Defining predoctoral prosthodontic curriculum: a workshop sponsored by the American College of Prosthodontists and the prosthodontic forum.

Prosthodontic educators participated in a workshop held at The American College of Prosthodontists annual session in Kansas City, MO, in October 1996. Their goal was to review elements of the predoctoral prosthodontic curriculum to establish a consensus on the levels of expected skill and knowledge. Skill components were designated at the competency and exposure levels, while knowledge components were designated at the understanding and familiarity levels. The workshop recommendations were distributed to American and Canadian dental schools and the communities of interest for comments in January 1997. The workshop recommendations were reviewed and finalized at the American Association of Dental Schools annual meeting in Orlando, FL, in March 1997. The recommendations may be used by dental educators to prioritize curricular elements in relation to limited time dedicated to the prosthodontic curriculum. Outcomes assessment methods will be needed to ensure competency in the new dentist.

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.

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.

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.

A comparison of mandibular denture base extension in conventional and implant-retained dentures.

A border outline for mandibular implant-retained dentures is described. The lingual extension of the impression is greatly reduced compared with a conventional mandibular denture. Because of the implant attachment, the shortened border is more comfortable and does not compromise denture retention. Improper implant position is also discussed with respect to denture extension.

An unusual presentation of a silicone implant as a prosthetic complication.

This article explores a case of migration and bony cavitation of a silicone implant on the lateral border of the mandible and its prosthetic implications.

The coronomaxillary space: literature review and anatomic description.

The dental literature has used a variety of terms to describe the distal buccal boundaries of the maxillae. The coronomaxillary space has been suggested as a more consistent descriptive term. It has been noted in the literature that this space narrows on mandibular opening. However, some authors recommend that overfilling this space aids retention. Explanations for this seeming contradiction in opinions have been suggested: In individuals with straight coronoid processes, the space can narrow on opening. The coronomaxillary denture may have to be thinned to maintain retention in function. In individuals with flared coronoid processes, the space can widen or remain constant on opening. The denture borders may have to be widened in contour to achieve retention.

The use of an attachment system for overlay prostheses.

The attachment system presented offers a prefabricated pin and post technique or use of a plastic pattern in a metal casting. Both provide the advantages of positive retention, stress-breaking effect, ease of maintenance, clinical or laboratory activation, and simplicity of technique. Both have the disadvantages of nonadjustable retention, nonparallelism of post portion to root axis, and unknown long-term effect. The casting system is the preferred method because of its accurate fit and smaller occlusal height.

A technique for fabrication of polydimethylsiloxane-acrylic resin obturators.

A flexible silicone obturator is an alternative to the acrylic resin obturator. It can be useful for patients with severe trismus who cannot insert a large prosthesis, as the flexibility of the hollow silicone section allows easy placement and removal (Fig. 9). Other patients cannot tolerate an unyielding substance against sensitive nasal tissues. Silicone can provide the necessary comfort without compromising retention. Silicone obturator sections can often be modified when further surgery is needed and result in a savings of time and expense (Fig. 10). For patients who can be reevaluated only twice a year, several silicone obturator sections can be made initially. One can be used while another is being cleaned or duplicated.