Oral Surg - Good program or not

[GenGts]

I'm looking into the programs that offer OMFS residencies and wanted to see if anyone knows something about some of these programs.

Denver Health Medical Center?
Hospital of St. Raphael?
University of Connecticut?
University of Florida, Jacksonville?
Tufts?
Henry Ford? (is it the same as Macomb Hospital program? 3 spots all together?)
UMDNJ?
Nassau?
Woodhull?
Brooklyn Hospital?
University of Washington?

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[Spirochete]

wow....you just listed some of the worst programs out there, no offense to anyone....except maybe Washington.

 

[GenGts]

well i'm trying to narrow down my choices, do you (or anyone else) know anything about these ones? I have another list of the better ones so I just wanna get some more fairly good programs.

 

[GenGts]

and you don't think tufts is good?

 

[Spirochete]

all the north east programs are SUBAVERAGE....start looking in the south-east region and midwest like louisville and kentucky.....

 

[GGYY]

wow....you just listed some of the worst programs out there, no offense to anyone....except maybe Washington.

hey,
for these subavgerage programs, what type of board scores could get me matched? i know the score isn't everything, but help me out please? thnx.

 

[Yah-E]

I've always heard that UF Jacksonville is a strong program!

Henry Ford, forget about it, the rumor had it that last year that they matched their residents on January 30, 2006 to start July 1, 2006, sometime in March 2006, they shut down their program and had to inform their matched incoming residents to go somewhere else!

I also have heard positive things about New Jersey's program from my classmate who interviewed there.

 

[High Desert Doc]

jax and uw are good programs...i would take them off that list of associations...they shouldn't be there....

i interviewed at denver health...which was the only 4 year i interview at....only one resident at a time...good mentorship with dr. zallen though...unfortunately, no relationship with univ. of colorado....nice residents...but just wasn't the program i was looking for...i was looking more into like lsu-no...right yah-e!

 

[shariq]

all the north east programs are SUBAVERAGE....start looking in the south-east region and midwest like louisville and kentucky.....

Not all north east programs are subaverage. Montefiore is an excellent program-excellent exposure to implants(best in the US), good exposure to orthognathics, trauma and pathology and ofcourse your bread and butter wizzies under sedation

 

[fightingspirit]

all the north east programs are SUBAVERAGE....start looking in the south-east region and midwest like louisville and kentucky.....

and all spirochetes make sweeping generalizations about stuff they know nothing about. FYI: LIJ is an excellent program. remember, not everyone is a cowboy with a hidden interest in doing breast implants after completion of their 6 yr OMFS residency. northeastern programs are just as good as others. may i also remind you that those who finish from northeastern prgrams also get certified.

 

[flat4]

all the north east programs are SUBAVERAGE....start looking in the south-east region and midwest like louisville and kentucky.....

Add Christiana Care (Delaware) to the list of solid top tier 4 year programs.

 

[shabu2]

Add Christiana Care (Delaware) to the list of solid top tier 4 year programs.

Coming from d-school, any OMFS programs will feel like a swift kick in the nuts for anyone. LONG hours and TONS to learn. Nothing is sub-standard for OMFS.

 

[oms fan]

...Montefiore is an excellent program-excellent exposure to implants(best in the US)

Just curious how much they do (implants)? We do what I consider to be a lot at UCLA.

 

[xXCOwHoRnXx]

For the year 2006-2007 Monte placed over 2000 implants
though i'm sure the director (Dr Kraut) placed most of them...

 

[charlestweed]

Coming from d-school, any OMFS programs will feel like a swift kick in the nuts for anyone. LONG hours and TONS to learn. Nothing is sub-standard for OMFS.

Agree 100%. Every OMFS program in the US only selects best students from d-school. To me, it is the most respected specialty in dentistry.

 

[charlestweed]

Just curious how much they do (implants)? We do what I consider to be a lot at UCLA.

No doubt, UCLA OMFS residents place a lot of implants. OMS fan, enjoy the 6AM round in the basement and say hello to Dr. Felsenfeld for me.

 

[shariq]

Just curious how much they do (implants)? We do what I consider to be a lot at UCLA.

I have already placed 61 implants and done 4 sinus lifts and i have only been at montefiore for one year

 

[Yellowman]

I have already placed 61 implants and done 4 sinus lifts and i have only been at montefiore for one year

here at case oms, residents place around 200 - 250 implants. I placed 48 my first year. lots of bone grafts, jaw, cranial and hip grafts. anyone know how many implants perio residents from a good program place?

 

[charlestweed]

here at case oms, residents place around 200 - 250 implants. I placed 48 my first year. lots of bone grafts, jaw, cranial and hip grafts. anyone know how many implants perio residents from a good program place?

USC perio residents place a alot of implants. They are also exposed to a lot of sinus lift, and ramus/chin graft procedures. The prosth dept is right next door and the prosth residents don't (or rarely) refer patients to OS b/c OS is in medical center (10 miles away from dental school). How do I know? my wife got her perio from there. However, the tuition is too expensive. Thank God, we've just finished paying all her student loans.

Dr. Nazowri, perio prog. director, does not believe in allogenous (spelling?) bone graft so he teaches residents how to harvest bone from patients' own ramus or chin. I am surprised that my wife can do all these procedures and she does them fairly regularly in her practice.

 

[Yellowman]

USC perio residents place a alot of implants. They are also exposed to a lot of sinus lift, and ramus/chin graft procedures. The prosth dept is right next door and the prosth residents don't refer patients to OS b/c OS is in medical center (10 miles away from dental school). How do I know? my wife got her perio from there. However, the tuition is too expensive. Thank God, we've just finished paying all her student loans.

Dr. Nazowri, perio prog. director, does not believe in allogenous (spelling?) bone graft so he teaches residents how to harvest bone from patients' own ramus or chin. I am surprised that my wife can do all these procedures and she does them fairly regularly in her practice.

yes i agree usc has a very strong perio dept. I should know, i am a USC grad. Nowzari runs a pretty good perio dept, many of the perio residents have 90+ boards and are from reputable schools like ucla, uconn etc. He has also done an excellent job of brain washing the dental students at USC into thinking that all implants should be placed by periodontists, and that oral surgeons are evil beings who have no place in the world of dentistry. Part of this is because oral surgery dept has almost no presence at dental school...they operate mainly out of LA county hospital, and whatever oral surgery presence at dental school is pretty weak in my humble opinion. Despite the fact that OMFS at USC is a very busy program, because they are more facial trauma surgeons than dentalalveolar surgeons (at least at the hospital, i am sure the residents have dentalalveolar exposure at the dental school), dental students can't really relate to them. This is one of the ways the USC perio dept can perpetuate the notion that periodontists are superior soft tissue handlers than oral surgeons. This isn't to knock USC perio, I think highly of their program. I am probably one of the few oral surgery guys out there who thinks not all periodontists are foreign, incompetent, etc. Hell, I considered doing perio at USC prior to choosing OMFS. I have no problems with periodontists as long as (1) they don't trash talk oral surgeons, and (2) don't call me to bail them out of trouble as they have performed procedures with complications that they couldn't handle. I also think it's unfortnate that the USC OMFS hasn't done more to have a stronger presence at dental school (especially because I think they are a strong surgical program), educating dental students what the true scope of oral surgery is, and just how resilient of a tissue gingiva is.

 

[charlestweed]

yes i agree usc has a very strong perio dept. I should know, i am a USC grad. Nowzari runs a pretty good perio dept, many of the perio residents have 90+ boards and are from reputable schools like ucla, uconn etc. He has also done an excellent job of brain washing the dental students at USC into thinking that all implants should be placed by periodontists, and that oral surgeons are evil beings who have no place in the world of dentistry. Part of this is because oral surgery dept has almost no presence at dental school...they operate mainly out of LA county hospital, and whatever oral surgery presence at dental school is pretty weak in my humble opinion. Despite the fact that OMFS at USC is a very busy program, because they are more facial trauma surgeons than dentalalveolar surgeons, dental students can't really relate to them. This is one of the ways the USC perio dept can perpetuate the notion that periodontists are superior soft tissue handlers than oral surgeons. This isn't to knock USC perio, I think highly of their program. I am probably one of the few oral surgery guys out there who thinks not all periodontists are foreign, incompetent, etc. Hell, I considered doing perio at USC prior to choosing OMFS. I have no problems with periodontists as long as (1) they don't trash talk oral surgeons, and (2) don't call me to bail them out of trouble as they have performed procedures with complications that they couldn't handle. I also think it's unfortnate that the USC OMFS hasn't done more to have a stronger presence at dental school (especially because I think they are a strong surgical program), educating dental students what the true scope of oral surgery is, and just how resilient of a tissue gingiva is.

Yes, Narzowri may be kind of arrogant sometimes (I was always afraid of just facing him when I visited my wife there ) but overall, he is a good prog director. He just tries to show his love for the specialty, that he believes that it should deserve some respects (as you know gum disease has been largely ignored...it is, after all, the leading cause of tooth loss).

He once said that "if you haven't seen implant failure during your residency, this means that you have not placed enough implants." And this I completely agree.

 

[Dr.Millisevert]

Yes, Narzowri may be kind of arrogant sometimes. He just tries to show his love for the specialty, that he believes that it should deserve some respects (as you know gum disease has been largely ignored...it is, after all, the leading cause of tooth loss).

True.. however. I somehow don't see how doing ramus grafts and placing hundreds of implants results in "treating gum disease".

 

[charlestweed]

True.. however. I somehow don't see how doing ramus grafts and placing hundreds of implants results in "treating gum disease".

Periodontists usually treat gum diseases by extracting hopeless teeth, doing necessary bone grafts, and placing implants. They see hopeless teeth in their practice just as often as OS seeing horizontally impacted third molars.

 

[Dr.Millisevert]

Periodontists usually treat gum diseases by extracting hopeless teeth, doing necessary bone grafts, and placing implants. They see hopeless teeth in their practice just as often as OS seeing horizontally impacted third molars.

I thought treating perio "usually" centered around trying to keep teeth.. ie. Raising a flap to "Clean and Save" teeth.

If the tooth is hopeless... and we are talking about a simple extraction of a perio involved teeth.. wouldn't the GP usually just do that?

Do perios consider 3rd molars hopeless teeth too?

extracting teeth, doing necessary bone grafts, and placing implants.

I thought this was considered dentoalveolar surgery and more part of the scope of Oral and maxillofacial surgery than perio.

Should Endos be placing implants too? Ortho?

 

[charlestweed]

As gum specialists, periodontists can perform all kinds of gum surgeries: ridge augmentation (ramus/chin graft, sinus lift etc.) to repair damaged periodontium caused by gum diseases, canine exposure for ortho, root tip removal (for immediate implant placement), biopsy(only incisional) etc. It is no longer regarded as a specialty of prevention and preservation....but also repairing and rebuilding. Of course, osseous (pocket reduction) surgery is mostly done in perio office to give teeth with damaged periodontium a 2nd chance. Sometimes it is too late for these teeth to even have this 2nd chance.

Yes, GP's extract most hopeless teeth but many of the GP's are not so "sure" if teeth are hopeless or not…that's why they refer. Most GP's are happy to let periodontists extract hopeless teeth, especially those that require subsequent bone graft or immediate implant placement.

With high implant success rate, it is more predictable to extract teeth with questionable perio prognosis and to place implants. It is sad to see a lot of patients who spend so much money and time on Arestin and 3month perio maint. prog. on teeth that were supposed to be extracted simply b/c they were afraid of surgery...and in the end, they end up paying even more for ext. and implants.

Endos don't place implants but they often do gum surgery for apicoectomy... and that is within their scope.

Implantology is not just an art of filling the edentulous spaces with implants but it also involves throrough diagnosis of remaining dentitions and comprehensive restorative treatment planning.

I am sorry to digress since this is an OS program post…. Deeply apologize.

 

[Yellowman]

As gum specialists, periodontists can perform all kinds of gum surgeries: ridge augmentation (ramus/chin graft, sinus lift etc.) to repair damaged periodontium caused by gum diseases, canine exposure for ortho, root tip removal (for immediate implant placement), biopsy(only incisional) etc. It is no longer regarded as a specialty of prevention and preservation....but also repairing and rebuilding. Of course, osseous (pocket reduction) surgery is mostly done in perio office to give teeth with damaged periodontium a 2nd chance. Sometimes it is too late for these teeth to even have this 2nd chance.

I would have to respectfully disagree with some of the points made above. What does doing biopsy of pathological lesion or doing ortho k9 exposure have anything to do with 'prevention and preservation/repairing/rebuilding periodontium'? Absolutely nothing in my opinion. The idea of periodontists doing 'incisional only' biopsy especially bothers me. First, this shows how trivial periodontists think of doing biopsy of pathological lesions. Look, yes the procedure itself is easy, sure anyone can do it. But if you cannot fully handle the procedure or the complication that comes along with it, the procedure should NOT be attempted and should be referred to an oral surgeon who can. Doing incisional biopsy of a palatal pleomorphic adenoma, then sending this pt to an oral surgeon for him/her to complete pt's care is kind of like a GP doing scaling/root planing on maxillary quads only because of light calculus, then referring the rest of the lower quads to a periodontist because of heavy calculus that teh GP thought he couldn't handle. If pt needs serious perio work, it would be the GP's moral and professional obligation for him/her to refer to a periodontist to manage the entire case, not referring the left over half after the GP's charged out for the easy procedure, after he's fattened his pockets. I share similar feelings regarding periodontists doing IV sedations and doing 3rd molar extractions, but I'll leave that for another discussion.

 

[charlestweed]

periodontists doing IV sedations and doing 3rd molar extractions, .

Really? Wow.

 

[cel083]

yes i agree usc has a very strong perio dept. I should know, i am a USC grad. Nowzari runs a pretty good perio dept, many of the perio residents have 90+ boards and are from reputable schools like ucla, uconn etc. He has also done an excellent job of brain washing the dental students at USC into thinking that all implants should be placed by periodontists, and that oral surgeons are evil beings who have no place in the world of dentistry. Part of this is because oral surgery dept has almost no presence at dental school...they operate mainly out of LA county hospital, and whatever oral surgery presence at dental school is pretty weak in my humble opinion. Despite the fact that OMFS at USC is a very busy program, because they are more facial trauma surgeons than dentalalveolar surgeons (at least at the hospital, i am sure the residents have dentalalveolar exposure at the dental school), dental students can't really relate to them. This is one of the ways the USC perio dept can perpetuate the notion that periodontists are superior soft tissue handlers than oral surgeons. This isn't to knock USC perio, I think highly of their program. I am probably one of the few oral surgery guys out there who thinks not all periodontists are foreign, incompetent, etc. Hell, I considered doing perio at USC prior to choosing OMFS. I have no problems with periodontists as long as (1) they don't trash talk oral surgeons, and (2) don't call me to bail them out of trouble as they have performed procedures with complications that they couldn't handle. I also think it's unfortnate that the USC OMFS hasn't done more to have a stronger presence at dental school (especially because I think they are a strong surgical program), educating dental students what the true scope of oral surgery is, and just how resilient of a tissue gingiva is.

An ignorant pre-dental student inserting himself in here, but I didn't know that dentists had turf wars among themselves like the physicians do (trauma vs. EM vs. FM in the ER, etc.).

 

[dentalmental]

I would have to respectfully disagree with some of the points made above. What does doing biopsy of pathological lesion or doing ortho k9 exposure have anything to do with 'prevention and preservation/repairing/rebuilding periodontium'? Absolutely nothing in my opinion.

As a practicing Orthodontist and son of a periodontist(in a foreign country), I strongly disagree with yellowman regarding role of perio in K9 impaction and agree with charles tweed on this matter.. Orthodontists sometimes need help from periodontists to raise a flap for placing bonded attachments to impacted canines. Who else would be better qualified than a periodontist to raise an apically positioned flap to maintain the width of attached gingiva. FYI, periodontal considerations are very important in the long term prognosis of canine impaction cases and the periodontist would play a vital role in maintaining it. (And that there is a lot of literature regarding that. )That's just one aspect of Ortho -perio interactions..

my 2 cents on this topic

 

[Yellowman]

As a practicing Orthodontist and son of a periodontist(in a foreign country), I strongly disagree with yellowman regarding role of perio in K9 impaction and agree with charles tweed on this matter.. Orthodontists sometimes need help from periodontists to raise a flap for placing bonded attachments to impacted canines. Who else would be better qualified than a periodontist to raise an apically positioned flap to maintain the width of attached gingiva. FYI, periodontal considerations are very important in the long term prognosis of canine impaction cases and the periodontist would play a vital role in maintaining it. (And that there is a lot of literature regarding that. )That's just one aspect of Ortho -perio interactions..

my 2 cents on this topic

so are you implying that oral sugeons are incapable of (1) raising flaps, (2) exposing impacted teeth and (3) bonding brakcets because they are only trained to extract impacted teeth (much like your impacted k9 scenario), place surgical implants, perform complex bone grafting procedures from donor sites OTHER than the mandible and bottled bone, repair facial lacs (which I might add are far more delicate than gingiva), repair facial fractures, perform orthognathic surgery, and perform head/neck dissections? In case you aren't familiar with the oral surgery training in the U.S., we do learn how to raise an apically positioned flap to maintain the width of attached gingiva.

The point that I was trying to make with the previous post was (1) don't do biopsies if you can't manage the entire case and (2) don't confuse the public and patients by saying that the periodontists are the only dentists capable of 'handling soft tissues' because they are not. ANY competent dentist with adequate training can raise flaps and perform procedures you've mentioned. If you buy into the propaganda that periodontists are more gentle with soft tissues, I really don't know what to tell you other than the fact that maybe it's because your father's a periodontist. You and everyone else who is reasonable knows that there are some oral surgeons who are superior than periodontist in handling soft tissue and there are periodontists who are better in performing certain surgical procedures than oral surgeons. That's just the fact. To say that periodontists are superior soft tissue handlers and thus should be doing all flap procedures, with all due respect, is not accurate.

 

[dentalmental]

My reply was for this.

or doing ortho k9 exposure have anything to do with 'prevention and preservation/repairing/rebuilding periodontium'? Absolutely nothing in my opinion. quote]


First of all, let me state this.. I did not imply perio surgeons are better surgeons and better handlers of soft tissue.. and that oral surgeons are not competent in handling gingiva. it appears that you misunderstood me on that.

My reply was to your statement that periodontists have got nothing to do with orthok9 exposures..

There are a lot of factors determining the success of therapy and a periodontist's job and expertise apart from raising a flap, is also to maintain the periodontium in good health after the procedure by regular followups which is required for the success of orthok9 impaction cases. Do oral surgeons follow up attachment losses? root coverage procedures?

Regarding better tissue handlers, as you said, there can be good periodontists and bad oral surgeons and vice versa. (I agree with you on that) It depends on the person how gentle they are at handling tissues and not because of their degree alone..it's a skill that you develop over a period of time and the attention to detail that matters

Regarding Raising a flap, we both know that it can be done by both surgeons and periodontists...For me, oral surgeons/periodontists raising flaps is not an issue here... following up a case from start to end by one person (periodontist) is the issue (as in the biopsy scenario that you mentioned which I agree )

Finally , My point is Periodontists do have a role in ortho k9 exposures . I hope we are clear on that..
good day!

 

[Yellowman]

Do oral surgeons follow up attachment losses? root coverage procedures?

Yes they do. Why wouldn't oral surgeons see pts for follow up?

 

[karlmone]

This is one of the ways the USC perio dept can perpetuate the notion that periodontists are superior soft tissue handlers than oral surgeons.

I find the better/more gentle at soft tissue handling argument quite amusing whenever I hear it from my periodontology colleagues. Lets see.. Periodontists deal with gingiva/oral mucosa. Oral and Maxillofacial surgeons deal with gingiva/oral mucosa and....skin, fascia, muscle, nerve, artery, vein, cartilage, nasal/sinus mucosa and others. Sorry, but I think that avoiding the marginal mandibular nerve during a risdon approach to the mandible or preventing ectropion during a subtarsal approach to the orbital floor requires greater skill/ "superior soft tissue handling" than putting a papilla back where it came from.

As gum specialists, periodontists can perform all kinds of gum surgeries: ridge augmentation (ramus/chin graft, sinus lift etc.) to repair damaged periodontium caused by gum diseases, canine exposure for ortho, root tip removal (for immediate implant placement), biopsy(only incisional) etc.

So are you saying that if you saw a fractured mb cusp at tooth #30 and a firm, subepithelial, well defined lesion at the right buccal mucosa contacting #30 you would only do an incisional biopsy rather than an excisional biopsy of the lesion? Or are you saying that if you saw a well defined mass at the palate you would perform an incisional biopsy at the junction of normal/diseased tissue like you were taught in dental school?

"Some people are so far behind in the race that they actually think they are winning." - Junior Soprano

 

[charlestweed]

I think my periodontist wife would be a better person to talk about this since I am only an orthodontist who cannot even give an IA block successfully. She didn’t know that I am on this forum…. She thinks that it is a waste of time since I am also on other electronic gadget forums as well. Any way, I asked her why do some GP’s refer pt to perio for biopsy? This is what she told me:

OS’s usually work a few days in their practice and a few days in their satellite office or as associates in other multispecialty practices. As a result, their appointments are always booked solid…. some pts have to wait a month to get an OS appointment. Some came in only to get an initial consultation and have to get another appt. for the actual surgical procedure. This is why a few GP’s refer pts to perio, who is more readily avail., for biopsy. Some patients are anxious and want to get it done the same day. All significant results that came back from the path labs are, of course, always referred out to OS for proper intervention. And OS's are always happy to take over the case.

I know you still think that the case should be managed entirely by OS and I do see your point. Of course, if the lesion, that you mentioned earlier, is well defined and needs exisional biopsy, who else would be better at doing this than OS? The answer is no one.


I am surprised that there is tension between OS and perio residents. In the real world, this rarely exists. We always get together with our OS friends and other dental colleagues on our kids’ B days, friends' engagements, and weddings etc. all the time. And we always have great times.

Cheers,

 

[drhobie7]

Who else would be better qualified than a periodontist to raise an apically positioned flap

As if raising a mucoperiosteal flap was a big deal. Why just last week I did a gingivalis major free flap utilizing the medial gingival artery!

 

[dentwannabe]

As a simple D1, a lot of this perio vs. OS crap makes me thing about the type of people in the dental field. Why so much immaturity, aren't most of you guys 30 year olds and you're on here name-calling? i mean, yea a jokes a joke but after a while it exposes your own insecurities. nothing in this particular thread, just something i've noticed on this website.

 

[dentalmental]

As if raising a mucoperiosteal flap was a big deal. Why just last week I did a gingivalis major free flap utilizing the medial gingival artery!

Congrats!

 

[drhobie7]

As a simple D1, a lot of this perio vs. OS crap makes me thing about the type of people in the dental field. Why so much immaturity, aren't most of you guys 30 year olds and you're on here name-calling? i mean, yea a jokes a joke but after a while it exposes your own insecurities. nothing in this particular thread, just something i've noticed on this website.

when you lose your sense of humor. you're f-ed.

 

[dentalmental]

when you lose your sense of humor. you're f-ed.

good one!

 

[aphistis]

As a simple D1, a lot of this perio vs. OS crap makes me thing about the type of people in the dental field. Why so much immaturity, aren't most of you guys 30 year olds and you're on here name-calling? i mean, yea a jokes a joke but after a while it exposes your own insecurities. nothing in this particular thread, just something i've noticed on this website.

Rx: Go spend some time in pre-allo. This place will seem like a 60's free-love festival afterward.

 

[psiyung]

here at case oms, residents place around 200 - 250 implants. I placed 48 my first year. lots of bone grafts, jaw, cranial and hip grafts. anyone know how many implants perio residents from a good program place?

I know at houston a friend of mine placed about 150 before graduating

 

[toofache32]

I know at houston a friend of mine placed about 150 before graduating

Don't come to Parkland if you want to do that stuff. I'm starting my chief year and placed my 2nd implant last week.

 

[Yellowman]

Don't come to Parkland if you want to do that stuff. I'm starting my chief year and placed my 2nd implant last week.

do u guys place them at VA? I recall during my interview at parkland that some of the implants were placed there....a good chunk of the implants at Case oms are placed at the VA. A lot of good cases at the VA....MRB to the fullest. Altho osteo seems to be the latest fad amongst the vets here at cleveland lately...

 

[rrc]

Don't come to Parkland if you want to do that stuff. I'm starting my chief year and placed my 2nd implant last week.

Dude, have no fear, how many implants you have placed means jack ****. Anyone can screw an implant into bone.

The hard part about implants is the treatment planning and dealing with the intraoperative complications. Like - you told the patient they are going to get a perfect 6 implant canine to canine span in the upper arch. Then you go to place them and 5 of them are dehisced through the buccal bone due to a thinned buccal cortex. Now what do you do???

This will come with experience. The more problems in residency you see the better. Not how many you have placed.

 

[UNLV OMS GUNNABE]

I know at houston a friend of mine placed about 150 before graduating

Not true. We are weak in implants. Most of them placed in the VA with complications out the whazoo.

 

[LSU-Cowboy]

It's amazing how few implants are placed in most residencies.....then you go to private practice and do tons of implants.....ironic....we should get much more experience in implants in residency

 

[toofache32]

do u guys place them at VA? I recall during my interview at parkland that some of the implants were placed there....a good chunk of the implants at Case oms are placed at the VA. A lot of good cases at the VA....MRB to the fullest. Altho osteo seems to be the latest fad amongst the vets here at cleveland lately...

We place a few of them at the VA, I just haven't rotated there yet as a chief. Implants are definately chief cases at Parkland.

 

[EuroOMFS]

Dude, have no fear, how many implants you have placed means jack ****. Anyone can screw an implant into bone.

The hard part about implants is the treatment planning and dealing with the intraoperative complications.

While I agree that anyone can screw an implant into bone, I respectfully disagree that the hard part in implant surgery is preoperative planning and dealing with complications.

We do a fair number of implants where I am, I guess I've placed somewhere between 100 and 150 implants in all, and I´ve made all the classic mistakes. Wrong angulation, too far buccally, too close to the adjacent tooth etc. All comprimizing esthetics and/or making prosthetics difficult to manage.

For me the hard part is placing the damn things where they give you the best possible esthetic and functional outcome. Even with a surgical index this can be surprisingly difficult. All goes seemingly well, and then.....before you know it, you've made your preparation too far buccally. Or the angle is way off, so the prosthetic dentist has to make an individual abutment. For me, even with good treatment planning and surgical planning, it's still no walk in the park to place implants, allthough, thankfully it's becoming more of a routine.

The more implants you do, the better at it you get. You become more experienced in using the different kinds of drills and burs, osteotomes and and chiesels. You get the feel for when to use what instrument, what kind of bone you're dealing with, how the soft tissue reacts etc. You get better at attaining primary stability and placing the implants correctly so the patient and the restoring dentist are happy.

This, in my opinion, is the really hard part.

 

[charlestweed]

Dude, have no fear, how many implants you have placed means jack ****. Anyone can screw an implant into bone.

The hard part about implants is the treatment planning and dealing with the intraoperative complications. Like - you told the patient they are going to get a perfect 6 implant canine to canine span in the upper arch. Then you go to place them and 5 of them are dehisced through the buccal bone due to a thinned buccal cortex. Now what do you do???

This will come with experience. The more problems in residency you see the better. Not how many you have placed.

I agree. The hard part is the treatment planning. Here is an example:

Patient came to my wife's office for a 2nd opinion. Teeth #8,9,10 are missing. My wife wanted to place 2 implants in #8 and 10 areas and let my GP sister restore them with a bridge using #8 and #10 implants as abutments. Patient said he is willing to pay more to get 3 implants and he doesn't want a bridge….. but my wife told him that it would be very difficult to achieve ideal emergent profile of implant crowns with 3 individual implants b/c it is almost impossible to place all 3 implants in ideal positions. Guess what? He went to another clinic that agreed to place 3 individual implants.

A few months later, this same patient came back told my wife that the prosthodontist told him that he could not ideally restore these 3 individual implants b/c they were not ideally placed….and he begged my wife for help. She told him if the prosthodontist cannot do it no one else can.

So I think it is very important to communicate with restoring prosthodontists or GP before placing implants. If they are not happy with implants that you placed, you will lose the referral.

 

[buck-E]

I agree. The hard part is the treatment planning. Here is an example:

the prosthodontist told him that he could not ideally restore these 3 individual implants b/c they were not ideally placed….

So I think it is very important to communicate with restoring prosthodontists or GP before placing implants. If they are not happy with implants that you placed, you will lose the referral.

While treatment planning is important it is being able to EXECUTE that treament plan that is important. What you decribed is not necessarily a failure of treatment planning but in the ability to take that plan and being able to translate it to the patient. The problem wasn't with 3 implants, it was that they were not in the proper place. If you cannot do this it is a failure of your surgical skill, which does come with practice. If you plan on learning this after you are out of residency, you will lose a lot of referrals.

I have heard a million times that if you can do a "craniofacial" (or insert orthognathic, panfacial, free flap)case you can put a "screw in a bone". I think implants are an entirely different ballgame because it really matters where that screw is. I believe this quote is often used at programs where there is a deficiency in implant training to convince residents you will be fine after you finish.

I graduated from a program where the first and second years place all of the implants at the VA and third/fourth years place them all at the dental school clinic. With prosth residents feeding you cases there was never a lack of sinus lifts, ramal/menton grafts, 10+ implant cases. Most of the time the chiefs are giving things to second & third years by the time they finish.

In private practice you will be doing a lot of hand-holding of your GP/prosth implant referrals. They will always be hesitant to refer to a new practitioner, let alone if you can't deliver what you say you can. There is plenty of competition for these cases in most communities and if you piss off the wrong person with an implant case word travels fast.