I have always thought PPS is a joke that OS residents play on Perio guys but looking the Net reveals that many periodontists call themselves as " Periodontal Plastic Surgeons". This is for my information so please offer non sarcastic answers please (you know who you are). What exactly is PPS? Is it an inflated name for periodontal surgery or some procedures that have been developed since I graduated in 95? DP
Periodontal Plastic Surgery is the term for a variety of procedures which periodontists perform to improve the soft tissue esthetics around teeth, augment periodontal and peri-implant tissues to improve disease resistance, as well as procedures which assist our restorative colleagues in achieving optimal restorative results.
PPS is NOT an effort for periodontists to do facial plastic surgery, which is the "terf" of Plastic surgeons and more recently OMFS's. I would be disappointed in our colleagues who advertise themselves as "perio plastic surgeons" since this is only one small area in the vast scope of practice which periodontists handle.
Also, a gingivectomy is a procedure which is rarely indicated without proper contouring of the underlying osseous topography.
From my experience there are many OMFS's who have additional training to complete PPS procedures, but if they do so they are held to the level of a periodontist, and owe it to their patients to make sure they are performing such procedures in a competent manner.
As far as periodontists doing tibia grafts, these procedures have been done under IV sedation with local anesthesia, but you can get only a limited amount (about 30cc) of cancellous bone from the tibia....this bone is probably not osteoinductive...so for what we do in perio it has limited value for the morbidity of such a procedure. We can do better harvesting from the symphysis or ramus, using a bone mill, and/or combining with allografts.
I have met Marx when he spoke at our program last year. He's all about PRP, and did not discuss tibia grafts at all.
By the way the AAP put out referral guidelines b/c we have done a piss poor job of educating dental students in what perio is, how to diagnose it, and how to treat it. The guidelines were based in clinical trials and cohort studies showing that many GP's are keeping perio patients in their office more so than ever, ignoring disease, and providing an inadequate level of care. I say Many GP's, not all, but the trends in the studies show that now more than ever, patients with perio disease are not getting the treatment they need.
When you look at the long term studies on perio treatment (some as long as 50 years of followup) perio therapy by a periodontist maintains 85-90% of patients without any tooth loss.....now when you compare that to implants (no studies beyond 35 years (case reports), and no "good" studies (RCCT's)better than 15-20 years), perio treatment doesn't sound so unsuccessful!!!
Wow that was long.
Or do them old school with the electrosurge, same result.
