surgical sc/rt planing. This shouldn't even be a topic of debate, if your going to take out teeth, you cannot call yourself a periodontist, you have to take that sign off the door and call yourself a general dentist again. Which i have no problem with if that is what you want to do. Just because the perio pie is shrinking, don't think you can jump into the OMFS pie and steal their work.


Ok next topic:

Why would you want to do gingival tissue work and fine implant work when OMFS's go to school for 4-6 years to learn to fix jaw and cut faces.

Well I got news, some OMS's go into the profession because they like to do this. What you don't realize is that there are very different types of OMS residencies out there. I happen to go to a very big surgical residency with big cancer cases and craniofacial stuff, we don't do small dental tissue surgeries the majority of the time; BUT!!!! I would say most OMS programs in the country are the opposite, they place implants, do bone grafts, sinus lifts, alveoloplasties most of the time; you know the stuff apparently we are not as good at.


Ok, sorry about the longevity of the post, but I was just tired of the OMFS have "brick hands" bashing. I was #2-4 in my class at marquette, had some of the best hands in preclinical and clinical, and I am tired of getting told I cannot do the finer touch surgeries in life by a pre-perio dental student.

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[DBEAR]

In light of a recent post about perio programs which eventually turned OMS vs. perio and led to the demise (banning) of my co-resident, I would like to start an informative and non-demeaning or derogatory post surround who does what and why one can be better than the other in performing certain procedures.

Here is my take on the subject:

In regards to implants I believe Oral surgeons feel their territory is being stolen from them, when afte all the Oral surgery profession pioneered the practice. Oral surgeons went through the trial and error of all the failed methods before our now tried and proven endosteal type implant. Oral surgeons struggled through the subperiostial types, the blade type, and those goofy bicortical type implants that lets face it, sucked. But eventually we learned and now have perfected the implant, the endosteal small diameter implant fixture that lets face it, is easy to place unless there is ridge augmentation or sinus modifications to make. So what happened when implants got easy, all the other specialties decided to jump on them like bulldogs on a meat truck. I don't think it has anything to do with "gingival esthetics" or "gingival scarring" what ever those are. Gingiva heals pink, period. Or is doesn't heal at all. So can periodontists place implants as well as oral surgeons, sure, when they are simple; but so can a general dentist.

Now, I do want to give the gum docs their due credit though, they have made research advanced with our current implant types with strides in osseointegration techniques and the roughened type implant surfaces, biological width preservation with depth of implant placement, epithelial attachment to the implant surface, so yes they have put in their due research on the topic, but I think the angst comes from the fact that the OS profession feels like the procedure/treatment they pioneered is being stolen from them, kinda like invisalign with the orthodontists vs the gen. dentists.


OK next topic:

Perios taking out teeth:

????????
I almost have no comment, it is so absurd. Do you think periodontists would raise a stink if oral surgeons started doing APF's on all their pt's, or better yet even hired their own hygenists and raised flaps and billed for surgical sc/rt planing. This shouldn't even be a topic of debate, if your going to take out teeth, you cannot call yourself a periodontist, you have to take that sign off the door and call yourself a general dentist again. Which i have no problem with if that is what you want to do. Just because the perio pie is shrinking, don't think you can jump into the OMFS pie and steal their work.


Ok next topic:

Why would you want to do gingival tissue work and fine implant work when OMFS's go to school for 4-6 years to learn to fix jaw and cut faces.

Well I got news, some OMS's go into the profession because they like to do this. What you don't realize is that there are very different types of OMS residencies out there. I happen to go to a very big surgical residency with big cancer cases and craniofacial stuff, we don't do small dental tissue surgeries the majority of the time; BUT!!!! I would say most OMS programs in the country are the opposite, they place implants, do bone grafts, sinus lifts, alveoloplasties most of the time; you know the stuff apparently we are not as good at.


Ok, sorry about the longevity of the post, but I was just tired of the OMFS have "brick hands" bashing. I was #2-4 in my class at marquette, had some of the best hands in preclinical and clinical, and I am tired of getting told I cannot do the finer touch surgeries in life by a pre-perio dental student.

North2South welcome to the real world. No matter what field you go into there will be competition. First, implants are not easy. Sure, anybody could place an implant into bone but could they do it so that it is in the right place and esthetically it looks good all the time. That is the hard part. It only takes one badly placed implant to have a referring dentist not to refer to you anymore. Actually, competition is what makes us strive to be better. On the issue of who is better OMS or Perio? You can not generalize like this. Like you said some programs emphasize different aspects within the specialty. The same goes for Perio. I think when a GP is deciding on who to refer to they need to look at the individual than the specialty. There are good and bad OMS and Perio docs. If I lived in Miami I might refer all my implant cases to Dr. Sclar (OMS) because he is known for his attention to esthetic detail both hard and soft tissue. If I lived in L.A., I might refer my cases to Dr. Javonovic (perio) because I think he can get me the results that I want. The point is that the GP will refer to the implant surgeon who will predictively get them good, esthetic results. Finally, I do not claim to know it all. I am a perio resident that will be graduating in 7 months. These are just my opinions. North2south, good luck with your training. out

 

[ip]

In regards to implants I believe Oral surgeons feel their territory is being stolen from them, when afte all the Oral surgery profession pioneered the practice.

But that's simply not true. The implant pioneers were dentists from all areas. Branemark (an orhopedic surgeon), Jemt (a prosthodontist), Zarb (a prosth), van Steenberghe (a perio), Mills (a GP), James (a GP). Tatum (a GP) invented the sinus graft. Tatum (a GP) invented the blade implant. Lots of these guys were viewed as quacks. Oral surgeone certainly played a role (Kent & Block) and Branemark himself felt that only oral surgeons should place implants. Then again, he also felt that implants should only be smooth-surfaced.

To say that oral surgeons pioneered implantology is not truthful. GP's played a bigger role.

Oral surgeons went through the trial and error of all the failed methods before our now tried and proven endosteal type implant. Oral surgeons struggled through the subperiostial types, the blade type, and those goofy bicortical type implants that lets face it, sucked. But eventually we learned and now have perfected the implant, the endosteal small diameter implant fixture that lets face it, is easy to place unless there is ridge augmentation or sinus modifications to make. So what happened when implants got easy, all the other specialties decided to jump on them like bulldogs on a meat truck. I don't think it has anything to do with "gingival esthetics" or "gingival scarring" what ever those are. Gingiva heals pink, period. Gingival recession is a different story. So can periodontists place implants as well as oral surgeons, sure, when they are simple; but so can a general dentist.

But a current OMS resident is not getting training in placing subperiosteals and blade implants. And truthfully, if OMS wants those cases I'm quite sure that perio would be glad to hand them over.

I'm still very surprised that you use quotes to type gingival esthetics and gingival scarring, saying "whatever those are". Are you serious?? Do you not believe that gingival esthetics and scarring are things that you need to pay attention to? I'm speachless.

"Gingiva heals pink" is too typical of old school OMS and is a major reason why perios get more implant referrals.

OK next topic:

Perios taking out teeth:

????????
I almost have no comment, it is so absurd. Do you think periodontists would raise a stink if oral surgeons started doing APF's on all their pt's, or better yet even hired their own hygenists and raised flaps and billed for surgical sc/rt planing. This shouldn't even be a topic of debate, if your going to take out teeth, you cannot call yourself a periodontist, you have to take that sign off the door and call yourself a general dentist again. Which i have no problem with if that is what you want to do. Just because the perio pie is shrinking, don't think you can jump into the OMFS pie and steal their work.

I agree that perios shouldn't extract 3rd molars. But you can't really be saying that a perio is supposed to eval a compromised tooth, determine that the +3 mobility gives an implant a better prognosis and refer the case for extraction so that the OMS can refer back for the implant, can you?

Well I got news, some OMS's go into the profession because they like to do this. What you don't realize is that there are very different types of OMS residencies out there. I happen to go to a very big surgical residency with big cancer cases and craniofacial stuff, we don't do small dental tissue surgeries the majority of the time; BUT!!!! I would say most OMS programs in the country are the opposite, they place implants, do bone grafts, sinus lifts, alveoloplasties most of the time; you know the stuff apparently we are not as good at.

So are you saying that when you graduate you will not be as good as a perio when it comes to small dental sx like implants, sinus and intra-oral grafting? And if you realize that perios also do those surgeries you describe but also seriously concentrate on esthetics and yes, gingival scarring, augmenting keratinized tissue, why do you have a problem with them doing these in private practice?

Ok, sorry about the longevity of the post, but I was just tired of the OMFS have "brick hands" bashing. I was #2-4 in my class at marquette, had some of the best hands in preclinical and clinical, and I am tired of getting told I cannot do the finer touch surgeries in life by a pre-perio dental student.

No one is saying that OMS have brick hands. But you can't deny that perios just spend more time on the esthetics and soft tissue considerations. Again, go ask Anthony Sclar if gingival scarring and esthetics exist. He's an OMS. See what he says and ask him why he's so successful.

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We need to keep in mind that like the poster above me said, it's the training and personality (not the degree) that makes the difference. There are great perio and there are crappy perios. Same with OMS. Yes, there's overlap. But so what, plenty of cases to go around for everyone. Again, I'm inno way attacking OMS, I just came to the defense of perio which was being bashed in those 2 other threads.

Let's keep things open and respectful. Cheers.

 

[texas_dds]

ive assisted several implant placement surgeries and it absolutely shocks me how many docs ive seen leave the surgical stent on the bracket table. perio or oms - i dont really care - the restorative dentist MUST choose someone who will help and not hinder the prosthodontic outcome.

 

[TX OMFS]

But FYI, nobody was banned.

I'm baaack!! Don't be scared.

Poor north2south has vested himself into this post as we (his co-residents) watch. N2S has requested that omsres and I jump into this fight and give our $0.02. YAWN. Look, this topic needs to die. It's like religion and politics, hard to make converts over the net.

In a similar previous post I let loose the fury b/c it was fun, but it got me suspened for a few days. I like riling people up, especially periodontists. In reality, I don't care about this issue that much. I'll set up a practice and do just fine. I'm not worried about perio competition and I'm sure they're not worried about me. Big freaking deal, we've all got a niche to fill. Sure I have some reservations about perio's expanded scope and their ability to step up, but I carry a pager and I'll be ready to help out if needed.

However, as N2S elluded to, our program has some weaknesses in routine dento-alveolar surgery. We aren't scared to rip off your face, throw it on the floor, and stare at your foramen magnum, but we are a little slow on gingival contouring and cosmetic crown lengthening. Then again, I can't imagine it would be hard to learn those topics at a weekend course.

 

[DBEAR]

Then again, I can't imagine it would be hard to learn those topics at a weekend course.[/QUOTE]

I am sure you will be able to get referals pretty easily by telling your refering docs that you just got back from Dr. Allens course on gingival grafting and ethetic C.L. Now instead of sending those procedures to the periodontist, the GP will send it to you because you just took a weekend course. You may even get a certificate that you completed the course that you can put on your wall. That will really impress your referring GPs.

 

[3rdMolarRoller]

NYUCD has this awesome 2 year implant program. You need a min of 3 years work exp. as a GP. Although I think there is a 2 or 3 year waitlist now. The course is $11k a year. They worked some deal out with the equipment you need in that you get enough implant placement material that you essential get the equipment for free.

Its pretty cool that GP's can do sinus lifts now. I have been hanging aorund in the Rosenthal clinic for awhile now and think they do as good as a job as an OS (which I used to assist back in the day)

Lets face it, as technology makes things easier, you have to accept change

http://www.nyu.edu/dental/patientinfo/rosenthal2.html

http://www.nyu.edu/dental/ce.html

 

[coolpoppy]

Are there any periodontists over there who regret being one? Any advice for people debating about joining this speciality?

 

[GQ1]

ive assisted several implant placement surgeries and it absolutely shocks me how many docs ive seen leave the surgical stent on the bracket table. perio or oms - i dont really care - the restorative dentist MUST choose someone who will help and not hinder the prosthodontic outcome.

any views on endo doing implants. ive heard the apico argument too often. "im in there doing an apico its not going to work out so ill stick in an implants"
no regard for the infection which is why you re doing an apico, angulation (therefore increased cost to restoring dentist - angled abutment) politics - id rather give it to perio omfs at least i can make a referral relationship with them

 

[texas_dds]

tx omfs you are too much!

guys, in real life he is really easy to be around

 

[north2southOMFS]

tx omfs you are too much!

guys, in real life he is really easy to be around

Yah, but he's kinda ugly.