Perio-ortho

[Tekado]

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I am currently a first year perio resident and one of the senior resident in my program was presenting a case of Periodontal Accelerated Osteogenic Orthodontics (PAOO) where they were combining ortho tx with selective periodontal ostectomy and bone grafts. I was really impressed by the result. The patient had a bilateral crossbyte and instead of going through 2 years of ortho and jaw surgery, the treatment was completed within 8 months.

However, to perform this procedure you need to have an extremely closed collaboration between the periodontist and orthodontist. This is why, I was wondering if it would be beneficial to have a double speciality in perio and ortho. I know that Upenn is offering such program and that it sounds really good on paper, but how is it really in real life?

Does someone in this forum knows anyone who is both perio and ortho ? would anyone advise against going down that road? or does anyone has more information about PAOO and related perio-ortho procedures?

Cheers,

 

[Quattro DMD]

When I was interviewing for perio last year I met a resident third year resident that was getting ready to apply to ortho. He said that he wanted to do ortho to compliment his training, stating that oral hygiene and misaligned teeth go hand and hand. I'm not sure how practical it was be to do both specialties in a single practice.

 

[Tekado]

When I was interviewing for perio last year I met a resident third year resident that was getting ready to apply to ortho. He said that he wanted to do ortho to compliment his training, stating that oral hygiene and misaligned teeth go hand and hand. I'm not sure how practical it was be to do both specialties in a single practice.

For sure it should be better than perio-prosth in term of referrals. You should get a lot of referrals for implants since you won't be restoring them AND you can make more space with ortho and align teeth!

 

[TJNova2011]

I am currently a first year perio resident and one of the senior resident in my program was presenting a case of Periodontal Accelerated Osteogenic Orthodontics (PAOO) where they were combining ortho tx with selective periodontal ostectomy and bone grafts. I was really impressed by the result. The patient had a bilateral crossbyte and instead of going through 2 years of ortho and jaw surgery, the treatment was completed within 8 months.

However, to perform this procedure you need to have an extremely closed collaboration between the periodontist and orthodontist. This is why, I was wondering if it would be beneficial to have a double speciality in perio and ortho. I know that Upenn is offering such program and that it sounds really good on paper, but how is it really in real life?

Does someone in this forum knows anyone who is both perio and ortho ? would anyone advise against going down that road? or does anyone has more information about PAOO and related perio-ortho procedures?

Cheers,

look at the folks who are dual specialties and how many practice both.... investigate overhead with supplies, training, etc. and whatnot and your question should be answered....unless you want academia.

 

[charlestweed]

My wife and I practice in one office. I've done a lot of space redistributions and molar uprightings for my wife's implant patients. My wife has also done a lot of canine exposures, frenectomies, gingivectomies, connective tissue grafts, and implant placements (for congenitally missing teeth) for my ortho patients.

As the above poster pointed out, high overhead may be an issue when you have 2 different specialties in one office. To save cost, we cross train our staff so they can assist both perio and ortho. We book the perio and ortho patients on separate days so my wife and I can use all 3 full time assistants.

 

[Tekado]

My wife and I practice in one office. I've done a lot of space redistributions and molar uprightings for my wife's implant patients. My wife has also done a lot of canine exposures, frenectomies, gingivectomies, connective tissue grafts, and implant placements (for congenitally missing teeth) for my ortho patients.

As the above poster pointed out, high overhead may be an issue when you have 2 different specialties in one office. To save cost, we cross train our staff so they can assist both perio and ortho. We book the perio and ortho patients on separate days so my wife and I can use all 3 full time assistants.

Thank you for sharing your valuable experience charlestweed! The perio-ortho collaboration does seem benificial in your practice. However, I am not sure to understand why the overhead would be more for 1 person practicing both perio and ortho. Since you and your wife are not working at the same time, wouldn't it be the same as one person working 5-6 days per week? Wouldn't it be about the same as a GP doing implant and ortho? Thank you in advance for your insight.

 

[charlestweed]

Thank you for sharing your valuable experience charlestweed! The perio-ortho collaboration does seem benificial in your practice. However, I am not sure to understand why the overhead would be more for 1 person practicing both perio and ortho. Since you and your wife are not working at the same time, wouldn't it be the same as one person working 5-6 days per week? Wouldn't it be about the same as a GP doing implant and ortho? Thank you in advance for your insight.

You are right. It should not cost you more if you use the same assistants for both perio and ortho. The problem is not everyone can assist ortho. In my state, California, the ortho assistant must have the RDA license. The girl, who is really good at assisting perio, doesn’t have the RDA license; therefore, she can only perform non-RDA duties (such as taking ortho records, sterilizing instruments etc) when she works on the ortho days. Another problem is that most ortho assistants only like doing ortho. It is not easy to find an ortho RDA who is willing to assist in the “bloody” procedures.

The reason my wife and I have no problem finding the RDA assistant who is willing to do both ortho and perio is we not very picky in choosing the assistant. As long as a person knows how to hold the suction for my wife, she is ok to have that person as her assistant. As long a person knows how to change wires, that person is good enough to be my ortho assistant.

I don’t like spending my day treating only a few patients. It’s boring to sit around doing nothing. I keep my schedule busy by booking as many patients (40-80 patients) in one day as possible. With such high volume of patients, having 3 F/T assistants is not enough. On the ortho days, I have to hire 2-3 additional P/T experienced ortho RDAs (on top of my 3 F/T employees) to help me.

 

[gryffindor]

It's not just staff costs in overhead, supplies will cost more. Stocking implant and surgery parts is probably way more expensive than the brackets, bands, and wires I have sitting in a cabinet.

PAOO is a really fascinating procedure. I would love to get more involved with it. So far I have only seen 1 adult case where I felt a very good indication for it, but the patient was strapped for money to be able to do both PAOO and Ortho. At the course they say that guesstimating that the surgical fee is going to be similar to the orthodontic case fee is reasonable. That's a big chunk of money for your average patient.

Edit - now that I think about it, there was a perio-ortho doctor at my course. He practiced somewhere in the western part of Washington. Spokane maybe?