periodontal plastic surgery ?????

[MAXFAC]

You guys are so misinformed it makes me laugh! If you think all Perio's do is crown lengthening, you need some help! Have you heard of GTR, GBR, sinus lifts, block grafts, ridge expansion, SECTG's - there is allot more learning in those 3 years than you think. To address the comment of GP's doing perio, I should hope a GP can crown lengthen a tooth, just like I hope they can do RCT's, exo teeth, etc!!!!! If you were having pre-pros surg for a full mouth rehab who would you want handling the ST and OMFS or a Perio - myself and 90% of dentists would choose the later!

I don't think dentists would prefer sending,sinus lifts, block grafts, ridge expansion to periodontist, especially if the same procedure that I can do in half hour, takes the periodontist five hours to do, and that my friend violates one of the vey simple surgical principles, tissue management, the longer you push, pull, retract, the more likely you compromise tissue health and blood supply, the more swelling, pain and the longer healing period.
And that's why the king of ST management is an OMFS Anthony Sclar not a periodontist.

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[UTDental]

What's all this business about oral surgeons being faster than periodontists? I've shadowed both and I don't see any differences.

I don't think dentists would prefer sending,sinus lifts, block grafts, ridge expansion to periodontist, especially if the same procedure that I can do in half hour, takes the periodontist five hours to do, and that my friend violates one of the vey simple surgical principles, tissue management, the longer you push, pull, retract, the more likely you compromise tissue health and blood supply, the more swelling, pain and the longer healing period.
And that's why the king of ST management is an OMFS Anthony Sclar not a periodontist.

 

[germ]

Last edited by ItsGavinC

ROFL Ah c'mon. You took out the punch. You had to have chuckled a little bit.

I guess I should add something to the debate. I think if you were getting "gum" surgery for esthetics you would definitely go to a periodontist. However PerioDs concentrate on gum disease Right?

OMFS pull wisdom teeth. I don't think you can just say Hey I can do that and do it because it is in the realm of your capabilities. You still need to formally or informally pursue the knowledge to do that procedure. Dentist are doing that all the time. They want to add to the scope of there practice so they take courses or seminars for certification.

Anyway, this thread is weak. For most OMFS , PerioDs, and Dentists in general this BS issue isn't even on the radar screen.

 

[UTDental]

amen. finally someone with a brain.

 

[north2southOMFS]

Did she have a harpoon stuck in her side?

Ouch, that hurts.

 

[ip]

As north2southOMFS wrote here on 10/21/04: "Gingiva heals pink, period".

I love this debate. What's hysterical is the reaction of OMS docs who graduate and realize that while they have great all around skills and are very well-trained for the most part, the perios get ALL the high-end cases.

It's understandable that the perio gets it because while the OMS resident is in the OR fixing a fx mandible, the perio residents are in tx planning seminars WITH prosth residents. Who do you think the prosth residents will go to after the graduate?

As long as guys keep up with comments like those in this thread and the one I quoted, perios will be very rich. Just ask the the oral surgeons who I helped teach implants to today.

 

[Drtrigeminal]

OUCH, that hurts even more!!! Time is well spent with gp's and pros and as a result I'll take the referals from them anyday instead of brushing them over thinking I'm a surgery GOD or should I say OMFS!!

 

[gumgardener2009]

As north2southOMFS wrote here on 10/21/04: "Gingiva heals pink, period".

I love this debate. What's hysterical is the reaction of OMS docs who graduate and realize that while they have great all around skills and are very well-trained for the most part, the perios get ALL the high-end cases.

It's understandable that the perio gets it because while the OMS resident is in the OR fixing a fx mandible, the perio residents are in tx planning seminars WITH prosth residents. Who do you think the prosth residents will go to after the graduate?

As long as guys keep up with comments like those in this thread and the one I quoted, perios will be very rich. Just ask the the oral surgeons who I helped teach implants to today.

There are differents shades of pink and if the graft is in the aesthetic zone then it will show.
Someday when these OMS residents get out into private practice, they will learn that they can't treat their patients and referring doctors the way they currently do. At our school, it is quicker to get your patient into perio for an extraction than into OMS. Once the patient is back in OMS, the resident dumps in a carpule of local and yanks it out quickly with no concern for preserving bone for restorative/implant purposes. Yes the perio residents take longer with the patients in the chair, because they see that tooth as a future implant site (and the patient gets the extraction done 3 weeks sooner than in OMS, to boot).
When these future oral surgeons get tired of patients being referred to periodontists instead of to themselves, they'll pay attention to those mailers talking about "periodontal plastic surgery". Anecdotally, a family member, who is an OMS and cares about the cosmetic results of his work, sees an increase in referrals for implants. It's good business to do good work for your referring doctors even if the patient doesn't recognize good work.

 

[tx oms]

(and the patient gets the extraction done 3 weeks sooner than in OMS, to boot).

Generally, the best docs have the longest wait.

 

[tjb]

At our school, it is quicker to get your patient into perio for an extraction than into OMS.(and the patient gets the extraction done 3 weeks sooner than in OMS, to boot).

It's like that at most schools because there is nothing going on in the perio departments. Step into the perio dept and it's deserted.

 

[UTDental]

Most schools are extraction mills so it's understandable why OS would be booked.

 

[north2southOMFS]

It's like that at most schools because there is nothing going on in the perio departments. Step into the perio dept and it's deserted.

LOL!

 

[omfsapplicant]

First off, perio has no business extracting teeth. It is not in their scope of practice. Secondly, when they do, what they don't realize is that the longer it takes, the more damaging it is for the tissue.

 

[Drtrigeminal]

First off, perio has no business extracting teeth. It is not in their scope of practice. Secondly, when they do, what they don't realize is that the longer it takes, the more damaging it is for the tissue.

It scares me to death that one day you may be an Oral Surgeon because you have no clue! Have you heard of the 'BUCCLE PLATE', it takes allot longer to exo a tooth a maintain the osseous architecture which is essential for osteointegration of implants! Have you heard of periotomes, they are pointy little instruments used to expand the socket and exo teeth without damage to bone. I think you better learn a little more before making unjustified comments like above!!!

 

[toofache32]

...you have no clue....Have you heard of the 'BUCCLE PLATE'...

oh the irony....

 

[ip]

First off, perio has no business extracting teeth. It is not in their scope of practice. Secondly, when they do, what they don't realize is that the longer it takes, the more damaging it is for the tissue.

I'll agree to this wrt 3rd molars. But it's amusing that you don't see the double standard you (or others in the thread) have. Taking a ramus graft is within the scope of perio but doing basically the exact same procedure in order to section & remove a tooth is not.

However according to you all, because an OS learns vessel anastomoses (which perios usually learn also BTW), crown lengthening and CT/FG grafts are within their scope. I'm not sure if it's just keyboard courage or incredible ignorance at play. Do you not see the double standard?

I feel bad for any patient whose doc thinks that because a procedure is less invasive than what he is used to doing, it's therefore a breeze to do. Less invasive usually goes hand-in-hand with being very technique sensitive.

 

[MAXFAC]

I'll agree to this wrt 3rd molars. But it's amusing that you don't see the double standard you (or others in the thread) have. Taking a ramus graft is within the scope of perio but doing basically the exact same procedure in order to section & remove a tooth is not.

However according to you all, because an OS learns vessel anastomoses (which perios usually learn also BTW), crown lengthening and CT/FG grafts are within their scope. I'm not sure if it's just keyboard courage or incredible ignorance at play. Do you not see the double standard?

I feel bad for any patient whose doc thinks that because a procedure is less invasive than what he is used to doing, it's therefore a breeze to do. Less invasive usually goes hand-in-hand with being very technique sensitive.

Who said chin and ramus grafts are within the scope of perio, perio started doing these procedures because of the fact that if perio refers these cases to an oral surgeon there is a chance of losing the patient to the oral surgeon, because if I'm gonna graft it I might as well place the implant, same story with extractions.
In my opinion any body can do the procedure if you are well trained in performing it.
Don't tell me that BS of perio are more careful than OMFS when it comes to ST esthetics, since that's a generalization and again it all depends on your training, it all comes down to patience and attention to details.
I can show you implants cases in the esthetic zone placed by OMFS and ones placed by perio and you can compare.
In my program we highly concentrate on implants, first year residents place at least 40 implants in their first year, you can compare to other programs where they can't reach this number through the whole training period whether it is OMFS or perio.
Regarding wisdom teeth, it's a different story since it takes only one case of paresthesia or fracture to shut down a periodontist practice, cause any rookie lawyer can win such case especially when they ask for a disposition from an expert,who in most of the time is an ORAL SURGEON.

 

[north2southOMFS]

Have you heard of the 'BUCCLE PLATE', ........... I think you better learn a little more before making unjustified comments like above!!!

HAHAHAHAHA!

 

[north2southOMFS]

However according to you all, because an OS learns vessel anastomoses (which perios usually learn also BTW), ............

HAHAHA, vessel anastamosis for a perio.

I think our program and maryland and oregon may be the only OMFS programs in the country that do free vascular tissue transfer.

Its nice to hear your perio program does it also.



This thread is so F$#%'ing funny its incredible. I would say about 10-15% of what is written in this thread is actual reality. (for both specialties) Its become a great pi$$ing contest though! Keep posting its fun to read.

 

[toofache32]

First off, perio has no business extracting teeth. It is not in their scope of practice.

Huh? Anyone with a dental degree can extract teeth. General dentists do this routinely, and this is the most basic and primitive procedure we do as dentists.

 

[toofache32]

I think our program and maryland and oregon may be the only OMFS programs in the country that do free vascular tissue transfer.

And probably Michigan (since they have a cancer fellowship) and Mayo (last year's Dierks/Potter Fellow is on faculty now), and maybe UMKC with Remy Blanchaert (from Maryland).

Does New Orleans not do cancer and their own free flaps? What about the Wilks guy?

Does Marx in Miami do free flaps?

 

[ip]

HAHAHA, vessel anastamosis for a perio.

I think our program and maryland and oregon may be the only OMFS programs in the country that do free vascular tissue transfer.

Its nice to hear your perio program does it also.

Didn't say that we do them. But we do learn vessel/nerve anastomoses as a skill. If we are doing surgery, it's nice to at least have the knowledge to fix a slip of the blade. I think overall perio got a bad rap from OS because of "old school" programs that would refer their emergencies to OS. Utterly ridiculous IMO. You should not be doing something if you don't know how to deal with the complications. FWIW, we refer only as a last resort and I haven't seen it done yet, including for infected sinus grafts. I think that things are changing as perio develops into "oral surgeons", minus the 3rd molars. Not much need for classic perio procedures when an implant (with or w/o ridge augmentation) has a better prognosis.

 

[omfsapplicant]

Huh? Anyone with a dental degree can extract teeth. General dentists do this routinely, and this is the most basic and primitive procedure we do as dentists.

true general dentist can practice the full scope of dentistry, buy once you specialize, you effectively limit your scope

 

[gumgardener2009]

Who said chin and ramus grafts are within the scope of perio, perio started doing these procedures because of the fact that if perio refers these cases to an oral surgeon there is a chance of losing the patient to the oral surgeon, because if I'm gonna graft it I might as well place the implant, same story with extractions.
In my opinion any body can do the procedure if you are well trained in performing it.
Don't tell me that BS of perio are more careful than OMFS when it comes to ST esthetics, since that's a generalization and again it all depends on your training, it all comes down to patience and attention to details.
I can show you implants cases in the esthetic zone placed by OMFS and ones placed by perio and you can compare.

And that's the crux of this whole argument. This is a turf war and nobody wants to admit that any of these procedures can be done by anyone with the training. The only way one group can win the argument is to prove that the other is not properly trained. It can't be done so we go around in circles--OMS residents saying perio isn't trained to do extractions etc. and perio residents saying OMS doesn't train you for esthetic results with ST. I agree that esthetics all comes down to patience and attention to details. And I agree that many practicing oral surgeons do pay attention to esthetics. But I don't think many of the OMS posters on this site have yet woken up to the importance of esthetics.

 

[omfsapplicant]

Didn't say that we do them. But we do learn vessel/nerve anastomoses as a skill. If we are doing surgery, it's nice to at least have the knowledge to fix a slip of the blade.

I think overall perio got a bad rap from OS because of "old school" programs that would refer their emergencies to OS. Utterly ridiculous IMO. You should not be doing something if you don't know how to deal with the complications. FWIW, we refer only as a last resort and I haven't seen it done yet, including for infected sinus grafts. I think that things are changing as perio develops into "oral surgeons", minus the 3rd molars. Not much need for classic perio procedures when an implant (with or w/o ridge augmentation) has a better prognosis.

If your are not doing them, then you should not be attempting them on pts. Any idiot can read-up on a procedure. From what I see perio has all the time in the world to read-up on procedures

perio can not develope into oral surgeons when they are not surgeons in the first place. Stick to S+RP.

 

[tx oms]

Drtrigeminal, have you heard of periotomes? They are pointy little instruments used by dental supply companies to take money from foolish periodontists who think their extractions don't "damage" the bone.

 

[ip]

If your are not doing them, then you should not be attempting them on pts. Any idiot can read-up on a procedure. From what I see perio has all the time in the world to read-up on procedures

perio can not develope into oral surgeons when they are not surgeons in the first place. Stick to S+RP.

Excellent points!

I have a feeling that you're going to make a lots of friends in your area. Good thing your livelihood is referral-based.

 

[GQ1]

this is like when perio get pissy when anyone else tries to place implants. its only because they took half their procedures from other specialties as they are now less interested in tx teeth.

heres the news
omfs place implants - theyre the true surgeons
prosthodontists place them - its a prosthodontic discipline - they know where the end result is heading best,

hell even gps and endo place them

youll notice the more experienced periodontists advertise their practices as periodontics and oral implantology.

-impant placement isnt a a part of perio its a part of many specialties

 

[ip]

Drtrigeminal, have you heard of periotomes? They are pointy little instruments used by dental supply companies to take money from foolish periodontists and Anthony Sclar (the most esthetically-oriented OMS because he pays attention to perio principles) who think their extractions don't "damage" the bone.

I fixed that for you.

 

[north2southOMFS]

I think that things are changing as perio develops into "oral surgeons", minus the 3rd molars. Not much need for classic perio procedures when an implant (with or w/o ridge augmentation) has a better prognosis.

So why go to perio school?

Just do OS.

 

[ip]

So why go to perio school?

Just do OS.

There is no OS. I'm not really interested in going through maxillofacial training when what I want is dento-alveolar surgery focusing on implants. From the OS and perio depts that I've had close contact with, perio has shown more of what I want. And yes, more esthetics. Of course, there's more crap work (sc/rp) but you deal with it for a bit.

 

[northcity]

hell i have ligated vessels in my senior year, you dont have to be a omfs or a perio to do this. Second whoever says perio are not surgeons maybe has never been to dental school, since that is about 90% of what we do. Hygenists take care of the rest. Im in a perio progam, and alot of my buddies are 6 yr omfs residents. We never have these pissing matches. Omfs are surgeons in all meanings of the word (OR privleges, reconstructive, orthognathics, etcc...)Periodontists are surgeons as well, sh**t our best friend is the 12 and 15 blade. We both have our place in dentistry, bragging rights are irrevelant, Perio will do what they have learned, omfs will do what they have learned, in all reality we are at the hands of the general dentist, from then on most of the personality seals the deal.

If your are not doing them, then you should not be attempting them on pts. Any idiot can read-up on a procedure. From what I see perio has all the time in the world to read-up on procedures

perio can not develope into oral surgeons when they are not surgeons in the first place. Stick to S+RP.

 

[tx oms]

Drtrigeminal, have you heard of periotomes? They are pointy little instruments used by dental supply companies to take money from foolish periodontists and Anthony Sclar (an oral surgeon who makes money on promoting such things to periodontists) who think their extractions don't "damage" the bone.

There, I helped you fix it correctly.

Man, if I'd only know Anthony Sclar used them...I mean, damn. Of course I can name at least 12 oral surgeons I know that don't use them. If we're name dropping to win arguements, I win.

 

[ip]

There, I helped you fix it correctly.

Man, if I'd only know Anthony Sclar used them...I mean, damn. Of course I can name at least 12 oral surgeons I know that don't use them. If we're name dropping to win arguements, I win.

But this is what you don't get. He is the one that lectures internationally on hard/soft tissue esthetics related to implants. Not those 12 other guys.

 

[excite4]

But this is what you don't get. He is the one that lectures internationally on hard/soft tissue esthetics related to implants. Not those 12 other guys.

I have a really quick question and I am not sure it even applies to this thread so sorry if it doesn't. Do oral surgeons, periodontists, general dentists, or all of the above work with dental implants? Is there special training associated with them and who receives it?

Thanks

 

[KY2007]

First off, perio has no business extracting teeth. It is not in their scope of practice. Secondly, when they do, what they don't realize is that the longer it takes, the more damaging it is for the tissue.

Its interesting that you say this because extracting 3rds is within the scope of even a general dentist. Not just simple extractions either but also partial or full bony impactions. If your school doesn't teach you this then I would ask for your money back. Many but not all general dentists refer these procedures either because they just don't like to do them or some may not feel comfortable with the added risks that come along with these procedures (perforation of the sinus). If a general dentist can do it, how is it out of the scope of practice of a periodontist.

 

[kato999]

Its interesting that you say this because extracting 3rds is within the scope of even a general dentist. Not just simple extractions either but also partial or full bony impactions. If your school doesn't teach you this then I would ask for your money back. Many but not all general dentists refer these procedures either because they just don't like to do them or some may not feel comfortable with the added risks that come along with these procedures (perforation of the sinus). If a general dentist can do it, how is it out of the scope of practice of a periodontist.

Just because something is within the scope of general dentistry does not mean is within the scope of a specialty. Obviously you wouldn't go to an orthodontist to get a crown. As a matter of fact I believe that is illegal. Specialists agree to only perform procedures in their specialty.

That being said, I do not know if extractions are considered in the realm of periodontics. Our perio instructor never mentioned anything about extractions. We got all that from OMFS instructors. Personally I would have no problems having a simple extraction done during a perio visit if necessary though.

 

[ItsGavinC]

Obviously you wouldn't go to an orthodontist to get a crown. As a matter of fact I believe that is illegal. Specialists agree to only perform procedures in their specialty.

Ethically illegal, according to the ADA Code of Ethical Conduct, but not in violation of any laws (since specialists do hold a dental degree and license).

 

[northcity]

Ext's are easily in the realm of perio, my general dentist sends premolars forward to a periodontist and the rest to oral surgeons, same with ortho's.

Just because something is within the scope of general dentistry does not mean is within the scope of a specialty. Obviously you wouldn't go to an orthodontist to get a crown. As a matter of fact I believe that is illegal. Specialists agree to only perform procedures in their specialty.

That being said, I do not know if extractions are considered in the realm of periodontics. Our perio instructor never mentioned anything about extractions. We got all that from OMFS instructors. Personally I would have no problems having a simple extraction done during a perio visit if necessary though.

 

[UTDental]

I have a really quick question and I am not sure it even applies to this thread so sorry if it doesn't. Do oral surgeons, periodontists, general dentists, or all of the above work with dental implants? Is there special training associated with them and who receives it?

Thanks

Gerneral dentists, periodontists, oral surgeons, prosthodontists and even endodontists place implants. It is usually part of the perio and OS grad curriculum (don't know about the other specialties). General dentists can take courses while in dental school (if offered) or CE courses to learn to place them.

 

[omfsapplicant]

quick question for the perio dents out there. Why silk, and why so manying sutres placed?

 

[GQ1]

Gerneral dentists, periodontists, oral surgeons, prosthodontists and even endodontists place implants. It is usually part of the perio and OS grad curriculum (don't know about the other specialties). General dentists can take courses while in dental school (if offered) or CE courses to learn to place them.

implant placement is now compulsory in all prsotho programs for them to be ada accredited i believe its also in the endo curriculum, they dont just belong to one specialty. ortho can place the onplant and mini screws.

 

[gumgardener2009]

When these future oral surgeons get tired of patients being referred to periodontists instead of to themselves, they'll pay attention to those mailers talking about "periodontal plastic surgery". Anecdotally, a family member, who is an OMS and cares about the cosmetic results of his work, sees an increase in referrals for implants. It's good business to do good work for your referring doctors even if the patient doesn't recognize good work.

Spoke to that OMS in the family today. Says that he has good working relationship with periodontist in town. Admits that he has taken some perio CE while the perio friend has taken OMS CE. He says that OMS is as guilty of treading on plastic surgeons' turf as perio is of stepping into OMS's turf. But you know what? He doesn't care because THERE'S ENOUGH TO GO AROUND FOR EVERYBODY.