how competitive is endodontics?

[dexadental]

Wondering about this, this speciality really interests me.

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[fightingspirit]

this speciality really interests me.

how and why so, if i may ask?

 

[ItsGavinC]

It is EXTREMELY competitive, especially if you are applying straight out of school. Some programs will only interview applicants who have had 2+ years of work experience (or a GPR/AEGD).

It has been speculate that applying to endo straight out of school is even tougher than applying to Ortho. It's tough to back up a claim like that, but it gives you an idea of what people are experiencing as they apply.

 

[drhobie7]

Endo and ortho are the hardest specialties to get into. Yeah, I love endo too. Oh wait, actually I love the income.

 

[simpledoc]

It is EXTREMELY competitive, especially if you are applying straight out of school. Some programs will only interview applicants who have had 2+ years of work experience (or a GPR/AEGD).

It has been speculate that applying to endo straight out of school is even tougher than applying to Ortho. It's tough to back up a claim like that, but it gives you an idea of what people are experiencing as they apply.

endo i believe is getting on the downhill now... it was as it's peak for the past couple of years..not anymore..i heard from a friend that at UCONN, there were 2 spots left to be filled with no takers and eventually they filled in with mediocre applicants. (ps: dont quote me on that one)
with GP'susing rotary and implants being snapped on left and right, there will not be that many oppurtunities for retreatments and complex endo's to keep the endodontist that busy..endo will not die..but it will just join perio...
my endodontist buddy is now taking courses on planning and placing implants..and quotes that the endo leaders all over the country are urging them (in almost every issue of J. Endo) to catch up with the implant boat!
ps: yeah my buddy as of now does make about 175 K per year

 

[ItsGavinC]

and quotes that the endo leaders all over the country are urging them (in almost every issue of J. Endo) to catch up with the implant boat!

I've heard the same. Everybody wants a piece of implants.

 

[dentalstudent1]

It is EXTREMELY competitive, especially if you are applying straight out of school. Some programs will only interview applicants who have had 2+ years of work experience (or a GPR/AEGD).

It has been speculate that applying to endo straight out of school is even tougher than applying to Ortho. It's tough to back up a claim like that, but it gives you an idea of what people are experiencing as they apply.

two girls in our school got in the first time so I think your spreading rumors.

 

[dentalstudent1]

endo i believe is getting on the downhill now... it was as it's peak for the past couple of years..not anymore..i heard from a friend that at UCONN, there were 2 spots left to be filled with no takers and eventually they filled in with mediocre applicants. (ps: dont quote me on that one)
with GP'susing rotary and implants being snapped on left and right, there will not be that many oppurtunities for retreatments and complex endo's to keep the endodontist that busy..endo will not die..but it will just join perio...
my endodontist buddy is now taking courses on planning and placing implants..and quotes that the endo leaders all over the country are urging them (in almost every issue of J. Endo) to catch up with the implant boat!
ps: yeah my buddy as of now does make about 175 K per year

this post is full of inconsistencies.

 

[toofache32]

this post is full of inconsistencies.

So is this one.

 

[GatorDMD]

this post is full of inconsistencies.

how do you mean? It seemed like an accurate post to me.

 

[nnjh]

how do you mean? It seemed like an accurate post to me.

Dentalstudent1 is a troll. Also happens to be a high school student.

 

[ktcook83]

I've heard the same. Everybody wants a piece of implants.

Agreed... prosth is even training residents in implant sx now at umich, as are a few endo programs around the country. When was the last time a gp referred an implant case to an endo... Endo programs training residents in surgical placement of implants are waisting their residents' time IMO. Leave the implants for GP's, OMS, and maaaaaaaaaaayyybe perio (not that they manage the soft tissue better or anything).

 

[ajmacgregor]

Agreed... prosth is even training residents in implant sx now at umich,

You need to learn some history my friend...Prosthodontists were the first specialists to place implants...OMS came into the game about a decade later...

 

[aphistis]

You need to learn some history my friend...Prosthodontists were the first specialists to place implants...OMS came into the game about a decade later...

Yeah. Despite my distaste for certain prosthodontists, they make a good point in saying that implants is a restorative discipline with a surgical component, and not the other way around.

 

[ktcook83]

You need to learn some history my friend...Prosthodontists were the first specialists to place implants...OMS came into the game about a decade later...

I won't argue with you as history sucks and was never my favorite class, but I can't imagine any GP referring implant sx to pros over OMS or perio... not gunna happen

 

[aphistis]

I won't argue with you as history sucks and was never my favorite class, but I can't imagine any GP referring implant sx to pros over OMS or perio... not gunna happen

Who said anything about GP's restoring the implants? Prosthodontist-placed implants are going to be for situations where the entire *case* is handled by the prosthodontist--full mouth reconstructions and the like. You might want to get another year or three or ten under your belt before making such sweeping statements about how the profession works.

 

[ktcook83]

Who said anything about GP's restoring the implants? Prosthodontist-placed implants are going to be for situations where the entire *case* is handled by the prosthodontist--full mouth reconstructions and the like. You might want to get another year or three or ten under your belt before making such sweeping statements about how the profession works.

In that case obviously pros would do the whole thing. Then again... how many prosthos can make it in private practice... not a lot... most are in academia because they almost NEVER get referrals from GPs unless its some negative ridge case for dentures or something. Prosth's in private practice get almost all their referrals from specialists.... until they build up a reputation prosth is a tough specialty outside of the dental school setting. I respect their knowledge, and I wish I had it when it comes to full mouth reconstruction as a GP. Some of the cases prosth and grad operative do here are amazing.

 

[GQ1]

I won't argue with you as history sucks and was never my favorite class, but I can't imagine any GP referring implant sx to pros over OMS or perio... not gunna happen

Ah my uneducated friend. This is how it goes. Some Gps do refer cases to prs for implant sx. The pros fully works up the case, comprehensive exam, plans where the implants will optimally be placed for restoration, waxes up the case, in a full arch will make the imterim and duplicate for ct scan. at or post surgery they can place the abutments for the gp to snap an impression and use the temporary as a final guide a few months later. thereby making the gps life a whole lot easier. you think perio or endo will do this.

for me my first option is to place them myself as a pros. second refer to OMFS as they re working with a full toolbox of tricks cf perio, then perio and never endo. if my endodontist is placing implants i dont want to work with him.

in addition to a lack of training and treatment planning knowledge he is either

1- unsuccessful at endo
2- hes not concentrating on endo
3- if im giving him endo pts he should be reciprocating in return. the few pts that come directly to him for implants hes got to be sending over.

plus you dont want to be working with someone selfish - placing the implants and getting the hell out of there, i want follow ups, options do do further grafting etc and continued care throughout the tx. endo is used to short term transactions with the pt.

 

[12YearOldKid]

There is only one guy in my class who wants to do endo. And, yes, it is the money. He pretty much admits that. Anyway we were all talking about how endo might be on the downhill side right now due to implants. He said he has talked to the faculty and other endos about this.

Many of them seem to think that the new paradigm will be that a tooth is referred for endo. The endodontist makes the call as to what the best option is and either 1. Does the RCT or 2. Extracts and places an immediate implant. It is then referred back to the GP for restoration. He seems to think this is a win-win situation. The GP still gets a crown to do, the patient still gets a tooth, the endo still makes bank.

But I would be pissed if I referred a patient for RCT and the endo placed an implant instead. That endo would NOT be getting another referral from me.

 

[12YearOldKid]

this speciality really interests me.

This

or this

Edit: Hey, why can't you post images here?

 

[Dr. Nubbs]

3rd year student also interested in Endo...for the sx and challenge (though the moolah isn't bad either). I have also been told (by several practicing endodontists, among other professionals) that endo is on the downhill due to rotary instrumentation and increased profitability for GP's. So, as long as I realize that I will be doing sx, gnarly molars, and botched GP retreats, I could still do it. No delusions of grandeur about what the specialty will entail!

Thanks,

Nubbs

 

[12YearOldKid]

I assume by endo sx you mean surgery and not some form of weird dental perversion.

I think the days of apical surgery are all but dead. In most cities there are only 1 or 2 endos who actually mess with apical surgery and even then they don't do much. The residents at my school only get to do a couple during their time here.

If a patient is going to be having surgery, it might as well be something with a decent prognosis -- like an implant. By the time you are resorting to apico there aren't many years left for that tooth. There is no way I would opt for apical surgery on myself or family members. Pull that sucker out and obturate with titanium.

 

[gryffindor]

If a patient is going to be having surgery, it might as well be something with a decent prognosis -- like an implant. By the time you are resorting to apico there aren't many years left for that tooth. There is no way I would opt for apical surgery on myself or family members. Pull that sucker out and obturate with titanium.

I disagree. If it was my mother, I would recomment an apico, especially if it was an anterior tooth. Implants are a very good solution for a lot things in dentistry (like bridges & dentures & flippers), but sometimes the older procedures are still worth considering (such as retreatments, apico, hemisections, root amputations). You may still get a few years out of it with an apico. Why pull it out prematurely? Nothing is as good as your own tooth. Eventually it will need the implant, why jump the gun? As long as the patient is aware that the apico isn't forever and the implant is coming down the line, I say refer for the apico.

Don't oral surgeons do apicos as well?

 

[12YearOldKid]

I disagree. If it was my mother, I would recomment an apico, especially if it was an anterior tooth. Implants are a very good solution for a lot things in dentistry (like bridges & dentures & flippers), but sometimes the older procedures are still worth considering (such as retreatments, apico, hemisections, root amputations). You may still get a few years out of it with an apico. Why pull it out prematurely? Nothing is as good as your own tooth. Eventually it will need the implant, why jump the gun? As long as the patient is aware that the apico isn't forever and the implant is coming down the line, I say refer for the apico.

Don't oral surgeons do apicos as well?

I'm going to have to concede this one to you. You have a very good point (and also a dental degree, something I do NOT have. ) There are situations where an apico might be a good idea - especially if money and repeated surgical insult is not a consideration.

But there can also be advantages to extracting rather than nursing along a doomed tooth for a few more years. One consideration is that most teeth that need apico are most likely going to have slowly progressing bone loss as well.

By extracting sooner rather than later you leave as much of the ridge as possible to provide an esthetic result when you place the inevitable implant. Plus the patient saves some money by not forking over cash for the apico and then again for the implant 5 years later.

I know now I'm getting into case by case specifics. There are no absolutes, but I still think it would be a rare situation where I would choose the apico for myself. Maybe that will change when I get some experience.

 

[dexadental]

This information is great. I am certainly not in it for the money, have shadowed a really talented endodontist and witnessed his procedures, surprisingly he has a lot of variety in his day to day work. I have a question though, how come perio is seemingly easier than endo to match into? Is perio on the "downhill" too? I am keeping an open mind and am going to bust my ass to hopefully get into one of these specialities, so I hope they still are needed and provide due income. What is the deal with perio anyways? How do you establish yourself right out of residency?

 

[biologic_width]

This information is great. I am certainly not in it for the money, have shadowed a really talented endodontist and witnessed his procedures, surprisingly he has a lot of variety in his day to day work. I have a question though, how come perio is seemingly easier than endo to match into? Is perio on the "downhill" too? I am keeping an open mind and am going to bust my ass to hopefully get into one of these specialities, so I hope they still are needed and provide due income. What is the deal with perio anyways? How do you establish yourself right out of residency?

Perio is a good specialty for those who enjoy both the surgical and non-surgical aspects of dental treatment. Also - very good lifestyle or, if you're like me and have a few kids, good for a part-time schedule.

In general, I would say that perio is one of the least competitive specialties to get into. In my program, half of the spots go to foreign grads. There are some fantastic perio programs (San Antonio and Houston come to mind) which are probably just as hard to get into as ortho, endo, or OMFS, but, in general, getting into a perio program is not difficult.

I agree with what has been said - don't do any specialty unless you truly love the day-to-day stuff. This is especially true in perio - unless you really like perio maintenance and periodontal surgery, don't do it - you will be very unhappy as a periodontist if you just want to put in implants. You can get good implant training via other routes.

If you have any other questions, PM me...

 

[scalpel2008]

i know this isn't the main topic of discussion in this thread, but since we brought up apicos, here's my $0.02. root end surgery (aka apico) is a region dependent procedure. in the midwest and south, its rarely done. from what i understand, some of the northeast OMS programs do several. I for one am not a big fan of the procedure. With implant success rates approaching >95% for 10 years, I would definitely recommend and implant over an apico to my mother (and i did) With the advent of abutments that optimize esthetics, a well planned anterior implant can provide excellent results. After a tooth has failed endo therapy and retreatment, an apico is just another procedure/cost/time off work/etc towards an implant that will very likely survive as long as the patient. Now if you have a diabetic smoker, it might be worth the apico because you implant success rate will be dramatically lower.

 

[ElDienteLoco]

most teeth that need apico are most likely going to have slowly progressing bone loss as well.

By extracting sooner rather than later you leave as much of the ridge as possible to provide an esthetic result when you place the inevitable implant. Plus the patient saves some money by not forking over cash for the apico and then again for the implant 5 years later.

What kind of slowly progressing bone loss are you talking about? It seems like a periodontally involved tooth (slowly progressing bone loss) would be a poor candidate for an apico (even by a money-grubbing endodontist... )

On the other hand, here's where I would say an apico has some merit: The RCT on the premolar abutment for a a beautiful new four unit bridge fails. Do we go through the crown to do another re-treat? Maybe we should just extract the abutment and replace the space with an implant supported bridge... I believe there are appropriate indications for ext and implant tx, but sometimes I get tired of the idea that all endo should be replaced by implants.

Another reason to try the apico...: what do you do when the apico fails? You can still extract and place an implant, but...what do you do when the implant-abutment interface fails in 10 years? I know the occurence of mechanical failure is low, but what choice will your patients have if their deus ex machina implant fails?

Anyone actually have any real numbers on the success rate of apicos?
How about real data on the success rate of implants? If you look carefully at the studies implant manufacturers tout as "success" rates, you might be surprised at what is missing from the data. I personally would think that an implant that fails to osseointegrate should be considered a "failure", but such an outcome is not counted as a failure in the implant literature. I recognize that implant therapy is excellent and very predictable, but there are biases that are often overlooked when compared to evidence in other dental disciplines.

 

[bkwash]

i know this isn't the main topic of discussion in this thread, but since we brought up apicos, here's my $0.02. root end surgery (aka apico) is a region dependent procedure. in the midwest and south, its rarely done. from what i understand, some of the northeast OMS programs do several. I for one am not a big fan of the procedure. With implant success rates approaching >95% for 10 years, I would definitely recommend and implant over an apico to my mother (and i did) With the advent of abutments that optimize esthetics, a well planned anterior implant can provide excellent results. After a tooth has failed endo therapy and retreatment, an apico is just another procedure/cost/time off work/etc towards an implant that will very likely survive as long as the patient. Now if you have a diabetic smoker, it might be worth the apico because you implant success rate will be dramatically lower.

okay so implants are about to be hot...but what specialty "dominates" implants? I have heard endo, perio and even OMS guys placing them. If you are interested in placing implants which specialty would be best to enter?

 

[toofache32]

okay so implants are about to be hot...but what specialty "dominates" implants? I have heard endo, perio and even OMS guys placing them. If you are interested in placing implants which specialty would be best to enter?

General dentistry.

 

[scalpel2008]

okay so implants are about to be hot...but what specialty "dominates" implants? I have heard endo, perio and even OMS guys placing them. If you are interested in placing implants which specialty would be best to enter?

perio...because they get to replace their failed implants over and over again...

 

[6897round2]

I have heard endo, perio and even OMS guys placing them.

This, coupled with the fact that you are going to the most overrated dental school in the nation, shows exactly how much you know about dentistry.

 

[scalpel2008]

endo placing implants is equivalent to me (OMS) uprighting impacted third molars, endodontically treating them, followed by crown lengthening and then scraping the calculus off the distal aspect...and by scraping i meant performing a cosmetic surgical debridement of the calculus.

 

[bkwash]

This, coupled with the fact that you are going to the most overrated dental school in the nation, shows exactly how much you know about dentistry.

that was uncalled for...why are you so bitter, last time i checked I have not taken any dental related classes, but I do seek to educate myself on the profession i am entering. Since you know so much about dentistry why not just answer my question like the other dental students did instead of clogging the board with your useless insults.

 

[ItsGavinC]

Many of them seem to think that the new paradigm will be that a tooth is referred for endo. The endodontist makes the call as to what the best option is and either 1. Does the RCT or 2. Extracts and places an immediate implant. It is then referred back to the GP for restoration. He seems to think this is a win-win situation. The GP still gets a crown to do, the patient still gets a tooth, the endo still makes bank.

What if the endo tooth is an abutment for a bridge? Does he still go ahead and extract it (sheesh?) and place an implant? Will he extract anything and everything under the sun?

Doesn't that model actually steal patients from several other specialties?

 

[ItsGavinC]

Implants are a very good solution for a lot things in dentistry (like bridges & dentures & flippers), but sometimes the older procedures are still worth considering (such as retreatments, apico, hemisections, root amputations). You may still get a few years out of it with an apico. Why pull it out prematurely? Nothing is as good as your own tooth. Eventually it will need the implant, why jump the gun? As long as the patient is aware that the apico isn't forever and the implant is coming down the line, I say refer for the apico.

Don't oral surgeons do apicos as well?

Excellent post, and I agree.

 

[ItsGavinC]

3rd year student also interested in Endo...for the sx and challenge (though the moolah isn't bad either).

You're probably one of the few in our class that has a decent shot of getting into programs straight out of skool, er school.

 

[ItsGavinC]

from what i understand, some of the northeast OMS programs do several.

Do OMFS programs *really* do apicos? Ugh.

 

[omfsStud]

In that case obviously pros would do the whole thing. Then again... how many prosthos can make it in private practice... not a lot... most are in academia because they almost NEVER get referrals from GPs unless its some negative ridge case for dentures or something. Prosth's in private practice get almost all their referrals from specialists.... until they build up a reputation prosth is a tough specialty outside of the dental school setting. I respect their knowledge, and I wish I had it when it comes to full mouth reconstruction as a GP. Some of the cases prosth and grad operative do here are amazing.

I heard that Michigan's grad operative program will put most GP's out of practice soon. The amalgam polishing is second to none.

 

[Extraction]

Do OMFS programs *really* do apicos? Ugh.

UGH is right. It depends on the geographic region. It can be very lucrative and may influence your referals if you do not provide the service and your competition does.

 

[6897round2]

...why not just answer my question like the other dental students did instead of clogging the board with your useless insults.

A) Because nicer people will do that anyway.
B) Because it's easier to make fun of you and Harvard

 

[ktcook83]

I heard that Michigan's grad operative program will put most GP's out of practice soon. The amalgam polishing is second to none.

I hope amalgams get banned in the U.S. 99% of the grad op residents are international students enabling themselves to practice here. As a future GP, I wish I could acquire some of the grad op training without having to do a masters thesis and spend 3 more years tuition money.

 

[groundhog]

I assume by endo sx you mean surgery and not some form of weird dental perversion.

I think the days of apical surgery are all but dead. In most cities there are only 1 or 2 endos who actually mess with apical surgery and even then they don't do much. The residents at my school only get to do a couple during their time here.

If a patient is going to be having surgery, it might as well be something with a decent prognosis -- like an implant. By the time you are resorting to apico there aren't many years left for that tooth. There is no way I would opt for apical surgery on myself or family members. Pull that sucker out and obturate with titanium.

I think a lot depends on the particulars of each case. I v'e got 2 molar implants (upper and lower). However, I opted for a root amputation on one upper molar with a failed root canal because the situation seemed worth the risk. The main mitigating factor was that the root which had to be snipped was the smallest of the three roots. Other factors which influenced my decision were that I have long roots, retain plenty of bone structure around those roots, and the molar in question remains somewhat supported by surrounding teeth.

P.S. Perio sunk the anchors and Endo snipped the root.

 

[S Files]

okay so implants are about to be hot...but what specialty "dominates" implants? I have heard endo, perio and even OMS guys placing them. If you are interested in placing implants which specialty would be best to enter?

generally speaking, OMS "dominates." if the case is anatomically complex, or pt. needs additional medical management it's a no brainer - straight to OMS. Perio would be second - some gp's prefer referring to perio's - they have the reputation of being gentler with soft tissue - i don't buy that, but some gps in private practice do. Endo? no way. As mentioned above, increasing number of general dentists are placing their own implants - of course depends on case selection. but straight fwd cases (which would account for approx 50-60% of cases) could be done routinely by a gp.

 

[S Files]

A) Because nicer people will do that anyway.
B) Because it's easier to make fun of you and Harvard

OK whatever makes you feel better about yourself buddy

 

[AUG2UAG]

will endo survive after the next fifteen to twenty years?

 

[Frank Cavitation]

generally speaking, OMS "dominates."

I generally agree, but OMS is a specialty that don't see the patients on a regular recall schedule. I have seen cases where the surgeon just wants to put the implant in the best quality bone and assumes a good prostho job can be done on abutments with weird angles. A GP or prosthodontist will at all costs avoid screwing themselves like that.

To get back on topic, I think endo will not get less competitive in the near future. If re-treatments and apico are eliminated from the world there will still be enough referring GPs that hate endo, or don't have scopes to do tough canals.

 

[ItsGavinC]

will endo survive after the next fifteen to twenty years?

Absolutely. Afterall, implants aren't really anything new, they're just more common now than ever before.

 

[toofache32]

I generally agree, but OMS is a specialty that don't see the patients on a regular recall schedule. I have seen cases where the surgeon just wants to put the implant in the best quality bone and assumes a good prostho job can be done on abutments with weird angles. A GP or prosthodontist will at all costs avoid screwing themselves like that...

Similarly, OMS's and any referral-based specialist will not want to screw themselves out of further referrals. I'm not sure that's a valid point.

 

[AUG2UAG]

Absolutely. Afterall, implants aren't really anything new, they're just more common now than ever before.

I'm curious on two counts:
1) new technologies making it more conveniant for a general dentist to perform complex RCT (not randomized clinical trials )

2) improvements in implant technology driving down prices where the pt. would rather have the compromised tooth extracted, than restored (maybe this latter reasoning isn't so well thought out on my part)

It just doesn't seem probable that the lucrative nature of this field will survive due to advancements in technology-- please advise because i'm very curious to know about the future of endo