Future of Perio

[dent2015]

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With more and more GPs placing implants (and even more will learn as they graduate and refer out less), other specialties placing implants and the 3 years of lost wages to residency - is a perio residency worth it financially?

How do private practice guys do? I really like perio, but don't want to put myself into a position where I won't do well when I get out. Does perio have a good future?

 

[Quattro DMD]

With more and more GPs placing implants (and even more will learn as they graduate and refer out less), other specialties placing implants and the 3 years of lost wages to residency - is a perio residency worth it financially?

How do private practice guys do? I really like perio, but don't want to put myself into a position where I won't do well when I get out. Does perio have a good future?

Perio is trying to move away from implants and more towards regenerative therapies, although perio may be referred the more difficult implant cases. Traditional osseous surgery will always be there along with crown lengthening and soft tissues grafts etc. Perio, like all specialties right now is struggling. A lot of periodontists compensate by working outside the practice and traveling to different offices everyday of the week, splitting procedure fees with the GP. But with that being said I'm still stoked to start residency this June. Perio just seems to fit my interests and is something I can see myself doing for the next 30 years.

 

[Quattro DMD]

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[charlestweed]

Perio is trying to move away from implants and more towards regenerative therapies, although perio may be referred the more difficult implant cases. Traditional osseous surgery will always be there along with crown lengthening and soft tissues grafts etc. Perio, like all specialties right now is struggling. A lot of periodontists compensate by working outside the practice and traveling to different offices everyday of the week, splitting procedure fees with the GP. But with that being said I'm still stoked to start residency this June. Perio just seems to fit my interests and is something I can see myself doing for the next 30 years.

Most periodontists I know (including my wife) are doing more and more implants. Why would they move away from implant, which is one of highest profitable procedures in dentistry? Every month, my wife orders $4-5k worth of implant, abuttment, screw, healing cap materials. Since a lot of GPs have very limited knowledge about implant treatment planning and complex implant restorations, they'll always need the treatment guidance from the periodontists like my wife. She actually prefers traveling to different GP offices because she doesn't like to deal with (and to beg) the referring GPs. Low overhead, higher take-home income and no headache of running a business. She still, however, works at her own office 4 days/month.

 

[Quattro DMD]

Most periodontists I know (including my wife) are doing more and more implants. Why would they move away from implant, which is one of highest profitable procedures in dentistry? Every month, my wife orders $4-5k worth of implant, abuttment, screw, healing cap materials. Since a lot of GPs have very limited knowledge about implant treatment planning and complex implant restorations, they'll always need the treatment guidance from the periodontists like my wife. She actually prefers traveling to different GP offices because she doesn't like to deal with (and to beg) the referring GPs. Low overhead, higher take-home income and no headache of running a business. She still, however, works at her own office 4 days/month.

I'm not saying perio is going to stop placing implants, but I was addressing the OP's concerns that GP's will keep more procedures in-house, thus limiting profitable referrals like implants. However, the periodontist will probably still be referred the more difficult anterior cases, and a lot of the peri-implantitis cases as well. As you eluded to, periodontists are very knowledgeable about implant tx planning since most residencies inter-mingle with the prosth department.

As a profession I think perio is trying to get back to the practice of "saving teeth", which is why more and more research is being directed towards regenerative therapies. From what I have heard, this was the general message at the AAP meeting this year. Maybe your wife can elaborate on that.

Being a traveling periodontist is very appealing, but from what I've heard it's generally focused on implants and grafts, with fewer traditional perio surgeries. However in this economy I think more periodontists will take what they can get. Overall I still think perio is a great profession, and with the baby boomers retiring, their services will be in demand.

 

[Mackchops]

charlestweed, do you think your wife's practice would be able to survive without implants? Is there anyone out there these days practicing full-time pure perio without placing implants? It's hard to imagine...

Perio lit looking at regenerative therapies is nothing new and my personal opinion is that the specialty is pretty well entrenched in the surgical placement (and augmentation) of dental implants. Sure other specialties and GPs are placing them, but that's because so many more are being placed! I think a lot of practitioners AND patients are drawn to the relative simplicity and high predictability of implants when compared to the herodontics necessary to save some teeth. Periodontists are appreciated for knowing when it's time to transition someone into titanium...

 

[charlestweed]

charlestweed, do you think your wife's practice would be able to survive without implants? Is there anyone out there these days practicing full-time pure perio without placing implants? It's hard to imagine...

Perio lit looking at regenerative therapies is nothing new and my personal opinion is that the specialty is pretty well entrenched in the surgical placement (and augmentation) of dental implants. Sure other specialties and GPs are placing them, but that's because so many more are being placed! I think a lot of practitioners AND patients are drawn to the relative simplicity and high predictability of implants when compared to the herodontics necessary to save some teeth. Periodontists are appreciated for knowing when it's time to transition someone into titanium...

No, she wouldn't survive since more than half of her income is from placing implants. Implant is an important part of periodontic specialty. A periodontist who lacks the knowledge in implants shouldn't practice perio. Patients who have periodontally compromised teeth are referred to my wife's practice every day. It is my wife's job to inform the patients and the referring GPs the comprehensive plan such as which teeth can be saved by osseous surgery, which teeth need to be extracted due to advanced bone loss, and the implant treatment plan (number of implants to be placed, single tooth, hybrid, overdenture etc) to replace these extracted teeth. If the GP can't obtain a clear recommended tx plan from a periodontist he/she refers the patients to, this periodontist can forget about getting the referrals from this same GP in the future.

If the majority of the GPs were able to do what I mentioned in the above paragraph (diagnose, tx plan, and execute the tx plan), my wife would have been out of job a long time ago.