1. What do you find most helpful? Give us your feedback on the 2019 SDN Member Survey to help further the SDN mission (and win prizes!)
    Dismiss Notice
  2. Dismiss Notice

Periodontal Plastic Surgeon

Discussion in 'Dental Residents and Practicing Dentists' started by Dr. Dai Phan, Feb 23, 2007.

Thread Status:
Not open for further replies.
  1. Dr. Dai Phan

    Dr. Dai Phan Senior Member
    Moderator Emeritus Lifetime Donor Verified Account 7+ Year Member

    Joined:
    Dec 20, 2005
    Messages:
    1,181
    Likes Received:
    153
    Status:
    Dentist
    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
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  2. toofache32

    15+ Year Member

    Joined:
    Apr 19, 2003
    Messages:
    3,873
    Likes Received:
    36
    Status:
    Resident [Any Field]
    who me?
     
  3. north2southOMFS

    5+ Year Member

    Joined:
    Jul 14, 2004
    Messages:
    704
    Likes Received:
    3
    Surely you must mean someone else?
     
  4. IcedOMFS

    IcedOMFS realultimatepower.net
    5+ Year Member

    Joined:
    Sep 7, 2006
    Messages:
    253
    Likes Received:
    2
    Status:
    Attending Physician

    PPS... P P S... Pee Pee S... Pee Pees... Heh heh... Pee Pees.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  5. psiyung

    psiyung 1K Member
    10+ Year Member

    Joined:
    Oct 23, 2004
    Messages:
    2,420
    Likes Received:
    25
    We just had a lecture on periodontal "plastic surgery" What a ****ing joke of a field
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  6. Jaybe

    Jaybe Lazy Tongs
    7+ Year Member

    Joined:
    Nov 30, 2006
    Messages:
    404
    Likes Received:
    2
    Status:
    Resident [Any Field]
    I would rather send my gingivectomies to an oral surgeon. They are just better at everything surgical, from my experience.

    Although I doubt they want to spend much time doing gingevectomies, but too bad, I'm sending them anyway. . .
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  7. docj1

    docj1 Walleye Whacker
    2+ Year Member

    Joined:
    Jan 12, 2007
    Messages:
    191
    Likes Received:
    0
    Status:
    Dentist
    PPS from my understanding is essentially trimming/recontouring etc. I refer to OMFS for anything surgical that I don't feel comfortable doing. Nowadays referral to a periodontist is just an excuse for us GPs to not make a diagnosis. Sorry, I don't mean to piss anyone off, but once Implants became more predictable than bone grafts around a tooth with a "guarded" prognosis
    I just figured why put the patient through that. Give them the best option.

    WHY DID THE AAP PUT OUT GUIDLINES FOR REFERRAL?
     
  8. gryffindor

    Dentist 10+ Year Member

    Joined:
    Feb 2, 2002
    Messages:
    2,806
    Likes Received:
    72
    Status:
    Dentist
    I'm gonna bust out the laser and do it myself. :D Or do them old school with the electrosurge, same result.
     
  9. drhobie7

    10+ Year Member

    Joined:
    Jun 9, 2005
    Messages:
    1,367
    Likes Received:
    9
    Status:
    Resident [Any Field]
    An oral surgeon I know says he knows a periodontist who feels he should be able to take his own hip grafts. :eek:
     
  10. aphistis

    Moderator Emeritus 10+ Year Member

    Joined:
    Feb 15, 2003
    Messages:
    8,392
    Likes Received:
    35
    Status:
    Attending Physician, Dentist
    Find a patient you don't like and let him give it a try. Just make sure he root planes the donor site and stuffs it full of minocycline dust.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  11. drhobie7

    10+ Year Member

    Joined:
    Jun 9, 2005
    Messages:
    1,367
    Likes Received:
    9
    Status:
    Resident [Any Field]
    Dude. Seriously. A periodontist sat in on a bone grafting lecture, and afterward asked the lecturer some questions about grafting from the tibia, specifically "Do you put a membrane on it?" I really hope he isn't going to try this in his practice.
     
  12. Bifid Uvula

    Bifid Uvula My Superior Wang...
    5+ Year Member

    Joined:
    Aug 16, 2005
    Messages:
    461
    Likes Received:
    9
    Status:
    Resident [Any Field]
    Word has it that there are some periodontists who have received training to do Tib grafts. Recently a perio resident told me that he has an Perio-attending who received training to do the Tibial Bone Grafts by Marx, and that all the residents went and observed some tibial grafts in this guy's private office.

    Has Marx been doing this as a CE course for those interested in learning to do Tibial Bone Grafts?

    Very Scary... Next thing you know they will be doing Below The Knee Amputations too! (extending the diabetes/oral care link a bit further).
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  13. EuroOMFS

    7+ Year Member

    Joined:
    Sep 26, 2005
    Messages:
    140
    Likes Received:
    3
    Status:
    Attending Physician
    One of the attendings at a hospital I did a one year rotation at, went to Miami to learn to do tibial grafts by Marx. Had to cough up a lot of cash but he got a free book on PRP :smuggrin: Now, he's OMS, not Perio, but who knows who else is taking these courses.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  14. aphistis

    Moderator Emeritus 10+ Year Member

    Joined:
    Feb 15, 2003
    Messages:
    8,392
    Likes Received:
    35
    Status:
    Attending Physician, Dentist
    And they'll be running their own anesthesia while they do it. After all, they stayed at a Holiday Inn Express last night. :hardy:
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  15. REGENR8R

    REGENR8R Perio Resident
    2+ Year Member

    Joined:
    Mar 14, 2007
    Messages:
    28
    Likes Received:
    0
    Status:
    Resident [Any Field]
    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.
     
  16. scalpel2008

    scalpel2008 beep beep beep...smash
    2+ Year Member

    Joined:
    Apr 2, 2006
    Messages:
    573
    Likes Received:
    4
    Status:
    Resident [Any Field]
    I would like to make a couple of comments in response to this. What you describe as a "limited amount of bone" (30cc) is enough to perform bilateral sinus augmentations or fairly significant ridge augmentation. So it maybe limited for an atrophic ridge augmentation, but is more than sufficient for most implant surgery. Secondly, although cortical bone has more BMP, I can assure you that cancellous tibia also has osteoinductive properties as with most autogenous bone grafts. Finally, I can guarantee you that you can transfer more viable osteocytes doing a tibial bone graft than harvesting ramus and milling it. I think ramus grafts have a completely different application than tibia bone grafts i.e. they are best utilized as vertical or horizontal ridge augmentation in the form of block grafts. I just don't see how milled cortical bone can replace juicy cancellous bone grafts. If you want a small block graft to vertically or horizontally augment the ridge, take ramus or symphisis. If you want particulate to augment walled defects or for sinus augmentation, cancellous is better than milling cortical. In summary, milled cortical bone should not be used as a replacement for cancellous bone. And finally, you mentioned that tibial bone grafts have high morbidity? They don't.
     
  17. IcedOMFS

    IcedOMFS realultimatepower.net
    5+ Year Member

    Joined:
    Sep 7, 2006
    Messages:
    253
    Likes Received:
    2
    Status:
    Attending Physician

    Does this mean we have to take 3 hours to do something that should only take 30 minutes, and then overbill for it?

    Wow, that was short.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  18. REGENR8R

    REGENR8R Perio Resident
    2+ Year Member

    Joined:
    Mar 14, 2007
    Messages:
    28
    Likes Received:
    0
    Status:
    Resident [Any Field]
    You are correct that there is low morbidity with tibia grafts...what I meant was for what we are doing in a perio practice, that's a significant procedure that should be done in a main OR or under OPGA, and not in the perio environment with IV sedation and local, or even deeper MAC/Local for that matter. When I have a need for such a procedure in my practice, I work with my OMFS buddies, and have done so in the past.

    As far as I know the only site which has been shown to reliably be a source for osteoinductive autogenous bone is the iliac crest, especially in older adults. From what I have been taught (by both periodontists and OMFS mentors), it is doubtful that viable osteoblasts and osteocytes survive the transplant from anywhere other than iliac crest.

    As far as "osteoinductive," I use this term with caution b/c this indicates that the material will form bone in an orthotopic site (ie a muscle pouch), and the only materials which can do this are iliac crest cancellous, DFDBA, and rh-BMP's.

    I agree on the use of block grafts from intraoral sites. I do alot of these in my practice with good results. For the sinus I use allografts b/c many studies show that success rates are the same or even better with allografts vs particulate autografts. When I have a really atrophic ridge thats outside what I can achieve in my perio setting, I call in my OMFS friends.

    The point is that not all periodontists are "idiot cowboys" who don't know their limits. I have a great relationship with my OMFS's and do my bigger cases with them, and go to the OR with them about once every 3 months. We all need to know our limits to achieve the best results for our patients. There are things that OMFS's do very well, and things that periodontists do very well, and working together on some cases we can achieve some incredible results.
     
  19. toofache32

    15+ Year Member

    Joined:
    Apr 19, 2003
    Messages:
    3,873
    Likes Received:
    36
    Status:
    Resident [Any Field]
    [​IMG]
     
  20. north2southOMFS

    5+ Year Member

    Joined:
    Jul 14, 2004
    Messages:
    704
    Likes Received:
    3
    I don't quite agree with that. I think we were fully "innundated" with all the perio knowledge, diagnosis, and treatment we could possibly swallow in dental school. Then being "forced" to come up with perio surgeries for the perio department in order to graduate didn't make anyone happy either. But i gotta hand it to ya guys with this "referral guidelines" thing. Not only do most oral surgeons hate you guys for starting to take out 3rds, but with this guidelines thing you've managed to piss-off all the general dentists as well.
     
  21. Jaybe

    Jaybe Lazy Tongs
    7+ Year Member

    Joined:
    Nov 30, 2006
    Messages:
    404
    Likes Received:
    2
    Status:
    Resident [Any Field]
    Most perio residents are nerds. Or else foreign. Or both.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  22. IcedOMFS

    IcedOMFS realultimatepower.net
    5+ Year Member

    Joined:
    Sep 7, 2006
    Messages:
    253
    Likes Received:
    2
    Status:
    Attending Physician

    Maybe I am wrong, but I am pretty sure osteoblasts and osteocytes from Calvarium do pretty well, particularly when grafted to the bony jaws... But what do I know... I am not a perio plastic surgeon...

    To quote Bruce Willis, "Yippee Kai-Yay, mother-f$%@#rs."
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  23. docj1

    docj1 Walleye Whacker
    2+ Year Member

    Joined:
    Jan 12, 2007
    Messages:
    191
    Likes Received:
    0
    Status:
    Dentist
    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.

    I would have to disagree also. If you said that Ortho has done a piss poor job teaching dental students how to diagnose and treat, you'd be right on the money ( nothing bad against ortho, ortho's complicated and that's just how it is). I think perio does a great job teaching dentists how to diagnose and treat perio. Hopefully everyone who graduated in recent years educates their patients on prevention of periodontal disease. Saying that many GPs Ignore Perio disease is probably offensive to alot of them. Not to me because I only refer 1-2 perio cases to the periodontist per year, but I got excellent perio training in DS and have 2 great hygenists (they both used to work for Periodontists). Most of the perio cases that come into my office are mild to moderate. The cases I do refer are juvenile and rapidly progressive perio and severe perio when the patient wants to do anything to save their teeth. As far as the trend in the studies showing that now more than ever, patients with perio are not getting the treatment they need, I'd really appreciate if you could give me some studies to read, because where I practice all but the crustiest of GPs treat perio.
     
  24. REGENR8R

    REGENR8R Perio Resident
    2+ Year Member

    Joined:
    Mar 14, 2007
    Messages:
    28
    Likes Received:
    0
    Status:
    Resident [Any Field]

    Sure:

    Dockter KM, Relationship between prereferral periodontal care and periodontal status at time of referral. J Periodontol. 2006.

    Cobb CM, Periodontal referral patterns, 1980 versus 2000: a preliminary study. J Periodontol 2003.
     
  25. Bifid Uvula

    Bifid Uvula My Superior Wang...
    5+ Year Member

    Joined:
    Aug 16, 2005
    Messages:
    461
    Likes Received:
    9
    Status:
    Resident [Any Field]
    Ok, so I'm at a local GP's office yesterday waiting to go to lunch. While waiting for him in his private office, I could hear his conversation with some crusty old patient that came in for a consult after leaving the periodontist's office across the street. To make a long story short, she was praising the periodontist as a "surgeon" (over and over again... stopped counting after she said it 15 times) cause "not just anybody can cut into gums"...

    Mind you, I just watched the GP place an implant in #19 and before that do a set of impacted 3rds that would have made any of us OMFS'ers proud to watch.

    This whole marketing of "periodontal gingival plastic oral reconstructive surgery" has to stop...

    And one more thing the AAP's guidelines aren't even worthy enough to wipe my @$$ with.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  26. REGENR8R

    REGENR8R Perio Resident
    2+ Year Member

    Joined:
    Mar 14, 2007
    Messages:
    28
    Likes Received:
    0
    Status:
    Resident [Any Field]
    The reality is that the future of OMFS and Periodontics is not implants. The future is that everyone will place implants, GP's, Endo, etc, and the tough, pain in the ass cases that noone wants to do will go to Perio and OMFS...and as far as I'm concerned OMFS can have them.

    The future of perio is periodontal regeneration and treating peri-implant disease when all these implants are 50 years old with bone loss and infected rough surfaces. All the OMFS implant cases that go bad end up with the periodontist anyhow. Im not saying that OMFS aren't good at implant surgery, I just mean that the OMFS practice profile does not include long term followup of patients, which is what periodontist do very well.

    As for the guidelines, anyone who believes that they are crap needs to go back and read some literature on perio treatment, and learn a little about what perio is all about. The guidelines are based in scientific evidence and were written to ensure patients who have periodontal disease are not ignored and treated with scaling and arestin until their teeth fall out.

    Implants are not a crutch for inadequate periodontal therapy.
     
  27. Bifid Uvula

    Bifid Uvula My Superior Wang...
    5+ Year Member

    Joined:
    Aug 16, 2005
    Messages:
    461
    Likes Received:
    9
    Status:
    Resident [Any Field]
    I'll give you credit for one thing... from what I've seen the last 2 years, you seem to be the most "moderate" of periodontists posting on this site. Thank god there are some of you out there. Don't take my rantings about perio plastic surgery personal, as I do have a handful of periodontist friends that I believe are excellent clinicians. But I hate the idea of hijacking, and misrepresenting oneself as a surgeon or implant specialist.

    Anyway, with that said, I still say the AAP guidelines are crap. This is why the AGD is in litigation with the AAP over the guidelines, especially because ALL of the AGD recommendations were IGNORED and the AAP says in their guidelines that the AGD is endorsing them.

    Enough about periodontists... lets start bitching about something more important to OMFS (especially the single degree guys/gals). Lets bitch about the Dermatologists that have over-run the AACS.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  28. drhobie7

    10+ Year Member

    Joined:
    Jun 9, 2005
    Messages:
    1,367
    Likes Received:
    9
    Status:
    Resident [Any Field]
    Same here.
     
  29. REGENR8R

    REGENR8R Perio Resident
    2+ Year Member

    Joined:
    Mar 14, 2007
    Messages:
    28
    Likes Received:
    0
    Status:
    Resident [Any Field]
    I don't take it personally, and thanks for the compliment. Some of us are not ******s. Unfortunately alot of new dentists are attracted to perio now b/c they see it as an "implantology" specialty (which it isn't), and implants are very lucrative right now. I was a GP for 4 years before I started my residency, and I got into Perio b/c it was the part of my practice as a GP that I found the most rewarding. Yes I do lots of implants in my clinical practice, but it's treating perio disease that I really enjoy and it's where I feel like I help the patients the most.

    Actually some of my fellow perio residents were just in the OR today with OMFS, helping them with a case....doing some crown lengthening and connective tissue grafts while the OMFS's were doing some other stuff on an ASA 3 pt in prep for a full mouth rehab with Pros.

    As for the guidelines, well if we had enough time I think I could convince you. The AGD is stupid for picking a battle with the AAP, since the AGD has no evidence to back their claims....and I used to be an AGD member, it's a great organization, but they are choosing a stupid battle over this.

    I mean do they actually believe that AGD GP's can treat perio better than a board certified periodontist can? Geez, if I needed a CABG I would want a CT surgeon to care for me, not my family practice physician!! But the fact is that alot (not all, but alot) of GP's are ignoring perio, or treating it at an inadequate level b/c their hygiene department is a "profit center", rather than "patient centered".

    As an aside, the American Academy of Endodontists put out similar Guidelines 10 years ago. People got pissed. It blew over in a year or so, and life went on.

    As for the Dermatologists....sounds like the AACS needs some "guidelines" of their own to ensure there is a legal precident to ensure that patents get the high quality care they deserve.

    Ok, my rant is done.
     
  30. Doggie

    Doggie Professional Jackass
    10+ Year Member

    Joined:
    Mar 22, 2001
    Messages:
    1,057
    Likes Received:
    1
    I beg to differ. Almost all the bad implant cases regardless if placed by GP or Perio ends up being treated by OMFS. Even the bad omfs placed implants go to OMFS.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  31. REGENR8R

    REGENR8R Perio Resident
    2+ Year Member

    Joined:
    Mar 14, 2007
    Messages:
    28
    Likes Received:
    0
    Status:
    Resident [Any Field]
    I guess this varies depending on where you work. Where I'm at when OMFS has ailing or failing implants they often end up in perio for surgical detoxification of the exposed implant surfaces, GBR around the implants, and soft tissue grafting as needed, and then lifelong perio maintenance to manage the chronic peri-implantitis. Now if they're failed implants that put the case back at square one, then whoever started the case to begin with handles it.
     
  32. scalpel2008

    scalpel2008 beep beep beep...smash
    2+ Year Member

    Joined:
    Apr 2, 2006
    Messages:
    573
    Likes Received:
    4
    Status:
    Resident [Any Field]
    how much does the patient pay to treat the "failing" implant? (cost of all the procedures you mentioned)
     
  33. S Files

    S Files Member
    5+ Year Member

    Joined:
    Oct 23, 2005
    Messages:
    368
    Likes Received:
    1
    what is this "surgical detoxification" you speak of...sounds very impressive. reminds me of the new term for anterior crown lenghtening...."gum lifts"....seriously...i heard some perios use that term the other day.

    regen8 you do seem like a moderate...how do you feel about your colleagues who take out 3rds???
     
  34. north2southOMFS

    5+ Year Member

    Joined:
    Jul 14, 2004
    Messages:
    704
    Likes Received:
    3
    hahaahaah

    You just summed up in one sentence the entire reason they are so pissed. Maybe the general dentist doesnt want to waste thousand on hopeless teeth until they fall out? Maybe he knows if he sends these hopeless teeth to the periodontist they will show back up at his office with a mouthfull of implants instead? Don't lie. You know that will happen.
     
  35. Jaybe

    Jaybe Lazy Tongs
    7+ Year Member

    Joined:
    Nov 30, 2006
    Messages:
    404
    Likes Received:
    2
    Status:
    Resident [Any Field]
    So, would you oral surgeons be pissed if I sent my esthetic crown lengthening cases to you??? I would rather, if OMS would like to take it.

    Thoughts???
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  36. REGENR8R

    REGENR8R Perio Resident
    2+ Year Member

    Joined:
    Mar 14, 2007
    Messages:
    28
    Likes Received:
    0
    Status:
    Resident [Any Field]

    No nothing impressive....when rough surface implants (TPS, Osseotite, etc) get exposed to the oral environment due to peri-implantitis they get contaiminated by oral biofilms.
    The pore size of these surfaces is >2-3 microns, and since a bacteria is about 1 micron, you can figure out what happens.
    If they are not detoxified, GBR will not work (ie: Aint no bone gonna grow next to that implant). This is an evolving field, but right now I'm using the Cavi-Jet, TCN, and other things.

    I don't charge anything, but that's another story.....:)
     
  37. OP
    OP
    Dr. Dai Phan

    Dr. Dai Phan Senior Member
    Moderator Emeritus Lifetime Donor Verified Account 7+ Year Member

    Joined:
    Dec 20, 2005
    Messages:
    1,181
    Likes Received:
    153
    Status:
    Dentist
    I can see this thread taking a life of its own. It should be noted too that implants can fail not only from lack of osteointergration but wrong placement making restorations impossible. In my career so far, I have seen at least 6 cases where the implants placed by OS or perio people so out of whacks that I had to end up using custom made abutments to correct the angulation. It always bother me when the person who places the implants don't consult with the restorative dentists about the case.

    Regarding the PPS, although the procedure itself has merit to be called so, advertising yourself as such makes you more than what you are. It's embarrasing. Look on the Net and see how many periodontists call themselves as such. DP
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  38. rrc

    rrc Member
    5+ Year Member

    Joined:
    Nov 10, 2004
    Messages:
    128
    Likes Received:
    2
    Uh, isn't that why they make custom abutments? Would you rather use a custom abutment or make the patient have a bone graft and take on added expense, an additional surgery, and wait another 6 months prior to placement of the implant to get "perfect angulation."
     
  39. Bifid Uvula

    Bifid Uvula My Superior Wang...
    5+ Year Member

    Joined:
    Aug 16, 2005
    Messages:
    461
    Likes Received:
    9
    Status:
    Resident [Any Field]
    I know plenty of OMFS who do that. That's exactly the case from this morning where a patient was sent for sinus lift and implant on #13, and we also did a crown lengthening for 14,15 at the same time while the patient was under general anesthesia. Great service for the patient.

    You just need to ask your oral surgeon if they care to do these procedures. If they say yes, you've just added another referral option to your tx armamentarium.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  40. OP
    OP
    Dr. Dai Phan

    Dr. Dai Phan Senior Member
    Moderator Emeritus Lifetime Donor Verified Account 7+ Year Member

    Joined:
    Dec 20, 2005
    Messages:
    1,181
    Likes Received:
    153
    Status:
    Dentist
    No offense to OS but I have seen cases where the OS have complete disregard to the restorability of the case. I am talking way way off target. Don't tell me OS are experts in prosthetic reconstruction too. DP
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  41. REGENR8R

    REGENR8R Perio Resident
    2+ Year Member

    Joined:
    Mar 14, 2007
    Messages:
    28
    Likes Received:
    0
    Status:
    Resident [Any Field]
    You can't make blanket generalizations about all periodontists and all oral and maxillofacial surgeons just b/c a couple dirtbags managed some of your cases. There are competent and incompetent practitioners in all fields.

    No dental implant surgeon (Perio or OMFS) is an expert in prosthetic reconstruction!!!! The expert is the prosthodontist / restorative dentist and they should drive the case. A surgeon cannot give you what you want if you don't tell them. If you tell them and they don't listen, well it's time to find a different surgeon to do your cases.

    No patient comes to my practice for an "implant"....they come for the crown or bridge or denture that goes onto that implant(s)!!!!! So the prosthetic drive of the case makes the most sense to me!!!!

    The key is for you to find those that you work well with, stick with them, develop a relationship, and get some great results together.

    Control of all the variables in a big case is sometimes not possible, and occastionally even the best practitioner will have a poor outcome.....if you never do, then you're not doing enough cases.

    As for your earlier comments about the "perio plastic surgery" procedures, I agree....the periodontists you are talking about are misusing this term.

    PPS is a term for several procedures that periodontists do to improve soft tissue esthetics.....these are PROCEDURES, they are not a practice model and any periodontist who goes around calling himself a "perio plastic surgeon" needs to reevaluate things and get back on track.

    The term Perio Plastic Surgery is a very accurate description of what these procedures are, but to call yourself a perio plastic surgeon...well that's just stupid.....at least in the opinion of yours truly....and I think the AAP code of ethics would agree.
     
  42. OP
    OP
    Dr. Dai Phan

    Dr. Dai Phan Senior Member
    Moderator Emeritus Lifetime Donor Verified Account 7+ Year Member

    Joined:
    Dec 20, 2005
    Messages:
    1,181
    Likes Received:
    153
    Status:
    Dentist
    I totally agree with you here. Those who put implants where they feel like it is a very small group and certainly does not represent the practice of OS/perio. Anyone who sends a patient to an OS or perio to put in implants without a properly made stent is downright negligence. Unless the case is really simple, putting in implants without a guide or without asking the restorative dentist for one is too down right dumb. I can't tell you how many times I scratch my head trying to solve misplaced implants. Placing implants is easy if you choose the case correctly and knowing your anatomy. People who have problems with implants failing or perforating or aborting the procedure after realizing inadequate bone are the ones who do not choose the case wisely.

    Regarding the periodontists who advertise themselves as "Periodontal Plastic Surgeon" well... I think it's a bit much with all respect to periodontists. Is there a need to elevate themselves more than just a periodontist? Does AAP have any problems with the American Academy of Periodontal Plastic Surgeons for its title? DP
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  43. S Files

    S Files Member
    5+ Year Member

    Joined:
    Oct 23, 2005
    Messages:
    368
    Likes Received:
    1
    so again how do you feel about your colleagues (and some perio programs) taking out 3rds???
     
  44. REGENR8R

    REGENR8R Perio Resident
    2+ Year Member

    Joined:
    Mar 14, 2007
    Messages:
    28
    Likes Received:
    0
    Status:
    Resident [Any Field]
    Well I took out tons of impacted 3rds in my AEGD and during my years as a GP, but I was in a unique practice setting.

    Right now I don't do 3rd's b/c I have a good relationship with my OMFS and he's right down the hall.

    But, I think removal if 3rd molars is appropriate for a periodontist to do.....IF the extraction is done in conjunction with periodontal therapy in progress. Ie: An impacted 3rd molar in a quadrant undergoing an APF and Osseous resective surgery for the treatment of advanced periodontal disease where the periodontal treatment outcome would be improved by removal of the 3rd molar at the time of surgery....rather than subjecting the patient to multiple surgical events in both the perio and OMFS office.

    If you are just taking them out in periodontally healthy patients then I would say refer these to an OMFS. Periodontists should not be trying to "take over" the routine extraction of 3rd molars from the OMFS community....and I don't see why we would need/want to....there's tons of periodontal disease out there to keep us busy....if we can just get the GP's to improve their ability to identify it, realize the limits of non-surgical therapy and arestin, and refer the cases for optimal treatment in a perio office.

    But that's just my opinion.
     
  45. OMFSdoc

    OMFSdoc Member
    5+ Year Member

    Joined:
    Jan 1, 2005
    Messages:
    173
    Likes Received:
    1
    I still don't get it. The periodontium is the supporting structure of teeth. Why would periodontists want to do extractions, implants and other procedures not related to the periodontium? Why don't you just become an OMFS if you want to practice a broader scope? And don't say because I don't want to do the long labor intensive residency, that's just laziness. I am sick of people wanting to broaden their scope and not put the energy into learning how to properly do it.
     
  46. REGENR8R

    REGENR8R Perio Resident
    2+ Year Member

    Joined:
    Mar 14, 2007
    Messages:
    28
    Likes Received:
    0
    Status:
    Resident [Any Field]
    That's a good argument, but I want to know why would an OMFS go to 4-6 years of residency to extract teeth and put in single tooth implants??? That's a waste of all that training. It's like a Prosthodontist who only does single unit crowns and 3 unit bridges.

    If you are going to get all that training, then use it to do head and neck cancer surgery, trauma reconstruction, cleft repair, orthognathic, facial plastics, and others. I'm not saying you should not do dentoalveolar surgery, but why go to all that training, then spend your entire career only using 5% of it????

    If extractions have a periodontal component then it's appropriate for a periodontist to do them. As I said above, I don't advocate periodontists advertising themselves as exodontists for non-periodontally or non-implant related extractions. However I feel very competent handling most extractions, the majority of which (in my practice) are done in conjunction with implant-related site preservation bone grafting, GBR, or immediate implants....which is perfectly appropriate for a periodontist.
     
  47. REGENR8R

    REGENR8R Perio Resident
    2+ Year Member

    Joined:
    Mar 14, 2007
    Messages:
    28
    Likes Received:
    0
    Status:
    Resident [Any Field]
  48. Supersonic

    Supersonic Junior Member
    10+ Year Member

    Joined:
    Feb 26, 2003
    Messages:
    28
    Likes Received:
    0
    An OMFS does single tooth implants after 4 years of training for the same reason a perio does single tooth implants after 3 years of training in GTR, palatal grafts, scraping roots, etc --> to pay the bills.

    Dentoalveolar surgery is a large component of OMFS training. Probably 10-20% of the time, if not more, spent in residency is on dentoalveolar. How much of it in perio residency?

    You say if there is a periodontal component to extractions, its appropriate for periodontists to do them. Then why don't endodontists extract teeth when there is a pulpal component to them that warrants extraction...
     
  49. Jaybe

    Jaybe Lazy Tongs
    7+ Year Member

    Joined:
    Nov 30, 2006
    Messages:
    404
    Likes Received:
    2
    Status:
    Resident [Any Field]
    Brilliant!!!

    A truly elegant statement demonstrating the absurdity of extractions under the ruse of "Periodontics".

    Perios probably won't see the point, though. . .
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  50. REGENR8R

    REGENR8R Perio Resident
    2+ Year Member

    Joined:
    Mar 14, 2007
    Messages:
    28
    Likes Received:
    0
    Status:
    Resident [Any Field]

    At least 10 percent of our time is spent on "dentoalveolar surgery" (as defined by tooth extractions), mostly implant site preparation related....few 3rd molars only if there is a perio component as part of the treatment goal.

    Again, it's not my goal to be an exodontist, but tooth extraction is a vital part of a full scope of practice for a periodontist, especially in both our advanced periodontitis patients and implant patients.

    In my practice all non-periodontal and non-implant related extractions go to OMFS. (IE impacted 3rds, Mx premolars for ortho, etc).

    As far as endodontists doing extractions, well just wait, it will come soon as they start doing more implants. The endo residents where I work have about as much surgical skill as a hygienist. It should be interesting!!
     
Thread Status:
Not open for further replies.

Share This Page