Periodontist vs. OMFS

[mmpatel0]

Hi Guys,

I know this topic may have been beaten down to death but I am still curious about what I am supposed to pursue.

I have few questions,

First of all, I am Indian Canadian in US dental school and thus plan to apply for post-doctoral program in US

Is it worth a shot for me to try for OMFS? I did hear that it is very difficult for non-US citizens to get into OMFS program.

Now, comparing apple to orange.

Periodontist vs. OMFS

Who makes more money? And is it worth studying 6 years for OMFS?

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[mike3kgt]

Hi Guys,

I know this topic may have been beaten down to death but I am still curious about what I am supposed to pursue.

I have few questions,

First of all, I am Indian Canadian in US dental school and thus plan to apply for post-doctoral program in US

Is it worth a shot for me to try for OMFS? I did hear that it is very difficult for non-US citizens to get into OMFS program.

Now, comparing apple to orange.

Periodontist vs. OMFS

Who makes more money? And is it worth studying 6 years for OMFS?

 

[4bq]

do perio. the only real plastic surgeons of mouth.

 

[Blue Moose]

Hi Guys,



Periodontist vs. OMFS

Who makes more money? And is it worth studying 6 years for OMFS?

Sounds like you only care about the money.

 

[wigglytooth]

You are probably not going to get very many productive responses from how you poised your questions and especially on this message board. The two are related surgical specialities with slightly different angles. Think about the procedures you want to do and practice philosophies you want to follow and then decide for yourself what is worth spending the next X years studying. Both fields can be financially rewarding, so you need to see what fits for you.

 

[live]

"The two are related surgical specialities with slightly different angles." This is not even close... you clearly missed the boat.

OP... OMFS and Perio are very different. If all you care about is money and a little surgery do endo or something. Perio is basic surgical procedures (Ext's that take way too long, minor bone grafts, implants, and oh yea some of them also do what perio was invented for... and that's treating periodontal disease). OMFS is the "surgical arm" of dentistry, read about the specialty on the ADA if you don't believe me. If you are genuinely interested in both outpatient and inpatient oral and "maxillofacial" surgery then you should be interested in at least several of these: trauma, orthog surgery, TMJ surgery, craniofacial surgery (CL/CP), anesthesia expert, dentoalveolar expert, implants, minor and major bone grafts (not just allografts either), cosmetic surgery, head and neck pathology (both benign and malignant), etc..... The list could go on. The choice is yours, but it sounds like perio would be more your style.

Surely "wigglytooth" will go back on her statement that the 2 fields are only "slightly" different. If not, please explain how they are even close to being the same thing wigglytooth?

Also, for those reading, wigglytooth is interested in applying for perio. Isn't it funny how yall perio folks are always try to blur the line b/w OMFS and perio when it's clearly distinct. OMFS wanna-be's

 

[Blue Moose]

"The two are related surgical specialities with slightly different angles." This is not even close... you clearly missed the boat.

OP... OMFS and Perio are very different. If all you care about is money and a little surgery do endo or something. Perio is basic surgical procedures (Ext's that take way too long, minor bone grafts, implants, and oh yea some of them also do what perio was invented for... and that's treating periodontal disease). OMFS is the "surgical arm" of dentistry, read about the specialty on the ADA if you don't believe me. If you are genuinely interested in both outpatient and inpatient oral and "maxillofacial" surgery then you should be interested in at least several of these: trauma, orthog surgery, TMJ surgery, craniofacial surgery (CL/CP), anesthesia expert, dentoalveolar expert, implants, minor and major bone grafts (not just allografts either), cosmetic surgery, head and neck pathology (both benign and malignant), etc..... The list could go on. The choice is yours, but it sounds like perio would be more your style.

Surely "wigglytooth" will go back on her statement that the 2 fields are only "slightly" different. If not, please explain how they are even close to being the same thing wigglytooth?

Also, for those reading, wigglytooth is interested in applying for perio. Isn't it funny how yall perio folks are always try to blur the line b/w OMFS and perio when it's clearly distinct. OMFS wanna-be's

Previous Statement by someone who has no experience in either field.

"Perio is basic surgical procedures." - I would like to know your definition of basic. I wouldn't consider any surgical procedure basic.

"Extractions that take way too long" - if by this statement you mean that periodontists actually take their time extracting teeth so that the alveolar bone is preserved, then yes periodontists do this. They don't drill away an inordinate amount of bone just to get the tooth out quickly, this is what oral surgeons typically do.

"Minor bone grafts" - Yes periodontists do bone grafting with particulate allograft. Perio also uses allograft block grafts, ramus grafts, and chin grafts, however the latter two are less common and unnecessary with the high success rate of allograft block and particulate materials. Autogenous block grafts are not necessary in majority of cases. Periodontists also routinely perform sinus lifts which is commonly needed with maxillary implant placement.

"Implants" - Periodontists place a lot of implants. How many oral surgeons do you know that will treat periodontal disease before placing an implant? none. (the literature has shown that periodontal disease does decrease the success rate of dental implants. IJOMI 2009; 24(suppl):39-68.) How many Oral surgeons will lay a flap and scale subgingival calculus in the area if present before placing the implant? none. Unfortunately they place implants in anyone, and don't follow them up. This is why periodontists are stuck fixing their peri-implantitis cases.

"treating periodontal disease" - yes as stated before, periodontists treat periodontal disease because they are trained to preserve the hard and soft tissues of the mouth. To retain teeth that are compromised through resective or regenerative therapy and not just to extract teeth and place implants, which is unfortunately all to common with most OMFS.

Periodontists are dentists. They think like a dentist. When they do surgery (extraction or implant) they perform it with the final restoration in mind. Communicating with the GP for desired restorative outcome. Taking a little extra time by thinking in millimeters or 1/2 millimeters (instead of thinking in centimeters like oral surgeons).

Oral surgeons that work in the hospital setting will perform "trauma, orthog surgery, TMJ surgery, craniofacial surgery (CL/CP)". These procedures are much less common in private practice however. OMFS make much more money working in private practice extracting third molars and less invasive surgeries. Some will keep hospital privaledges to perform larger procedures a couple days a month. Working in a hospital full time would mean being an employee of the hospital, good luck with that. Thats one big reason I became a dentist is to avoid that.

"anesthesia expert" - Not quite an expert. Familiar with general anesthesia yes. But by no means the equivalent of an anesthesiologist

"dentoalveolar expert" - i would say this is a generic phrase, i would say the field of dentistry is to become a "dentoalveolar expert".

"major bone grafts" - unless needed for facial reconstruction, patients do not want to undergo procedures like iliac crest bone grafting procedures. These procedures are invasive and very painful to the patient. Useful however for large reconstruction cases or TMJ cases, but not necessary for 99% cases seen by the general dentist or prosthodontist.

"cosmetic surgery" - if you are referencing botox, rhinoplasty or most procedures "cosmetic", you will be disappointed when all of those patients go to a plastic surgeon. Orthognathic surgery is "cosmetic" however not as common in private practice.

"head and neck pathology (both benign and malignant)" - mostly referred to ENT.

Also, for those reading, live is interested in applying for OMFS. Obviously biased. He isn't even in a residency. Isn't it funny how yall pre-OMFS folks are always trying to put down perio, but yet what do you really know?

 

[bigbadaboom]

http://www.youtube.com/watch?v=BRTVnGptf6E

 

[DrFelt]

http://www.youtube.com/watch?v=BRTVnGptf6E

That vid is classic. But you got to watch this one too. The whole Perio v. OMFS is ridiculous.

http://www.youtube.com/watch?v=SJj7_xwXCgY

 

[Charmm]

Oral surgeons and periodontists talk $**t to each other, I guess noproblem.

But a bunch of dental students or undergrads, taking sides and pretending to be OS or periodontist, this is just amazing.

with this level of maturity, applicants to either field will get rejected.
grow up

op, no matter what you do, if you're good at it, you'll make a good living.

 

[DrReo]

"The two are related surgical specialities with slightly different angles." This is not even close... you clearly missed the boat.

OP... OMFS and Perio are very different. If all you care about is money and a little surgery do endo or something. Perio is basic surgical procedures (Ext's that take way too long, minor bone grafts, implants, and oh yea some of them also do what perio was invented for... and that's treating periodontal disease). OMFS is the "surgical arm" of dentistry, read about the specialty on the ADA if you don't believe me. If you are genuinely interested in both outpatient and inpatient oral and "maxillofacial" surgery then you should be interested in at least several of these: trauma, orthog surgery, TMJ surgery, craniofacial surgery (CL/CP), anesthesia expert, dentoalveolar expert, implants, minor and major bone grafts (not just allografts either), cosmetic surgery, head and neck pathology (both benign and malignant), etc..... The list could go on. The choice is yours, but it sounds like perio would be more your style.

Surely "wigglytooth" will go back on her statement that the 2 fields are only "slightly" different. If not, please explain how they are even close to being the same thing wigglytooth?

Also, for those reading, wigglytooth is interested in applying for perio. Isn't it funny how yall perio folks are always try to blur the line b/w OMFS and perio when it's clearly distinct. OMFS wanna-be's

Hospital OMFS, I agree. Private practice, I disagree. The recent graduate periodontists do IV sedation, extractions, grafts , implants, etc. How does this differ from the majority of oral surgeon who are in private practice and do not take their trauma call, orthog, tmj and other low reimbursement procedures? Thanks, I'm curious.

 

[DavesNotHere]

OMFS is better, it goes on first and cleans the hair

but

Perio is actually better because it leaves the hair silky smooth

IMHO

 

[Localnative]

Hospital OMFS, I agree. Private practice, I disagree. The recent graduate periodontists do IV sedation, extractions, grafts , implants, etc. How does this differ from the majority of oral surgeon who are in private practice and do not take their trauma call, orthog, tmj and other low reimbursement procedures? Thanks, I'm curious.

Graduated from a dual degree OMS program a few years back and it took me a while to get situated in a full scope private practice. They are few and far between... most OMS practices in my county concentrate on 9-5 office based stuff. My partner and I do full scale TMJ, orthognathics, cosmo, severe atrophy cases, not unlike alot of the stuff I did during residency sans the craniofacial stuff. I'm lucky in this regard. Its also the duty of our profession to take facial trauma call, something that is not echoed by every OMS.

So, in answer to your query, the lines are slowly becoming blurred. Sad, indeed. I do respect the role of every dental specialist and respect the role perio has in our profession. But OMS is a distinct entity whose beauty lies in its diversity of surgical procedures. Wish more would invest some time in hospital based cases. Sure, the reimbursements can be less that grand but a broad scope is what defines us as a profession. And protects us from the tentacles of outside interests such as the AMA.

 

[Michael Scarn]

Graduated from a dual degree OMS program a few years back and it took me a while to get situated in a full scope private practice. They are few and far between... most OMS practices in my county concentrate on 9-5 office based stuff. My partner and I do full scale TMJ, orthognathics, cosmo, severe atrophy cases, not unlike alot of the stuff I did during residency sans the craniofacial stuff. I'm lucky in this regard. Its also the duty of our profession to take facial trauma call, something that is not echoed by every OMS.

So, in answer to your query, the lines are slowly becoming blurred. Sad, indeed. I do respect the role of every dental specialist and respect the role perio has in our profession. But OMS is a distinct entity whose beauty lies in its diversity of surgical procedures. Wish more would invest some time in hospital based cases. Sure, the reimbursements can be less that grand but a broad scope is what defines us as a profession. And protects us from the tentacles of outside interests such as the AMA.

I salute you. This is a true OMS. I know my fellow residents would all agree that this is the ideal scenario.

The truth is, OMS feel that perio is taking business that has traditionally been theirs (OMS). I know virtually nothing of perio training, but the assumption is that their traditional techniques of saving teeth SUCK and thus they have moved over to what OMS have been doing for years to avoid dying as a specialty all together.
In summary, OMS have been at it longer and have far more training. They don't want the little sister that is perio to creep. It's also super annoying that the dude that was bottom half of your dental school class with board scores in the 70's is pimping himself as a surgeon. (I'm sure this comment will elicit a bevy of responses about the correlation... yada yada. The truth is you wouldn't want someone with that track record stepping near your mouth)

 

[flapaTron]

I salute you. This is a true OMS. I know my fellow residents would all agree that this is the ideal scenario.

The truth is, OMS feel that perio is taking business that has traditionally been theirs (OMS). I know virtually nothing of perio training, but the assumption is that their traditional techniques of saving teeth SUCK and thus they have moved over to what OMS have been doing for years to avoid dying as a specialty all together.
In summary, OMS have been at it longer and have far more training. They don't want the little sister that is perio to creep. It's also super annoying that the dude that was bottom half of your dental school class with board scores in the 70's is pimping himself as a surgeon. (I'm sure this comment will elicit a bevy of responses about the correlation... yada yada. The truth is you wouldn't want someone with that track record stepping near your mouth)

to be fair, PRS/ENT can (And do) say the same about OMFS's in terms of scope of practice.

 

[Michael Scarn]

to be fair, PRS/ENT can (And do) say the same about OMFS's in terms of scope of practice.

This is true. I guess the difference is that OMS has loooong paid its dues. From the old days of the military oral surgeon to guys like William Bell pioneering othognathic surgery.
Additionally, the turf war with ENT/PRS is largely based on elective vs. Non-elective proceedures. For example they have no problem with OMS fixing a frontal sinus with a bicoronal flap but do seem to have a problem with

I'm certainly biased though.

 

[Blue Moose]

I know virtually nothing of perio training, but the assumption is that their traditional techniques of saving teeth SUCK and thus they have moved over to what OMS have been doing for years to avoid dying as a specialty all together.

I'm glad you admit that you know nothing of perio training. The techniques of saving teeth however do not suck at all. There are a lot of longitudinal studies of which i can give you the articles if you would like, demonstrating the ability to save teeth with grade 2 and 3 furcation involvement for 20+ years by means of regenerative and resective therapies.

To say that Perio has moved over to what OMS has been doing to avoid a dying specialty is an uneducated statement. I assume you are talking about implants by saying that, and periodontists have been placing implants since the 80's. Its not a new trend by any means.

Perio is anything but a dying specialty. Personally I would rather do mucogingival procedures like connective tissue grafts all day long than instead of extracting third molars. Just my personal preference however. Its more apparent every day to me the lack of knowledge about perio and what periodontists can do among the general dentists and other specialties.

 

[shabu2]

I'm glad you admit that you know nothing of perio training. The techniques of saving teeth however do not suck at all. There are a lot of longitudinal studies of which i can give you the articles if you would like, demonstrating the ability to save teeth with grade 2 and 3 furcation involvement for 20+ years by means of regenerative and resective therapies.

To say that Perio has moved over to what OMS has been doing to avoid a dying specialty is an uneducated statement. I assume you are talking about implants by saying that, and periodontists have been placing implants since the 80's. Its not a new trend by any means.

Perio is anything but a dying specialty. Personally I would rather do mucogingival procedures like connective tissue grafts all day long than instead of extracting third molars. Just my personal preference however. Its more apparent every day to me the lack of knowledge about perio and what periodontists can do among the general dentists and other specialties.

I gotta admit, it was my despise for my perio profs that I went into OMFS.

 

[Michael Scarn]

I'm glad you admit that you know nothing of perio training. The techniques of saving teeth however do not suck at all. There are a lot of longitudinal studies of which i can give you the articles if you would like, demonstrating the ability to save teeth with grade 2 and 3 furcation involvement for 20+ years by means of regenerative and resective therapies.

To say that Perio has moved over to what OMS has been doing to avoid a dying specialty is an uneducated statement. I assume you are talking about implants by saying that, and periodontists have been placing implants since the 80's. Its not a new trend by any means.

Perio is anything but a dying specialty. Personally I would rather do mucogingival procedures like connective tissue grafts all day long than instead of extracting third molars. Just my personal preference however. Its more apparent every day to me the lack of knowledge about perio and what periodontists can do among the general dentists and other specialties.[/QUOTE

I don't think even a periodontists would try to save a class III furcation involved tooth while risking bone loss to adjacent teeth over placing an implant do you?

 

[Blue Moose]

I don't think even a periodontists would try to save a class III furcation involved tooth while risking bone loss to adjacent teeth over placing an implant do you?

[DeVore CH, et al. Retained “hopeless” teeth – Effects on theproximal periodontium of adjacent teeth. J Periodontol 1988;59:647-651.

The article states:
There is no significant difference in probing depths, radiographic alveolar bone height, or width of the periodontal ligament space at pre-therapy for the adjacent surfaces versus the non adjacent surfaces. Following therapy there was a significant reduction on probing depths for proximal surfaces. The teeth diagnosed as hopeless and still retained may have no effect on the proximal periodontium of adjacent teeth prior to and following therapy. ]

Retaining periodontally compromised teeth, even with furcation involvement doesn't compromise the adjacent teeth/periodontium in patients that have periodontal treatment and maintenance.

[Hirschfeld, L., and Wasserman, B.: A long-term survey of tooth loss in 600 treated periodontal patients. J Periodontol, 49:225, 1978.

Study demonstrates that molars with furcation involvement can be maintained for more than 15 years with a success rate of 81%. ]

What you are saying is also assuming your patient has enough money to just extract teeth and place implants. Most patients will want to retain their teeth as long as possible, especially on non-symptomatic teeth with furcation involvements.

So to answer your question, I think that in a patient that is compliant with oral hygiene, demonstrates adequate plaque removal and home care and is compliant with periodontal maintenance and recall appointments, yes i would not hesitate in maintaining a tooth with grade 3 furcation involvments.

 

[Michael Scarn]

[DeVore CH, et al. Retained “hopeless” teeth – Effects on theproximal periodontium of adjacent teeth. J Periodontol 1988;59:647-651.

The article states:
There is no significant difference in probing depths, radiographic alveolar bone height, or width of the periodontal ligament space at pre-therapy for the adjacent surfaces versus the non adjacent surfaces. Following therapy there was a significant reduction on probing depths for proximal surfaces. The teeth diagnosed as hopeless and still retained may have no effect on the proximal periodontium of adjacent teeth prior to and following therapy. ]

Retaining periodontally compromised teeth, even with furcation involvement doesn't compromise the adjacent teeth/periodontium in patients that have periodontal treatment and maintenance.

[Hirschfeld, L., and Wasserman, B.: A long-term survey of tooth loss in 600 treated periodontal patients. J Periodontol, 49:225, 1978.

Study demonstrates that molars with furcation involvement can be maintained for more than 15 years with a success rate of 81%. ]

What you are saying is also assuming your patient has enough money to just extract teeth and place implants. Most patients will want to retain their teeth as long as possible, especially on non-symptomatic teeth with furcation involvements.

So to answer your question, I think that in a patient that is compliant with oral hygiene, demonstrates adequate plaque removal and home care and is compliant with periodontal maintenance and recall appointments, yes i would not hesitate in maintaining a tooth with grade 3 furcation involvments.

I don't even do this...

But in all seriousness, thanks for the references. I still think that the majority of dentists/perio are gonna scrap any furcation that bad and place an implant regardless of what the research says.

 

[mmpatel0]

So what is the actual difference between OMFS and Peridontist if both of them are quite specialized in extracting third molars? Surely, OS can do trauma surgery and etc, but these sure aren't their breads & butter. Is 3 years of extra training for procedures that you won't really do in the future?

 

[booooom]

So what is the actual difference between OMFS and Peridontist if both of them are quite specialized in extracting third molars? Surely, OS can do trauma surgery and etc, but these sure aren't their breads & butter. Is 3 years of extra training for procedures that you won't really do in the future?

I am currently a resident in a 6 year OMFS program. Periodontists have their little niche, but to say that there isn't really a difference between the private practice OMFS and periodontist is ludicrous. While the procedures we do can overlap, we are the safety net of dentistry. How many transfacial I+D's (and no, not little stab incisions into the buccal mucosa) do periodontists perform for odontogenic infections? Do they even know what a lateral pharyngeal abscess is? (I'm not being condescending here...I'm actually wondering if they have any sort of this training) How many times have you had to dig out needles that got displaced by other dental specialists? Caldwell Luc for lost root tips? If a general dentist has any sort of "crisis"...they do they send them to the oral and maxillofacial surgeon, or do they send them to the periodontist? When there is a question about medical management...do they call the periodontist? I'm not here to say we are doing our share of taking trauma call or what not because I know a lot of private practitioners aren't. But to say that there isn't much of a difference between private practice OMFS and periodontists is a bit ridiculous.

 

[GreatOMFSHope]

So what is the actual difference between OMFS and Peridontist if both of them are quite specialized in extracting third molars? Surely, OS can do trauma surgery and etc, but these sure aren't their breads & butter. Is 3 years of extra training for procedures that you won't really do in the future?

Penis size.

Instead of starting a pissing contest, just do some research and look for the differences. There are plenty of things that a periodontist does that an OMFS doesn't and vice versa. Realistically, they are both very different specialties that are brought closer by a few procedures.

And I completely agree with Secret Agent Michael Scarn, much respect goes to Localnative.

 

[mmpatel0]

Penis size.

Instead of starting a pissing contest, just do some research and look for the differences. There are plenty of things that a periodontist does that an OMFS doesn't and vice versa. Realistically, they are both very different specialties that are brought closer by a few procedures.

And I completely agree with Secret Agent Michael Scarn, much respect goes to Localnative.

I may sound like an idiot and I do know that there are many different aspects between OMS and Periodontist, but, comparing the source of main income (3rd molar extraction), would you guys go for 3+ training at OMS instead of just doing 3 year perio unless you guys are really interested in hard-to-come-by trauma calls?

 

[GreatOMFSHope]

Is the main source of income for a periodontist 3rd molar extractions? I wouldn't think so, but I have never looked into a practice.

I don't care what a periodontist does. Again, do your research. Regardless of income, I like my specialty and the things I could do with it better.

 

[mmpatel0]

Is the main source of income for a periodontist 3rd molar extractions? I wouldn't think so, but I have never looked into a practice.

I don't care what a periodontist does. Again, do your research. Regardless of income, I like my specialty and the things I could do with it better.

I wouldn't say their main source of income is 3rd molar extraction, but if periodontists are just as skilled as OMS in 3rd molar extraction, I don't see why anyone would go for OMS... sorry if I sounded little offensive

 

[Michael Scarn]

I wouldn't say their main source of income is 3rd molar extraction, but if periodontists are just as skilled as OMS in 3rd molar extraction, I don't see why anyone would go for OMS... sorry if I sounded little offensive

I don't think anyone with any knowledge would EVER claim perio are 'just as skilled' at removing 3rd molars.

In the end, patients will go where their dentist refers them or where they feel the most comfortable. There are many factors that come into play with this. In fact, this is one area where OMS are losing ground. Perio does a fine job of sucking up to dentists and OMS do not. A shift in referrals to perio for traditionally OMS dominated proceedures is because of this.

I've got to give credit to perio for being able to do this. This is certainly an area where it is largely against our nature to suck up as OMS (if you can't tell).

But to say that perio are equal surgically AS A WHOLE is downright silly.

 

[mmpatel0]

I don't think anyone with any knowledge would EVER claim perio are 'just as skilled' at removing 3rd molars.

In the end, patients will go where their dentist refers them or where they feel the most comfortable. There are many factors that come into play with this. In fact, this is one area where OMS are losing ground. Perio does a fine job of sucking up to dentists and OMS do not. A shift in referrals to perio for traditionally OMS dominated proceedures is because of this.

I've got to give credit to perio for being able to do this. This is certainly an area where it is largely against our nature to suck up as OMS (if you can't tell).

But to say that perio are equal surgically AS A WHOLE is downright silly.

Well, not as a whole but in terms of simple surgical extraction such as 3rd molar extraction, would there be such a great skill difference b/t periodontist and OS?

And, I understand that it would be hard for OMS to suck up to GD...

 

[DrFelt]

Perio does a fine job of sucking up to dentists and OMS do not. A shift in referrals to perio for traditionally OMS dominated proceedures is because of this.

I've got to give credit to perio for being able to do this. This is certainly an area where it is largely against our nature to suck up as OMS (if you can't tell).

I don't know if its that perio guys are suck-ups, or if it's just that most oral surgeons are dicks.

[Hirschfeld, L., and Wasserman, B.: A long-term survey of tooth loss in 600 treated periodontal patients. J Periodontol, 49:225, 1978.

Study demonstrates that molars with furcation involvement can be maintained for more than 15 years with a success rate of 81%. ]

Typical perio quote. It's over 30 years old. They weren't even placing implants then. In 2011 Class 3 furcation= implant.

 

[flapaTron]

I don't know if its that perio guys are suck-ups, or if it's just that most oral surgeons are dicks.

it's the latter. the notion that an OMFS needs to constantly exude arrogance is unnecessarily perpetuated...particularly by OMFS's themselves. i say this as a (hopeful) future OMFS.

 

[GreatOMFSHope]

I don't think anyone with any knowledge would EVER claim perio are 'just as skilled' at removing 3rd molars.

In the end, patients will go where their dentist refers them or where they feel the most comfortable. There are many factors that come into play with this. In fact, this is one area where OMS are losing ground. Perio does a fine job of sucking up to dentists and OMS do not. A shift in referrals to perio for traditionally OMS dominated proceedures is because of this.

I've got to give credit to perio for being able to do this. This is certainly an area where it is largely against our nature to suck up as OMS (if you can't tell).

But to say that perio are equal surgically AS A WHOLE is downright silly.

Agreed. In most training programs across the country, I would believe that OMFS do a substantially greater amount of 3rds than a perio program, even if just because "that's the way it's always been done". To be more proficient at removing 3rds, you need to do plenty. Not saying a perio guy/gal can't do it, just that we probably do it more.

 

[GreatOMFSHope]

it's the latter. the notion that an OMFS needs to constantly exude arrogance is unnecessarily perpetuated...particularly by OMFS's themselves. i say this as a (hopeful) future OMFS.

You sure you want to do OMFS? Some folks have a very thin line between arrogance and confidence.

 

[flapaTron]

You sure you want to do OMFS? Some folks have a very thin line between arrogance and confidence.

that's precisely my point. confidence does not necessitate arrogance, and arrogance does not equal confidence. discriminating between the two is important. you can be an amazing surgeon w/out being douche.

 

[Charmm]

that's precisely my point. confidence does not necessitate arrogance, and arrogance does not equal confidence. discriminating between the two is important. you can be an amazing surgeon w/out being douche.

this is the next level

 

[PChemGrad]

"How many oral surgeons do you know that will treat periodontal disease before placing an implant? none."

Uhh Oral and Maxillofacial Surgeons do treat periodontal disease.
They extract the offending sourse.
Extract the tooth, periodontal disease is treated, you've eliminated the periodontium. Problem Solved.

Periodontist are funny.

 

[dcshus]

[DeVore CH, et al. Retained “hopeless” teeth – Effects on theproximal periodontium of adjacent teeth. J Periodontol 1988;59:647-651.

The article states:
There is no significant difference in probing depths, radiographic alveolar bone height, or width of the periodontal ligament space at pre-therapy for the adjacent surfaces versus the non adjacent surfaces. Following therapy there was a significant reduction on probing depths for proximal surfaces. The teeth diagnosed as hopeless and still retained may have no effect on the proximal periodontium of adjacent teeth prior to and following therapy. ]

Retaining periodontally compromised teeth, even with furcation involvement doesn't compromise the adjacent teeth/periodontium in patients that have periodontal treatment and maintenance.

[Hirschfeld, L., and Wasserman, B.: A long-term survey of tooth loss in 600 treated periodontal patients. J Periodontol, 49:225, 1978.

Study demonstrates that molars with furcation involvement can be maintained for more than 15 years with a success rate of 81%. ]

What you are saying is also assuming your patient has enough money to just extract teeth and place implants. Most patients will want to retain their teeth as long as possible, especially on non-symptomatic teeth with furcation involvements.

So to answer your question, I think that in a patient that is compliant with oral hygiene, demonstrates adequate plaque removal and home care and is compliant with periodontal maintenance and recall appointments, yes i would not hesitate in maintaining a tooth with grade 3 furcation involvments.

Dental implants weren't even placed with any regularity until the early 90's and then they were being placed by OMS. Your sources are from 1978 and 1988.

I think this would explain your literary references. This same problem today would most likely end in an "atraumatic" extraction, "sterile" bone graft, followed by an implant from a soft tissue professional.

If you're going to cite literature, I think it's important to use relevant/current articles.

 

[Blue Moose]

Just because an article is classic, doesn't mean that it is worth throwing out. It demonstrates that molars with furcation involvement don't need to be extracted just because implants are available. There is actually a lot of current research demonstrating the same thing. Also, not all patients can afford implants, especially if its in an area where ridge augmentation or sinus lift would be necessary.

One example:

Fugazzotto PA. A Comparison of the Success of Root Resected Molars and Molar Position Implants in Function in a Private Practice: Results of up to 15-Plus Years. JOP. 2001. 72:8;1113.

A total 701 root resected molars and 1,472 molar implants were evaluated after ≥15 and 13 years in function, respectively.Cumulative success rates were 96.8% for root resected molars and 97.0% for molar implants. Success and failure are discussed by tooth and/or implant position, and resected root, where applicable. Possible ramifications of these findings upon treatment planning are also reviewed.
Conclusions: Both molar root resection and appropriate restoration and molar implant placement and restoration demonstrated a high degree of success in function. However, this success rate is markedly affected when either the root resected molar or molar implant is a lone standing terminal abutment. Care must be taken to choose the appropriate treatment modality for a given patient scenario.

 

[servitup]

OP is trolling....and it worked. IMO. Went to a great lecture from a periodontist last night on implant site development. A good implant surgeon is a good implant surgeon whether he is a GP, Prosth, Perio, or OMS.

The biggest difference is medical training, anesthesia training, and potential scope of practice.

An additional benefit in referring to an OMS is the ability to manage virtually any possible complication that should arise, whether it be pathologic fracture, huge sinus exposure, root tip in the sinus, medical complication, anesthesia complication, etc. My opinion is that the extra training makes me a better doctor than I would be without it, and thus a more attractive referral option in the future.

Furthermore, OMS is the only specialty in dentistry that performs procedures that GP's literally cannot do. GP's can practice the full scope of any other specialty in dentistry.

 

[fonze]

I have the unique perspective in that I am an OMFS resident and my brother is a perio resident. We definitely bust each other’s chops all the time about each other’s profession but, that has more to do with the fact that we’re brothers. What I can add from my point of view is that both perio and OMFS have their definite areas of expertise with some overlap which I believe is more dependent on the clinician than the specialty. So here it goes:
1. Soft tissue manipulation: when it comes to CT grafts and free gingival grafts I’ll give this one to perio. In their training they have a higher case load and get more experience in this area. OMFS does this as well, just not as much as perio. Perhaps this is where the myth that perio are soft tissue wizards an OMFS are hacks. Sorry but it is much easier to suture mucosa than it is to close complex lid lacs.
2. Bone grafting: when it comes to “bone in a bottle,” PRP, BMP etc. I think that it is completely clinician dependant. Both perio and OMFS does this type of bone grafting on a regular basis. When it comes to autogenous grafts from chin and ramus I would lean toward OMFS. Perio does this as well, just not as much. Obviously hip, tibia, calivarium and ribs go to OMFS.
3. 3rds- whoever suggests that perio is > or = to OMFS in this regard should go to an OMFS clinic. 3-6 sets of 3rds is a routine day in our program. No perio program comes close to this.
4. Atraumatic exos- whenever a pt is a candidate for implants we break out the periotomes. It is current thinking that perio is king of atraumatic extractions but, I think it is clinician dependent. This being said I would think that perio would be more likely to break out the periotomes.
5. Management of periodontal disease: this is a no brainer
6. Anesthesia: If you haven’t done 100’s of intubations, ran codes, or performed trachs (practice for slash crics) you shouldn’t be pushing drugs no matter how good the week long course you took was. I don’t know of any perio program that includes this in their current curriculum.
7. Implants- clinician dependent. There are awesome periodontists that place implants, some terrible OMFS and vice versa.

 

[alphaDDS]

Good morning read, guys, thanks!

 

[dcshus]

Just because an article is classic, doesn't mean that it is worth throwing out. It demonstrates that molars with furcation involvement don't need to be extracted just because implants are available. There is actually a lot of current research demonstrating the same thing. Also, not all patients can afford implants, especially if its in an area where ridge augmentation or sinus lift would be necessary.

One example:

Fugazzotto PA. A Comparison of the Success of Root Resected Molars and Molar Position Implants in Function in a Private Practice: Results of up to 15-Plus Years. JOP. 2001. 72:8;1113.

A total 701 root resected molars and 1,472 molar implants were evaluated after ≥15 and 13 years in function, respectively.Cumulative success rates were 96.8% for root resected molars and 97.0% for molar implants. Success and failure are discussed by tooth and/or implant position, and resected root, where applicable. Possible ramifications of these findings upon treatment planning are also reviewed.
Conclusions: Both molar root resection and appropriate restoration and molar implant placement and restoration demonstrated a high degree of success in function. However, this success rate is markedly affected when either the root resected molar or molar implant is a lone standing terminal abutment. Care must be taken to choose the appropriate treatment modality for a given patient scenario.

I'm not sure what your definition of "classic" is, however, I know I would not call either of the first two articles "classics".

The above article isn't exactly "budding" research, being over ten years old. It's also a retrospective study of Tx provided over the previous 15 years. I believe my original comment of using current research still applies here.

I agree, not every tooth with "furcation" involvement should be immediately extracted. However, teeth with class II and III furcation, as was the original debate, are destined for extraction. Restoration of the space created can be done several ways depending on various factors, one such solution (most commonly the best in my opinion) is implant placement.

 

[GitYouSukka]

"Minor bone grafts" - Yes periodontists do bone grafting with particulate allograft. Perio also uses allograft block grafts, ramus grafts, and chin grafts, however the latter two are less common and unnecessary with the high success rate of allograft block and particulate materials. Autogenous block grafts are not necessary in majority of cases. Periodontists also routinely perform sinus lifts which is commonly needed with maxillary implant placement.

Not necessary in the majority of cases? You mean, not necessary in the majority of cases that periodontists encounter. You may think that we general dentists are oblivious to the difference between oral surgeons and periodontists, but we’re not. Many of us tend to refer the more complex implant cases to oral surgeons.

"Implants" - Periodontists place a lot of implants. How many oral surgeons do you know that will treat periodontal disease before placing an implant? none. (the literature has shown that periodontal disease does decrease the success rate of dental implants. IJOMI 2009; 24(suppl):39-68.) How many Oral surgeons will lay a flap and scale subgingival calculus in the area if present before placing the implant? none. Unfortunately they place implants in anyone, and don't follow them up. This is why periodontists are stuck fixing their peri-implantitis cases.

Yeah. Sure. Because you guys are experts on infection and inflammation, whereas oral surgeons are not? Your statement here is laughable. Periodontists are about as medically-clueless as most dentists. Put another way: I’d trust a periodontist to treat an infection about as much as I’d trust a general dentist.

"treating periodontal disease" - yes as stated before, periodontists treat periodontal disease because they are trained to preserve the hard and soft tissues of the mouth. To retain teeth that are compromised through resective or regenerative therapy and not just to extract teeth and place implants, which is unfortunately all to common with most OMFS.

Most of what periodontists do is perform surgical procedures that produce minimal results. And this includes your surgeries to restore attachment and bone around teeth.

Periodontists are dentists. They think like a dentist. When they do surgery (extraction or implant) they perform it with the final restoration in mind. Communicating with the GP for desired restorative outcome. Taking a little extra time by thinking in millimeters or 1/2 millimeters (instead of thinking in centimeters like oral surgeons).

This statement is baseless, and pure nonsense.

Oral surgeons that work in the hospital setting will perform "trauma, orthog surgery, TMJ surgery, craniofacial surgery (CL/CP)". These procedures are much less common in private practice however. OMFS make much more money working in private practice extracting third molars and less invasive surgeries. Some will keep hospital privaledges to perform larger procedures a couple days a month. Working in a hospital full time would mean being an employee of the hospital, good luck with that. Thats one big reason I became a dentist is to avoid that.

Your first correct statement.

"anesthesia expert" - Not quite an expert. Familiar with general anesthesia yes. But by no means the equivalent of an anesthesiologist

Your second correct statement. And as someone interested in OMFS myself, I can honestly say that this is the ONE area where I think oral surgeons are pretty comical -- they think they are experts in anesthesia. Four months on an anesthesiology rotation does not make an expert.

"major bone grafts" - unless needed for facial reconstruction, patients do not want to undergo procedures like iliac crest bone grafting procedures. These procedures are invasive and very painful to the patient. Useful however for large reconstruction cases or TMJ cases, but not necessary for 99% cases seen by the general dentist or prosthodontist.

This may be true, but the bottom line is that oral surgeons have a larger repertoire of treatment options in order to address patients’ prosthetic needs. This automatically makes them superior to periodontists where prosthetics are concerned.

"cosmetic surgery" - if you are referencing botox, rhinoplasty or most procedures "cosmetic", you will be disappointed when all of those patients go to a plastic surgeon. Orthognathic surgery is "cosmetic" however not as common in private practice.

Yeah, but the option is there for oral surgeons looking to pursue it. It’ll be a cold day in hell before a periodontist performs a facelift or nosejob.

"head and neck pathology (both benign and malignant)" - mostly referred to ENT.

And as a periodontist, you have been keeping track of what cases get referred to which specialty? LOL. Talking out of your backside again. There are plenty of oral surgeons who deal head/neck pathology on a regular basis, i.e. as a major component of their practice. Yeah, it’s easier to encounter as an ENT, but it is VERY available to an OMFS who wants to deal with it.

 

[GitYouSukka]

I have the unique perspective in that I am an OMFS resident and my brother is a perio resident. We definitely bust each other’s chops all the time about each other’s profession but, that has more to do with the fact that we’re brothers. What I can add from my point of view is that both perio and OMFS have their definite areas of expertise with some overlap which I believe is more dependent on the clinician than the specialty. So here it goes:
1. Soft tissue manipulation: when it comes to CT grafts and free gingival grafts I’ll give this one to perio. In their training they have a higher case load and get more experience in this area. OMFS does this as well, just not as much as perio. Perhaps this is where the myth that perio are soft tissue wizards an OMFS are hacks. Sorry but it is much easier to suture mucosa than it is to close complex lid lacs.
2. Bone grafting: when it comes to “bone in a bottle,” PRP, BMP etc. I think that it is completely clinician dependant. Both perio and OMFS does this type of bone grafting on a regular basis. When it comes to autogenous grafts from chin and ramus I would lean toward OMFS. Perio does this as well, just not as much. Obviously hip, tibia, calivarium and ribs go to OMFS.
3. 3rds- whoever suggests that perio is > or = to OMFS in this regard should go to an OMFS clinic. 3-6 sets of 3rds is a routine day in our program. No perio program comes close to this.
4. Atraumatic exos- whenever a pt is a candidate for implants we break out the periotomes. It is current thinking that perio is king of atraumatic extractions but, I think it is clinician dependent. This being said I would think that perio would be more likely to break out the periotomes.

Oral surgeons, by virtue of taking out thousands upon thousands more teeth than periodontists, are far more comfortable with the subtleties of taking out teeth. And yes, there are many subtleties that make cases easier or harder. An oral surgeon is going to be able to predict which cases are tougher or easier, and thus can plan accordingly in order to ensure the most atraumatic extraction possible........simply by virtue of the sheer experience advantage.

 

[IcedOMFS]

. Atraumatic exos- whenever a pt is a candidate for implants we break out the periotomes. It is current thinking that perio is king of atraumatic extractions but, I think it is clinician dependent. This being said I would think that perio would be more likely to break out the periotomes.

What's a periotome?