getting into perio residency

[BuckeyMcGee]

how hard is it realistically to get into a perio residency after graduation? my grades aren't the best and I have average board scores, but am pretty interested in perio - 2nd year ds...

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[NileBDS]

how hard is it realistically to get into a perio residency after graduation? my grades aren't the best and I have average board scores, but am pretty interested in perio - 2nd year ds...

If you're really interested in perio, you should make sure that that is reflected on your application, ie; externship, perio surgery assisting, perio faculty recommendations ... some research never hurt anyone. Hard work and dedication go a long way.
It is fair to say however that perio is not as competitive as some of the other specialty programs at this point in time, specially if you're not picky about location.

 

[BuckeyMcGee]

Thank ya for the reply. Since I've been trying to plan all this out, I have one more question - how hard is it to start up a perio practice? Do most periodontists take over a retiring periodontist's practice? It seems it would be really hard to just go out there and start one up, also, how is the future outlook for perio? Do you think perio will mostly be placing implants? Thank you.

 

[NileBDS]

Thank ya for the reply. Since I've been trying to plan all this out, I have one more question - how hard is it to start up a perio practice? Do most periodontists take over a retiring periodontist's practice? It seems it would be really hard to just go out there and start one up, also, how is the future outlook for perio? Do you think perio will mostly be placing implants? Thank you.

Well, I really can not speak to any experience of starting up a perio practice, since I am not training to become a periodontist. I would not suspect it to be any more (or less) difficult than starting any other office. You could probably buy a general dentist office, and just make it your own.

As far as outlook, I think perio and prosth are some of the "sleeper" specialties out there. Just because they are not as competitive as some of the other specialties, dental students tend to shy away from them, thinking they are not as lucrative. Periodontists place implants all day, and a lot of them. Depending on what program you go to, you can expect to place anywhere between 100 and 200 during your training.

On a separate note, I really am still not sure how implants fall under the scope of practice of periodontists in the first place, but that's just the way it is. Implants should really take on a specialty branch of their own.

Perio and prosth are projected to experience a sharp hike in demand over the next 20-30 years. You know times have changed, when they start teaching endo residents how to place implants.

 

[charlestweed]

Like Nile BDS pointed out, it won’t be very easy to start a new perio practice. Most new practice owners have to work at another office as associate periodontist.

You will do very well as a periodontist, if there are enough patients for you to place 10-15 implants and do10-15 perio surgeries every month (or 1 implant and 1 perio surgery a day). Perio has very low overhead….. you don’t have to pay the lab fee, you don’t need to have a large office, and you only need to hire 1 part time dental assistant. Don't underestimate the earning potential of this specialty!

 

[BuckeyMcGee]

Thanks, encouraging advice.

 

[caspian26]

how hard is it realistically to get into a perio residency after graduation? my grades aren't the best and I have average board scores, but am pretty interested in perio - 2nd year ds...

I'm a first year perio resident straight out of dental school. I had average grades and average board score. I think my strength was my resume having done perio externships, observed private practice, research, and being very involved with other things. Do as much perio stuff as you can (surgeries and assists) and get to know you perio faculty and residents. If you don't have competitive grades and scores, apply to many schools to increase your chances.

As with starting a practice, or going into an existing one, starting your own would be by far the hardest. I just talked to a periodontist that just finished his residency last year, and built his own. He recommended becoming an associate. That way, you don't have to take out more loans at that time, make some money to get on you feet before you buy in.

 

[koobpheej]

As I understand, there are some residencies that require a pulse and the ability to qualify for loans to pay for tuition. There are others that are highly competitive (Mich, UW, UTHSC San Antonio)

 

[Rube]

Thank ya for the reply. Since I've been trying to plan all this out, I have one more question - how hard is it to start up a perio practice? Do most periodontists take over a retiring periodontist's practice? It seems it would be really hard to just go out there and start one up, also, how is the future outlook for perio? Do you think perio will mostly be placing implants? Thank you.

Well here is my two cents... Any specialty that's trying to lay claim to implants as a primary reason for their existence is a specialty that was/and still may have problems. The thing with implants is, there is good reason to believe that they are heading rapidly towards primarily being placed by the general practice dentist. This isn't just my opinion, but it's where the big money is placing its bets in the field. For example, the large implant manufacturers are aggressively marketing implants to the GP, and offering Teeth in a Day to the public -- -- and there is no way that periodontists are going to start fabricating provisionals and still hope to keep referrals coming. In 5-10 years there is no way that any new GP shouldn't be trained to place implants. None of this is to disrespect the top-notch work that periodontists do in placing implants in the esthetic zone.

Right now, the market for implants is growing and it is not a zero same sum game. However, for every GP that gains confidence with the predictability of placing implants, that's one less referral to any specialist.

 

[Wayne Coronado]

Well here is my two cents... Any specialty that's trying to lay claim to implants as a primary reason for their existence is a specialty that was/and still may have problems. The thing with implants is, there is good reason to believe that they are heading rapidly towards primarily being placed by the general practice dentist. This isn't just my opinion, but it's where the big money is placing its bets in the field. For example, the large implant manufacturers are aggressively marketing implants to the GP, and offering Teeth in a Day to the public -- -- and there is no way that periodontists are going to start fabricating provisionals and still hope to keep referrals coming. In 5-10 years there is no way that any new GP shouldn't be trained to place implants. None of this is to disrespect the top-notch work that periodontists do in placing implants in the esthetic zone.

Right now, the market for implants is growing and it is not a zero same sum game. However, for every GP that gains confidence with the predictability of placing implants, that's one less referral to any specialist.

Very good point. The market seems to be directed at making the implants seem simple enough for GPs to tackle and with the success being over 90% it appears that this is reasonable. With the advent of CT technology like Cone Beam and 3D software (ex. SimPlant), a lot of the guess-work about vital structure locations, bone thickness and quality, and implant spacing is taken out of the equation. Hell, a SimPlant rep told me that by this spring they'll be able to fabricate your surgical guide for you based on your how you planned the implants on their software (which kicks a$$) So, yeah, you think about it and the GP is in really good shape to place implants routinely. However, I do not believe that specialists are going to be out of the loop. If there is any need for bony augmentation (sinus lifts, block grafts, etc.), who is going to manage this? Another thing to think about is soft tissue augmentation. In sites that have been edentulous for some time (ex. pontic space), the contour of the soft tissue will tend to have a concave appearance and will not match the adjacent teeth. As you move anteriorly, this becomes more noticeable and may or may not be a concern of the patient, but if you want to bulk things up a bit with a connective tissue graft, who will take this on? There are many other instances, but I just wanted to shed some light on a couple scenarios that will most likely be outside the scope of a GP. Grant it, there are courses out there that will get the GP going in these areas and more power to them if they can perform these procedures at the level of a specialist. IMO, I think that the GP should know what he/she is getting into when treatment planning these cases. Some cases will be slam dunks and those will most certainly be in good hands with the GPs. But there are many times where augmentation is a necessity for a good long-term outcome and I think that the specialist will still have plenty on the plate in this regard.

 

[EuroOMFS]

Implant manufacturers are marketing implants to GPs, not because it's so simple and easy to place them, but because there are many more GPs than there are specialists. They can sell more implants this way.

Simplant surgical guides made from CT data, "Teeth-In-An-Hour" and a bunch of other stuff, may look pretty cool but they are really just expensive gadgets that are developed to give dentists that are not trained in surgery the ability to place implants with minimal risk. In other words, they are tools for GPs to avoid having to refer implants to a specialist.

Now, is there anything wrong with that? Well ... it adds a big sum to the bill, a fair amount of radiation to the patient and it's not really neccesary. A well trained surgeon can place these implants using conventional techniques, with minimal additional discomfort to the patient, and absolutely the same (or better) results in the end. The surgeon can augment bone where needed to place the implants more stratetically and maybe even place more of them. He is also better equipped to handle complications then the GP is.

We do use SimPlant at my program though. We use it to place implants in resected, and sometimes irradiated bone, where we want to expose as little bone as possible. It's in those situations I can see the real benefit of such a system.

Just my two cents.

 

[scalpel2008]

So, yeah, you think about it and the GP is in really good shape to place implants routinely. However, I do not believe that specialists are going to be out of the loop. If there is any need for bony augmentation (sinus lifts, block grafts, etc.), who is going to manage this?

So are you saying that the GP should keep all the easy dollar slam dunk cases for themselves while they should refer the pain in the a$$ cases to the specialist? As much as specialists like challenging cases, these are usually balanced out by easy cases. I hope you don't ask that specialist for any favors such as getting a favorite patient a prompt appointment for an urgent extraction.

 

[Wayne Coronado]

So are you saying that the GP should keep all the easy dollar slam dunk cases for themselves while they should refer the pain in the a$$ cases to the specialist? As much as specialists like challenging cases, these are usually balanced out by easy cases. I hope you don't ask that specialist for any favors such as getting a favorite patient a prompt appointment for an urgent extraction.

C'mon, I'm not saying that the GP should keep all of the easy cases (and why would I want them to?). But do you disagree that implant placement are going to be more and more in the hands of the GP (I mean the easy ones that do not require bone aug)? The bottom line in my statement was that the GPs that take on implant placement need to be aware that in many cases you are not going to be able to just throw in an implant and be done without some augmentation of the bone. Hey, I want the easy cases (well-preserved bone w/h in a single site) as much as the next guy, but do you think that the GP who makes implants a mainstay in his/her practice is going to let these go to the specialist? I think probably not. Just my opinion on the matter and not trying to shake things up. What's your take on the GP/implant deal, Scalpel?

 

[scalpel2008]

C'mon, I'm not saying that the GP should keep all of the easy cases (and why would I want them to?). But do you disagree that implant placement are going to be more and more in the hands of the GP (I mean the easy ones that do not require bone aug)? The bottom line in my statement was that the GPs that take on implant placement need to be aware that in many cases you are not going to be able to just throw in an implant and be done without some augmentation of the bone. Hey, I want the easy cases (well-preserved bone w/h in a single site) as much as the next guy, but do you think that the GP who makes implants a mainstay in his/her practice is going to let these go to the specialist? I think probably not. Just my opinion on the matter and not trying to shake things up. What's your take on the GP/implant deal, Scalpel?

i don't have a problem with GPs placing implants. But a GP who makes implants the mainstay of one's practice and only refers out the compromised cases may not be able to find an OMS who will do any favors for him/her and will definitely not get bailed out from any complication they can't handle(implant or otherwise) unless they are a strong with other referrals. It's just how it works. Like I said, I have no issues with GPs and implants. I would, in fact, be willing to teach my primary referral base GPs in my implant club on how to place simple implants.