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PubMed1976

Prosthodontics--Past, present, and future.

1. The geographic areas served by licensed dental mechanics will increase in number and size in the future. 2. There will be increasing difficulties in supplying dental graduates of a high caliber from our faculties of dentistry to serve adequately in the field of prosthodontics. 3. More graduate (postdoctoral) programs will be needed to train dentists to treat difficult prosthetic patients. The need for prosthetic services is still with us and will continue to grow. Only with progressive thought and aggressive action can organized prosthodontics go forward to meet its challenges. A battle is not won on defense alone, for such has been the game plan to date. Currently, dentists have a reasonable way to deliver an important health service to the population at large. However, only with a rapid advancement in the concept of delivery of total prosthodontic care can the best interests of the public be maintained. Finally, the highest standards of practice and ethics must be the guiding principles to any future changes in the delivery of prosthodontic services to the public.

Canada↗
PubMed1990

Prosthodontics. Clinical practice--third-party relations. Review of the literature.

The business component of prosthodontics is certain to become a greater focus for those who enter the profession in the 21st century. Whether future professionals are prepared to accept the inevitability of change is, in part, the present generation's responsibility to decide. Prudent management decisions based on basic business principles will be essential to those who venture into prosthodontics in the future. Understanding computers, electronic data transmission, FAX data transfers, and government rules and regulations should be essential components in the education of prosthodontic residents now. When to ask how the law will affect the young practitioners will be as important as where to place the call. Those unfamiliar with governmental regulations that govern any business venture may be caught in a nightmare of fines and economic and personal time loss. Moreover, those who are untrained in dealing with money managers (banks, credit unions, lenders) and patients (where money matters) can be assured of failure. Familiarity with all phases of third-party payments becomes an essential ingredient for future success. However, for those who are knowledgeable about business, the joy of practicing prosthodontics in the 21st century should be rewarding.

Health Expenditures↗
PubMed1990

Predoctoral removable prosthodontics education.

As the 21st century is approached, changes are occurring that directly relate to removable prosthodontics at the undergraduate level. Edentulism will continue to decline, although the need for complete dentures will diminish slowly because of the replacement needs for the existing edentulous population. In the short- to medium-term future, partial edentulism will increase in the older population at the expense of total edentulism. Therefore, the need for removable partial dentures will increase, but subsequently will decline. In the long-term, tooth loss, regardless of etiology, will be reduced. However, the replacement of lost teeth is unlikely to disappear completely as a needed dental service. With 73% of dental schools reporting inadequate or marginal numbers of complete denture patients, Meskin and Entwistle have identified a shortage of patients needing removable prostheses. On the other hand, 50% of the schools report a surplus of removable partial denture patients. Dental school curriculum time related to prosthodontics has declined significantly over the past 20 years. However, over the past 10 years it has risen slightly. Techniques that are taught in dental schools are frequently not being used in practice. Yet the practitioner's interest in removable prosthodontics as it relates to new techniques and materials remains high according to a 1988 survey of Academy of General Dentistry members. Removable prosthodontics was rated first in regards to continuing education courses desired by its members. There are two basic objectives stated in the prologue of the Council on Dental Education Directive on Accreditation Standards. First, faculties are ultimately responsible for the quality of care rendered to the patient population by students.(ABSTRACT TRUNCATED AT 250 WORDS)

Curriculum↗
PubMed1996

Clinical and laboratory parameters in fixed prosthodontic treatment.

Prosthodontic treatment demands competence from each member of the professional team; this includes the staff of the dental office and the dental laboratory. Members of the dental team should understand their responsibility to each other and their patients to ensure optimal prosthodontic care. Knowledge of individual limitations are critical, as are two specific attributes of technical success, quality and communication. The dentist and dental technician should provide services in concert, practice mutual respect, and encourage each other to critique results. Successful prosthodontic treatment also represents a collaborative effort between the patient and attending dentist. Because specific limitations exist with various treatment options, patients need to make decisions concerning their treatment on the basis of detailed informed consent comprehensively presented by the dentist. This article illustrates examples of fixed prosthodontic treatments and demonstrates collaborative, professional responsibilities of the dentist and dental laboratory technicians.

Crowns↗
PubMed2001

Control of bias in randomized controlled trials published in prosthodontic journals.

STATEMENT OF PROBLEM: Randomized controlled trials (RCTs) have become the gold standard for evaluating the effectiveness of treatment interventions. If not properly controlled, bias in the design of trial methodology can affect the validity of the study results. PURPOSE: The purpose of this investigation was to assess the methodological quality of RCTs published in 3 prosthodontic journals over a 10-year period. MATERIAL AND METHODS: Issues of The International Journal of Prosthodontics, The Journal of Prosthetic Dentistry, and The Journal of Prosthodontics published between 1988 and 1997 were searched manually to identify RCTs. Specific inclusion and exclusion criteria were established to identify articles about studies that qualified as RCTs. Two independent reviewers evaluated all qualified RCTs on the basis of how potential sources of bias in the trial methodology were controlled. Three areas-control of bias at entry, control of bias in assessment of outcome, and control of bias after entry-were evaluated with a scheme developed through the Cochrane Collaboration. A score of 1 or 0 was assigned for each of the 3 potential sources of bias, with the maximum quality score for an RCT being 3 (good bias control) and the minimum 0 (poor control). Frequencies were calculated for each dimension of trial methodology and overall quality scores of the RCTs. RESULTS: Sixty-two RCTs were identified from 3631 articles screened. The method of randomization was explicit in only 47% of the RCTs. Forty percent of RCTs incorporated blinding in the assessment of outcome, and 76% accounted for all subjects at the end of the study. Overall quality scores revealed that only 16% of RCTs attempted to control bias in all 3 areas examined. Forty percent were deficient in 1 area, 34% were deficient in 2 areas, and 10% were deficient in all areas examined. CONCLUSION: The quality of RCTs published in prosthodontic journals may be improved by minimizing potential sources of bias and adequately reporting trial methodology.

Dental Research↗
PubMed1998

A method for communication analysis in prosthodontics.

Particularly in prosthodontics, in which the issues of esthetic preferences and possibilities are abundant, improved knowledge about dentist patient communication during clinical encounters is important. Because previous studies on communication used different methods and patient materials, the results are difficult to evaluate. There is, therefore, a need for methodologic development. One method that makes it possible to quantitatively describe different interaction behaviors during clinical encounters is the Roter Method of Interaction Process Analysis (RIAS). Since the method was developed in the USA for use in the medical context, a translation of the method into Swedish and a modification of the categories for use in prosthodontics were necessary. The revised manual was used to code 10 audio recordings of dentist patient encounters at a specialist clinic for prosthodontics. No major alterations of the RIAS manual were made during the translation and modification. The study shows that it is possible to distinguish patterns of communication in audio-recorded dentist patient encounters. The method also made the identification of different interaction profiles possible. These profiles distinguished well among the audio-recorded encounters. The coding procedures were tested for intra-rater reliability and found to be 97% for utterance classification and lambda = 0.76 for categorization definition. It was concluded that the revised RIAS method is applicable in communication studies in prosthodontics.

Communication↗
PubMed1996

Removable prosthodontics: a survey of practices and attitudes among South Australian dentists.

All dentists registered in South Australia were surveyed in July 1993 in relation to removable prosthodontics. The replies indicated that removable prosthodontics constituted a significant part of most dental practices. Most dentists felt that removable prosthodontics should be an essential part of the undergraduate curriculum. They felt that more expertise is now required to manage the treatment of the ageing population with either their first or replacement removable prostheses. The majority of dentists felt that their own undergraduate training had equipped them well to manage removable prosthodontic treatment for their patients; however, many helpful suggestions were made on areas that they thought required more emphasis.

Adult↗
PubMed2002

Are prosthodontics a vital part of dentistry?

Prosthodontics in all of its various subspecialties is in high demand in the United States. It represents a major portion of a typical dentist's income. On the basis of data recently obtained about the projected increase in the physiological need for prosthodontic services and the extensive involvement of U.S. dentists in all areas of prosthodontics, one cannot deny the need for continued and increased predoctoral, doctoral and postgraduate education in prosthodontics.

Dental Implants↗
PubMed2006

[Strategy of prosthodontics in an aged society with fewer children].

In this article, intrinsic problems lying in Prosthodontics research and educational field were pointed out and Prosthodontics as it ought to be as a nature science was discussed. Prospect of prosthetic dentistry/Prosthodontics as a clinical science was categorized the following four and discussed: 1) systematizing of conventional Prosthodontics, such as crown, bridge, partial and complete denture, 2) contribution to oral rehabilitation of mastication, swallowing, and speech for elderly and inpatient elderly, 3) innovation of prosthetic dentistry using more comfortable and aesthetic prosthesis, such as Implant and Adhesive Dentistry, and 4) translational research. Finally, essential prerequisites to achieve bright future of Prosthodontics were proposed.

Aged↗
PubMed2006

Denture repairs in different regions of Croatia in relation to prosthodontic teams.

The purpose of this paper is to evaluate the incidence of denture repairs in different districts of Croatia through the year of 2002. and to analyse the percentage of different repairs (relinings, simple repairs up to 2 elements and complicated repairs-more than 2 elements) in relation to prosthodontic teams. Data on the number of dentures, and the number and types of denture repairs delivered in the Croatian regions of Zagreb, Rijeka, Split and Karlovac were obtained from the Croatian Institute for Health Insurance for the whole of the year 2002. Information of the number of prosthodontic teams operating in those regions was also obtained. Proportionally more denture repairs were carried out in Karlovac (18%) than Split (5%). The smallest percantage of dentures that required relining was registered in Split and the highest in Rijeka (chi2 = 36.7, p < 0.01). The smallest percentage of simple repairs was registered in Rijeka and the highest in Split (chi2 = 24.3, p < 0.01). The smallest percentage of complicated repairs was registered in Split and the highest in Karlovac. In each region the proportion of denture repairs and types of repairs were correlated with a number of prosthodontic teams in that region. Karlovac had the smallest percentage of specialistic prosthodontic teams and the highest rate of denture repairs.

Croatia↗
PubMedDate not supplied

Undergraduate and graduate education in prosthodontics in continental Europe.

Many factors, such as reduction in caries and periodontitis prevalence, decrease in the number of edentulous patients, and more frequent demand for implants, will have an important influence on prosthodontic treatment in the future. To provide more data on the reaction of prosthodontic departments to these changes and the implication in the teaching and training of dental students, a survey with 25 questions was sent to 40 universities in five European countries. The questions referred to teaching and training time in the three branches of prosthodontics; integration of periodontics, occlusion, and orthodontics; implant dentistry; and graduate training and postgraduate programs. The survey revealed that teaching and training in prosthodontics is still very conservative, not biologically oriented, and neglecting the future impact of changes in prevalence of caries and periodontal disease.

Education, Dental↗
PubMed1995

Achieving positive predictive prosthodontic treatment outcomes.

Dental disease patterns have changed resulting in a population of patients seeking comprehensive prosthodontic care while presenting with a complexity of limitations. Predicting prosthodontic treatment outcomes can be facilitated by identification and accommodation of these limitations. A five step problem solving format is presented to assist in developing individualised treatment plans designed to maximise positive outcomes. Emphasis is placed on the significance of informed consent and patient compliance. Applications of the principles discussed are illustrated by reviewing three potential prosthodontic treatment options for a partial endentulous patient. Long-term predictive prosthodontic success depends on accurate planning, quality care, patient compliance and professional monitoring.

Dental Implants↗
PubMed1995

Occlusion and prosthodontics.

Occlusion in prosthodontics is extremely important. Muscle dysfunction can interfere with prosthodontic restoration of occlusion. Occlusal interferences are the primary cause of the hyperactivity that cause muscle dysfunction. Occlusal interference can also place adverse stress on restorations and result in premature failures. Lateral stresses on restorations can cause cement failures, porcelain fractures, and solder joint failures. Our goal in prosthodontics is to restore occlusion that is occlusal interference free. This article gave an overview of how this can be done in phases. In Phase I, a diagnosis is made as to the presence or absence of muscle dysfunction. If it is present, the OIs are hidden. Occlusal splint therapy is needed to get rid of the muscle dysfunction so the OIs can be found. The occlusal splint diagnosis whether OIs are the cause of the dysfunction. The cure is to correct the occlusion. The restoration of the occlusion should be OI free. The various factors to consider in design and restoration of the occlusion were presented. After successful restoration of the occlusion, the recall appointments should include an evaluation of the occlusion. The PRI, COS, and clinical examination can all be helpful in diagnosing whether muscle dysfunction is developing and whether OIs are developing again as a result of the normal changes that can occur. Suggestions were made on how to slow these changes. This article was not meant to cover every aspect of prosthodontic occlusion in detail. The goal was to present an overview for readers to make a self-evaluation as to what areas of their practice might need to be improved to improve the restoration of the occlusion. All was not taught in dental school. As one practices and improves in skill, more knowledge and abilities must be sought through graduate and postgraduate education. Occlusion is too important for a successful practice and happy patients to be ignored. Time will make this obvious; however, the failures may be costly. The best approach would be to anticipate the failures and prepare yourself to reduce the risks. Occlusal interferences are truly the plague of dentistry.

Bite Force↗
PubMed1995

Fixed provisional restorations for extended prosthodontic treatment.

During extensive and extended prosthodontic treatment, there is need for a durable esthetic fixed provisional restoration that can be easily modified as treatment is completed and that is cost-effective. The needed strength of provisional restorations can be underestimated, and the management of complex treatment is then more difficult and the prosthetic results less predictable. Knowledge of the criteria for treatment restorations and the adequacies of their construction is essential for the prevention of catastrophic failures, patient management problems, and compromised results. Many times in complex prosthodontic treatment, changes are needed in esthetics, the plane of occlusion, incisal edge position, lip support, and type of occlusion, or the soft and/or hard tissues need to be altered or grafted surgically. In addition, after first- and second-stage implant surgery and extractions, there is a need for immediate tooth replacement with extended time between prosthodontic treatments. These prosthodontic changes and challenges can be addressed with reinforced acrylic provisional restorations that are adequately cemented and retained during the interim stage of healing and treatment. In addition, the provisional restoration should serve as a guide for the final restoration while esthetics and phonetics are evaluated for patient acceptance. This article describes the materials used with an indirect technique for fabrication of an extended-treatment acrylic provisional restoration that uses an internal cast metal support system for strength. This support system consists of metal bands or copings with extensions into edentulous areas and that have been opaqued to neutralize the metallic color. A matrix of vinyl polysiloxane made from the diagnostic wax-up simplifies construction of the acrylic, resulting in a strong, ridged, yet esthetic result.

Acrylic Resins↗
PubMed1976

Significance of the Frankfort-mandibular plane angle to prosthodontics.

Cephalometric information, specifically, vertical facial types and the Frankfort-mandibular plane angle, pertinent to prosthodontics has been discussed. The Frankfort-mandibular plane angle (FMA) is formed by the intersection of the Frankfort horizontal plane and the mandibular plane. This angle can be traced and measured by means of a diagnostic overlay. An FMA of 25 +/- 5 degrees is within normal range. A high-angle patient has an FMA of 30 degrees or more, and a low-angle patient has an FMA of 20 degrees or less. A high FMA is characterized by open-bite skeletal patterns, and a low FMA by closed-bite skeletal patterns. The clinical manifestations pertinent to prosthodontics in high- and low-angle (FMA) patients are shown in Table I. However, not all clinical characteristics are present in a given patient. The classification in Table I is a beginning. The authors consider the prosthodontic study of cephalometrics an unexploited research tool. Hopefully, in the future, it will help to bridge the gap of the biological-technical interplay that is such an integral part of prosthodontics.

Alveolar Process↗
PubMed2004

In vitro shear bond strength of cementing agents to fixed prosthodontic restorative materials.

STATEMENT OF PROBLEM: Durable bonding to fixed prosthodontic restorations is desirable; however, little information is available on the strength of the bond between different cements and fixed prosthodontic restorative materials. PURPOSE: This study determined the shear-bond strength of cementing agents to high-gold-content alloy castings and different dental ceramics: high-strength aluminum oxide (Procera AllCeram), leucite-reinforced (IPS Empress), and lithium disilicate glass-ceramic (IPS Empress 2). MATERIAL AND METHODS: Prepolymerized resin composite cylinders (5.5 mm internal diameter, n=20) were bonded to the pretreated surfaces of prosthodontic materials. High-gold-content alloy and high-strength aluminum oxide surfaces were airborne-particle-abraded, and pressable ceramics were hydrofluoric acid-etched and silanized prior to cementing. The cementing agents tested were a zinc-phosphate cement (Fleck's zinc cement), glass ionomer cements (Fuji I, Ketac-Cem), resin-modified glass ionomer cements (Fuji Plus, Fuji Cem, RelyX Luting), resin cements (RelyX ARC, Panavia F, Variolink II, Compolute), and a self-adhesive universal resin cement (RelyX Unicem). Half the specimens (n=10) were tested after 30 minutes; the other half (n=10) were stored in distilled water at 37 degrees C for 14 days and then thermal cycled 1000 times between 5 degrees C and 55 degrees C prior to testing. Shear-bond strength tests were performed using a universal testing machine at a constant crosshead speed of 0.5 mm/min. Statistical analysis was performed by multifactorial analysis of variance taking interactions between effects into account. For multiple paired comparisons, the Tukey method was used (alpha=.05). RESULTS: In a 3-way ANOVA model, the main factors substrate, cement, time, and all corresponding interactions were statistically significant (all P <.0001). In subsequent separate 1-way or 2-way ANOVA models for each substrate type, significant differences between cement types and polymerizing modes were found (all P <.001). None of the cement types provided the highest bonding values with all substrate types. CONCLUSION: After 14 days of water storage followed by thermal cycling, only the self-adhesive universal resin cement (RelyX Unicem) and 2 of the resin cements (Panavia F and Compolute) exhibited strong bond strengths to specific prosthodontic materials. In contrast, zinc-phosphate, glass ionomer, and resin-modified glass ionomer cements showed the lowest values of all tested cementing agents after 14 days of water storage followed by thermal cycling.

Acid Etching, Dental↗
PubMed2004

Color stability of provisional prosthodontic materials.

STATEMENT OF PROBLEM: Discoloration of provisional prosthodontic materials may result in patient dissatisfaction and additional expense for replacement. PURPOSE: The purpose of this study was to determine the color stability of 5 provisional prosthodontic materials before and after immersion in distilled water or coffee for 20 days or exposure to ultraviolet (UV) light for 24 hours. MATERIAL AND METHODS: A total of 105 disc-shaped specimens (20+/-0.1 mm by 1+/-0.05 mm) were fabricated with 5 provisional prosthodontic materials: polyethyl methacrylate resins (Trim II), polymethyl methacrylate resins (Duralay; Alike), and bis-acryl methacrylate resin (Luxatemp; Integrity), according to manufacturers' instructions (n=21). Seven specimens of each material were randomly selected and immersed individually in distilled water (60 degrees C) or coffee (37 degrees C) for 20 days or exposed to UV irradiation for 24 hours, respectively. Color was measured as CIE L*a*b* with a colorimeter before and after the immersion or UV exposure. Color change (Delta E) was calculated and data were analyzed with 1-way ANOVA and the Tukey multiple comparisons test (alpha=.05). RESULTS: For specimens immersed in water, the color change of bis-acryl-methacrylate-based provisional materials (Integrity and Luxatemp) was significantly less than that of 3 methyl/ethyl methacrylate-based provisional materials (Trim II, Alike, and Duralay) (P<.002). After immersion in coffee, the 3 methyl/ethyl methacrylate-based provisional materials exhibited significantly less color change compared to the 2 bis-acryl methacrylate-based provisional materials (P<.0001). After ultraviolet irradiation, 2 bis-acryl methacrylate-based provisional materials showed significantly less color change than any of the 3 methyl/ethyl methacrylate-based provisional materials (P<.0001). CONCLUSION: Luxatemp and Integrity (bis-acryl-methacrylate-based resins) demonstrated acceptable color stability and were the most color-stable provisional prosthodontic materials tested compared to the methyl/ethyl methacrylate-based resins.

Analysis of Variance↗
PubMed2000

Tooth loss and the condition of the prosthodontic appliances in a group of elderly home residents.

The study assessed the number of missing teeth, the state of the existing prosthodontic appliances and the need for their replacement. Dental status and anamnesis were taken on a group of 120 elderly home residents by trained examiners. Prosthodontic appliances were evaluated according to the Karlsson's index for the crowns and bridges, and according to the modified Nevalainen et al. index for the evaluation of the complete dentures, as well as the need for prosthetic treatment. The most persistent teeth in both jaws were lower canines, while the most commonly missing teeth were lower first molars. On average, the crowns were older and in poorer condition than the bridges. Lower complete dentures had better stability but were also less retentive in comparison with the upper complete dentures. More than 82% of the subjects were in need of either fixed, removable or combined prosthodontic treatment. The high prevalence of needs for prosthodontic treatment pointed to the requirement for frequent dental check ups within elderly home residents in order to better identify and meet their dental needs.

Aged↗