Which Dentist is Better?

Oral surgery specialists are trained, by default, to provide treatments and procedures for tooth replacement for nearly every imaginable need or circumstance. Oral Maxillofacial Surgeons work with all of the supportive and structural features that define dental function.

For congenital disorders such as cleft palate and other early developmental issues, OMS surgeons are the specialists of choice. Prosthodontists often work hand in had with oral surgeons to help develop orthotics and prosthetic appliances to treat a number of functional issues.Restorative procedures are rarely provided by an Oral Surgeon although a specialist team may have a Prosthodontist or General Practitioner member that provides the treatment in a “seamless” fashion (all services, reconstructive to restorative, provided in same location but with different doctors).

Not all Prosthodontic specialists, however, perform implant dentistry. Rather, they are focused on the development of prosthetics (dentures, partials, bridges, individual tooth replacements) and are often a member of a team of specialists that, when combined, can offer an infinite range of treatments.
Periodontists are specialists in the treatment of supportive and connective tissues involved with dental function. They are the definitive specialists when it comes to diagnosis, treatment and maintenance of all periodontal tissues (gums, gingiva, connective tissue).

Tissue repair, replacement and augmentation are common procedures. Not all periodontal specialists however, perform implant dentistry procedures. Implant services, if provided by a Periodontist, typically are not restored at the same time. Rather, the patient is re-directed back to the general or cosmetic dentist who originally referred the patient.

Dynamics of Specialization

When it comes to finding an expert for a specific condition or need… nothing beats having access to a specialist. All specialists in dentistry have significant training qualifications that go beyond general dentistry. But…. not all is perfect… as some patients have discovered.

Because of the basic referral process whereby additional appointments, time frames and additional needs for diagnostics (performed or yet to be performed), it is not uncommon for communication to break down along the way.

A general dentist, without implant dentistry skills, will refer a patient to an oral surgeon or periodontist for the implant surgery. At this juncture, the general or restorative dentist typically has an idea or visualization of what the patient’s eventual cosmetic and functional outcome will be. Chances are stone models, articulation studies and perhaps the beginning of diagnostic waxups have been initiated.

A situation can arise however whereby the periodontist performs procedures that follow his/her definition of best treatment possibility that creates a finished result (implants placed, not yet restored) that can be at variance with what was originally planned.

Causes for variances to occur typically include dental conditions that are not known until surgery begins. Deficient or compromised bone structure, periodontal issues, nerve locations, etc …. all of which can change implant site preparation and the actual implant devices used.

The quality of communication between the restorative dentist and specialist can sometimes play a role in determining the quality of the final cosmetic and/or functional result. A dentist’s access to dental technologies and products may prove inadequate when unforeseen events occur. A common example of this situation might be a patient having a new tooth (or teeth) not line up properly with adjacent teeth since bone differences were discovered at the time of implant placement.

These relationships and potential for events that affect outcomes also exist in general dentist – oral surgeon referral network dynamics. It can be expected that some specialists may have a different diagnosis and treatment outlook for a particular patient. In the end…. it is the task of the restorative dentist to deliver the cosmetic goal that the patient wants versus what was ultimately needed during implant surgery.

General Dentists – Special Focus Doctors and Practices

A growing number of general dentists are attending specialized workshops that are designed to equip dentists with the skill sets and hands-on experience of implant dentistry skills. These Post Graduate training facilities are frequently operated through universities and dental schools, along with training specialists employed by manufacturers of dental equipment, supplies and technologies.

Nobel Biocare, Imtec, 3M and BioHorizons are good examples of superb training resources that general dentists have access to. Combine this with specialized advanced training available through xray equipment manufacturers, laser equipment companies and hand piece/hand tool developers.

Dentists who have a fervent desire to deliver the best…..or desire to keep up with the best, now have nearly ready access to acquire skill sets and working know how that was once only available through specialization.

Many dentists who start out in their professional careers with general dentistry training often acquire skill levels that approach what is taught in dental specialty schools but more importantly can acqure technologies and hands-on experience with certain facets of dental reconstruction that some specialists dodn’t have.

These dentists, via developing personal interests and self discovery of a “developmental knack” pursue certain facets of reconstructive dentistry that even some specialists can provide. The “focus” of Cosmetic Dentistry is perhaps one of the most common. It is not a recognized specialty.

Just as some general dentists develop a “focus” or knack for cosmetic dentistry wherein they master full mouth makeovers, smile line rehabilitation and instant orthodontics through the creative use and combinations of porcelain components, advanced articulation analysis, dynamics of occlusion physics, Rule of Golden Proportions, etc…. there are general practitioners who migrate toward implant dentistry.

It is not uncommon for a general dentist to be more “exacting” in the placement of implants that can exceed what a periodontist or oral surgeon can provide (access to catscans, CAD/CAM engineering fabrication, PRP equipment, access to lasers, expert in oral surgery and suturing, etc.).

Getting the Strongest Advantage

Trying to decide which dentist/doctor would represent the most advantageous choice is not a simple task.

When the primary focus is on correcting serious periodontal issues (gum disease, loose teeth, connective tissue abnormalities, etc.) a Periodontist has the specialist training and most access to resources to a degree that exceeds most, if not all, general practitioners.

Oral surgeons can be the perfect choice for Orthognathic Surgery, complex jawbone reconstruction (disease, physical trauma complications, congential deformities), complex extractions, TMJ joint surgery, etc.

Patients who are researching local resources for implant tooth replacements will discover many general dentists are very active in the placement of dental implants. As mentioned above, some dentists develop special interest areas within dentistry, as a result of practicing general restorative dentistry.

Interests in technology, dental science, bonding chemistry, porcelain component fabrication (we know of one general dentist who earned a Federal Patent on porcelain crown fabrication), laser electronics, holistic dentistry, minimally-invasive dentistry, occlusal physics (we know a dentist who has successfully treated 10 year occlusal problem in less than one hour), upgradeable dentistry (delivering treatments that are not wasted) and striving to deliver “cutting edge” dentistry … is what differentiates the average dentist from “special focus” dentists.

Documenting the Preferred Selection

Determining who or which practice is best involves a lot of due diligence. Relying totally and singularly on having a Specialist Title does not guarantee the best cosmetic and/or functional result, although it does provide a margin of safety.

If Cosmetics are the primary goal, research restorative dentists who have the most access to technologies, the most documented case histories of complex cases (good dentists who love their craft can be expected to have ample photography), a strong willingness to discuss or describe what they do (we all enjoy talking about what we do best) and have actual patients you can talk to who have had similar treatments. These groups of dentists can also be expected to have large accumulations of CEU Post Graduate training credits on their resumes.

A general dentist with a long history of successfully treating the most challenging cases are usually in the best position to make a marriage of implant dentistry and dental cosmetics. Many dentists have developed proven treatment – procedure combinations that produce the best results for a given dental issue and incorporate a seemingly long list of brand names, dental labs and sequence (what to do first, then second) that changes for each patient.

When dental function outweighs cosmetics (keeping teeth, overcoming congenital growth issues, controlling rampant disease, treating trauma related damage, etc., specialists are the resource of choice. General dentists, orthodontists, pediatric dentists and medical doctors usually function as the referral source.