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PubMed1996

Patient-centered competency-based education in fixed prosthodontics.

Revision of a traditional fixed prosthodontic curriculum was undertaken in response to observed private practice patterns, recent literature in fixed prosthodontics, and an increasingly crowded dental school curriculum. The revision was further motivated by the commitment of the faculty to become patient-centered in all components of instruction. The resultant preclinical and clinical curriculum emphasizes patient care activities and minimizes student-generated laboratory products. This program is characterized as patient-driven, competency-based, and criterion-referenced, and it places heavy reliance on validated pedagogical strategies, which include evaluation of self and peers. The curriculum requires the development of good communication skills with peers, faculty, and commercial laboratories and creates time for the student to develop critical patient care skills without requiring more curriculum time. The new fixed prosthodontic curriculum appears to be consistent with current private general practice, national licensing examinations, and the recommendations of the Institute of Medicine's report to dental education.

Competency-Based Education↗
PubMed1998

Predoctoral fixed prosthodontics curriculum survey.

PURPOSE: In 1996, a survey of American dental schools was conducted. The purpose of the survey was to determine the curricular structure, techniques taught, and materials used in predoctoral fixed prosthodontics courses. MATERIALS AND METHODS: The survey was mailed to the course directors of predoctoral fixed prosthodontic programs at 53 American dental schools. Of these, 42 schools returned the completed survey, resulting in a response rate of 79%. The mean, median, and the range of responses were computed where applicable. RESULTS: The results from this survey show that the mean student-to-faculty ratio in the preclinical course was 11:1, with a median of 10:1 and a range of 5:1 to 25:1. The mean number of laboratory clock hours was 164, with a median of 148 and a range of 81 to 288. The mean number of lecture hours reported was 42, with a median of 35 and a range of 20 to 80. Fifty-five percent of the schools used the Hanau semiadjustable articulator. The most commonly used provisional technique was the thermoplastic custom external surface form (44%). The finish line of choice for the full metal restoration was the chamfer placed circumferentially (74%). The finish line of choice for the porcelain-fused-to-metal restoration was the shoulder placed facially and the chamfer placed lingually (38%). CONCLUSIONS: Predoctoral fixed prosthodontics education and technical experience varies from school to school, yet a large percentage of schools agree on certain topics.

Curriculum↗
PubMed1999

A survey of private prosthodontic practice.

The data from a survey of private prosthodontic practitioners are reported in this article. The author provides a brief look at employment status, number of employees, time spent in the office, number of patient visits per week, gross billings, net income, and practice expenses of prosthodontic practices. In addition, the author has developed a profile for a median prosthodontic practice and practitioner.

Adult↗
PubMed2005

A survey of U.S. prosthodontists and dental schools on the current materials and methods for final impressions for complete denture prosthodontics.

PURPOSE: The purpose of this study was to survey members of The American College of Prosthodontists (ACP) to evaluate current materials and methods for final impressions for complete denture prosthodontics in the United States. In addition, those methods were compared with methods and materials taught in U.S. dental schools via a second survey sent to the chairpersons of prosthodontic/restorative departments. MATERIALS AND METHODS: An anonymous questionnaire was mailed to all 1762 active ACP members in the United States in 2003. A slightly modified questionnaire was also distributed to chairpersons of prosthodontic/restorative departments in the 54 U.S. dental schools. Data analysis was performed via frequency distribution and chi-square statistics. RESULTS: Nine hundred and forty-five questionnaires were returned by members of the ACP (54% return rate) and 42 questionnaires were returned by the U.S. dental schools (78% return rate). The majority of the reporting prosthodontists (88%) and dental schools (98%) use a border-molded custom tray for final impressions for complete denture prosthodontics. The most popular material for border molding was plastic modeling compound (67% of reporting ACP members, and 95% of the responding dental schools). Variability of the materials used for final impressions was observed, with the most popular materials being polyvinylsiloxane for the ACP members (36%) and polysulfide for the dental schools (64%). Statistically significant differences were found in the materials used for border molding by prosthodontists based on the time elapsed since completion of prosthodontic training. No differences were found in the materials used for impression of edentulous arches based on years of experience. Geographic location did not influence the materials and methods used by prosthodontists for complete denture final impressions. CONCLUSIONS: There was variability of the materials and techniques used for final impressions by ACP members and dental schools; however, overall there was an agreement on the materials and techniques used by prosthodontists and dental schools. Distinct trends for increasing use of polyvinylsiloxane and polyether for border molding procedures and impressions of edentulous arches were observed both in members of the ACP and in the U.S. dental schools.

Dental Impression Materials↗
PubMed2003

Understanding prosthodontics--where did it all go wrong?

This paper addresses the anatomical and physiological effects of tooth loss on the patient and, further, audits the teaching of prosthodontics over the last 30 years. There is an abundance of evidence to outline changes that occur post-extraction related to morphological changes in the maxilla, the mandible and combined changes in inter-maxillary relations. In addition to the knowledge of patterns of bone loss, we are also now well aware that there is evidence to suggest that planned retention of roots and/or the placement of implants can help reduce post-extraction bone loss. Awareness by clinicians of the anatomical, physiological and psychological effects of edentulousness, is essential if empathy is to be struck with the patient. Equally, patients being rendered edentulous must be made aware of these factors if true informed consent is to be gained. New graduates are now less well equipped to practice complete denture prosthodontics than, say, 10 years ago and this is a consequence of three factors: crowded curricula, diminution in laboratory hours and the time a dental student spends in clinical prosthodontics.

Dental Implants↗
PubMed2003

The evidence for prosthodontic treatment planning for older, partially dentate patients.

This paper provides a review of the available evidence for traditional prosthodontic need determination and management strategies for older, partially dentate individuals, and compares it to the documented functional benefits of a more limited yet targeted approach to alleviating morphological shortfalls for this group of people, at the population level. The reasons for which the traditional total replacement strategy is not universally applicable or viable are discussed, and research is presented which tests many of the assertions made for the mandatory replacement of posterior teeth. Evidence is presented of the growing prosthodontic challenge posed by an increasing number of middle-aged and older partially dentate individuals in society: many of their remaining teeth are in poor condition, yet few such patients are willing to accept the prospect of becoming edentulous. The shortened dental arch concept is discussed and proposed as an appropriate strategy when complex intervention is to be avoided, inadvisable, or not possible. At the population level, current evidence suggests that prosthodontic strategies aimed at the restoration and/or replacement of all lost molars may be inappropriate in older, partially dentate individuals. A more limited yet targeted strategy is both more effective and more efficient, and should not be seen as compromised care.

Adaptation, Physiological↗
PubMed1999

General dental practitioners' perceptions of removable prosthodontics in the undergraduate curriculum.

The undergraduate dental curriculum is undergoing rapid change and revision in dental schools worldwide. Decreasing edentulism, the advent of the clinical dental technician, and advances in technology (such as dental implantology) have led to changes in patient management and treatment options for general dental practitioners in New Zealand. The current undergraduate removable prosthodontic curriculum has seen very little change in past years at the School of Dentistry, University of Otago, and is under review to facilitate the teaching of general dental practice in the Final Year. A questionnaire-based survey of 150 general dental practitioners (response rate 74.6 percent) supported modification of the existing removable prosthodontics curriculum to improve its relevance to modern general dental practice. Integration of fixed and removable prosthodontic teaching was recommended.

Attitude to Health↗
PubMed2001

[Prosthodontic correction of severe deep vertical overbite combined with dimensional discrepancy of the upper and lower dental arch. 31 years follow-up].

Sz. S. a 39-years-old patient was referred to our department in 1968. Patient's masticatory dysfunction, orofacial pain syndrome and substantial weight loss was due to a combined genuine and acquired deep vertical overbite aggravated by a marked difference between the size of the lower and upper jaw bones. The premolars and molars had already been extracted. The lower incisors bit onto the palatal gingiva in centric occlusion causing direct mechanical irritation on the palate. Consequently the centric occlusion position of the mandible was only defined by the contact between the lower central incisors and the palatal soft tissue. According to the literature this kind of defect can only be corrected by a combined surgical prosthodontic therapy (increasing the mandibular arch by vertical osteotomy combined with bone grafting followed by complex prosthodontic reconstruction). Because patient refused any kind of surgical treatment a special upper full arch bridge was constructed with an extended occlusal surface on the palatal surfaces of the front crowns to provide full occlusal contact for the mandibular anterior teeth. The OVD was raised by 11 mm. The present paper reports the history of a 31 years long prosthodontic treatment and patient's follow up. It is shown how the correct centric occlusion, the masticatory functions, the phonetics and also the esthetics could have been maintained by a series of gradually changing fixed restorations meeting the demands imposed by the continuing tooth loss.

Adult↗
PubMedDate not supplied

The reporting of randomized controlled trials in prosthodontics.

PURPOSE: This article evaluates the reporting of randomized controlled trials (RCT) in prosthodontics, excluding endosseous implant-based prosthetics. MATERIALS AND METHODS: Reports of RCTs published to the end of 2000 in any language were identified using a multilayered search strategy. The Cochrane Oral Health Group specialized register, Medline, and personal libraries were searched. Three researchers appraised the articles independently using guidelines following Jadad and CONSORT, complemented with an evaluation of the appropriateness of the reported statistics. RESULTS: Ninety-two reports of RCTs were evaluated, covering a wide spectrum of study hypotheses, topics, and issues within various prosthodontic domains. The interrater agreements on appraisal criteria were relatively high, with median kappa values ranging between 0.65 and 0.79. The reports were in general of poor methodologic quality. Randomization and procedures for concealment allocation were not described in 70% of the articles. The methods used to generate the random allocation sequence were not mentioned in 82%. The methods used to implement the random allocation sequence, clarifying whether it was concealed until all interventions were assigned, was not mentioned in 94%. Reporting who generated allocation sequence, who enrolled patients, and who assigned participants to groups was not reported in 7%. Reasons for withdrawals were not given in 23% of the reports. No attempt at blinding was reported in 72%. Statistical analysis was not described in 6% of the papers, while these analyses were assessed as appropriate for 75%, unclear in 12%, and inappropriate in 7%. CONCLUSION: Few RCTs in prosthodontics are reported in accordance with contemporary guidelines for adequate reporting of trials.

Adhesives↗
PubMed2002

Twenty years of progress in implant prosthodontics.

Prosthodontic focus on the restoration of osseointegrated dental implants has evolved dramatically in the last 20 years. Many of the original guiding principles for restoring implants have changed and/or disappeared altogether, and new ideas have taken their place. It is appropriate that this evolution be examined with a 2-fold focus. First, the art and science of prosthodontics as it relates to dental implants today is the result of very real and important lessons learned during the past 2 decades. Second, an appreciation of the history of implant prosthodontics as it relates to osseointegration gives insight into the future direction of research and clinical exploration aimed at continually improving the state of the art and, ultimately, the quality of care provided to patients. This article reviews what the authors consider the most important aspects of the evolution of osseointegrated implants. Pertinent literature was selected for citation, but the discussion does not represent a comprehensive review of the literature.

Cementation↗
PubMedDate not supplied

Systematic review of 10 years of systematic reviews in prosthodontics.

PURPOSE: The objective was to make an inventory of systematic reviews in the field of prosthodontics and to assess the strength of evidence yielded by these studies. MATERIALS AND METHODS: The literature was searched using MEDLINE (keywords "dental" in subset combined with "meta-analysis" in publication type, and "dental" in subset combined with "systematic review"). Reviews related to prosthodontics were selected by hand. Analogies between the reviewing processes were assessed, and the quality was described. RESULTS: There were 138 articles qualifying as either systematic reviews or meta-analyses. Of these, 13 reported pooled data on prosthodontic subjects. Two pairs of reviews were identified as dealing with comparable items; the others described all different subjects. In one pair, the studies reviewed the survival of conventional fixed partial dentures (FPD); the other pair was on single-tooth implants. The pooled results within each pair were almost equal. For the FPD reviews, 65% of the unity of studies was included in both reviews. For the single-tooth implants, 29% of the potentially useful studies were included in both reviews. The data pooling processes showed the same pattern. One large study included in both reviews explained a large part of the similarity of the combined survivals of FPDs. For the single-tooth implant reviews, the largest common study explained 20% of the similarity. CONCLUSION: Although there were methodologic differences between the paired reviews, they produced similar results. The outcomes of the evaluated reviews may be used as prognostic data; however, they cannot be used for direct comparison of treatments.

Dental Implants, Single-Tooth↗
PubMed1992

A predoctoral honors program in prosthodontics.

Over the last 25 years, the advent of new disciplines in dental education and the increasing body of knowledge in various dental specialties have led to a struggle for curriculum hours within many dental schools. At the same time, the amount of time available for teaching clinical skills in dental schools has not increased appreciably, and fewer patients require (or can afford) sophisticated prosthodontic treatment. As a result of these trends, there has been a general decline in the depth and range of clinical skills of recent dental school graduates, particularly in prosthodontics. New York University College of Dentistry has attempted to address this problem by establishing a predoctoral honors program in prosthodontics.

Education, Dental, Graduate↗
PubMed2005

Prosthodontics: a past with a future?

As one of the oldest dental specialties, prosthodontics has a long history of innovation and adaptability. This overview of the field presents landmarks in the development of prosthodontics from mediaeval times to the present and speculates on some future trends. It effectively sets the stage for the other articles in this issue, which explore the many facets of prosthodontic evolution.

Computer-Aided Design↗
PubMed1992

The Swedish patient insurance scheme and guarantee insurance for prosthodontic treatment.

During 1975-76 a no-fault compensation system for treatment injuries in dentistry and failures within prosthodontics was introduced in Sweden. The guarantee insurance scheme for prosthetic treatment has changed somewhat during the years and, in 1987, became mandatory for all dentists in Sweden. All necessary retreatment not included in the National Dental Insurance Scheme (eg allergy to dental materials, all treatment following radiotherapy-related xerostomia) is included. For fixed prosthodontics, all replacements are covered by the scheme for the first 2 years. For removable prosthodontics, this is limited to the first year. A patient may choose any dentist in Sweden to carry out the retreatment. The claim system is simple and the number of cases has steadily increased, probably because dentists are becoming more familiar with the system and are willing to use it. The costs are paid for by private practitioners, the Public Dental Service and private dental laboratories. The insurance files are available for research purposes.

Humans↗
PubMed1991

Malpractice reports in prosthodontics in Sweden.

Prosthodontics is the branch most often involved in dental malpractice cases in Sweden. The number of cases has increased with the growing production of fixed prosthodontics after the introduction of the National Dental Insurance Scheme and the increase in the number of dentists. Prosthodontic treatment accounted for one-third of the working hours of private practitioners but two-thirds of the sanctions during the period 1974-78. The patients' complaints are often justified in some parts. The most common faults are elementary and have been similar throughout the whole period 1947-1988. Bridges (2-4 units), complete dentures and single crowns are the constructions most often involved in complaints. The maxillary frontal and premolar regions are in this order the regions most often involved. There are no differences between different age groups of dentists concerning the quantity of faults, but there is probably concerning the quality of faults because older dentists get more severe sanctions than younger.

Adult↗
PubMedDate not supplied

Prosthodontic education in Japan.

The need for prosthodontic instruction in Japan is increasing as the mean age of its population rises. The Japanese government formulated a policy in 1967 to ensure a sufficient number of dentists to deal with the challenge; with this new course of action has come an increased standard of dental care. Even though prosthodontic education occupies 20% of the 4-year predoctoral program in Japan, the author feels that predoctoral prosthodontic education must be improved to meet the needs of its people.

Adolescent↗
PubMedDate not supplied

Education in prosthodontics: Britain, South Africa, and Australia.

The consultant in restorative density, Great Britain's closest equivalent to the prosthodontist in the United States, has a broad base of specialist training that includes periodontology, conservative dentistry, and prosthodontics. The dentist specialising only in prosthodontics is rare. British dental education has developed a curriculum that educates a dental provider to serve the needs of the British Health Service and as such has not emphasized prosthodontics as a separate discipline in either the undergraduate or graduate level.

Australia↗
PubMedDate not supplied

Prosthodontic education in the United States.

Prosthodontic education in the United States is well established and closely supervised by the American Dental Association, prosthodontic specialty organizations, and dental educators. Since the social and economic environment is rapidly changing in relation to medical care, it is incumbent that the prosthodontic community be willing to adapt new scientific and technical information to be able to continue to provide high-quality dental care.

Humans↗