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Discussion in 'Dental' started by nug, Mar 23, 2004.
Who will be doing the majority of implants? Perio or OMS?
Hey DrRob, how many of the GP's in your area are placing implants?
Probably perio, but it depends on the difficulty of the case, I suppose.
If you're going to end up doing some serious bone grafting (and I mean anything where you have to harvest autogenous bone whether it's from the symphysis of the mandible, or from the hip), I imagine OMS would be doing the surgery. Also, if the patient is going to be sedated, or if there is a high degree of medical compromise in the patient, I imagine OMS would be doing it.
Of course, I could be wrong, so if anyone actually knows enlighten us!
If you look at the percentage of a specialty that does the most (placement of the implant body that is), it would be the OMFS folks, followed by the perio folks and then about equal between the endo and prosth guys. If you look at absolute numbers of docs, then its the GP's that place the most.
In my practice, its an OMFS that places them for me.
This past fri I was with a GP that placed 6 maxillary implants. He did the bone graft back in sept. I believe he got the bone from a bone bank.
It should be noted he took the 2 year implant course at NYU
Thanks to bio/tech advances, continuing education courses, and (fankly) economics, I predict that dentistry will evolve as follows:
Dental schools will be absorbed by the medical schools.
Dentistry will become an oral medical/surgical specialty much like opthomology which is now the ocular medical/surgical specialty.
DDS/DMD's will do the hands on complicted surgical procedures now performed by dental specialists.
RDH/CDA's will do many of the routine procedures under the supervision and/or diredtion of DDS/DMD's.
So, if you already have your DDS/DMD or are in dental school now..rejoice....your profession may become the "to die for" specialty on match day for future grads of medical schools.
Can endos really do implants? I thought it was ethically wrong to do procedures outside of your specialty?
I'm wondering about this too. I don't see how an endo could say implants are within his/her scope of practice.
Well if one thinks of the titanium anchor as an artificial root, placement of the anchor by an Endodonitst may well fall within ethical standards. If technology advances to such a point that implants become both more economical and reliable than root canals, Endodonitsts would certainly desire to have established a stakehold in the implant arena. This gets us back to the point I was making in my previous post. I believe this whole bio/tech thing is going to blur the boundaries making dental speciaties an obsolete idea sometime in the future...
I understand what you're saying; my thinking is that the procedure is inherently both surgical and periodontal...but what does it really have to do with dental pulp? That's what I'm having trouble reconciling.
Going one beyond, I also think dental specialties will be around for quite some time. There's too much in dentistry for a GP to be an expert at every procedure, and having someone to punt the hard cases to is beneficial to both doctor and patient. Dentistry is a rapidly expanding field, and that inclines me to think we'll be adding dental specialties in the future, rather than eliminating them. DrJeff, DrRob, Griffon, Tom, River, or any other knowledgeable sources want to chime in?
Thanks for joining the debate. I value your inputs. You could very well be correct about dental specialties. My vision is long term and based upon my sense of the direction of socio/economic forces in the USA. As I see it, the name of the present economic game seems to be consolidation of productive enterprizes and value added justification of labor. Hence my thoughts about medical schools absorbing dental schools (consolidation) which would then produce MD/DO's who would compete for matching into highly competitve oral medical/surgical speciality programs. The new "dentists" would be trained to do all OMS, Endo, Ortho, Pros, in a highly competent manner while also directing and/or supervising allied professionals who would do the routine screen/clean/restoration functions (value added labor justification).
I actually called up one the the endodontists in the group that I refer to and asked him this today(he does place implants). To paraphrase his response: His view of the scope of endodontics is that he not only specializes in the pulp and its treatment and restoration, but also the root and its treatment and "restoration". He rightly acknowledges that the endodontic treatment of a tooth, while having a long term success rate in the 95%+ range, is not 100%, and also due to other factors such as root fracture/ perforation, and unrestorable teeth secondary to extensive coronal decay/ perio disease, and failed previous endodontic treatment, that he needs to have an alterbative treatment option for the replacement of that tooth, without potentially compromising the health of the pulps of the adjacent teeth that a bridge can do long term.
Frankly I agree with him 100% on this assessment. Believe you me, if an endondontist can do anything to save that tooth, they will, but as all of you here will eventually find out, not everything you do/can do works 100% of the time Plus, from the surgical side of things, if an endodontist has the surgical skills to perform an apicoectomy on the DB root of #15 they can certainly "spin some titanium" and sink an implant. BTW, when I asked my endodontist what percentage of his practice is implants, we said "less than 5%, .........maybe even less than 2%" so you can infer that he uses way more titanium in his NiTi files than in titanium implant bodies.
Great info as always...thanks!
It used to be like that in some places before, like in Spain. But only a few years back they finally made Dentistry a different profession from Medicine.
I'm not sure, but I beleive they had some kind of shortage and also a lot of their own citizens, going to dental school abroad and then going back to Spain as foreign trained.
I guess dental schools there weren't making enough, plus it was taking wayyy to long to finally become a dentist, let alone a specialist.
I know you were reffering to the US situation, but it just my 2 cents worth on how it worked abroad. It didn't.
Dr. Gordon Christensen spoke to our class today and told us something nearly exact opposite -- citing that Prosth. placed the highest percentage, followed by OMS.
That must have been a nice meeting.
One thing that I'll say about "Gordo" is that he's a huge wealth of information about just about every aspect of dentistry that you can imagine. However, his world of dentistry "provo style" tends to be a bit different from the real world that the rest of us practice in, so as time goes on you'll likely learn to take many things that Gordo says with a grain of salt or two.
Dr. Jeff, I hear ya. I assumed his data wasn't from "provo" dentists but was more inclusive of the profession as a whole.
Still, I'm also from Provo and I've got to respect my relatives