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PubMed2005

Prosthodontic status and recommended care of patients with epilepsy.

STATEMENT OF PROBLEM: Epilepsy is a chronic disease that can affect oral health and prosthodontic status in different ways. However, epilepsy is a condition of various etiologies and seizure types, and different patients may have differing needs in prosthodontic care. PURPOSE: The purpose of this study was to examine the prosthodontic status of patients with epilepsy to determine if the disease has any effect on prosthodontic treatment and to obtain information regarding the level of prosthodontic care. This information was used to provide recommendations for the prosthodontic treatment of patients with epilepsy. MATERIAL AND METHODS: One hundred one epileptic patients were examined, interviewed, and compared with 101 age-matched control (nonepileptic) subjects of the general population. Epileptic patients were recruited at an epilepsy outpatient clinic. The only exclusion criterion was a mental handicap severe enough to exclude cooperation of the patient during a dental examination. Control subjects were recruited at a community radiographic chest-screening clinic. Epileptic patients were first grouped according to dental risk factors and dental manageability. Dental classification of patients with epilepsy considered the frequency and type of seizures, as seizures may damage the teeth and dental prostheses. The number of missing teeth, the ratio of missing and replaced teeth, and the number of fixed and removable partial dentures and complete dentures, and the characteristics (material, degree of abrasion, and age) of the dentures was determined by dental examination. Finally, the state of oral mucosa and the number of seizure-related injuries was noted. Statistical comparison of the patient and the control group was performed, using the 2-tailed t -test for continuous variables and the chi-squared test or Fisher's exact test for categorical variables (alpha=.05). RESULTS: The number of missing teeth was significantly higher in the epilepsy group than in the control group (P =.021). The ratio of replaced and missing teeth was lower in the epileptic group (P <.01), indicating inadequate prosthodontic care. There was also a significant difference in the age of the fixed prostheses (P =.0016), being lower in the epilepsy group, and in the material of fixed prostheses (P =.033), metal-ceramic being more common in the control group. More epileptic patients were edentulous than control subjects (8 versus 3) and the average age at the time of examination was younger (48 versus 57 years). Seizure-related injuries were reported by 11% of patients, all belonging to the subgroup of patients with frequent generalized tonic-clonic seizures. CONCLUSION: Patients with epilepsy have an increased risk for loosing teeth and, furthermore, the prosthodontic status of epilepsy patients was not as optimal as compared with the control group. Seizure-related injuries to prostheses are also an issue, but only in those suffering from frequent generalized tonic-clonic seizures. Therefore, the large majority of patients can and should receive prosthodontic treatment without restrictions. For a smaller group of patients, however, certain restrictions apply, to prevent potentially dangerous seizure-related complications.

Adult↗
PubMed1990

Advanced education in prosthodontics.

1. The ADA Council on Dental Education Commission on Accreditation, using the Standards for undergraduate education and current National Board scores, does not believe there has been a deemphasis in prosthodontic knowledge and skill. This opinion is not shared by program Directors or representatives of the laboratory industry. The Council on Dental Education has a mechanism for periodic review in place. State Boards of Dental Examiners did not respond. 2. Teaching experience for residents or graduate students should be encouraged in advanced education programs in prosthodontics as an elective or be limited to no more than 10% of the curriculum time. 3. The American Board of Prosthodontics would not comment on any changes regarding the clinical or didactic knowledge of candidates. 4. Meaningful research is not possible within the current minimum 22-month program duration. 5. Accredited advanced education programs in prosthodontics are currently meeting the standard guidelines for clinical and didactic experiences. 6. Accredited advanced education programs in prosthodontics are currently satisfying the requirements on supervision and faculty; however, the data from the annual reports suggest a marked decrease in staff support and amount of time that program directors are devoting to the program. 7. Expanding the curriculum to include implant prosthodontics will require lengthening the curriculum time. 8. TMJ therapy and geriatric dentistry need to be better defined in the educational guidelines. 9. The criterion-based examination currently given by the American Board of Prosthodontics clearly delineates acceptable, marginal, and unacceptable levels of performance. 10. Program directors desire more "feedback" from the American Board of Prosthodontics on the performance of candidates.(ABSTRACT TRUNCATED AT 250 WORDS)

Accreditation↗
PubMed2000

Dentist-related factors influencing the amount of prosthodontic treatment provided.

OBJECTIVES: To evaluate, using multivariate methods, the associations between indicators of the amount of prosthodontic treatment and dentist-related factors. METHODS: Questionnaires were sent to a random sample of 2,059 general dentists, response rate was 76%. Two indicators of prosthodontic activity were used as dependent variables: 1) reported weekly working hours used for prosthodontics and 2) reported numbers of produced single crowns, fixed partial dentures, and removable dentures. Independent variables were 'social and demographic attributes', 'job situation' and 'attitudes of dentists'. Multiple regression analysis was used in models with continuous dependent variables and logistic regression analysis for categorical dependent variables. RESULTS: 'Weekly working hours used for dental care of adults' showed a strong association in all models with the dependent variable 'weekly working hours used for prosthodontics'. Male dentists provided more prosthodontic services than female dentists, even if reporting less time used for prosthodontics. Private practitioners produced more fixed prosthodontics than dentists employed in the public dental health service. Dentists in the public dental health service reported a higher production of removable dentures than private practitioners. CONCLUSION: The results indicate that factors, besides those in the rational clinical model for decision-making, e.g. gender and delivery system, play a role in the provision of prosthodontic services.

Adult↗
PubMed2005

Prosthodontic research: breaking traditional barriers.

There is considerable concern among leaders in both academia and the prosthodontic profession about the vitality of prosthodontic research and the discipline in general. Many feel that prosthodontics should be focused more on issues of societal significance. In addition, patient-oriented research is becoming more difficult to support within the current climate of ever-lower priority for discipline-based research.A break with traditional lines of enquiry is required, which will entail a corresponding break with established departmental boundaries, to gain access to a multiplicity of complementary skills. Several themes will be crucial in future prosthodontic research: clinical decision making, including health economics; materials science and host response at the implant interface; biocompatibility, functional properties and serviceability of prosthodontic materials; and function and dysfunction of the masticatory system. These themes are at the core of future projects that will address quality-of-life issues related to tooth loss. Prosthodontic researchers will have to be far more aggressive in developing synergistic collaborative arrangements, to align prosthodontic research with the major issues of the day, such as aging of the population, health disparities and access to preventive strategies. Through these collaborations, prosthodontics will remain a flagship discipline within dentistry, and its practitioners will be engaged in the major issues of health care.

Dental Research↗
PubMed1989

[Osseointegrated implants in clinical dentistry from the point of view of prosthodontics].

With the life expectancy of our country reaching 80s we are encountering a society with greater proportion of the population in old ages. This social problem creates a relatively important assignment in the area of prosthodontics, especially in full denture prosthodontics. Though the most important factor that affects the success or failure of full denture prosthodontics is the condition of the residual ridge, recent studies have shown that the residual ridges continue to resorb throughout one's life span. Also our survey on the present Japanese denture patients tells us that an average person becomes edentulous at an age of 57.6, has made a full denture twice or more, has worn the denture for 8 to 10 years, and by age 65 to 67 over half of the patients have their mandibular residual ridges being even or the ridge has resorbed extremely so that the ridge is actually lower than the floor of the mouth. With the situation as it is, when we look into the future of the full denture prosthodontics it is inevitable that there will be a rapid increase in patients with extremely resorbed ridges which the present theory of full denture prosthodontics could not handle. In this sense, prosthodontic treatment of edentulous patients with implants is a relatively interesting field. In this article we will comment of the basic application technique and the prosthodontic technique which we have improved of the Brånemark's Osseointegrated implants which possess the long term basic objective clinical data and whose long term safety has been established in edentulous patients. First we will explain the basic application technique using a real case. The patient was a 56 years old female. She came to the clinic with the chief complaint of severe masticatory dysfunction due to unstable full dentures. She strongly desired fixed prosthodontics. She had worn dentures for the past 17 years. The dentures that she had on when she came in for the first visit were her 4th set of dentures. For the past 8 years she had her dentures adjusted and rebased repeatedly. Her maxillary residual ridge had an average height but her mandibular residual ridge was extremely resorbed. EMG examination exhibited conspicuous distortion in chewing rhythm. From the mandibular movement, radiographs of the TMJ regions and the clinical observations it was determined that the vertical dimension had been lost and that her mandible was displaced toward her left and anteriorly. Palpation indicated the condition of muscular tension similar to that of TMJ dysfunction patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Dental Implantation, Endosseous↗
PubMed1985

Does one articulator meet the needs of both fixed and removable prosthodontics?

A survey to determine the type of articulators used in teaching fixed and removable prosthodontics in the 59 United States dental schools was conducted. Of 115 questionnaires mailed, 104 responses were received. The following observations resulted from analysis of the questionnaire. Of the 81 articulators used in fixed and removable prosthodontics, 65 (76.5%) were of the arcon design. The most common articulators used were the Whip-Mix (16 schools), the Hanau 158 (14 schools), the Hanau 96 H-2 (13 schools), and the Denar Mark II (11 schools). The most common articulators used in fixed prosthodontic programs were the Whip-Mix (16) and the Denar Mark II (11), while the most common articulators for removable prosthodontics were the Hanau 158 (14) and the Hanau 96 H-2 (13). Twenty-two schools issued two articulators of different design, and three schools issued two articulators of the same design. The outstanding difference in requirements for fixed and removable prosthodontic teaching programs was that those in fixed prosthodontics desired an articulator in which the maxillary and mandibular members could be separated, while those in removable prosthodontics did not.

Dental Articulators↗
PubMed1989

Removable prosthodontics research--quo vadis?

The need to improve removable prosthodontic treatment through research has not diminished. Most recent research reports in prosthodontics are in fixed prosthodontics, indicating a declining interest in removable prosthodontics. A survey of dental schools in the United States and Canada reveals that the financial support for research in removable prosthodontics is a mean of $42,500 per year. Present research is not directed toward solving the major problems in removable prosthodontics. The key to making progress in removable prosthodontic research is to interest capable trainees in securing the necessary basic science and clinical training. Adequate financial support is then needed to conduct the research.

Denture, Partial, Removable↗
PubMed2002

Minimal intervention prosthodontics: current knowledge and societal implications.

Minimal intervention prosthodontics can be considered a treatment option for a country's overall dental health care plan. Prosthodontics can cover a range of increasingly aggressive treatment interventions depending on the severity and progression of the disease. The 'shortened dental arch' concept is a minimal treatment intervention approach that has been advocated for a wide range of partially edentulous patients. This concept favors limited prosthodontic intervention to achieve patient-perceived acceptable function levels in the presence of multiple missing teeth. The implementation of minimal interventions should be balanced by considering risk-to-benefit ratios, as well as the consequences of nonintervention of low-level prosthodontic interventions. The 'nonintervention' approach and low-level prosthodontic interventions have inherent consequences and well-documented risks; professional ethics dictate that a practitioner present these risks as well as the known benefits of all treatment options. Developing countries are under significant pressure to effectively utilize limited resources, increase skilled human resources, provide advanced levels of care to very large numbers of patients and plan for the future dental health care of their society. Many developing countries are prime candidates for inadvertent abuse and misappropriation of prosthodontic materials, treatment modalities and human resources in trying to provide cost-effective prosthodontic care. A developing country can learn from the mistakes that developed countries have made in the past and use the evidence from these experiences to plan for a better future state of dental health for their society.

Delivery of Health Care↗
PubMed2006

Trends in prosthodontics.

Prosthodontics is concerned with the impact of tooth or tissue damage and partial or complete loss of teeth on oral function in its broadest sense. It deals with this largely through prosthetic replacement. The discipline occupies a major portion of a dental school curriculum, and dental practitioners usually devote much of their practice to prosthodontic services. With the rapid improvement in oral health and the reduction of edentulism in many countries, increasing numbers of people are retaining more teeth later in life.Gradually,the main focus in prosthodontics has shifted from removable dentures to fixed prostheses, while implant-supported restorations have attracted intense interest in the dental community. Another factor increasingly influencing prosthodontic practice is patients' awareness of newer technologies in aesthetic dentistry. Because prosthodontic interventions as well as maintenance and repair are by nature costly, the global development in the field manifests fundamental inequalities in the levels of service that patients can access. Diminishing resources for health care in general challenges educators and practitioners of prosthodontics alike. This review is an attempt to describe the recent developments in prosthodontics and its therapeutic areas, and the impact such developments may have on the theory and practice of the discipline.

Health Education↗
PubMed1997

Practice profile differences among Swedish dentists. A questionnaire study with special reference to prosthodontics.

A questionnaire measuring differences in prosthodontic practice profiles was sent to 2100 Swedish dentists working as general practitioners. The response rate was 76%. Among the responders, 58% were men and 42% women. Fifty per cent were private practitioners, the other 50% being publicly employed. The practice profile variables showed a great variation, and several of the distributions differed with regard to sex and dental care system. The working hours per week the time spent on prosthodontics were on average higher for men than for women. Private practitioners more frequently worked in large communities and cities than did dentists working in the Public Dental Health Service. Practically all (98%) of the private practitioners used more than 75% of their clinical time on treating adults, compared with less than half of the dentists in the Public Dental Health Service. Male dentists reported higher percentage figures with regard to clinical time used for dental care of adults and for prosthodontic services than did female dentists. The figures for fixed prosthodontic service rates varied in the same manner. Fixed prosthodontic services were much more common in private practice than in the Public Dental Health Service, in which more removable dentures were made. Even though private practitioners used more time for prosthodontic services, they referred fewer patients to specialists in prosthodontics and consulted a specialist less often than did the dentists in the Public Dental Health Service.

Adult↗
PubMed2004

Alginate impressions for fixed prosthodontics. A 20 year follow up study.

The aim of this study was to estimate whether the survival ratios after 20 years of fixed prosthodontics made of alginate impressions was higher, equivalent or lower, compared to the survival ratios, shown in studies, where different impression materials were used. 151 females and 104 males were screened regarding the condition and age of the restorations at the annual check-up in one of the author's surgeries. Average ages were 55 and 54 years respectively, when the fixed prosthodontics were seated. A total of 1.271 units were produced during the twenty years, 911 abutment teeth and 360 pontics. The type of prosthetic work was divided into three groups: 1) larger fixed prosthodontics 6-14 units (469), 2) smaller fixed prosthodontics 2-5 units (541) and 3) single crowns (261). The results show that alginate impressions can produce fixed prosthodontics with survival ratios similar to those presented in other studies, after 5 years (99%), 1o years (93-96%) and 15 years (74-96%). After 20 years the survival ratio was 61-63%. In conclusion, fixed prosthodontics made according to the syringe-tray alginate impression method may have the same success rates after 20 years compared to that of fixed prosthodontics presented in previous longitudinal clinical studies where other impression materials had been used. In this study, caries and root fractures were the main reasons for removing abutment teeth and pontics.

Adult↗
PubMed2005

Changes in the prosthodontic literature 1966 to 2042.

PURPOSE: To describe the growth and content of the prosthodontic literature over the last 4 decades, to make a prognosis on its probable development in the coming 4 decades and to discuss changes in the content of the International Journal of Prosthodontics (IJP) from its start in 1988 to 2004. METHODS: MEDLINE was searched for articles on prosthodontics published between 1966 and April 2004. All volumes of IJP were examined with respect to type, subject area and geographic origin of articles. RESULTS: Using the term "prosthodontics," the MEDLINE search produced 66,600 hits. The proportion of clinical studies increased from 1% during the first 10-year period to 13% since 2001. Articles on removable dentures decreased during the period reviewed, whereas those on implant prosthodontics increased. Randomized controlled trials were rare and often of inadequate quality. Literature reviews have become popular, but many do not follow current guidelines for systematic reviews. A marked change in geographic origin of articles in IJP has occurred, with a decrease in material from North America and an increase in that from Europe and Asia. The Internet and open-access publishing will probably have a great impact on the future development of the prosthodontic literature. CONCLUSIONS: Substantial changes have occurred in the prosthodontic literature between 1966 and 2004, and they can be expected to continue with the rapid development of information technology and increased use of the Internet.

Bibliometrics↗
PubMedDate not supplied

The prosthodontic maintenance requirements of mandibular mucosa- and implant-supported overdentures: a review of the literature.

PURPOSE: This article presents a critical review of the literature on the prosthodontic maintenance requirements of mandibular mucosa- and implant-supported overdentures. MATERIALS AND METHODS: A search of the literature produced 35 papers pertaining to prospective and retrospective studies. The relationship of these prosthodontic maintenance requirements to the axis of rotation treatment concept was examined. RESULTS: More often than not, 2 anterior mandibular implants either splinted (round or ovoid bars) or unsplinted (balls or magnets) have been used to evaluate this prosthodontic follow-up. Wide variation existed in the categories used for prosthodontic complications. Although principally related to alterations of overdenture contour and aspects of patrix and matrix maintenance, they also provide subjective information on relines and the rationale for avoiding overdenture fractures. These prosthodontic maintenance requirements undoubtedly have a direct impact on the time to retreatment of mandibular mucosa- and implant-supported overdentures. CONCLUSION: There appears to be a need for a more uniform, standardized categorization with criteria for determining prosthodontic success, in terms of maintenance requirements and complications, for mandibular mucosa- and implant-supported overdentures. Controlled prospective evaluations of exact prosthodontic maintenance requirements of mandibular overdentures using different systems are lacking and encouraged. There is also an absence of prospective studies on such maintenance requirements of mandibular overdentures using multiple round bars on 3 or 4 implants.

Dental Abutments↗
PubMed1976

Teaching prosthodontics in general dentistry.

Because of the projected increase in the demand for high-quality prosthodontic services in the future, it will be necessary to upgrade undergraduate prosthodontics and to provide, in addition, improved prosthodontic training in the general dentistry residencies. The Federation of Prosthodontic Organizations is the unified voice of our specialty and must stand at the forefront to provide and direct this training. Every accredited program should be required to offer training in prosthodontics. We cannot expect graduate students to specialize in prosthodontics if we allow it to be downgraded, reduced in scope in our dental schools, and excluded from general dentistry residencies.

General Practice, Dental↗
PubMed1993

Recent graduates' and current dental students' evaluation of their prosthodontic curriculum.

This survey of recent graduates and third- and fourth-year dental students at Indiana University School of Dentistry determined whether the prosthodontic curriculum adequately prepared students for the prosthodontic portion of dental practice and whether there was material that should be added to or omitted from the prosthodontic curriculum. The survey evaluated 106 topics in the prosthodontic curriculum and areas related to prosthodontics. On the basis of their importance to the respondents, 59.4% of the topics were considered adequately emphasized, 2.9% of the topics were overemphasized and should be reduced in emphasis or eliminated, and 37.7% of the topics were underemphasized, which indicated the need to increase time devoted to these topics. Most of the underemphasized topics dealt with new materials, alternate techniques, private practice and its management, and the prosthodontic needs of special types of patients.

Curriculum↗
PubMed1984

Role of the dental hygienist in the prosthodontic practice.

Prosthodontic practices can benefit from the inclusion of a dental hygienist on the dental team. The dental hygienist can successfully complete procedures traditionally performed by the dentist. Delegation of these duties permits the dentist to spend time and energy on intricate procedures for which he or she has special expertise. The major modalities of responsibility that can be delegated include diagnostic data collection, educational and preventive services, and corrective therapy. It has been suggested that there is a need for expanding the duties of auxiliaries for prosthodontics in the future. It is our recommendation to use effectively the important auxiliary, the dental hygienist, in prosthodontic practice. For prosthodontic patients, the importance of the dental hygienist can be supported from two perspectives. First, the dental hygienist is formally educated in the oral and basic sciences and is qualified to perform intraoral procedures. Second, the dental hygienist is able to educate patients in regard to diet and oral hygiene habits. The dental hygienist's role in the prosthodontic practice has a potential that must not be overlooked. This opportunity, when provided, can be challenging, successful, and beneficial to the dentist, the patient, and the practice of prosthodontics.

Dental Hygienists↗
PubMed2003

Introducing dental students to clinical patient care: the Complete Denture Prosthodontics Transition Clinic.

Using complete denture treatment as an introduction to clinical patient care for dental students, the purposes of the Complete Denture Prosthodontics Transition Clinic at the University of Colorado School of Dentistry are to reduce the time lapse between the preclinical complete denture prosthodontics course and the first denture patient experience, and to encourage development of student self-confidence and skills. In the 2002 spring semester, faculty at the University of Colorado School of Dentistry initiated the Complete Denture Prosthodontics Transition Clinic for DS-II (second-year) dental students, as an introduction to clinical patient care. Each patient was assigned to a team of two dental students. Three Division of Prosthodontics faculty members staffed each clinic session, providing a student-to-faculty ratio of approximately 6.6:1 and a patient-to-faculty ratio of approximately 3.3:1. All DS-II students in the Class of 2004 delivered their first complete dentures no later than 8 months (average, 184 days) after the last day of the preclinical complete denture prosthodontics course. The time from the diagnostic appointment through the denture placement appointment averaged 39 days for patients treated in this program, compared with an average of 98 days or more for previous classes. The program was successful in achieving the goal of reducing the time lapse between the preclinical complete denture prosthodontics course and the first denture patient experience.

Clinical Clerkship↗
PubMed1999

Congruence between self-reported and actually provided prosthodontic services among Swedish dentists.

The purpose of this study, comprising two parts, was to investigate the congruence between answers given by general dentists in questionnaires concerning prosthodontic services and the recorded information on the services actually performed by each dentist. In Part I it is investigated whether questionnaire reports of weekly working hours devoted to prosthodontics can be used as indicators of actual prosthodontic production. Part II deals with the dentists' self-reported numbers of single crowns, fixed partial dentures (FPDs), and removable dentures. These reported services are compared with the services actually provided. Part I: A regression analysis indicates a lacking precision for the individual dentist, indicated by a relatively low explained variance (R2 = 0.20). However, a highly significant association is seen between the two production measures (P = 0.000). Part II: The congruence between stated and actually provided services is higher for single crowns and removable dentures than for FPDs. Bivariate regression models are statistically significant for all three services. In Part II, the reported weekly working hours used for prosthodontics covaries significantly with prosthodontic production, but the association is not as strong as in Part I. Although the precision in both Part I and Part II is low for the individual dentist, the questionnaire measure is found to be useful as an indicator in a population of dentists. It is concluded that the questionnaire data can be used as reasonably valid expressions of prosthodontic activity in population-oriented analyses among general dentists.

Crowns↗