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Implants or OMFS?

Discussion in 'Dental Residents and Practicing Dentists' started by joyride, Dec 9, 2005.

  1. joyride

    joyride Member
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    I'm in my 2nd year right now and I'm debating between going into OMFS or just do an implant program. In the end, I would like to place implants and do the restorations. The idea of going into a 4 year OMFS program interests me, just because I would be able to do 3rds and bone grafts, sinus lifts, etc....Is busting your behind through 2nd year worth it? or does anyone think just taking it easy and doing a fellowship in implants and placing and restoring them in GP is enough? any thoughts?
     
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  3. Yah-E

    Yah-E Toof Sniper
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    First of all, there are no ADA certified "fellowships" in Dental Implants. You'll find PLENTY dental implant CE courses and seminars around the country, but no "fellowships".

    Is busting your behind through 2nd year worth it? If you can't answer that yourself, then I don't believe anyone of us can help you. It's gotta start within!
     
  4. TiggerJSA

    TiggerJSA Examing the colon stinks
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    Here are my thoughts... OMFS is a beast of a career path. It's about a whole lot more than implants, bone grafts, sinus lifts. If those are the main things that interest you, Perio (I know, I said it) can be another option to consider. To explore your desire to go into oral surgery, you should spend some time with some residents and shadow what they do. Figure out what really grabs your interest. I know I may be biased because of the way I feel about OMS, but it seems like it would be damn difficult, if not impossible, to get through any residency program if you weren't friggin in love with it. General dentists can place implants, restore them, and can even do bone grafts and sinus lifts if they are trained. So, again, I think going into surgery would be a long hard road to endure to learn those things. This is just my perspective :)
     
  5. Periogod

    Periogod Senior Member
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    TiggerJSA is right, OMFS is a lot more thant just implants (its also third molars) :laugh: . If all you want to do is implant and site augmentation (be it bone/soft tissue grafts or sinus lifts) you may want to try Perio. Its only three years and, in most programs, the acceptance criteria are somewhat less stringent. However, if you want to restore these implants, you may want to stick to general dentistry (most GPs get pissed if the Periodontist or OMFS restores the implant).
     
  6. OzDDS

    OzDDS Senior Member
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    Don't Prosth both place and restore implants?
     
  7. OMFSdoc

    OMFSdoc Member
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    If you were getting an implant in your own mouth, who would you want placing it? Someone who did a 1 year fellowship, or someone who spent 4-6 years in OMFS learning how to perform any maxillofacial procedures AND complications. No offense, but if it were my mouth, I would want the person who put the time in to put my implant in. On the same note, I would want a prosthodontist restoring the implant. Specialists are specialists because they are the best at what they do. Why go to someone inferior? Doesn't make sense to me.
     
  8. ip

    ip Senior Member
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    By that logic, wouldn't you go to someone who did a 3 year residency in implants for the implant you need? I guarantee you that he knows more about implants than a perio or prosth or OMFS....
     
  9. OMFSdoc

    OMFSdoc Member
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    There's a 3 year implant residency?
     
  10. ip

    ip Senior Member
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    Yep.
     
  11. toofache32

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    It's called Perio.
     
  12. atlanta478

    atlanta478 "Open wide"
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    It's called PERIO. :)
     
  13. ip

    ip Senior Member
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    Lemme guess. You guys have no idea what there is to learn about implants for 3 years? Too predictable.

    The thing is, the less you know about something the less you realize how complex it is. :)
     
  14. toofache32

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    ....kind of like women....
     
  15. Jediwendell

    Jediwendell Senior Member
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    From someone that did OMS and didn't quite dig it, I would suggest that you either consider perio or just get into a great associateship with someone with experience, particularly if you are only interested in implants. The implant fellowships are way too expensive, and you are still just a general dentist when you get done. OMS really focuses little on implants, and while you will do a ton at most programs, it is little more than an afterthought most times.


     
  16. toofache32

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    Jedi, just out of curiosity, you got your MD didn't you? Now you can run your own codes when that bonding goes bad!
     
  17. ip

    ip Senior Member
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    :thumbup:
     
  18. OMFSdoc

    OMFSdoc Member
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    Why does perio boast a 3 year implant residency??? Implants had nothing to do with perio 10 years ago, and now they seem to be all periodontists talk about. Don't respond with saying OMFS didn't do a ton of implants in the early 90's either because I know implants weren't huge for anybody at that time. My point is that OMFS docs talk about a lot more than implants (wisdom teeth, impacted canines, pathology, trauma, orthognathic, TMJ...). Does perio do anything else anymore, what happened to perio, they all went implant crazy.
     
  19. Jediwendell

    Jediwendell Senior Member
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    Yeah, it happens all the time at first. Kid sucks one down the wrong way and BAM, I'm doing shocks.

    Seriously, we have this fossil of an instructor come in that gets a little strange sometimes. My mind wanders to: who goes to get the crash cart, who goes to call 911, who does chest compressions, etc. So you never know. It just may happen.
     
  20. Jediwendell

    Jediwendell Senior Member
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    It's because Perio really doesn't do anything else except for esthetic crown lengthening. At least not that I can see. It is kindof interesting to go from the attitude of "you have a twelve millimeter pocket, but I wouldn't take it out" to one of "You have a five millimeter pocket, the tooth has a very bad prognosis, so let's take it out and put in an implant." :smuggrin:
     
  21. OMFSdoc

    OMFSdoc Member
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    That's an interesting point you bring up. When I started in my dental school clinics a few years ago, a perio consult almost always went in the way of saving teeth at all costs. The philosophy was to keep/save your own teeth for as long as you can. Get them cleaned up and in good shape if there was any possibility of saving the tooth. 2.5 years later (2 months prior to graduation).....there was an almost 180 degree change in philosophy during perio consults. The recommendation was to extract teet with a marginal prognosis and replace with implants. Don't bother attempting to save the tooth, the prognosis 50/50. You would likely be better served by having an implant placed. My reaction was what the [email protected]^% are these people trying to teach? What am I supposed to be learning. This is nuts.....these people are nuts. So where does perio stand, and don't tell me it's more complicated than that. I know that implants have a better prognosis than a moderate-severely compromised tooth, and through my training, I would recommend an exo and implant if prognosis was marginal, but where does perio stand...are they tooth savers are not???
     
  22. OMFSDR

    OMFSDR Junior Member

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    Perio never saved any teeth they only cleaned them up so oral surgeons could take them out. Unlike Perio oral surgeons are trained not only in treatment planning and placement of implants they can also manage the complications that can result from the procedure. Oral surgeons have admitting privileges in hospitals and are trained in treatment of all complications that can arise from the procedures they perform. In my opinion that differentiates a real surgeon from someone who was just trained to place screws in to a jaw. If I ever had to have a surgical procedure performed on me I would hope that the surgeon performing the procedure is trained to handle all possible complications. And yes placing implants is a surgical procedure that can have devastating complications.
     
  23. Periogod

    Periogod Senior Member
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    Now I don't know what kind of "second-tier" dental training you have undergone that you base such ignorant comments on but I can tell you there is not a implant complication that can arise that I am not trained to take care of. The exception being the possible need for a neck dissection that can arise if you happen to sever lingual artery :eek: -something easily avoided with proper treatment planning. Your comments make me believe that you have never placed an implant. The fact is that placing an implant is a simple procedure. Any General Dentist, Periodontist, OMFS, Endodontist, or Prosthodontist can place an implant if they know their anatomy and know how to manage the few complications that can arise. Proper treatment planning is the key. There aren't many people that can screw-up an implant case with a CT scan or a proper CBVT.
     
  24. Periogod

    Periogod Senior Member
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    Hasn't this been OMFS's approach all along, maybe Perio is finally coming around :idea:
    This, again, is a very broad generalization. There are teeth now that are better served by an extraction and implant but this does not go to say that if the patient really wants to save their teeth we can't still do outdated procedures like hemisection, bicuspidization, or root amputations. The nice thing is that if you ask a patient whether they want to spend $x on a surgery, RCT, and crown for a tooth that has only a poor long-term prognosis or the same amount on a dental implant, which one do you think the patient will choose? And, in the end, after the patient is well-informed of all the possible options, this is who should be choosing whether the teeth should be extracted, not the OMFS or Periodontist.

    I still save plenty of "periodontally-involved" teeth.
     
  25. OMFSdoc

    OMFSdoc Member
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    Oh boy are your wrong!!!!! You CANNOT handle any complication short of a neck dissection. That is not in your scope of training as a periodontist. That is in the scope of an oral and maxillofacial surgeon. ALL complications short of a neck dissection is not limited to the periodontium. I don't know any periodontists that can even admit a patient to a hospital for IV antibiotics!!! What if you need to drain a submandibular space abscess (DUE TO AN IMPLANT RELATED INFECTION) extraorally in the OR that is impinging upon the patient's airway? Yes, I've seen this happen after a periodontist placed an implant and there was a subsequent major infection, needless to say he referred to OMFS to manage the complication. Do you even know how to access the OR? Have you been to an OR in your training? Do not say that you can manage any implant complication short of a neck dissection. That is simply NOT TRUE! If it were true, you would be an OMFS.
     
  26. Periogod

    Periogod Senior Member
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    That is what OMFS is for. If there is something that goes drastically wrong, I can refer on over to OMFS. Flap surgery, extractions, apicoectomies, can all cause the same thing, with a large enough infection. Does that mean that no one but an Oral Surgeon should perform these? (The answer is NO by the way :D ). As for your second question, again you demonstrate a lack of experience; there are Periodontists and even General Dentists that are associated with hospitals. And, yes we have "some" training in the OR but the OR, for us, is just another place to do perio surgery on a medically compromised/difficult-to-manage patient. No, I will not be associated with a hospital due to lack of monetary compensation, but who cares? If a patient has a huge cancer, neck infection, or just wants his impacted thirds out I have no qualms about referring to OMFS. If he wants a screw placed into his bone, I can guarantee you that I am more than adequately trained.
     
  27. esclavo

    esclavo from frying pan into fire
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    Neck dissections are a cancer procedure not a hemorrhage control procedure. Most lingual arteries I've seen shouldn't be severed in implant surgery. Now a submental artery, yes. There is a few cases in the literature. Rapid hemorrhage into the fascial spaces of the floor of mouth-emergent airway issue and good protocols that have been proposed. In most of those emergent algorithms the periodontist/dentist can only go as far as "crying mommy", "call 911", and wetting themselves. Floor of mouth disections to find the little bugger-that is a cool little procedure, but it is done most often intraoral. I bet in perio school they teach you how to cut down to the bifurcation of the carotid and tie it off... for a wayward implant. I can't type, I'm laughing so hard....I really don't care who places implants. I didn't go into OMFS for teeth or implants. But I definitely didn't go into OMFS to bail out other dentists when they don't have the judgment to refrain from doing stuff that ends up costing me time, money, and patient's well being. I'm going to have special "fee's" for those few dentists and their lack of better judgement.
     
  28. OMFSDR

    OMFSDR Junior Member

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    There is really no need for personal insults. So I am going to treat you like an adult and respond to your statement.

    1) I received my dental education from an Ivy League university and I am currently training in one of the top Oral Surgery programs in the nation.
    2) If you had any surgical experience you would know that a severed lingual artery is not managed with a neck dissection. ( YOU MIGHT WANT TO LOOK THAT UP BEFORE YOU PLACE YOUR NEXT IMPLANT)
    3) Most surgeons do not consider picking up the phone and calling another surgeon to handle their complications as appropriate surgical training.
    4) Although serous complications with placement of dental implants are rare they do occur and sometimes require surgical reconstructive treatment, hospitalization and long term IV antibiotics non of which can be provided by a Periodontist.
    5) Proper treatment planning only lowers your rate of complications it does not prevent them.
    6) There are more screw-up’s out their then you think. You just never see them we do.

    I do agree with you on one point “anyone can place an implant” but only an oral surgeon has the appropriate training to handle all of the complications.
     
  29. HuyetKiem

    HuyetKiem Senior Member
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    According to my professor, #1 cause of malpractice lawsuits in Ohio are involving oral surgeons and severing the lingual nerve. :D :D I'm sure everyone would make mistake one in awhile. :D :D :D
     
  30. OMFSDR

    OMFSDR Junior Member

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    Man I was going to make him look that up.
     
  31. OMFSDR

    OMFSDR Junior Member

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    Your professor is probably a periodontist and doesn’t even know how to find the lingual nerve.
    :laugh:
     
  32. HuyetKiem

    HuyetKiem Senior Member
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    Amen :D :D :D I believe those oral surgeons were trained by periodontists. :) ;)
     
  33. Periogod

    Periogod Senior Member
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    Forgive my lack of knowledge when it comes to OMFS semantics but, whatever its called, lingual artery ligation can require an extraoral approach in cases of anastomoses and anatomic variability of the mylohyoid, sublingual, and submental arteries. In any case, extraoral ligations are out of my scope of practice. I agree that, if I can't ligate the artery from an intraoral approach, I would probably keep pressure in the area and then call EMS. However, like you said so yourself, these cases are most often the result of a lack of judgment and/or not knowing one's own boundaries. I will repeat my previous statement, properly treatment planned implants are not outside the scope of any reasonable dental professional.
     
  34. Periogod

    Periogod Senior Member
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    I guess they do not teach proper grammar and spelling at Ivy League universities. No worries, I corrected your post for you :D .

    By the way, nothing I said was meant as an insult, simply an observation. I am sorry if you misconstrued my meaning.
     
  35. superchris147

    superchris147 Senior Member
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    ah, the good ole "make fun of their grammar when you can't think of anything else" :eek:

    (sorry periogod but i just couldn't resist :( )
     
  36. OMFSDR

    OMFSDR Junior Member

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    Please forgive me I did not have time to spell check had to run over to the OR that stands for operating room. You should pop in to a hospital sometime and check it out.
    PS. Don’t touch the blue.
     
  37. OMFSCardsFan

    OMFSCardsFan Senior Member
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    Part of the job...gotta take the good with the bad.
     
  38. OMFSCardsFan

    OMFSCardsFan Senior Member
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    Hmmm...strange. At our level of education, we need spell-check? I didn't realize that deciding between "there", "their", and "they're" is something that takes so much time and effort to get right. When I'm on my way to the OR, my ability to utilize my brain doesn't disappear. I don't think people who spell poorly really realize how stupid it makes a person seem. Nothing irritates me more than getting a consult from an "educated" doctor who hasn't yet mastered fourth-grade English. Or, even more irritating is reading personal statements from applicants full of grammatical and spelling errors. You would think that these people would spend a little time making sure everything was correct. Say what you want, but you lose credibility when you can't spell correctly. If you disagree, you're probably not catching the mistakes--you're one of them.
     
  39. OMFSCardsFan

    OMFSCardsFan Senior Member
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    You're right about this. The problem is that most of them are too egotistical to ask for help when they need it. Not irregularly, I see people who have repeatedly gone to an oral surgeon who provided treatment to them, only afterwards to tell them, "Everything is fine" when everything is not fine.

    We got a patient recently who had been undergoing conservative TMJ therapy for six months for trismus that had not resolved. The patient came to see us because she didn't think something was right. Turns out, she had a nasty RMT SCCA, which subsequently ended in a hemimandibulectomy, RND, and free flap to replace the defect. I think this would fall into the category of a complication from non-treatment.

    It's ridiculous to brag that surgeons don't call other surgeons to help handle complications. This is either naive or an accident waiting to happen.
     
  40. toofache32

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    Ahh, yes...the elusive "TMJ pain that never goes away."

    Was there an obvious mass? If so, this is a lawsuit waiting to happen.
     
  41. ItsGavinC

    Dentist Moderator Emeritus 15+ Year Member

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    Which I've learned, through perio consults, is a tooth with pockets greater than 5 mm.
    :rolleyes:
     
  42. OMFSDR

    OMFSDR Junior Member

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    That is a very ignorant statement to make about someone you don’t know. Unlike you I was not born or raised in this country and had to work twice as hard to be where I am today. Comeback and talk to me again after you earn two doctorate degrees in a foreign language or at least learn how to spell poorly in one.
     
  43. north2southOMFS

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    Wow, you get CT scans for implants? That's kinda expensive isn't it.

    Well, i guess if it is like a whole mouth full of them and your grabbing bone from some other site also it might work....hmmm.

    Do you get tests like Erythrocyte sed. rate, C-reactive protein, etc.. for inflammed gums to?

    Seems kinda expensive.
     
  44. north2southOMFS

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    Holy $hit! Where are you sticking your implants????????? I hope you don't hit the lingual artery!

    Cardsfan, get a leash on your boy here, he's gonna kill someone.

    Oh, and do you guys know who is doing the real laughing here. Its the general surgery resident meandering through here reading this thread laughing his ass off about our arguing who has the proper talent to basically drill a hole and put a screw in.
     
  45. north2southOMFS

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    Yah, you bums, now i come back on service for 1 week and have to be on call while she (with my luck)goes downhill in the unit and also have to do q3hr flap checks.

    I didn't even get to be in on or see the any of the surgerys! I was too busy checking out very low tanner stages on the peds kids to be comfortable!
     
  46. Periogod

    Periogod Senior Member
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    CT scans are only for Simplant and NobelGuide cases and CBVT for a single tooth (we only charge $50 for our CBVTs).
    And you jest about elevated C-reactive protein levels but Loos et al. are doing research on its connection to IL-6 and perio. I guess you haven't heard that perio causes heart disease :laugh:
     
  47. toofache32

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    Whatever floats your boat.... :eek:
     
  48. north2southOMFS

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    It might be ignorant ivy league boy, but its true. You will lose credibility in this country if you can't spell.

    Sucks, but its true.

    And i also disagree with your statement about never calling another surgeon for help. That is just your ivy league colors shining through.
     
  49. OMFSCardsFan

    OMFSCardsFan Senior Member
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    I was about to post the same exact thought. I guess it suffices to say that neither of your doctorates are in English. I'm sure, however, that the doctorate in pig latin is big with your Pedo patients.

    By the way, I'm curious which OMFS program that you're in, since you've mentioned that it's one of the best in the country. Willing to humor us?
     
  50. OMFSdoc

    OMFSdoc Member
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    Seriously, you guys are going to rag on someone for spelling in an SDN post. That's a bit much don't you think?
     
  51. OMFSCardsFan

    OMFSCardsFan Senior Member
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    I'd never call someone out who is making an intelligent comment or asking an intelligent question--though it would bother me. I will call a person out when he starts running his mouth/fingers and acting as though oral surgeons are the only people qualified to do anything--but the same guy can't even manage correct spelling. If you can't write and speak correctly, your credibility drops. Really, I think he should keep his mouth shut completely until he can come up with something positive to contribute.
     

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