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PubMed2005

Maxillomandibular relationship philosophies for prosthodontic treatment: a survey of dental educators.

STATEMENT OF PROBLEM: A variety of treatment philosophies persist concerning the need for coincidence of centric occlusion (CO) and maximum intercuspation (MI) in prosthodontic restoration; however, no consensus exists. PURPOSE: The purpose of this study was to determine the philosophies of dental educators throughout the United States at both the predoctoral and postdoctoral levels and to compare their attitudes toward desirable maxillomandibular relationships in defined clinical situations. MATERIAL AND METHODS: A survey was constructed with 5 clinical scenarios presented describing patients with a difference between maximum intercuspation and centric occlusion. The survey was mailed to 171 dentists involved in either predoctoral or postdoctoral dental programs in the United States; including 56 dental schools; the Army, Navy, and Air Force postdoctoral programs; 8 Department of Veterans Affairs postdoctoral programs; and 7 hospital-based programs. Descriptive statistics of the responses were provided. Chi-squared (alpha=.05) and Fisher's exact test analyses (alpha=.05) comparing predoctoral and postdoctoral program responses for each question were performed. RESULTS: Forty-three predoctoral dental school program responses were received. Forty-one postdoctoral program directors, including the dental school-based programs, 3 armed service branches, 2 Veterans Administration programs, and 1 hospital-based program responded to the survey. Fifteen respondents indicated that they represented both predoctoral and postdoctoral programs, and these data were deleted from the sample. Summarized results for each question reflect on whether the clinicians philosophically believed patients were better off with the elimination of an existing occlusal interference between MI and CO or not. There was no statistically significant difference seen between the predoctoral and postdoctoral responses. CONCLUSION: The controversy regarding the preferred mandibular position for treatment of dentulous and partially edentulous patients continues among dental educators at both the predoctoral and postdoctoral levels in the United States.

Attitude of Health Personnel↗
PubMed1995

Prosthodontic treatment of patients receiving implants by predoctoral students: five-year follow-up with the IMZ system.

Twenty-four patients were treated with 71 IMZ implants between 1987 and 1991 at Tufts University School of Dental Medicine by senior dental students. Soft tissue, marginal bone height, and prostheses were evaluated. Inflammation was noted around 70% of the implants, and marginal bone loss around 13% of the implants exceeded 2 mm. Prosthodontic complications included broken screws, broken dentures, broken intramobile elements (IMEs), porcelain fracture, and IMZ clip replacement. All 71 implants were immobile.

Adult↗
PubMed1995

A survey of temporomandibular disorder conducted by the Greater New York Academy of Prosthodontics.

The results of a temporomandibular joint survey sent to 167 members of the Greater New York Academy of Prosthodontics indicated a great variation in the diagnosis and treatment of patients with temporomandibular joint dysfunction. Although most indicated that their background in temporomandibular joint disorders was from clinical experience and/or textbooks and the dental literature, only 59% treated patients for these disorders. The most common diagnostic procedures were occlusal evaluation; joint evaluation for tenderness, crepitus, and click; evaluation of range of motion of the mandible; and a muscular evaluation. Only 35% used a formal temporomandibular joint dysfunction questionnaire. The percentage of complete denture patients with these symptoms was 5% or less. Thirty-three percent of clinicians sometimes treated asymptomatic patients who were without pain but had a click. Two thirds of the respondents believed that surgery was sometimes indicated for disk degeneration and displacement. More recent graduates are more likely to treat patients who have temporomandibular joint dysfunction than are older more experienced practitioners.

Attitude of Health Personnel↗
PubMed1996

Clinical evaluation in prosthodontics: practical methods to improve validity and reliability at the undergraduate level.

The potential causes of reliability and validity problems with traditional methods of evaluating a student's clinical prosthodontic skills are reviewed. Practical methods of evaluating critical skills in a reliable and valid way are presented. These methods include clinical tests using written criteria and anonymous examiners, skills assessment by faculty members, patient-based written examinations, and bell ringer examinations.

Clinical Competence↗
PubMed1996

Use of the Internet for educational applications in prosthodontics.

Internet is the common term for the information superhighway. The Internet has become a major information resource for educational, governmental, and business institutions. This article reviews the current operation of the Internet as a background for discussing educational opportunities for instruction in prosthodontics. Electronic mail, news groups, file transfer protocol, Gopher, and network navigators are discussed. The use of the World Wide Web for educational purposes by The Ohio State University College of Dentistry Department of Restorative and Prosthetic Dentistry is described.

Computer Communication Networks↗
PubMed1997

Implant placement in prosthodontics practice: a five-year retrospective study.

UNLABELLED: Dental implants have revolutionized dentistry in every aspect of treatment including surgery, restorative dentistry, and orthodontic treatment planning. PURPOSE: This retrospective study analyzes the treatment of completely and partially edentulous patients in a prosthodontics practice and the Edmonton Implant Seminar. MATERIAL AND METHODS: All implant surgery was performed by the prosthodontist. The majority of implants (336) were restored by the prosthodontist (71%). A total of 135 restorations were provided by 12 different general practitioners (29%) in a study group environment. RESULTS: Of 471 implants that were placed, 453 (96.2%) integrated successfully. Treatment groups were divided into single implant restoration (19.3%), fixed partial dentures (51%), overdentures (12.3%), and mandibular fixed partial denture cantilever (17.6%). Retention of final prosthesis was 99.4%. Of 18 failures, four occurred between Stage I and II surgeries, 11 occurred between Stage II surgery and final impressions, and three occurred after placement of final restorations. All three restorative failures were single implants. CONCLUSION: The results indicated that implant placement by a prosthodontist is comparable to the success of previous studies.

Adolescent↗
PubMed1998

Organizational considerations for an electronic curriculum. Part II: A multimedia approach to dental education in general and to prosthodontics in particular.

STATEMENT OF PROBLEM: In using multimedia electronic knowledge-transfer as a tool in dental education, an overriding concern has centered on how to devise an organizational model that will accommodate the vast and diverse arrays of information involved, yet be sufficiently simple to provide students with a rational and consistent means of accessing the information they require. PURPOSE: This article presents a model that adopts the Natural History of Dental Diseases as the organizing principle. This article also encourages a mindset in prosthodontics that focuses on the dynamics of energy-dispersal through the supporting structures, in an attempt to provide learners with a deeper cognitive dimension for problem solving and to facilitate their empowerment as life-long learners.

Computer-Assisted Instruction↗
PubMed2001

Assessment of the use of problem-orientated, small-group discussion for learning of a fixed prosthodontic, simulation laboratory course.

AIM: To evaluate a simulation laboratory course that used student-centred small-group problem-orientated discussion activities as the main medium of instruction. METHODS: A structured questionnaire using a six-point Likert scale with 30 statements relating to a fixed prosthodontics course was distributed to 4th-year and 5th-year students who had completed the course. RESULTS: A 93% response rate was achieved for both years with a mean score for the 4th-year being 94.2 (+/- 13.7) and the 5th-year 107.5 (+/-16.9). The differences between the scores of both years are highly significant (P = 0.0006) indicating that the 5th-year were more favourable about the course and learning approach used. Consistency and reliability of the questionnaire was judged reliable according to Cronbach's alpha (4th-year = 0.7, 5th-year = 0.83). Many aspects of the small-group student-centred activities were highly valued by students however, students expressed a preference for learning and interacting with teachers than colleagues. CONCLUSION: Small-group student-centred learning activities were reported as creating an active, safe learning environment with beneficial opportunities for peer-peer interaction such as questioning, teaching and learning from students. However, students expressed a preference for teacher-centred information dissemination and activities. An understanding of the rationale of student dependence to teacher-centred learning may allow improved modifications in a student-centred learning environment.

Denture, Partial, Fixed↗
PubMed2001

Vital pulp therapy with bipolar electrocoagulation after intentional pulp exposure of fixed prosthodontic abutments: a clinical report.

A clinical protocol is described for the treatment of intentional and unavoidable exposed pulps during crown preparation. The protocol includes a definitive cavity preparation to create space in the exposed dentin for an adhesive pulp barrier; procedures to develop the highly desirable hybrid zone to prevent microleakage; the use of a specific resinous material that serves as a long-term pulp barrier with a relatively neutral and biocompatible impact on the pulp; and the use of precise bipolar electrocoagulation to provide durable hemostasis for restoration of the pulp wall and a relatively clot-free surgical wound to facilitate healing. The protocol involves the application of gentle surgical and restorative procedures to support the inherent healing process to restore the health of the pulp. The patient presented was part of a larger investigation and was selected in an attempt to identify a fixed prosthodontic application of the proposed pulp therapy protocol.

Acrylic Resins↗
PubMed1988

The long-term impact of a training program in maxillofacial prosthodontics.

A follow-up survey of trainees in a National Cancer Institute-sponsored program in maxillofacial prosthodontics was conducted. Information about the trainees' current professional activities indicated that the majority work in private practice or a dental school, are primarily involved in clinical work or teaching, and see few cancer patients. Inadequate reimbursement and lack of collaboration with surgeons were cited as barriers to involvement in cancer patient care. It is suggested that barriers to applying training expertise in actual practice settings require emphasis in the planning and curricula of training programs.

Career Choice↗
PubMed1995

The use of clinical computer workstations as an educational adjunct in prosthodontics.

Current computer systems improve the health professional's ability to store, retrieve, and present visual data in a way never before possible. Health professionals in general are beginning to use computer-based digital imaging to improve the diagnosis and treatment planning of disease processes. The use of computer-based networks to transmit medical and dental data is in its infancy but promises to be the main form of data transmission of the future. This article outlines a few applications presently being used and developed at the Ohio State University College of Dentistry in the preclinical and clinical courses in prosthodontics.

Computer Communication Networks↗
PubMed1996

The results of a brief survey of complete denture prosthodontic techniques in predoctoral programs in North American dental schools.

A brief mail survey of North American dental schools was undertaken to ascertain the current techniques in complete denture prosthodontics regarding preliminary and final impressions, record bases, and denture teeth. Of the 64 schools surveyed, 54 responded (84%). Seventy-four percent of the respondents used only irreversible hydrocolloid (alginate) for their preliminary impressions; 15% used only modeling plastic impression compound. Eighty-one percent used only modeling plastic impression compound for border molding of the final impression tray; 7% used only polyether impression material. Forty-eight percent used only polysulfide rubber (PR) impression material for their final impression material; 4% used only polyether impression material. Only 1 school still used shellac as one of its materials for record bases. Thirty-five percent used only Triad; 35% used only acrylic resin; 24% used both of these materials. Thirteen percent of responding schools used only nonanatomic teeth. The majority (54%) used all three options (nonanatomic, semianatomic, and anatomic). Eleven percent used lingualized occlusion. As compared with a survey performed in 1985, the use of irreversible hydrocolloid as a preliminary impression material, the use of visible light-cured resins for record bases, and the use of anatomic teeth have increased. The use of plastic impression compound for border molding and PR as the final impression material has largely remained the same.

Canada↗
PubMed1997

Quality assurance for the laboratory aspects of prosthodontic treatment.

Inconsistency in the product returned from the commercial dental laboratory led to the development of a formal quality assurance (QA) program at the University of Detroit Mercy School of Dentistry in 1994. The goal of the program was to improve the quality of prosthodontic laboratory submissions and the returned product, facilitate laboratory communications, and, ultimately, enhance the quality and timeliness of patient care. Each student submission is evaluated with a criterion-referenced evaluation form. Deficiencies are communicated to the student, and the corrected submission is then sent to the laboratory. Three-year remake data from the main clinic (QA site) and an extramural clinic (non-QA site) demonstrate the effectiveness of the program. The major benefits are more efficient, cost-effective patient care, as well as the provision of a model for the student to practice the skills needed for effective communication with the dental technician, upon graduation.

Humans↗
PubMed1999

Effective taper criterion for the full veneer crown preparation in preclinical prosthodontics.

PURPOSE: Effective taper criteria must define a realistic, measurable goal that the student can visualize and achieve. Six degrees is widely accepted as the taper criterion for the full veneer crown preparation. However, studies show the actual taper of most preparations to be greater than 12 degrees. The purpose of this study was to determine whether 12 degrees is an effective taper criterion for the full veneer crown preparation in preclinical prosthodontics instruction. MATERIALS AND METHODS: A group of 191 full veneer crown preparations with 6 degrees as the taper criterion, and a group of 130 full veneer crown preparations with 12 degrees as the taper criterion were evaluated. All preparations were accomplished by preclinical dental students working on typodonts under examination conditions. RESULTS: The overall mean taper for each group exceeded the targeted criterion. The overall mean taper for the 6 degrees group was 14,490. When 12 degrees was the criterion, the overall mean taper was 15,580. The t test results indicate significant differences (p < .0001) between the targeted criterion and the actual preparation mean taper in all samples except one: the faciolingual measurements in the 12 degrees group. The faciolingual measurement of 12,920 was not statistically significantly different (.0542) from the targeted criterion of 12 degrees. CONCLUSION: The use of a 12 degrees taper criterion did not result in preclinical students achieving the goal of a 12 degrees taper. However, a 12 degrees criterion is more realistic than a 6 degrees criterion for full veneer crown preparations.

Crowns↗
PubMedDate not supplied

Prosthodontics as a specialty private practice: net income of private practitioners.

PURPOSE: The aim of this study was to use data from a survey of prosthodontists in the US to examine average net earnings of prosthodontists in private practice. MATERIALS AND METHODS: A survey of 2500 prosthodontists in the US was used to estimate the net earnings of practicing prosthodontists. The national average net earnings of prosthodontists in private practice was estimated along with average earnings for subgroups of prosthodontists. Estimates for private practitioners by age, gender, size of practice, full-time/part-time status, practice ownership, and by type of treatment procedures rendered by the practitioner were also included. RESULTS: Average earnings for prosthodontists in private practice on a primary or secondary basis were estimated to be $215,300 and for prosthodontists who own or share in the ownership of a private practice, $233,920. Reported earnings estimates ranged from $96,160 for non-owners of a private practice and $103,350 for part-time private practitioners to $233,920 for practice owners and $275,170 for prosthodontists in practice with two prosthodontists. The average earnings of prosthodontists who are practice owners were estimated to be 35% higher than the corresponding general practitioners. CONCLUSION: Average net earnings are often used to examine the current economic health of a profession. The average net earnings of prosthodontists in private practice exceed the average net income reported by the American Dental Association for all dentists and all general practitioners and they are competitive with earnings among all specialty groups. This evaluation of the net earnings of prosthodontists shows that prosthodontics offers a competitive career opportunity for the general dentist with a personal desire to pursue advanced dental education in a specialty as a profession.

Adult↗
PubMedDate not supplied

Dentist communication with the dental laboratory for prosthodontic treatment using implants.

PURPOSE: A questionnaire was sent to U.S. dental laboratories to evaluate the level of communication between dentists and laboratory technicians and to determine trends in procedures and materials used in fixed and removable implant restorations. METHODS AND MATERIALS: Dental laboratories were randomly chosen from the National Association of Dental Laboratories for each of the 50 states. The questionnaire was mailed to the laboratory directors for 199 dental laboratories. One hundred fourteen dental laboratories returned the survey, yielding a response rate of 57%. Of those laboratories, 37 indicated that they did not participate in the fabrication of fixed implant restorations, yielding a response rate of 39%. Forty-two dental laboratories indicated that they did not participate in the fabrication of implant-retained overdenture prostheses, yielding a response rate of 36%. RESULTS: Results from this survey show inadequate communication by dentists in completing work authorization forms. Custom trays are used more frequently for implant-retained overdenture impressions and stock trays for impressions of fixed implant prostheses. Poly(vinyl siloxane) is the material most commonly used for both fixed and removable implant-supported prostheses. Two implants with stud attachments are used more widely than those with bar attachments for implant-retained overdentures. CONCLUSIONS: Most laboratories working on implant prosthodontic cases report inadequate communication between the laboratory and dentists related to materials and techniques used in fabrication of implant restorations.

Communication↗
PubMed2006

Reducing subjectivity in the evaluation of pre-clinical dental preparations for fixed prosthodontics using the Kavo PrepAssistant.

The evaluation of pre-clinical technical achievement in fixed prosthodontics cannot be objective when using visual examination of dental preparations. This is, however, still the main method used in dental schools. The present study introduces a new method, based on a mathematical formula, to reduce the problem. The idea emerged when using the Kavo PrepAssistant system (software version 1.05). This system is a 3D-scanner with software that can quantify geometrical differences between an instructor and student dental preparation in model teeth. Therefore, a mathematical formula was created, integrating selected clinically relevant geometric characteristics of dental preparations measured by the system. In this new formula, 70% of the evaluation parameters were computer analysed, whilst 30% were visually evaluated. This new method was compared with the traditional visual evaluation system during a pre-clinical practical examination, with the participation of 25 students. Using both methods to evaluate the 25 preparations, results showed similar grading for both methods (K-S test = 0.16; P < 0.05). Although this method does not provide overall clinical evaluation of student performance these results suggest that it can be helpful accessing technical achievement. In this method, the student has the guarantee that 70% of his/her grade results from an objective computer evaluation, with the possibility to visualise the mistakes with the software. It also reduces problems related to the calibration between different examiners. The Kavo PrepAssistant is a powerful tool in pre-clinical teaching, but has some drawbacks. It has to be developed towards the actual needs of pre-clinical departments, in order to achieve its full potential, as described in this study.

Computer-Aided Design↗
PubMed1997

The teaching of prosthodontic care for older people: a non-rote philosophy.

This essay complements that de Baat et al in the last issue with emphasis on the importance of the variability between individual older people. The consequent need for an open minded approach towards planning Prosthodontics is discussed, based on each patient's motivation for aesthetics, function, comfort and self esteem. Both functional expectations and motivation to learn effective health behaviour vary widely, and evaluation of both is essential for realistic planning because further tooth loss and the need for partial dentures occur so frequently. The consequent variation in plans raises the question--which are the strategic teeth to maintain a stable dental occlusion or a future tooth stabilised denture? For undergraduates this demands a non-rote approach to learning.

Aged↗