The future of ortho and endo...

[bkwash]

What are you guys opinion on this?

1. With ortho it seems that over our practicing years (the next 30-35 years) OEC and other corporations will have overtaken this area. Or is this not percieved to be a real threat?

2. I have heard a lot of talk that a large number of endo cases are being handled by GP's and this trend will increase with rotary equip.

3. With the above statements are these two specialties not going to be as attractive in the future as they were?

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[Demeter]

You might be correct in your opinion about the future of Endo. I know a couple old timers you would never do Molar endo.
With Apex locators, rotary etc... molar endo just got a lot easier.
Most of my colleagues love molar endo.
It would have to be a redo or a an extremely difficult Molar for me to refer it.

 

[StarGirl]

i was at meeting a few months ago... the speaker said, w/ any teeth that may be compromised... for long term prognosis, it's better to exo, implant and restore than it is to do rct, p/c, and cr. I have to say I'll agree w/ it for the most part... rather than spending thousands on rct and trying to "save" the tooth and having it fail 4, 8, 10 or whatever years down the road...

 

[MIKEJACK5]

What are you guys opinion on this?

1. With ortho it seems that over our practicing years (the next 30-35 years) OEC and other corporations will have overtaken this area. Or is this not percieved to be a real threat?


3. With the above statements are these two specialties not going to be as attractive in the future as they were?

I completely disagree about the ortho part. Why would a well run organiztion like the ADA allow corporate America take over one of its specialties like that? People think that the ADA doesn't know what will happen if the OEC continues to expand? Whats to stop copycat organizations from using this model and then taking over endo? Pedo? My guess is that the ADA will allow the OEC to expand to certain point, but eventually it will run into a wall and eventually fold. JMO though.

 

[mike3kgt]

I completely disagree about the ortho part. Why would a well run organiztion like the ADA allow corporate America take over one of its specialties like that? People think that the ADA doesn't know what will happen if the OEC continues to expand? Whats to stop copycat organizations from using this model and then taking over endo? Pedo? My guess is that the ADA will allow the OEC to expand to certain point, but eventually it will run into a wall and eventually fold. JMO though.

The ADA can only do so much, remember, legislators ultimately make the decisions if there is enough pressure from the OEC upon them. Same thing goes for ADHAP (Hygiene Practitioners), enough pressure and the magic phrase "access to care in rural areas" gets stuff passed. Remember, most politicians want quick fixes and rather than increase funding for dentists for Medicaid, increase dental schools or whatnot, we could have the hygienists providing restorative care.

The ADA has a big bark, but it seems like their bite isn't as strong.

-Mike

 

[ItsGavinC]

With Apex locators, rotary etc... molar endo just got a lot easier.
Most of my colleagues love molar endo.

And in theory, it also has become a lot easier to jack up an endo, simply because the GP is relying on easier instrumentation, and perhaps working out of his true comfort zone.

 

[Demeter]

I think a GP should be very comfortable doing Molar Endo. If not then he/ she is not a great GP. ANd if you are a GP and are handing over easy Endos you are losing out on huge profits.

 

[S Files]

I think a GP should be very comfortable doing Molar Endo. If not then he/ she is not a great GP. ANd if you are a GP and are handing over easy Endos you are losing out on huge profits.

only maybe after an aegd/gpr would i be comfortable doing molar endo. i don't think the oec will be viable. this whole thing about owing the company several years after graduation is ridiculous. i don't think it'll impact at all.

 

[blotterspotter]

My dentist felt ortho would be screwed because of new techniques, like INvisalign being used in GP's offices. BW, what is OEC?!

 

[koobpheej]

oec will be little more than the western dental of the ortho world. granted they have a stronger foothold then western, but they won't get much bigger. that is unless the practitioners are able to provide a service equal to traditional ortho, then it may grow much larger (only time will tell).
more technology makes GPs think they can tackle larger cases. For example, UT just passed (or it is in the works) a law that prevents a GP from advertising ortho. They can still Tx ortho cases, just no ads. Evidently technologies like Invisalign are getting screwed up by the GP, and the ortho is left trying to clean up the mess. same thing with endo technologies. a well trained GP can do most any procedure-- ext 3rds, place implants, ortho, endo, perio surgerey-- as long as they know their limitations, and know when to quit while they are ahead.

 

[Do You Endo]

first of all, I would never trust my teeth endodontically with a GP. Some say it sounds egoistic, but in reality, there is a reason that I graduated at the top of my class....I am the best of the best. GP are usually (ill give credit to a few bright spots) the worst skilled of the dental profession. GP's will end up botching the procedure and you will end up coming to see me to fix it and i'll charge you triple....so, wait, nevermind.....i guess let the GPs keep messing up peoples teeth.

 

[blotterspotter]

first of all, I would never trust my teeth endodontically with a GP. Some say it sounds egoistic, but in reality, there is a reason that I graduated at the top of my class....I am the best of the best. GP are usually (ill give credit to a few bright spots) the worst skilled of the dental profession. GP's will end up botching the procedure and you will end up coming to see me to fix it and i'll charge you triple....so, wait, nevermind.....i guess let the GPs keep messing up peoples teeth.

Wow, that's bold. What happens when the dental vaccine eliminates the cavities, and, consequently, the need for rct?!

 

[adamlc18]

first of all, I would never trust my teeth endodontically with a GP. Some say it sounds egoistic, but in reality, there is a reason that I graduated at the top of my class....I am the best of the best. GP are usually (ill give credit to a few bright spots) the worst skilled of the dental profession. GP's will end up botching the procedure and you will end up coming to see me to fix it and i'll charge you triple....so, wait, nevermind.....i guess let the GPs keep messing up peoples teeth.

I was just wondering how you can graduate at the top of your class at harvard when it is Pass/Fail?

 

[aphistis]

first of all, I would never trust my teeth endodontically with a GP. Some say it sounds egoistic, but in reality, there is a reason that I graduated at the top of my class....I am the best of the best. GP are usually (ill give credit to a few bright spots) the worst skilled of the dental profession. GP's will end up botching the procedure and you will end up coming to see me to fix it and i'll charge you triple....so, wait, nevermind.....i guess let the GPs keep messing up peoples teeth.

Selection bias: Being a specialist who gets called in to put out fires, but never seeing success stories, and subsequently thinking the success stories don't actually exist.

Myself, I'll probably just do an implant & crown. For the same fee that you'd charge to RCT, that tooth is treated for keeps. But I didn't graduate from Harvard, so my opinion probably shouldn't count for anything.

 

[aphistis]

Wow, that's bold. What happens when the dental vaccine eliminates the cavities, and, consequently, the need for rct?!

Realistically, this is a long way from happening, and there are some compelling arguments that it may never occur at all. If endo ever goes extinct, it'll be because better treatment options are available, not because caries has disappeared as a disease.

 

[bkwash]

I was just wondering how you can graduate at the top of your class at harvard when it is Pass/Fail?

exactly...this guy is a troll...students at hsdm don't have a rank...

 

[Tightseal]

first of all, I would never trust my teeth endodontically with a GP. Some say it sounds egoistic, but in reality, there is a reason that I graduated at the top of my class....I am the best of the best. GP are usually (ill give credit to a few bright spots) the worst skilled of the dental profession. GP's will end up botching the procedure and you will end up coming to see me to fix it and i'll charge you triple....so, wait, nevermind.....i guess let the GPs keep messing up peoples teeth.

Rank or no rank, its just sad to know that the specialists who get most of their pts through GP referral have such a low opinion of them.

 

[blotterspotter]

Rank or no rank, its just sad to know that the specialists who get most of their pts through GP referral have such a low opinion of them.

Do You is very confused overall. He said that he can easily "produce 1.5 mill a year ? Easy...I do it and still only work 4 days a week, cancel appoints all the time, and produce 2+ mill a year," but he only finished his residency in 2005. Sorry we all didn't go to Hah-vad

 

[Dr. Parm]

Pray tell what is an OEC and how they operate. Furthermore, please also explain how the emergence of these OEC's is detrimental to Ortho's. Thanks.

 

[simpledoc]

first of all, I would never trust my teeth endodontically with a GP. Some say it sounds egoistic, but in reality, there is a reason that I graduated at the top of my class....I am the best of the best. GP are usually (ill give credit to a few bright spots) the worst skilled of the dental profession. GP's will end up botching the procedure and you will end up coming to see me to fix it and i'll charge you triple....so, wait, nevermind.....i guess let the GPs keep messing up peoples teeth.

if endo is so lucrative (for endodontists) then why the hell are endodontists resorting to placing implants now?? (especially, in programs like UCONN, UCLA etc etc) last year's Journal of Endo has a big article on insisting endodontists to implants, in almost every issue!
i see endo as mainly a dying specialty in the near future; however, endo is certainly at its peak now and will probably continue to be so for the next 2-3 years ONLY..

 

[koobpheej]

Selection bias: Being a specialist who gets called in to put out fires, but never seeing success stories, and subsequently thinking the success stories don't actually exist.

Myself, I'll probably just do an implant & crown. For the same fee that you'd charge to RCT, that tooth is treated for keeps. But I didn't graduate from Harvard, so my opinion probably shouldn't count for anything.

So if a patient presents with an irreversible pulpitis on #3-- its extract and implant?

 

[ItsGavinC]

GP are usually (ill give credit to a few bright spots) the worst skilled of the dental profession.

I agree with most of what you said, but that statement is a huge error. A good GP (and of course they aren't all good) is probably the MOST skilled of the dental profession, especially if they are delving into all areas of the profession (C&B, implants, extractions, crown lenghtening, RCT, etc.). It takes skill to be able to do all of those things well.

 

[ItsGavinC]

So if a patient presents with an irreversible pulpitis on #3-- its extract and implant?

I'd say not always, but it certainly is a viable option that should be presented to the patient.

 

[jpollei]

Pray tell what is an OEC and how they operate. Furthermore, please also explain how the emergence of these OEC's is detrimental to Ortho's. Thanks.

Search old threads on SDN and get plenty of info on this. Here's one recent thread for example: http://forums.studentdoctor.net/showthread.php?t=249844&highlight=OEC

 

[drhobie7]

I didn't read this whole thread but I know a GP who hardly refers any endo. In fact, he says he probably does nearly as much endo as an endodontist. He seems to be doing a good job too due to the lack of recurrence. New techniques are making it easier for the GP to do endo.

As far as EXT & implant as a Tx option for a tooth with an endo Dx, there is still value in proprioception from the PDL space innervation. This is obviously absent with an implant. Furthermore, natural teeth are valuable for protecting neighboring implants from excessive forces since they alone have this proprioception.

Endodontists placing implants? I think that's silly. They don't do bone or soft tissue grafting. They don't restore them. If it's easy enough for an endodontist to place you can bet the GP will do it instead. If it's not easy enough for the GP to place, he's sure not going to refer it to an endodontist over an OS or perio.

 

[GQ1]

So if a patient presents with an irreversible pulpitis on #3-- its extract and implant?

koobpheej]So if a patient presents with an irreversible pulpitis on #3-- its extract and implant?

rct the first time round.if a tooth requires re tx or apico place an implant unless its an abutment in an FPD.

 

[garo]

koobpheej]So if a patient presents with an irreversible pulpitis on #3-- its extract and implant?

rct the first time round.if a tooth requires re tx or apico place an implant unless its an abutment in an FPD.

Hi,
I would not do this.

 

[GQ1]

Hi,
I would not do this.

ok i wont do it, but what the hell is a garo

 

[garo]

ok i wont do it, but what the hell is a garo

We are a Swedish manufacturer of electrical products and active within the European Market.

http://www.garo.com

 

[OMFSCardsFan]

As far as EXT & implant as a Tx option for a tooth with an endo Dx, there is still value in proprioception from the PDL space innervation. This is obviously absent with an implant. Furthermore, natural teeth are valuable for protecting neighboring implants from excessive forces since they alone have this proprioception.

I was surprised that no one mentioned this earlier. There's a time and a place for implants and RCTs. How about a subluxated anterior tooth? When one walks through my office doors, I'll splint it and send it for RCT therapy.

 

[drhobie7]

If a tooth requires re tx or apico place an implant unless its an abutment in an FPD.

GQ1 you're a pros resident, right? Maybe you can lend some thoughts on this. I've been told that RCT teeth fail much more often when they are part of a FPD. However, I'm also aware that using an implant as an abutment for a FPD where the other abutment is a natural tooth is sometimes a bad idea due to the fact that the tooth moves 0.2mm in the PDL space and the implant doesn't. Is this always taboo? What about a stress breaker/semi-precision attachment?

 

[blotterspotter]

if endo is so lucrative (for endodontists) then why the hell are endodontists resorting to placing implants now?? (especially, in programs like UCONN, UCLA etc etc) last year's Journal of Endo has a big article on insisting endodontists to implants, in almost every issue!
i see endo as mainly a dying specialty in the near future; however, endo is certainly at its peak now and will probably continue to be so for the next 2-3 years ONLY..

Is it really dying?! I'd rather have save my teeth than have an implant placed, even if implants become as affordable as RCT. Am I crazy?! If it's done right, the tx can last 20+ years as far as I know. I want my own teeth!!

 

[blotterspotter]

Won't invisalign eventually take away lots of the business of orthodontics? I think it seems like a great idea, but I've never actually met anyone using it.

 

[drhobie7]

Won't invisalign eventually take away lots of the business of orthodontics? I think it seems like a great idea, but I've never actually met anyone using it.

Tons of people get invisalign treatment. Many of my classmates have gotten it. However, invisalign is used for minor to moderate misalignments and cannot be used in all ortho tx. I've heard the outcome is often less favorable than brackets and it takes substantially longer than brackets to get the desired result. That being said, it is a nice option for those cases in which it is indicated.

I think ortho is going to be just fine, especially with the advent of mini-implants. These little critters are really cool. I wouldn't be surprised if they complicate treatment planning to a degree that GPs don't want to attempt.

 

[bkwash]

Tons of people get invisalign treatment. Many of my classmates have gotten it. However, invisalign is used for minor to moderate misalignments and cannot be used in all ortho tx. I've heard the outcome is often less favorable than brackets and it takes substantially longer than brackets to get the desired result. That being said, it is a nice option for those cases in which it is indicated.

I think ortho is going to be just fine, especially with the advent of mini-implants. These little critters are really cool. I wouldn't be surprised if they complicate treatment planning to a degree that GPs don't want to attempt.

hey do you have a link or could you share more info on what "mini-implants" are?

 

[drhobie7]

hey do you have a link or could you share more info on what "mini-implants" are?

Also talked about as 'absolute anchorage'. They're kinda like dental implants but tinier. Here's one company's product info: http://www.imtec.com/demo/ortho_release.php

 

[bkwash]

Also talked about as 'absolute anchorage'. They're kinda like dental implants but tinier. Here's one company's product info: http://www.imtec.com/demo/ortho_release.php

thanks, those do look pretty cool.

 

[esclavo]

first of all, I would never trust my teeth endodontically with a GP. Some say it sounds egoistic, but in reality, there is a reason that I graduated at the top of my class....I am the best of the best. GP are usually (ill give credit to a few bright spots) the worst skilled of the dental profession. GP's will end up botching the procedure and you will end up coming to see me to fix it and i'll charge you triple....so, wait, nevermind.....i guess let the GPs keep messing up peoples teeth.

Two friends graduated from Harvard and they both said their clinical experience sucked...very academic but when they got out they got hosed by guys from other schools...

In my class the top people in the class hated the clinic because it meant that studying their little brains out couldn't compensate for their clinical skills. My class did a complete flip. Many of the C guys the first two year came to the top of the class when we hit clinic because they could manage a patient well, had developed good hand skills while their counterparts were competing to know every ounce of minutiae for some bone headed test. Top of class doesn't necessarily mean best hands and clinical judgement.

 

[losingfaith27]

If I were getting endo done I would have it done by an endodontist always, even for a tooth that usually has one canal and that can be treated well in many cases by a GP. That being said, I 'm in the dental profession, and I'm willing to shell out more money for a more predictable result. Of course there are GP's that do excellent work, but I'm not willing to take that risk. I'd also rather have endo treatment over titanium, because if the endo fails you can likely get an implant later. For anterior teeth it's probably in most cases easier to get an esthetic result with endo therapy and a conventional crown than with an implant. I'm no expert on this, but say #7, #8 needed endo...wouldn't you want to save these teeth instead of having them extracted and replaced with 2 Ti screws with lots of proximal bone loss? The PDL comment is of value as well, and as stated above both treatments are good. there is a time and place for both.

 

[Do You Endo]

Two friends graduated from Harvard and they both said their clinical experience sucked...very academic but when they got out they got hosed by guys from other schools...

In my class the top people in the class hated the clinic because it meant that studying their little brains out couldn't compensate for their clinical skills. My class did a complete flip. Many of the C guys the first two year came to the top of the class when we hit clinic because they could manage a patient well, had developed good hand skills while their counterparts were competing to know every ounce of minutiae for some bone headed test. Top of class doesn't necessarily mean best hands and clinical judgement.

I agree completely, but what if you ace tests and dominate clinics= most successful professional