Patient-Centered Risk Assessment in Implant Treatment Planning.

PURPOSE: To evaluate the current scientific evidence on estimating cumulative risk for biologic complications relating to dental implants and to develop a patient-centered risk assessment tool for establishing aggregate risk. MATERIALS AND METHODS: A review of the scientific literature on risk indicators relating to dental implants was completed with the goal of identifying and weighting individual risk indicators so aggregate biologic risk could be estimated. Three authors completed independent reviews of the literature, identifying 31 systematic reviews on risk indicators for biologic complications with dental implants, from which 24 potential risk indicators were considered. Due to inconclusive scientific data on risk indicators, a Delphi process was used to gather structured expert opinion to supplement findings from the literature. Eleven Delphi participants with expertise in prosthodontics or periodontics participated in two email exchanges and one face-to-face meeting to comment and debate on the initial identification and weighting of risk indicators, propose the addition or removal of risk indicators, and provide recommended clinical management for each risk indicator. RESULTS: After three rounds of debate, literature review, and additions and removals of various risk indicators, consensus (defined as 95% or more in agreement) was achieved on 20 risk indicators. The Delphi group concluded that the risk indicators of smoking, diabetes, antiresorptive agents, and cemented restorations should include subcategories to more accurately identify and represent patient-specific risk. Clinical recommendations based on individual and aggregate risk were established by consensus. CONCLUSION: The literature on risk indicators for biologic complications was conflicting and inconclusive. The Delphi method was used to identify and establish the weighting of individual risk indicators, resulting in a risk assessment tool for estimating aggregate risk.

Immediate load on the edentulous mandible: treatment planning considerations.

Immediate load protocols for the edentulous mandible offer the patient many advantages in terms of decreased number of visits, improved early function, and reduction of surgical exposure; however, this treatment modality is not universally appropriate for all patients. The available evidence will assist the clinician in developing a customized and comprehensive informed consent. Patient selection and patient-mediated factors will dictate the suitability of not only a fixed or removable prosthesis, but also whether immediate loading would enhance the cost/benefit ratio. The indications, objective and subjective patient considerations, and design strategies are discussed for the immediate load scenario.

2008 Survey of Pro Bono Services Provided by Practicing Prosthodontists.

PURPOSE: The purpose of this article is to analyze data from the results of the 2008 Survey of Pro Bono Services Provided by Practicing Prosthodontists. Survey results are used to examine characteristics and to compare the charitable care rendered by practicing prosthodontists to the dental field at large. MATERIALS AND METHODS: The character and incidence of pro bono services (PBS) provided by prosthodontists are based on a 2008 survey, made possible through an American College of Prosthodontists Board of Directors' sponsored initiative. Survey results are used to assess the distribution of respondents practicing the specialty of prosthodontics in the United States, percentage of prosthodontists who render pro bono dental services for the community, percentage of total patient care devoted to pro bono treatment at no charge, number of patients treated annually with PBS, monetary value of pro bono care annually, types of pro bono procedures, percentage of practitioners using Prosthodontic Diagnostic Index (PDI), PBS by PDI category to assess complexity of donated work, and percentage of practicing prosthodontists using informatics to track services by the PDI. RESULTS: Thirty-nine states were represented in the survey data. The highest responses were in the most populous states. The percentage of practicing prosthodontists providing PBS was 71.7%. For this cohort, the annual percentage of total care provided for treatment at no fee was greater than 1% in more than 54.8% of the practices. Almost 50% of these prosthodontists reported treating more than five patients per year at no charge. The average annual value of donated services was $25,078.00. The types of services rendered were most frequently diagnostic (83.5%) and radiographic (76.6%), followed by operative dentistry (61.5%) and fixed prosthodontics (49.4%). The percentage of practicing prosthodontists using the PDI to establish the complexity of PBS was 17.9%. For those using the PDI, there was almost an even distribution in categories I-IV. Informatics was used to track PBS in only 3% of the respondents. CONCLUSION: Based on this survey, practicing prosthodontists compare favorably to dental generalists and other specialists in terms of the annual dollar value donated in pro bono care. Their treatment addresses a broad scope of prosthodontic services including the restoration of patients with complex needs.

Private practice of prosthodontists: current conditions of practice in the United States.

PURPOSE: The purpose of this article is to examine data and results from the 2008 Survey of Prosthodontists. Survey results are used to examine current trends and characteristics of prosthodontists in private practice. MATERIALS AND METHODS: Characteristics of prosthodontists and conditions of private practice are based on surveys conducted in 2002, 2005, and 2008 sponsored by the American College of Prosthodontists. Survey results are used to estimate several characteristics including age, gender, number of patient visits, hours in the practice, employment of staff, referral sources, and financial conditions (gross receipts, expenses of the practice, and net income of prosthodontists). RESULTS: The average age of a private-practicing prosthodontist reached 51 years in 2007; 12.3 is the number of years in the current practice; and most prosthodontists (71%) are solo private practitioners. The average amount of time per week by prosthodontists in the practice averaged 36.1 hours, and prosthodontists treated an average of 44.1 patient visits per week. The largest source of patient referrals is the patient themselves. The largest percentage of a prosthodontist's treatment time is spent rendering procedures in fixed prosthodontics, but this percentage has declined since 2001. In 2007, the average gross billings of a practicing prosthodontist reached $805,675; average total practice expenses were $518,255; the mean net earnings of practitioners were $268,930. CONCLUSION: In 2007, prosthodontists in private practice paid out about $1.4 billion in practice expenses to provide $2.2 billion dollars in prosthodontic care. Based on survey results from 2007 and the previous 6 years, specialization in prosthodontic care continues to be an economically attractive and productive healthcare profession in the United States.