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DENTAL TRIBUNE | May 2010 Opinion Feedback 5A Subject: Re: Where did all the periodontists go? | Dental Tribune International From: Dr. Stuart J. Froum Sent: Monday, May 10, 2010 To: dryowza@mail.com Cc: r.goodman@dental-tribune.com Dear Dr. Malcmacher, I am writing in response to your commentary in the Dental Tribune posted [online] on May 7, 2010, titled “Where did all the periodon- tists go?” In answer to this question, I would say “We’re still here.” Your observation that there have been changes in all specialties (you cite orthodontics, endodontics and periodontics in your article) is of course accurate. Any specialty that has not undergone change in light of all of the new emerging information, technologies and materials would certainly be failing our patients and profession. One of the most significant changes in the periodontal specialty has been that clinical diagnoses, treatment planning and treatment procedures are now decided, wherever possible, on evidenced-based data and controlled clinical studies as reported in peer-reviewed sci- entific literature. As such, your reporting that you are being told by many periodontists whom you “spoke to over the last couple of years” that “they would rather remove teeth and place implants than actu- ally treat patients through tra- ditional periodontal surgery and try having them maintain their dentition” is quite dis- concerting. As a periodontist who treats patients in private practice, and as a clinical professor in the department of periodon- tology and implant dentistry at New York University Den- tal Center who teaches peri- odontics and implant dentistry to periodontal residents in training, I feel that the perio- dontists you are quoting are, at the very least, misguided and should be made aware of a number of facts that may change their opinions. First, by and large, most of the periodontists I meet in my lectures and travels around the country realize the value of attempting to save a tooth or teeth that can be retained in a healthy functional and an esthetic state. In fact, traditional peri- odontal treatment including both non-surgical and surgi- cal techniques, have very high success rates in accomplish- ing this goal as shown in lon- gitudinal studies (see Hirsh- feld and Wasserman, J Perio 1978; Oliver J, West Society Perio 1969; Goldman MJ et al., J Perio 1986, etc.) over 20–50 years. It has been known for over three decades that peri- odontal surgery, when not followed by good profession- al and personal care, will in many cases fail (Nyman et al. J Clin Perio 1977). That is why successful sur- gical treatment designed to save teeth requires meticu- lous and regular professional maintenance. Becker et al. (J Perio 1984) and others have shown that when this main- tenance is provided, a surgi- cal approach to treatment of moderate and advanced periodontitis is highly successful. Patient compliance, even when not optimal, must be reinforced by frequent maintenance and recall. This requires a team effort by the referring dentists, hygienist and periodontist, which will result in tooth retention and successful treatment in most cases. To extract teeth and place implants is not the panacea that you and those periodontists that you spoke to believe it is. First, the 94 percent implant success rates you quote should be qualified. You mean a 94 percent implant survival rate because success implies implants that lose no more then 0.2 mm of bone per year following final restoration and remain esthetically pleasing to the patient. By the way, these long-term survival rates that are often quoted are based on use of implants with surfaces that are no longer available (i.e., machined surface implants) and no longer being placed. There- fore, to compare long-term success of implants versus treated teeth is not possible because long-term data on currently used implants is lacking. However, as I stated above, there are many long-term studies show- AD g DT page 6A