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PubMed1999

Foundation restorations in fixed prosthodontics: current knowledge and future needs.

PURPOSE: The Ad Hoc Committee on Research in Fixed Prosthodontics established by the Academy of Fixed Prosthodontics publishes a yearly comprehensive literature review on a selected topic. The subject for this year is foundation restorations. METHODS: Literature of various in vitro and in vivo investigations that included technical and clinical articles was reviewed to provide clinical guidelines for the dentist when selecting methods and materials for restoration of structurally compromised teeth. Topics discussed and critically reviewed include: (1) desirable features of foundation restorations, (2) foundations for pulpless teeth, (3) historic perspectives, (4) cast posts and cores, (5) role of the ferrule effect, (6) prefabricated posts, (7) direct cores, (8) foundation restorations for severely compromised teeth, (9) problems and limitations, (10) future needs, and (11) directions for future research. CONCLUSION: This comprehensive review brings together literature from a variety of in vitro and in vivo studies, along with technique articles and clinical reports to provide meaningful guidelines for the dentist when selecting methods and materials for the restoration of structurally compromised teeth.

Dental Casting Technique↗
PubMed2001

Students' evaluation of online course materials in fixed prosthodontics: a case study.

PURPOSE: The purpose of this study was to assess a new online course format for dental students. Preclinical Fixed Prosthodontics I is a didactic and laboratory course given in the first year of the dental school curriculum. In the spring semester of 1999, the didactic portion of the course was offered in a web-based format as a supplement to the traditional lecture format. METHODS: The study population was 53 first year dental students at one school. The study design was a one group post test without a control group. The online questionnaire consisted of multiple choice questions, Leikert scale questions and open-ended questions. Data were collected using Filemaker Pro and analyzed using Epilnfo. RESULTS: Student response rate was 96% (52/53). All of the students responded that they felt comfortable with their computer skills in utilizing this course format. Most (96%) responded that the online materials were either very helpful or helpful to them. About half, (54%) recommended that the online format be continued as a supplement to traditional lectures, while 28% recommended replacing traditional lectures with the new format in order to provide more laboratory time in the course. The syllabus, lecture materials, bulletin board and handouts were found to be the most helpful online features. The least helpful features were the listserve, decision tree, and e-mail options. Most frequently mentioned strengths of the online material were listed as 1) the ability to view material at their own pace and at a time convenient to them, 2) quality photographs in lecture materials and 3) online quizzes. Weaknesses of the course were ranked by students as 1) problems with access to the materials and the intranet system, 2) taking quizzes online and 3) difficulty in printing the web-based lecture materials. CONCLUSIONS: The delivery of web-based material as a course supplement in Fixed Prosthodontics I was determined to be an overall success. Fine tuning of problems with access to the materials took place throughout the course. The student feedback will help direct future development of web-based course materials in the dental school curriculum.

Adult↗
PubMed2005

Quality of communication between dental practitioners and dental technicians for fixed prosthodontics in Ireland.

The aim of this investigation was to examine the quality of communication between dental practitioners and dental technicians for fixed prosthodontics in Ireland. A pre-piloted questionnaire was distributed to large commercial laboratories in Ireland. Information was sought relating to the quality of written instructions and use of impression trays and materials for two forms of fixed prosthodontics--full veneer porcelain-fused-to-metal crowns (PFMs), and conventional fixed partial dentures (FPDs). Information was received relating to 241 items (145 PFMs, 96 FPDs). All items were funded privately. Using pre-determined grading criteria, poor or no written instructions were provided in 55% of cases examined (n=128). Fifty-four per cent of master impressions were (n=129) made using a plastic stock tray. Three-quarters of written instructions for FPDs (n=73) did not specify the number of pontics to be included in its design. Despite the existence of various legal and ethical guidelines relating to the prescription and fabrication of fixed prostheses, more than one-half of the written instructions and master impressions examined in this study were inadequate.

Crowns↗
PubMed1993

Infection control in a prosthodontic residency program.

Awareness of the need to incorporate an effective infection control program within a prosthodontic practice requires the faculty of a prosthodontic residency program to present a clear and workable model that will allow the flexibility necessary to accommodate the changes in infection control procedures and materials. The use of the barrier system to insulate the operatory, resident, faculty, and dental laboratory is discussed. Current disinfection and sterilization methods used to maintain the barriers are recommended.

Dental Service, Hospital↗
PubMed1994

Image quality of intraoral radiographs used by general practitioners in prosthodontic treatment planning.

A number of studies have shown a low standard of radiographic image quality in general dental practices. Image quality was evaluated on 1094 radiographs from 100 consecutive cases submitted to a dental insurance office for approval of planned prosthodontic treatment. It was found that only 404 radiographs were without any type of error and that 690 radiographs had a total of 959 errors. The most common errors were projection and film density errors. The number of submitted radiographs ranged from one to 40. Nearly every fourth tooth proposed for treatment was not properly documented. The results also showed that 43 of 100 cases did not meet the criteria for acceptance for assessment of the proposed prosthodontic treatment. This means that they were incompletely documented radiographically so that the treatment plan could not be evaluated. This study suggests that new or additional radiographic documentation ought to be requested frequently before approval of proposed treatment plans.

Denture, Partial, Fixed↗
PubMed2000

Prosthodontics: achieving quality esthetic dentistry and integrated comprehensive care.

BACKGROUND: Prosthodontics is the dental specialty responsible for diagnosis, rehabilitation and maintenance of patients with complex clinical conditions involving missing or deficient teeth and/or craniofacial tissues. The essence of the specialty is expert treatment planning. OVERVIEW/LITERATURE REVIEWED: In recent years, new approaches and technology have been introduced as a result of research performed in universities and by industry. The field of prosthodontics continues to evolve owing to a better understanding of the biology of the oral cavity and the introduction of new techniques and improved biomaterials. Improvements in periodontal and oral surgical techniques, implant procedures and materials, esthetic restorative materials, and jaw tracking recorders and articulators have led to enhanced functional and esthetic oral and maxillofacial prostheses. CONCLUSIONS AND CLINICAL IMPLICATIONS: The complexities of today's technical and clinical procedures and the higher expectations for more esthetically pleasing dentistry by the general patient population have placed a premium on teamwork involving general dentists, specialists and dental technicians.

Dental Porcelain↗
PubMed1996

A questionnaire instrument to assess clinical decision-making in prosthodontics among general practitioners.

There are great variations in dentists' choice of treatment. The aim of this study was to evaluate a Patient Paper Case (PPC) technique to investigate such variation, adjusted for prosthodontics. The questionnaire was sent to all 131 general practitioners (GP) in the Public Dental Service in Orebro County and to all 100 GPs in private practice in Skaraborg County, Sweden, with 81% responding. There were three PPC questions, concerning 1) crown therapy or amalgam/composite filling, 2) fixed or removable partial denture, 3) fixed partial denture or single implant restoration. Respondents were asked to assess 13 or 14 items concerning the patient, dental conditions, and own skills. There was great variation in responses. In factor analysis four factors were found to capture between 54% and 60% of the variance of the items. They were interpreted as a time factor, a patient subjective factor, a clinical factor, and finally, for the PPC 1 and 2, a general health factor. The Swedish insurance regulations of single implant therapy, mandatory caries/filling-free, and vital adjacent teeth were reflected in the factor solution of PPC 3. It is concluded that the PPC method is feasible and useful in studies of clinical decision-making in prosthodontics.

Decision Making↗
PubMedDate not supplied

General dentists' attitudes toward delegation, information, and patient influence in a prosthodontic context.

PURPOSE: The aim of this study was to investigate attitudes among general dentists in Sweden in relation to gender, age, prosthodontic activity, and dental delivery system (private or public). MATERIALS AND METHODS: Questionnaires were sent to a random sample of 2,059 dentists, and a response rate of 76% (1,567 dentists) was achieved. Among those who responded, 50% were private practitioners and 50% were publicly employed practitioners; 42% were female and 58% were male. The questionnaire contained 10 statements aimed at measuring attitudes. Their dimensionality was analyzed using principal components analysis. The resulting factors were related to delivery system (public or private), gender, age, job satisfaction, and weekly working hours used for prosthodontics in multiple regression models. RESULTS: There was a wide variation in the answers to the statements, indicating great individual differences in opinions among dentists. Several distributions differed with respect to gender and delivery system, but the mean differences between various groups of dentists were small. The most affirmative attitude was shown for delegation of impression taking to auxiliaries (mean 6.7; SD 1.8), and the most negative attitude was shown for close cooperation between dentists (mean 1.8; SD 1.4). The factor analysis gave 3 factors, with a variance explanation of 57%. Regression models for the 3 attitude dimensions ("patient influence," "delegation," and "patient information") showed that female dentists felt more positive about delegation and information than male dentists. The explained variance was very low for all 3 models and varied from 0.01 to 0.05. CONCLUSION: Although the differences in attitudes between various groups of dentists were statistically significant, these differences were small in relation to the large variation in attitudes among individual dentists.

Adult↗
PubMed1992

[The fundamental method of preventive prosthodontics: complex rehabilitation of the masticatory organ].

The most effective prosthetic prophlaxis could be the prevention of causes leading to tooth extractions. As now the caries and periodontal preventions are not efficient enough we are obligated to deal with the consequences of tooth loss. Even the loss of a single tooth might cause disfunctions in the masticatory system. Besides the well known consequences, like diminished masticatory, phonetic functions and esthetical problems we have to face to the consequences related to morphological changes in the dentition leading to difficulties in prosthodontic treatment planning and tooth preparation. So, the most important step in prosthodontic prophylaxis is the early replacement of the lost tooth. The early prosthetic reconstruction can only be prophylactic if it does not interfere with the normal hygienic procedures in the oral cavity. Consequently it is very important to consider all the possible factors affecting the oral hygiene during our prosthetic treatment planning. We should also consider the basic gnatological principles in designing the occlusal surface of crowns and pontics to avoid any traumatic occlusal forces related to our would be reconstructions.

Humans↗
PubMed2005

[Influence of the prosthodontic construction on the marginal gingiva nearby dental crowns and bridges].

Along with the functional and aesthetic results, prosthodontic constructions must correspond to biological needs as well. They don't have to irritate the periodontal tissue, alveolar bone and gingiva. The aim of the study was to investigate gingival status under modified artificial teeth using cytomorphology (PAP) methods. Cytological investigations were carried out in 30 patients. 19 of them were using modified crowns and 11--modified bridges. Gingival status was marked using CD I and II indexes. Cytomorphometric investigations showed that modified prosthodontic constructions do not harm gingivas which are under the modification. Dynamic cytological changes found at the time of treatment represent individual biological reaction to the artificial teeth.

Crowns↗
PubMed2006

[Quality of life and prosthodontics].

Orofacial pain, functional limitations, psychosocial impacts, and concern about appearance are all dimensions of oral health-related quality of life. Consequently, OHRQoL is especially important for prosthodontics. OHRQoL is assessed by multiple-item questionnaires that ask about numerous symptoms, problems and social impacts. 49 items into seven dimensions were developed in the OHIP which was then verified among several different cultural circumstances. Evaluating baseline (To) immediately after treatment (T1) and after a longer observation time (T2), a decrease of symptoms and problems could be followed in prosthodontic care. Fastest improvement in patient satisfaction was observed in case of fixed partial denture wearers. The profile of pre- and post-treatment problems differed extensively among removable partial and complete denture wearers, and only minor problems were found after a longer time of adaptation. OHIP instrument seems to be a reliable indicator of change in oral health-related quality of life, for cultural circumstances deviated largely from each others.

Cross-Sectional Studies↗
PubMed2006

Internal adaptation of fixed prosthodontics at shoulder preparation level evaluated by horizontal sections.

AIM: The precision of fixed prosthodontic restorations is fundamental for clinical success: well-fitting crowns reduce the risk of recurrent caries and periodontal disease. The aim of this study is to evaluate the internal fit of fixed prosthodontics at the shoulder preparation level by examining horizontal sections. METHODS: Twenty-four extracted teeth were resin-embedded and prepared on the platform of an iso-parallelometer with a 90 degrees shoulder with a rounded internal angle. Auro Galva Crown (AGC) copings were cemented in place. The preparations were observed by 3 different assessors at 8 points, first externally and then internally at 2 levels by grinding the specimen perpendicular to the long axis at 0.5 mm and at 0.2 mm from the margin of the preparation. A correction factor was calculated to derive real values from measured values. The results were analyzed using a linear regression with robust standard errors, accounting for within-subject correlation introduced by multiple measurements. Shrout-Fleiss Intraclass Correlation Coefficient (ICC) for Inter-Rater Reliability were calculated at each stage. RESULTS: Internal measurements at 0.5 and 0.2 mm from the margin provided data similar to the external margin data. Average inter-assessor differences were in the range of 2 mm. ICC ranged from 0.93 for the 0.5 mm level to 0.97 for the external level. CONCLUSIONS: External measurements effectively predict the internal precision at the shoulder level. Horizontal perimarginal sections allow the fit to be studied through the evaluation of a great number of points. Traditional vertical sections for the evaluation of internal fit enable only a few points to be observed. This internal observation method may be suitable for testing new materials.

Humans↗
PubMedDate not supplied

Cross-contamination control in prosthodontic practice.

Prosthodontic patients are generally a high-risk group relative to their potential to transmit infectious diseases as well as acquire them. There has been a recent increase in awareness of the need for cross-infection control measures to protect against possible routes of transmission frequently ignored in the past. This article is essentially a literature review of cross-infection control measures especially relevant to removable prosthodontic practice. Cross-contamination control measures are considered within the following categories: patient evaluation, personal protection, instrument and equipment contamination, clinical technique, impression handling, and laboratory asepsis.

Cross Infection↗
PubMed1983

New materials and techniques in prosthodontics.

In looking back over the past few years, dentistry has seen many changes. The newer methods and materials in complete denture prosthodontics, and the update on dental materials has been exciting. The development of many good disposable products is in keeping with other technologic advancements. Unlike aerospace and industry, dentistry has not yet entered the computer age. However, that day is not far off. With the newer materials used in the multiphases of prosthodontics, the astute practitioner can become acquainted with time-saving, clinically orientated dental materials, and new products. The clinician's appreciation of a particular product is based on individual reaction to the disposable qualities, the cost factors, the ease of handling, and the end product. The advantages of time-saving methods are crucial to office overhead today. This article has covered various phases of removable complete dentures, dental materials, and products that are appropriate to those procedures. No particular product or procedure has been specifically recommended. Instead, I have introduced products that I have used and enjoyed. Not all products can be studied and reported, so if certain materials are not mentioned, it is because not enough time was available to pursue every new product or procedure offered to the disciplines of dentistry.

Adhesives↗
PubMed1995

Quality of intraoral radiographs used for prosthodontic treatment planning by general dentists in the public dental health service.

The image quality of intraoral radiographs used by general public health dentists in prosthodontic treatment planning was evaluated on 763 radiographs from 72 consecutive cases. It was found that 349 (45.7%) radiographs were without any type error and that 414 radiographs had a total of 577 errors. The most common errors were projection and film density errors. The number of submitted radiographs ranged from 2 to 22. Three prosthodontists evaluated if the radiographs gave "satisfactory" or "not satisfactory" information for approval or not of the proposed treatment. Of the 72 cases did 34 (47%) not meet the criteria for acceptance. For the cases where the prosthodontists found the radiographic documentation "satisfactory", the mean number of periapical radiographs was 10.8, while for cases found "not satisfactory" the mean number was 7.1. This difference was found to be statistically significant (p < 0.01). It was shown that nearly every seventh tooth planned to be used as an abutment was radiographically not properly documented. The poor radiographic quality found in this study and in other similar studies should be taken into serious consideration, especially as prosthodontic treatment accounts for a substantial part of the total costs for dental insurance in Sweden.

Dental Abutments↗
PubMed1996

The Institute of Medicine study of dental education: issues affecting prosthodontics. Report of the Educational Policy Subcommittee of the American College of Prosthodontists.

In 1993, the National Academy of Sciences' Institute of Medicine (IOM) convened a committee to study dental education and to make recommendations regarding the future of dentistry. The study was prompted by educational and professional concerns: specifically, the number of dental school closures, the high cost of dental education, the size of the dental workforce, and the role of dentistry within medicine and the health care system. In January 1995, the IOM's Committee on the Future of Dental Education concluded "Dental Education at the Crossroads-Challenges and Change," a 345-page report that includes eight policy and strategic principles and presents 22 recommendations. The unabridged text of the strategic principles and recommendations is published at the beginning of this paper. The IOM text notes impressive achievements in dentistry, and the recommendations form a foundation for the assessment of the many crucial issues that face dental education and dentistry today. The IOM report urges each dental school to review its curriculum and individually determine how best to fulfill its missions of education, research, and patient care. As dental education looks to the future, the practice of dentistry will be altered by social, economic, political, and technological developments as our consumers (students and patients) demand professional accountability and effectiveness. In the midst of this call for change, the specialty of prosthodontics is faced with many challenges and opportunities. This article is the response to a request from the American Dental Association (ADA) to address the IOM study on dental education as it affects the specialty and practice of prosthodontics. This article presents the position of the American College of Prosthodontists (ACP); however, some sections have been expanded to provide additional background information.

American Dental Association↗
PubMed1995

The effect of magnification on the performance of fixed prosthodontic procedures.

This study attempts to quantify the effect of magnifiers on the quality of typical procedures in fixed prosthodontics that are technique-sensitive and have significant increase in clinical success when errors are minimized. Dental students who performed fixed prosthodontic procedures while using magnifiers were found to have committed half as many errors as students who performed the same preparation without the aid of a magnifier.

Dental Equipment↗