Teaching surgical principles in dental school

[txdent2be2007]

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We are watching a video presenting “atraumatic tooth removal,” outlining the use of periotomes, microperiotomes (to slice through the pdl fibers directly, as opposed to using forces directed through the tooth root to separate pdl fibers from bundle bone), preservation of the interproximal papilla, collagen membranes (also detailed was the removal of these 2 wks later), cyanoacrylate (“special” superglue) to hold the collaplug in place, and the use of Teflon sutures for “optimal soft tissue response during final closure.” Also highlighted in the course is the use of retraction sutures with dangling hemostats for minimizing flap trauma, as the use of a Minnesota or other retractor would be too dangerous. What seems silly to me is the narrator’s British accent and the classical music playing, which crescendos at critical moments like knot-tying.

I understand there is peer-reviewed research to support each of these practices (I have conducted research in perio for two years). What I don’t understand is why I feel there is so much emphasis placed on perio as the “tissue-friendly” specialists? In our GP-focused curriculum we are constantly reminded that perio are the folks to call when esthetic results are needed; in fact, our general dental faculty scorn OMS for “never being available,” and "hamburger-ing" the tissue and encourage us to use perio whenever we can for implants and even extractions in the esthetic zone.

So, are there real reasons periodontists advertise in these ways, or am I just seeing specialists who advertise themselves to a future referral base (3rd year dental students) by using sub-specialized research, enticing music, and flashy graphics to drum up business?

Any healthy discussion to help me clear this up would be great…

 

[InMyCrossHairs]

We are watching a video presenting “atraumatic tooth removal,” outlining the use of periotomes, microperiotomes (to slice through the pdl fibers directly, as opposed to using forces directed through the tooth root to separate pdl fibers from bundle bone), preservation of the interproximal papilla, collagen membranes (also detailed was the removal of these 2 wks later), cyanoacrylate (“special” superglue) to hold the collaplug in place, and the use of Teflon sutures for “optimal soft tissue response during final closure.” Also highlighted in the course is the use of retraction sutures with dangling hemostats for minimizing flap trauma, as the use of a Minnesota or other retractor would be too dangerous. What seems silly to me is the narrator’s British accent and the classical music playing, which crescendos at critical moments like knot-tying.

I understand there is peer-reviewed research to support each of these practices (I have conducted research in perio for two years). What I don’t understand is why I feel there is so much emphasis placed on perio as the “tissue-friendly” specialists? In our GP-focused curriculum we are constantly reminded that perio are the folks to call when esthetic results are needed; in fact, our general dental faculty scorn OMS for “never being available,” and "hamburger-ing" the tissue and encourage us to use perio whenever we can for implants and even extractions in the esthetic zone.

So, are there real reasons periodontists advertise in these ways, or am I just seeing specialists who advertise themselves to a future referral base (3rd year dental students) by using sub-specialized research, enticing music, and flashy graphics to drum up business?

Any healthy discussion to help me clear this up would be great…

No offense to people in Amway or any other pyramid scheme, but periodontists have become to dentistry what these irreputible sales hacks are to the business/commerce profession. You can not sit through a perio class anymore without one of these schleps trying to pull the wool over our eyes as to why the periodontists are the specialists to refer to when eshtetics count. Their habitual misrepresentation of how real surgeons handle tissue is ludicrous not to mention completely unethical. The more these perios ***** themselves out with unsubstantiated evidence the more they look like their counterparts in the "business".....errr ..... pyramid scheme world.

 

[txdent2be2007]

Whoa, gunner. This isn't supposed to be a perio-bashing session.

I am just wondering if you guys have these sort of questions regarding perio (or any other specialty group) in your DDS/DMD training programs -- is there a preponderance of folks who claim their guru-status to unwitting pre-docs?

Your sort of language will turn this thread into a pissing match; we've had enough of these lately!

Thoughts, anyone?

 

[Periogod]

Whoa, gunner. This isn't supposed to be a perio-bashing session.

I am just wondering if you guys have these sort of questions regarding perio (or any other specialty group) in your DDS/DMD training programs -- is there a preponderance of folks who claim their guru-status to unwitting pre-docs?

Your sort of language will turn this thread into a pissing match; we've had enough of these lately!

Thoughts, anyone?

Probably the best way to actually get your question answered is to ask a few faculty members that you trust if they have any cases they can show you to support their claims. I am of the mind that you have skilled and unskilled periodontists and good and bad oral surgeons. It is more dependent upon the doctor than the specialty. OMFS guys and periodontists both receive extensive training, but the surgeon must choose to implement that training.

 

[OMFSCardsFan]

This doesn't happen often, but I think I'll have to agree with PerioGod on this one. There are definitely more and less qualified oral surgeons and periodontists. Rather than deciding to use one exclusively based on the training that they've had (Perio or OMS), I'd find one that can prove his worthiness by providing excellent surgical results. There are situations where exercising a little more care with the tissues are beneficial. In the majority of cases, the time that the "overzealous" perio guys spend spooning a tooth out with a periotome or placing stay sutures in a flap is completely worthless. I think PerioGod will agree with me there. Rather than listening to the crazies with videos and hypnotic music, find sources of information from those that are published in the major journals. See what they have to say.

Probably the best way to actually get your question answered is to ask a few faculty members that you trust if they have any cases they can show you to support their claims. I am of the mind that you have skilled and unskilled periodontists and good and bad oral surgeons. It is more dependent upon the doctor than the specialty. OMFS guys and periodontists both receive extensive training, but the surgeon must choose to implement that training.

 

[12YearOldKid]

I used to buy into the idea that perio was the way to go for good soft-tissue results. But the further along in school I get, the more I realize that 90% of the time it doesn't matter.

And soft-tissue results for extractions... give me a break. Whether the perio putzes around with his microperiotomes and silk sutures for an hour and half or the OS guy busts out the hall drill and cowhorns and is done in 15 minutes really doesn't make much difference. Either way you are leaving that person with a hole in their jaw. The bone will heal, the soft tissue will heal. I'll get to do my bridge, implant, or (god forbid) denture and everyone will be happy.

But I guarantee that in the end the patient will be a lot happier with the quick and "brutal" approach vs. a long, drawn out production.

 

[12YearOldKid]

Though there are some isolated times when I would probably prefer perio over OS. For example, if I was doing an anterior bridge from #6 to #11 and wanted some pre-pros surgery to recontour the ridge and soft-tissue to create a better emergence profile I would send them to perio. All the oral surgeons I have met just don't seem like they would have the patience to sit and work meticulously from a surgical guide to get the results I would want.

But I'm guessing most oral surgeons out there wouldn't want that kind of referral anyway.

Oh, I almost forgot. Root planing and open flap debridement. That definitely goes to perio. And they're welcome to it.

 

[OMFSCardsFan]

All the oral surgeons I have met just don't seem like they would have the patience to sit and work meticulously from a surgical guide to get the results I would want.

The only surgical guide I ever get is called a denture...

 

[12YearOldKid]

The only surgical guide I ever get is called a denture...

 

[Bifid Uvula]

Who care about "soft-tissue trauma" if ur patient is having an MI because the periodontist wants to drive a spatula around the tooth for 3 hours....