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Constraint in the use of new materials and techniques
LETTERS TO THE EDITOR
666
erty, we concede that the TRIAD splint must not be flexed excessively to align fragments. Anatomic reduction or passive placement of segments is necessary prior to application of the splint. We have used the TRIAD System in approximately 40 cases, including segmental maxillary and mandibular surgery and trauma. We have had three failures attributed to trying to force segments into the splint. The majority of the uses have been for occlusal wafers and the material has been quite satisfactory for this purpose. We feel that the disadvantage of the material’s brittle nature is outweighed by its ease of use, decreased damage to surgical models, and diminished exposure to noxious chemicals. The use of many dental materials is a matter of personal preference. We have found that the TRIAD System works well for us, but it is certainly not the only way to make a surgical splint. JOHNR. SCUBA, DDS JOHNP. MCLAUGHLIN,DDS
Fort Sam Houston,
Texas
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as rejlecting the views of the Department of the Army or the Department of Defense.
CONSTRAINT IN THE
USE OF NEW MATERIALS
AND TECHNIQUES To the Editor:-The editorial in the January 1991 issue of the JOMS entitled “Reading Between the Lines” hit the nail right on the head! In reviewing oral and maxillofacial surgery cases that went awry, some of which ended up in litigation, the one thing that a significant number of them had in common is that the surgeon used a technique that was not adequately tested beforehand. The problem is that many products and techniques get their start at meetings, where enthusiastic oral surgeons report preliminarily on methods that they feel have worked well in their hands. Then the manufacturer starts to bombard the specialty with “literature” that implies that the material or the method has been adequately tested. Substances in point are hydroxyapatite, Proplast-Teflon, and various metallic materials advocated for use as implant materials. Some have worked, but many have simply not stood the test of time. Reviews of the literature show that too many oral surgeons plow in where angels would fear to tread, and their patients, in many instances, pay the price for their premature enthusiasm. The oral surgeon also pays the price through lost or settled lawsuits. In addition to the commendable editorial on the subject, the JOMS should specify where oral surgeons have inadvertently erred so that the editorial, which would sound good to any thinking oral and maxillofacial surgeon, will be more meaningful to those who have been guilty of premature enthusiasm in the use of inadequately tested techniques and materials in the practice of oral and maxillofacial surgery. BRUCEL. DOUGLAS,DDS, MPH Chicago, Illinois PROVIDING ACCURATE INFORMATION TO RESIDENCY CANDIDATES
To the Editor:-As director of an MD-integrated residency program, I just completed interviews of prospective residents for 1991. I was impressed by the lack of
information that candidates have regarding the MD degree obtained with OMFS education and it’s impact. Some of the myths I heard at this year’s interviews include the following: to practice the full scope of oral and maxillofacial surgery you need a medical degree; having a medical degree allows you to be paid for procedures that a single-degree oral and maxillofacial surgeon cannot be paid for; hospitals might deny privileges to those without medical degrees; it will be easier to get employment as an associate after training with a medical degree; to get on the trauma call schedule at a hospital you must have a medical degree; medical-degree oral and maxillofacial surgeons are far more successful in the business of practice than single-degree surgeons; having a medical degree will help in communicating with physicians. As a result of much misinformation, many of the candidates were applying only to medical degree programs. Only 25% of those were placed in last year’s match. Those that were seeking both types of programs were certain that they would be in an inferior position in practice if they did not gain entrance to a medical degree program. I feel that many of these areas of misinformation are owing to poor advice received from faculty in dental schools, as well as by practicing oral and maxillofacial surgeons. These “reasons” for seeking the medical degree are unfortunate exaggerations and untruths promulgated by surgeons who feel threatened in a crowded professional environment. I wish that some truly rational reasons for seeking dual degrees were promulgated to these applicants. These include the clinical and academic nature of the degree obtained; the structured educational format; objective measurements of strengths and weaknesses in training; the broadened training that is obtained; the improved ability to obtain advanced surgical training; and community recognition for educational achievement. These are all excellent and importafit reasons that a candidate for training in oral and maxillofacial surgery would seek a medical degree. My additional concern is that in the quest for medical training many candidates have looked past the need to become an excellent oral and maxillofacial surgeon. The desire for academic credentials should not supersede the practical need to have excellent OMFS didactic and clinical skills that can only be obtained in excellent residency training. To those candidates who matched in dual-degree programs, I would say that with great effort you will be able to obtain both excellent academic credentials and fine surgical training. For those students that matched in single-degree programs this year, I would say that for your effort you will also achieve superb academic credentials and excellent oral and maxillofacial surgery training. In addition, both individuals will be able to practice the full scope, will be able to be reimbursed, will not be denied privileges, will be able to gain employment, and will be able to practice in their chosen specialty. To those who have promulgated inaccurate information with regard to the medical degree, I would say look to yourselves and decide the line between thoughtful concern and alarmism. While you are thinking, be reminded that we should use this option of training to build the specialty and not tear it down. LEON A. ASSAEL, DMD Farmington, Connecticut
666
erty, we concede that the TRIAD splint must not be flexed excessively to align fragments. Anatomic reduction or passive placement of segments is necessary prior to application of the splint. We have used the TRIAD System in approximately 40 cases, including segmental maxillary and mandibular surgery and trauma. We have had three failures attributed to trying to force segments into the splint. The majority of the uses have been for occlusal wafers and the material has been quite satisfactory for this purpose. We feel that the disadvantage of the material’s brittle nature is outweighed by its ease of use, decreased damage to surgical models, and diminished exposure to noxious chemicals. The use of many dental materials is a matter of personal preference. We have found that the TRIAD System works well for us, but it is certainly not the only way to make a surgical splint. JOHNR. SCUBA, DDS JOHNP. MCLAUGHLIN,DDS
Fort Sam Houston,
Texas
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as rejlecting the views of the Department of the Army or the Department of Defense.
CONSTRAINT IN THE
USE OF NEW MATERIALS
AND TECHNIQUES To the Editor:-The editorial in the January 1991 issue of the JOMS entitled “Reading Between the Lines” hit the nail right on the head! In reviewing oral and maxillofacial surgery cases that went awry, some of which ended up in litigation, the one thing that a significant number of them had in common is that the surgeon used a technique that was not adequately tested beforehand. The problem is that many products and techniques get their start at meetings, where enthusiastic oral surgeons report preliminarily on methods that they feel have worked well in their hands. Then the manufacturer starts to bombard the specialty with “literature” that implies that the material or the method has been adequately tested. Substances in point are hydroxyapatite, Proplast-Teflon, and various metallic materials advocated for use as implant materials. Some have worked, but many have simply not stood the test of time. Reviews of the literature show that too many oral surgeons plow in where angels would fear to tread, and their patients, in many instances, pay the price for their premature enthusiasm. The oral surgeon also pays the price through lost or settled lawsuits. In addition to the commendable editorial on the subject, the JOMS should specify where oral surgeons have inadvertently erred so that the editorial, which would sound good to any thinking oral and maxillofacial surgeon, will be more meaningful to those who have been guilty of premature enthusiasm in the use of inadequately tested techniques and materials in the practice of oral and maxillofacial surgery. BRUCEL. DOUGLAS,DDS, MPH Chicago, Illinois PROVIDING ACCURATE INFORMATION TO RESIDENCY CANDIDATES
To the Editor:-As director of an MD-integrated residency program, I just completed interviews of prospective residents for 1991. I was impressed by the lack of
information that candidates have regarding the MD degree obtained with OMFS education and it’s impact. Some of the myths I heard at this year’s interviews include the following: to practice the full scope of oral and maxillofacial surgery you need a medical degree; having a medical degree allows you to be paid for procedures that a single-degree oral and maxillofacial surgeon cannot be paid for; hospitals might deny privileges to those without medical degrees; it will be easier to get employment as an associate after training with a medical degree; to get on the trauma call schedule at a hospital you must have a medical degree; medical-degree oral and maxillofacial surgeons are far more successful in the business of practice than single-degree surgeons; having a medical degree will help in communicating with physicians. As a result of much misinformation, many of the candidates were applying only to medical degree programs. Only 25% of those were placed in last year’s match. Those that were seeking both types of programs were certain that they would be in an inferior position in practice if they did not gain entrance to a medical degree program. I feel that many of these areas of misinformation are owing to poor advice received from faculty in dental schools, as well as by practicing oral and maxillofacial surgeons. These “reasons” for seeking the medical degree are unfortunate exaggerations and untruths promulgated by surgeons who feel threatened in a crowded professional environment. I wish that some truly rational reasons for seeking dual degrees were promulgated to these applicants. These include the clinical and academic nature of the degree obtained; the structured educational format; objective measurements of strengths and weaknesses in training; the broadened training that is obtained; the improved ability to obtain advanced surgical training; and community recognition for educational achievement. These are all excellent and importafit reasons that a candidate for training in oral and maxillofacial surgery would seek a medical degree. My additional concern is that in the quest for medical training many candidates have looked past the need to become an excellent oral and maxillofacial surgeon. The desire for academic credentials should not supersede the practical need to have excellent OMFS didactic and clinical skills that can only be obtained in excellent residency training. To those candidates who matched in dual-degree programs, I would say that with great effort you will be able to obtain both excellent academic credentials and fine surgical training. For those students that matched in single-degree programs this year, I would say that for your effort you will also achieve superb academic credentials and excellent oral and maxillofacial surgery training. In addition, both individuals will be able to practice the full scope, will be able to be reimbursed, will not be denied privileges, will be able to gain employment, and will be able to practice in their chosen specialty. To those who have promulgated inaccurate information with regard to the medical degree, I would say look to yourselves and decide the line between thoughtful concern and alarmism. While you are thinking, be reminded that we should use this option of training to build the specialty and not tear it down. LEON A. ASSAEL, DMD Farmington, Connecticut