Retrospective Evaluation of the Status of Advanced Dental Education in Prosthodontics from 2006 to 2016.

The aim of this study was to analyze information about advanced education programs in prosthodontics (AEPPs) collected in American Dental Association (ADA) surveys on advanced dental education from 2006-07 to 2016-17. Data recorded included number of AEPPs and information on program directors, applicants, and enrollees in AEPPs. The results showed that, from 2006 to 2016, there was an increase in the number of AEPPs and enrollment of prosthodontic residents, and the number of applicants per program more than doubled. Despite these increases, steps are needed to increase the number of underrepresented minority residents in prosthodontics. Also, a periodic survey of prosthodontic residents to identify their goals, experiences during training, and career plans could benefit the specialty by providing more insight into the future prosthodontic workforce.

Dental Students' Exposure to Periodontal and Implant Placement Surgeries in U.S. Dental Schools.

The aim of this study was to assess nationwide trends in the exposure of dental students to periodontal and implant surgical procedures and to evaluate the potential factors that influence these clinical experiences. A 19-item questionnaire was sent to all 64 directors of predoctoral periodontics in U.S. dental schools. In addition to gathering information on the percentage of students who perform surgical periodontics or implant placement procedures in each program, data on student research groups, periodontics residency programs, and periodontics faculty practices were collected. A total of 33 responses were received, for a response rate of 51.5%. Among the responding institutions, 97% and 45.5% allowed dental students to perform periodontal and dental implant placement surgeries, respectively, although only 26.4% and 15.2% of the dental class ended up performing periodontal and dental implant placement surgeries, respectively. Crown lengthening was the most commonly reported (84.8%) periodontal surgical procedure performed by dental students. A negative correlation was found between the presence of a periodontics residency program and dental students' placing dental implants, while the size of the residency program positively correlated with dental students' placing dental implants. Overall, a wide variation in the exposure of dental students to periodontal and dental implant placement surgical experiences was found. Future surveys should assess clinical procedures performed in other special-ties to gain a broader picture of the experience students are gaining in these areas.

The Extent and Scope of Prosthodontic Practice in Iowa.

PURPOSE: The purpose of this questionnaire was to ask general dentists in private practice in the state of Iowa about the extent and scope of their prosthodontic practice. MATERIALS AND METHODS: A 22-item questionnaire was developed and tested on 5 general dentists. The Iowa Dental Association agreed to electronically distribute the survey to all general practice dentists in their database. After three rounds, a total of 289 responses were received from the 996 general dentists in the database. RESULTS: The average age of the respondents was 50.3 ± 13.2 years (range 28 to 78 years), and 56.3% were in solo practice. The respondents stated that 68.1% had made at least one set of complete dentures and 88.9% had made a removable partial denture (RPD) in the last 3 months, while 76.4% had restored a least one implant in the last 3 months and 11.6% had surgically placed one. Nearly 20% of the respondents had a digital impression scanner in their office. There was a statistically significant difference between the dentists who had made complete dentures in the past 3 months and those who had not with regard to age, gender, and years in practice (p < 0.05 for all instances). No significant difference was found between the general dentists who had made an RPD in the past 3 months and those who had not. Compared to their counterparts, general dentists who had an AEGD or GPR training (p = 0.0312), whose primary practices were in cities of 50,000+ (p = 0.0065), or had a digital scanner (p = 0.0062) and a CAD/CAM milling machine (p = 0.0504) in their office were more likely to have restored an implant in the last 3 months. Furthermore, the general dentists who had surgically placed an implant in the last 3 months were more likely to be male (p = 0.0301) or have a digital impression scanner (p < 0.0001) and/or a CAD/CAM milling machine (p = 0.0007) in their office. CONCLUSIONS: The majority of general dentists in this survey are still making complete and partial removable dentures, and a majority is using implants, while only a minority is surgically placing them. PRACTICAL  IMPLICATIONS: Although Iowa general dentists are carrying out sophisticated procedures such as implant placement and restoring implants, as well as using digital technology, there is still a need for removable prosthodontic services in their practices. Therefore, these skills will still need to be taught in dental school.

Research Productivity of Directors of U.S. Advanced Education in Prosthodontics Programs.

The aims of this study were to measure the research productivity of directors of U.S. advanced education in prosthodontics programs (AEPP) and to identify associations between the directors' publication metrics and professional characteristics. A list of AEPP directors was obtained from the American College of Prosthodontists website in December 2015. Information on gender, academic rank, and highest degree was collected from the institutional website for each individual. Citation databases (Scopus and Google Scholar) were searched for each director's h-index and i10-index (both indexes are based on numbers of citations of the author's articles) and total numbers of publications and citations. The search identified 50 AEPP directors. The majority were male and had a primary appointment at a university. Most held the rank of associate professor or professor and held both DDS and MS degrees. The mean h-index and i10-index of all directors were 6.32±6.97 and 6.84±10.77, respectively. Their mean numbers of publications and citations were 24.60±31.21 and 288.40±625.97, respectively. The analysis showed that the program directors affiliated with a university had significantly higher mean values for all indexes than those of non-university-affiliated program directors. Professors had productivity metrics significantly higher than those of other ranks in all measures of research productivity.

Effectiveness of prosthodontic interventions and survival of remaining teeth in adult patients with shortened dental arches-A systematic review.

OBJECTIVES: A systematic review of randomised and non-randomised controlled trials was conducted to evaluate studies of the effectiveness of different tooth replacement strategies in adult patients with shortened dental arches. The objectives of the review were to determine the survival rates of different prosthodontic interventions, the risk of tooth loss with and without prosthodontic interventions, and the impact of different tooth replacement strategies on oral-health related quality of life (OHRQoL). METHODS: The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42017064851), and the review was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). RESULTS: The search strategy identified 112 potentially relevant publications; 22 from Medline (OVID), 54 from EMBASE (OVID), 35 from CENTRAL, one from the authors' knowledge of the subject area, and none from OpenSIGLE. Ten articles were included in this systematic review. Of these, four were analyses of different outcomes from a multicentre randomized controlled trial in Germany, whilst one study was the pilot phase for this trial. Two further randomized controlled trials were included from the United Kingdom and Republic of Ireland. The remaining articles were reports of prospective cohort studies from Denmark and the Netherlands. CONCLUSIONS: there is currently insufficient evidence to recommend one tooth replacement strategy over another in adult patients with reduced dentitions. CLINICAL SIGNIFICANCE: There is a need for further research as there are insufficient numbers of good quality randomised controlled trials currently available. Authors should be encouraged to adhere to CONSORT guidelines for randomized controlled trials, and report findings in such a way that facilitates future meta-analysis.

Dental responsibility loadings and the relative value of dental services.

OBJECTIVE: To estimate responsibility loadings for a comprehensive list of dental services, providing a standardized unit of clinical work effort. METHODS: Dentists (n = 2500) randomly sampled from the Australian Dental Association membership (2011) were randomly assigned to one of 25 panels. Panels were surveyed by questionnaires eliciting responsibility loadings for eight common dental services (core items) and approximately 12 other items unique to that questionnaire. In total, loadings were elicited for 299 items listed in the Australian Dental Schedule 9th Edition. Data were weighted to reflect the age and sex distribution of the workforce. To assess reliability, regression models assessed differences in core item loadings by panel assignment. Estimated loadings were described by reporting the median and mean. RESULTS: Response rate was 37%. Panel composition did not vary by practitioner characteristics. Core item loadings did not vary by panel assignment. Oral surgery and endodontic service areas had the highest proportion (91%) of services with median loadings ≥1.5, followed by prosthodontics (78%), periodontics (76%), orthodontics (63%), restorative (62%) and diagnostic services (31%). Preventive services had median loadings ≤1.25. CONCLUSION: Dental responsibility loadings estimated by this study can be applied in the development of relative value scales.

Quantifying Appointments, Treatment Time, Impressions, and Diagnostic Data of Cases Staffed by General Dentists and Prosthodontists in a Dental School Clinic.

The aim of this retrospective study was to quantify differences between general dentists and prosthodontists regarding appointments, treatment time, impressions, and preoperative diagnostic data in teaching predoctoral clinical fixed prosthodontics. Electronic dental records (n=356) of patients treated at one dental school in academic year 2012 were randomly selected for review to obtain the following data: faculty and student demographics, number of appointments and treatment time from preparation to cementation, number of impressions made, completion of oral disease control treatment (ODCT), and presence of preoperative periapical radiographs and diagnostic casts. The results showed that ODCT was completed in 78%, preoperative radiographs were present in 76%, and diagnostic casts made in 53% of the cases reviewed. There was no statistically significant difference in number of appointments, treatment time, or number of final impressions when students were staffed by general dentists or prosthodontists. When students were supervised by multiple faculty members, there was generally an increase in treatment time and number of appointments and final impressions. Although this study found no statistically significant differences between general dentists and prosthodontists regarding the criteria evaluated, the results suggest that faculty development and calibration are needed to ensure ODCT is completed and preoperative radiographs are present prior to initiating fixed prosthodontic procedures.

Missing Teeth and Prosthodontic Replacement in an Institutionalized Dentate Population of 60 Years and Older in Qingdao, China.

PURPOSE: The aim of this study was to investigate missing teeth and prosthodontic replacements in an institutionalized elderly population in China, and to assess dental functionality before and after the prosthodontic replacements based on a hierarchical dental functional classification (HDFC) system. MATERIALS AND METHODS: A sample of 512 participants (9% aged 60-69 years; 29% aged 70-79 years; 62% aged ≥ 80 years) living in eight nursing homes in Qingdao were categorized by the HDFC with and without tooth replacements. A functional dentition in the HDFC meets all the following criteria: ≥ 10 natural teeth in each jaw; a complete anterior region; 3 or 4 posterior occluding pairs (POPs) in the premolar regions; and ≥ 1 POP bilaterally in the molar region. Participants with tooth replacements were reclassified. The score for effectiveness of replacements were as follows: 4 for ≥ 10 teeth in each jaw; 3 for a complete anterior region; 2 for 3 or 4 POPs in premolar regions; and 1 for ≥ 1 molar POP bilaterally. RESULTS: Twenty percent of the participants had functional dentitions, but 42% met none of the functional criteria. In the branch '≥ 10 teeth in each jaw' the mean number of teeth present was 26.3 ± 2.9, and the mean number of POPs was 6.2 ± 2.0. In the branch '< 10 teeth in each jaw,' there were 13.4 ± 5.5 teeth and 1.1 ± 1.5 POPs. Of the 384 participants with natural teeth in each jaw, 44% had no replacements and 56% had fixed dental prostheses (FDPs), partial removable dental prostheses (PRDPs), or both. FDPs usually replaced 1 or 2 teeth, and PRDPs 3 or more teeth. On the basis of natural teeth plus artificial teeth (214 participants with replacements), 46% had functional dentitions while 18% met none of the functional criteria. In the promoted participants, the mean number of teeth added by FDPs was 3.6 ± 2.5, and for PRDPs it was 11.9 ± 6.5. FDPs had a significantly higher mean promotion value per tooth added than PRDPs. CONCLUSION: Approximately half the tooth replacements effectively met all criteria for a functional dentition.

Patterns of impaired oral health-related quality of life dimensions.

How dental patients are affected by oral conditions can be described with the concept of oral health-related quality of life (OHRQoL). This concept intends to make the patient experience measurable. OHRQoL is multidimensional, and Oral Function, Oro-facial Pain, Oro-facial Appearance and Psychosocial Impact were suggested as its four dimensions and consequently four scores are needed for comprehensive OHRQoL assessment. When only the presence of dimensional impact is measured, a pattern of affected OHRQoL dimensions would describe in a simple way how oral conditions influence the individual. By determining which patterns of impact on OHRQoL dimensions exist in prosthodontic patients and general population subjects, we aimed to identify in which combinations oral conditions' functional, painful, aesthetical and psychosocial impact occurs. Data came from the Dimensions of OHRQoL Project with Oral Health Impact Profile (OHIP)-49 data from 6349 general population subjects and 2999 prosthodontic patients in the Learning Sample (N = 5173) and the Validation Sample (N = 5022). We hypothesised that all 16 patterns of OHRQoL dimensions should occur in these individuals who suffered mainly from tooth loss, its causes and consequences. A dimension was considered impaired when at least one item in the dimension was affected frequently. The 16 possible patterns of impaired OHRQoL dimensions were found in patients and general population subjects in both Learning and Validation Samples. In a four-dimensional OHRQoL model consisting Oral Function, Oro-facial Pain, Oro-facial Appearance and Psychosocial Impact, oral conditions' impact can occur in any combination of the OHRQoL dimensions.

Assessment of 68 Prosthodontic Crowns in 41 Pet and Working Dogs (2000-2012).

A search of the medical and dental records at the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania was conducted to identify dogs that received full or partial prosthodontic crowns over a 13-year period (2000-2012). Forty-one dogs with a total of 68 prosthodontic crowns were identified. Further criteria for acceptance into the study included presence of complete medical records containing adequate information pertaining to the procedures performed, and current follow-up either by telephone, electronic mail, or via in-person examination. Treatment was considered to be successful when the prosthodontic crown was in place and there was no further structural injury to the tooth upon making contact with the client or at the time of death of the dog confirmed by the client. The mean number of days the prosthodontic crowns remained in place without further injury to the tooth was 1,598 (range, 161-4, 464 days [median, 1,414 days], standard deviation 1,093 days). Bond failure between the cement and the tooth or the cement and the prosthodontic crown occurred in 3 cases (4.4%). Fracture of the prosthodontically treated tooth occurred in an additional 7 cases (10.3%). Treatment was classified as successful in 58 cases (85.3%). The results suggest that prosthodontic crown therapy is a successful, practical, and durable treatment option for protection of previously injured teeth in pet and working dogs.

An Assessment of the Risk of Bias in Randomized Controlled Trial Reports Published in Prosthodontic and Implant Dentistry Journals.

PURPOSE: The objective of this study was to assess the risk of bias of randomized controlled trials (RCTs) published in prosthodontic and implant dentistry journals. MATERIALS AND METHODS: The last 30 issues of 9 journals in the field of prosthodontic and implant dentistry (Clinical Implant Dentistry and Related Research, Clinical Oral Implants Research, Implant Dentistry, International Journal of Oral & Maxillofacial Implants, International Journal of Periodontics and Restorative Dentistry, International Journal of Prosthodontics, Journal of Dentistry, Journal of Oral Rehabilitation, and Journal of Prosthetic Dentistry) were hand-searched for RCTs. Risk of bias was assessed using the Cochrane Collaboration's risk of bias tool and analyzed descriptively. RESULTS: From the 3,667 articles screened, a total of 147 RCTs were identified and included. The number of published RCTs increased with time. The overall distribution of a high risk of bias assessment varied across the domains of the Cochrane risk of bias tool: 8% for random sequence generation, 18% for allocation concealment, 41% for masking, 47% for blinding of outcome assessment, 7% for incomplete outcome data, 12% for selective reporting, and 41% for other biases. CONCLUSION: The distribution of high risk of bias for RCTs published in the selected prosthodontic and implant dentistry journals varied among journals and ranged from 8% to 47%, which can be considered as substantial.

Survey of the use of statistical methods in the international journal of prosthodontics.

PURPOSE: This survey aimed to review how scientific articles were reported and to describe the types of statistical tests that had been recently and commonly used in The International Journal of Prosthodontics. MATERIALS AND METHODS: All 174 articles published in 2012 and 2013 were hand-searched to identify scientific articles (n = 151) and those using at least one statistical test to explore results (n = 111). Editorials, letters, comments, erratum, and award proceedings were excluded. The number and type of statistical tests used within articles were collated, and the 10 commonly used methods were identified and described. RESULTS: Of the 151 scientific articles, 76% (n = 111) used at least one statistical test and 24% (n = 40) used qualitative methods. Up to 10 tests were used per article, with 237 in total, of which 36 were unique. The 10 most commonly used tests were analysis of variance (ANOVA; n = 34), survival analyses (n = 29), Student t test (n = 19), chi-square (n = 19), Mann-Whitney U (n = 14), logistic regression (n = 13), Wilcoxon signed rank (n = 12), Fisher exact (n = 11), log-rank (n = 10), and Cox proportional hazards (n = 8), and they accounted for 71% (n = 169) of all tests used. CONCLUSIONS: The vast majority of articles published in recent years in The International Journal of Prosthodontics employed statistical analyses. Across 2 years, nearly 250 tests were completed, including 36 unique tests. Statistical test use was common but diverse.

Reporting of statistical results in prosthodontic and implantology journals: p values or confidence intervals?

PURPOSE: Confidence intervals (CIs) are integral to the interpretation of the precision and clinical relevance of research findings. The aim of this study was to ascertain the frequency of reporting of CIs in leading prosthodontic and dental implantology journals and to explore possible factors associated with improved reporting. MATERIALS AND METHODS: Thirty issues of nine journals in prosthodontics and implant dentistry were accessed, covering the years 2005 to 2012: The Journal of Prosthetic Dentistry, Journal of Oral Rehabilitation, The International Journal of Prosthodontics, The International Journal of Periodontics & Restorative Dentistry, Clinical Oral Implants Research, Clinical Implant Dentistry and Related Research, The International Journal of Oral & Maxillofacial Implants, Implant Dentistry, and Journal of Dentistry. Articles were screened and the reporting of CIs and P values recorded. Other information including study design, region of authorship, involvement of methodologists, and ethical approval was also obtained. Univariable and multivariable logistic regression was used to identify characteristics associated with reporting of CIs. RESULTS: Interrater agreement for the data extraction performed was excellent (kappa = 0.88; 95% CI: 0.87 to 0.89). CI reporting was limited, with mean reporting across journals of 14%. CI reporting was associated with journal type, study design, and involvement of a methodologist or statistician. CONCLUSIONS: Reporting of CI in implant dentistry and prosthodontic journals requires improvement. Improved reporting will aid appraisal of the clinical relevance of research findings by providing a range of values within which the effect size lies, thus giving the end user the opportunity to interpret the results in relation to clinical practice.

The current status of prosthodontic specialists in Japan--the Japan Prosthodontic Society has played an important role in certification of prosthodontic specialists.

A board certification system for prosthodontic specialists was established in 2005 by the Japan Prosthodontic Society (JPS), significantly later than the system established by the American Board of Prosthodontics in 1947. The purpose of this study is to outline the certification system for prosthodontic specialists in Japan and discuss and evaluate its current status. In 2012, the number of board certified prosthodontic specialists was 1150 and that of mentorial specialists was 693. The number of board certified institutions was 78 and that of certified adjunct institutions was 23. Although the history of the certification system is not very long, we conclude that a well-organized system has been developed. In addition, prosthodontic departments of dental schools also play an important role in the certification system for prosthodontic specialists.

Dental school vacant budgeted faculty positions, academic years 2008-09 to 2010-11.

The annual turnover of dental school faculty creates a varying number of vacant budgeted positions from year to year. The American Dental Education Association (ADEA) conducts an annual survey to determine the status and characteristics of these vacant faculty positions. The number of vacant budgeted faculty positions in U.S. dental schools increased throughout the 1990s, with a peak of 417 positions in 2005-06. Since that time, there has been a decrease in the number of estimated vacancies, falling to 227 in 2010-11. The 2008-09 to 2010-11 faculty vacancy surveys explored these decreases, along with information relevant to the number and characteristics of dental faculty vacancies, including data on the distribution of full-time, part-time, and volunteer faculty, reasons for faculty separations, and sources of new faculty.

Private practice of prosthodontists in the United States: results from the 2008 & 2011 surveys of prosthodontists.

PURPOSE: The purpose of this article is to review data and results from past surveys of prosthodontists sponsored and conducted by the American College of Prosthodontists. Surveys were conducted in 2002, 2005, 2008, and 2011. Selected survey results are examined for prosthodontists in private practice. MATERIALS AND METHODS: Results from past surveys of prosthodontists were statistically examined and used to estimate several characteristics of the current population of practicing prosthodontists. The selected characteristics included age, gender, number of patient visits, hours in the practice, employment of staff, referral sources, and financial conditions (e.g., gross receipts, expenses in the practice, and net income of prosthodontists). While the most recent survey was conducted in 2011, the results reported by respondents are for the previous year, 2010. RESULTS: The average age of a private practicing prosthodontist in 2010 reached 53 years; 26 years since graduation from dental school and 20 years since completion of residency; an average of 13 years in their current practice. Sixty percent were in solo practice. The mean number of hours per week in the practice was 35 hours, and practicing prosthodontists treated an average of 35 patient visits per week. The patient was the single largest source of referrals, while general practitioners were a close second. The largest percentage of time spent treating patients was for fixed prosthodontics (21%), which declined from a mean of 24.1% in 2007. The mean amount of gross billings in 2010 was $721,970, which was a decline from 2007. Average total practice expenses were $538,230, and the mean net earnings of prosthodontists in private practice were $238,010. CONCLUSION: Changes have occurred since the last survey of prosthodontists in 2008 (with results for the year 2007). The prosthodontist private practice industry, not unlike dentistry as a whole, has undergone economic challenges that have affected the private practice of prosthodontists.

Use of implant-supported prostheses in edentulous mandibles among prosthodontists in Sweden.

The aim of this study was to investigate the production of mandibular implant-supported fixed and removable prostheses among prosthodontic specialists in Sweden and to compare the results with findings in a similar study made in 2001 (17). Questionnaires regarding treatment with mandibular implant prostheses during 20011 were mailed to all specialists in prosthodontics in Sweden (n = 156, according to available data). Of the 156 questionnaires, 129 (83%) were returned and of those 114 were completed. The reported number of treatments with mandibular implant-supported prostheses varied much among the specialists. Fixed implant prostheses were more common than overdentures (means 11 and 3, median values 8 and 2, respectively). However, the range was large for both alternatives. Ten (9%) of the specialists reported no treatment with fixed implant prostheses while 29 (25%) had not made any implant overdenture during 2011. The most common anchorage system for overdentures in 2011 (as well as in 2001) was two un-splinted implants with ball attachments or Locator abutments. The most common reasons for choosing overdenture treatment instead of a fixed implant prosthesis in 2011 were the reduced cost and the patient's main wish to improve denture retention. A majority of the prosthodontists (58%) reported that patients with implant overdentures were as satisfied as those with fixed implant-supported prostheses, whereas 40% claimed they were less satisfied. Two respondents (2%) considered that overdenture patients were more satisfied than those with a fixed prosthesis. It can be concluded that the general attitude among Swedish prosthodontists towards implant overdentures has not changed much during the 10-year period between the present and the previous investigation.An overdenture is still a seldom-used option in implant treatment of patients with edentulous mandibles in Sweden. Instead, a fixed implant-supported prosthesis continues to be the preferred option,

Prosthetic modalities used to treat cleft palate patients in a university clinic: a 10-year review.

Cleft palate patients are not usually seen in general dental clinics, but this congenital anomaly is one of the most frequent of cases. General dental practitioners are usually unwilling or/and not sufficiently trained to treat such patients for whom rehabilitation and interdisciplinary cooperation is often needed. The aim of this study was to determine the incidence of prosthetic modalities most frequently used by licensed prosthodontists for prosthetic rehabilitation of cleft palate patients. Participants in this study were 56 cleft palate patients (aged 23-66 years) who received prosthetic treatment between 2000 and 2010. Patients' dental status and prosthetic modalities used were noted from patient records archived at Department of Prosthodontics, School of Dental Medicine, University of Zagreb. Data analyses revealed that combined prosthetic constructions (fixed + removable, p < 0.05) were the most frequently used. In a group of molar teeth, the most frequent fixed prosthetic modalities were crowns with rests; in a group of premolar teeth, telescopic crowns; on canines, metal ceramic crowns and telescopic crowns; and in a group of incisors, metal ceramic pontics (p < 0.05). Understanding the distribution of prosthetic modalities for cleft palate patients could serve to guide dental practitioners towards planning adequate prosthetic treatment for their patients since only a well-planned prosthetic therapy will result in satisfactory function and alleviation of the deformities.