What the hell is with these periodontists??

[simpledoc]

excuse me..but i've never actually been an anti-perio or a pro-oral surgery person, as I realize both have their own places....i just finished reading this forum on Dental Town, where a general dentist brought this up: He had a patient who had a long spanning bridge and the patient also had some periodontal problems...he first referred her to a periodontist for a consult and possible therapy. He doesn't hear back from the patient for months. After a couple of months, to his dismay, he recieves a progress note from the periodontist that the ugly guy had taken out the bridge himself and had already placed 4 implants!!!. A picture of those implants on DTown shows their horrible angulation and placement. the general dentist is now stuck up in restoring this awkward case.....
I have heard similar stories of "proud periodontists" in the past, but this one just ignited me to start a discussion....
what the hell are they thinking?? first they ventured into implants, and then the 3rd molars and "dento-alveolar surgeries" and now restorations?? where will this end? would we expect the periodontists in future to do the RCT's and Ortho as well? is there any legislature which should come out in the future to contain their agressive ambitions??
i mean who would wanna refer to a guy who would not even consider the referring doctor's opinion and go ahead and place implants on his own?? i hope i dont hear any furture stories about the OMFS guys doing similar stuff..

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[TucsonDDS]

excuse me..but i've never actually been an anti-perio or a pro-oral surgery person, as I realize both have their own places....i just finished reading this forum on Dental Town, where a general dentist brought this up: He had a patient who had a long spanning bridge and the patient also had some periodontal problems...he first referred her to a periodontist for a consult and possible therapy. He doesn't hear back from the patient for months. After a couple of months, to his dismay, he recieves a progress note from the periodontist that the ugly guy had taken out the bridge himself and had already placed 4 implants!!!. A picture of those implants on DTown shows their horrible angulation and placement. the general dentist is now stuck up in restoring this awkward case.....
I have heard similar stories of "proud periodontists" in the past, but this one just ignited me to start a discussion....
what the hell are they thinking?? first they ventured into implants, and then the 3rd molars and "dento-alveolar surgeries" and now restorations?? where will this end? would we expect the periodontists in future to do the RCT's and Ortho as well? is there any legislature which should come out in the future to contain their agressive ambitions??
i mean who would wanna refer to a guy who would not even consider the referring doctor's opinion and go ahead and place implants on his own?? i hope i dont hear any furture stories about the OMFS guys doing similar stuff..

Its funny that you brought this up. I was just reading my D-Town magazine today that just showed up and that case was in the magazine. I am sure that this isn't the norm for a periodontist to perform implants without consulting the guy doing the restoritive though. I am willing to bet the guy just saw the $$$$$$.

 

[airvent]

It really has nothing to do with periodontists. That was just one guy not "they". No need to flip out. Also if they have the training(which they do) i see no problem with perio expanding their scope.

 

[HITMAN]

It really has nothing to do with periodontists. That was just one guy not "they". No need to flip out. Also if they have the training(which they do) i see no problem with perio expanding their scope.

Any impartial person can see this. However, SimpleMindedDoc clearly has something against periodontists, and he is simply looking for an excuse to justify his animosity towards them. Hence, he searches for one unethical, unskilled periodontist and holds the entire specialty responsible. In any social context, that's called bigotry/prejudice. He knows that this is plainly obvious to the casual observer, so in his first [run-on] sentence he states the contrary, hoping to mislead us.

 

[psiyung]

Any impartial person can see this. However, SimpleMindedDoc clearly has something against periodontists, and he is simply lookng for an excuse to justify his animosity towards them. Hence, he searches for one unethical, unskilled periodontist and holds the entire specialty responsible. In any social context, that's called bigotry/prejudice. He knows that this is plainly obvious to the casual observer, so in his first [run-on] sentence he states the contrary, hoping to mislead us.

ouch

 

[DrJeff]

My partner, myself and another dentist in my town were discuss this case over lunch last week with our Dentaltown Mags inhand. While the 3 of us as GP's don't have any problems with periodontists placing implants, and many of them do a very, very good job at it. The biggest issue with case case was the NON communication of the periodontist to the GP. Let alone the shi$$y placement of a couple of those, and we even argued about the merits of 4 individual implants vs 2 implants and a bridge. From a restorative standpoint, you as the dentist placing porcelain on top of those is going to be in for a HUGE lab bill due to the placement. Between the anugulation, spacing and varible depths of the 4 that the periodontist placed, you're looking at custom abutments on however many of those you plan on using. To put some real world lab fee numbers to what this case means for your lab bill. In my office, with the lab I use for most all of my crown and bridge, a porcelain to gold crown (what i use from pre-molars back) is roughly $170 in lab fees, an all ceramic is $10-$15 either side of that depending on the type of ceramics I choose. For a standard implant crown (one where the manufacturers stock abutment and screw can be used) the lab fee is in the $250 to $270 range depending on the diameter of the implant. Now if either the bone dictates or a cra$$y placement anuglation dictates a custom abutment be made to allow for the restoration to be functional and esthetic, I typically then see a lab bill of about $450 per tooth

Looking back at that case, if I was restoring it, I'd expect to see a lab bill in the $1800 range if I restored then a 4 indiviudal teeth and about $1200 for a 4 unit double abutment bridge. Whereas if you as the restorative doc can guide their placemnt via a surgical template so that you can restore the case with stock parts, then the lab costs would be roughly $1000 for 4 individual teeth and $800 for a bridge.

I actually have one rogue oral surgeon in my area where every now and then I'll refer a patient over for some extraction(s) and they'll come back in a few weeks unbeknownst to me with an implant placed already. The 2nd time he did that to me, I sent him the lab bill for the custom abutment along with a liittle "love note" about failing to consult with me about placement location and how it was going to be almost impossible for me to restore that implant (for #7) without it looking like a giant buck tooth chicklet due to the SEVERE buccal angulation he placed it at. His response was that he put it "where the bone was". My answer was "if there wasn't bone where it needed to be to PROPERLY restore it, then do some bone grafting 1st!"

One of the true problem sources in this profession is when the general dentist - specialist line of communication is either broken or non existant That alone causes so many problem and in return often ends up with both the general dentist and specialist looking foolish in the patients eyes

 

[simpledoc]

Any impartial person can see this. However, SimpleMindedDoc clearly has something against periodontists, and he is simply lookng for an excuse to justify his animosity towards them. Hence, he searches for one unethical, unskilled periodontist and holds the entire specialty responsible. In any social context, that's called bigotry/prejudice. He knows that this is plainly obvious to the casual observer, so in his first [run-on] sentence he states the contrary, hoping to mislead us.

looks like Hitman is asking to be hit for this weak and insecure statement he has made! firstly, i have nothing against periodontists..however! i do have animosity towards those specialists (mostly periodontists unfortunately) who take the authority from the restoring dentist and place implants on their own even without first consulting them! yeah, if you are planning on being one of these unethical perio guys, yes this post is targetted towards you!
how much training does a perio residency provide on concepts of treatment planning and occlusion? how do they even know the occlusal scheme before proceeding to place the implants? in contrast a general dentist or a prosthodontist regularly deal with occlusion and treatment planning concepts at a day to day level!
in this very case as Jeff pointed out, it could have easily been restored with a 3 unit bridge with just 2 implants!
also, am not just targetting towards one periodontist...i have heard about 2 other stories, where the periodontist extracted and placed implants on his own and then sent the patient back to the referring dentist!!
i bet there are more stories coming up on this thread!
ps: i just remembered another incident where the periodontist extracted 2 wisdom teeth on his own, even before the referring dentist was consulted!

 

[airvent]

I just find it hard to believe that Periodontists are randomly placing implants then telling the patient to go find a gp to finish it. If that is the case it is just malpractice not lack of communication.

What's up with the bizarre hatred of periodontists. These are highly trained professionals and your dental colleagues. I just find your attitude childish

 

[UTDental]

I can go on Dentaltown and find just as many threads about idiot oral surgeons as I can about idiot periodontists. The issue isn't about a particular specialty (like you presented it), it's the lack of communication between dentist-specialist. It's obvious this thread was set up to be another perio-oral sx battle.

 

[groundhog]

Dr Jeff and UTDental hit the bull's eye. Communication is key in any relationship. Some thoughts come to my mind. First, had the GP even discussed implants as an optional treatment plan with the patient before giving out the referral? Second, was the referal short and ambiguous (evaluate and treat) or was it detailed and clear (My opinion is that patient presents with xxxx. I suggested xxxxx, xxxxx, and xxxx as possible remedies. Patient appears to lean towards xxxx. I advised patient that you might have additional suggestions. I appreciate your assistance in this matter and am desireous that we coordinate our efforts in a manner that is consistant with the patient's privacy in order to sucure the best possisble outcomes for said patient). etc etc etc.

 

[ItsGavinC]

I can go on Dentaltown and find just as many threads about idiot oral surgeons as I can about idiot periodontists. The issue isn't about a particular specialty (like you presented it), it's the lack of communication between dentist-specialist. It's obvious this thread was set up to be another perio-oral sx battle.

Great post, and you nailed it on the head. I'm not a fan of gum-gardening, but to say (or infer) that all periodontists are idiots, or even the majority, is just ridiculous.

The vs. threads between OS and Perio get real old.

 

[OMFSCardsFan]

Great post, and you nailed it on the head. I'm not a fan of gum-gardening, but to say (or infer) that all periodontists are idiots, or even the majority, is just ridiculous.

That case wasn't sent to a new first-year at UTHSCSA, was it? I know a shafty perio resident there. He steals all my third molar cases and then places four immediate load implants afterwards. This guy is such a crook. If he doesn't have room for an implant, he fills the socket with hydroxyapatite and charges for a bone graft. How long can this go on? Someone has to put a stop to it...

 

[Periogod]

That case wasn't sent to a new first-year at UTHSCSA, was it? I know a shafty perio resident there. He steals all my third molar cases and then places four immediate load implants afterwards. This guy is such a crook. If he doesn't have room for an implant, he fills the socket with hydroxyapatite and charges for a bone graft. How long can this go on? Someone has to put a stop to it...

Hell yeah, then I do a soft tissue graft with fetal foreskin (see Dermagraft) You people have to understand that there are ******* specialists and ******* general dentists. If I met ya'll in person I would probably think that 80% of the posters on this forum are *******es (OmfsCardsFan is an excellent example).

As for occlusion training, I know we have 2.5 semesters of classes in the subject. My opinion, however, is that general dentists should be restoring implants and placing the abutments instead of making the surgeon (be it OMFS or Perio). And thats right CardsFan, I did just call myself a surgeon. Whatcha going to do about it?

 

[Comet208]

DrJeff,
It is people like you who make dentistry so prestigious. Your insights are the best.

 

[OMFSCardsFan]

And thats right CardsFan, I did just call myself a surgeon. Whatcha going to do about it?

Nothing...just laugh...

 

[groundhog]

Hell yeah, then I do a soft tissue graft with fetal foreskin (see Dermagraft) You people have to understand that there are ******* specialists and ******* general dentists. If I met ya'll in person I would probably think that 80% of the posters on this forum are *******es (OmfsCardsFan is an excellent example).

As for occlusion training, I know we have 2.5 semesters of classes in the subject. My opinion, however, is that general dentists should be restoring implants and placing the abutments instead of making the surgeon (be it OMFS or Perio). And thats right CardsFan, I did just call myself a surgeon. Whatcha going to do about it?

The perio grad dept resident did my sinus lift and molar implants...(had choice of perio grad or oms grad...D4 recommended perio grad). All turned out great. D4 is scheduled to do the abutements and crown restorations.

 

[OMFSCardsFan]

The perio grad dept resident did my sinus lift and molar implants...(had choice of perio grad or oms grad...D4 recommended perio grad). All turned out great. D4 is scheduled to do the abutements and crown restorations.

That fetal foreskin feels smooth on the tongue, huh! I certainly think that there are plenty of good perio programs out there that promote good surgical technique. In most cases, I think implants are well within the scope of the general dentist's practice. I was only joking around with my buddy since he's a future periodontist...

 

[omfsres]

excuse me..but i've never actually been an anti-perio or a pro-oral surgery person, as I realize both have their own places....i just finished reading this forum on Dental Town, where a general dentist brought this up...

They're moving in on general dentistry and other specialties b/c their own is dying.