A survey of program directors: trends, challenges, and mentoring in prosthodontics. Part 1.

PURPOSE: This study consisted of two parts. Part 1, a survey of program directors, was conducted to examine current trends in advanced education in prosthodontics in the United States. Part 2 will report on the survey results distributed to the deans of US dental schools to evaluate their observations of trends in prosthodontics. MATERIALS AND METHODS: A national e-mail survey of 45 program directors was used to collect enrollment data for years 1 to 3 of prosthodontics training for US and international dental school graduates, the total number of applicants and applications considered, and the trends over time of applicants to prosthodontic programs for US dental school graduates and for international graduates. In addition, the program directors were asked to rank 13 key factors that may have contributed to any changes in the prosthodontic applicant pool. Comments were accepted on why more or less US- or internationally trained applicants have applied. Program directors were also asked for information on student financial incentives, whether their programs were state or federally funded, and whether their sponsoring institution was a dental school. RESULTS: Of the 45 program directors, 39 responded, for an 86.7% response rate. Respondents reported that 64% of their enrollments were graduates of US dental schools. Between 2000 and 2004 the applicant pool in prosthodontics increased by 23%, with 41% of program directors reporting an increase in US-trained applicants, 46.2% reporting no change, and only 12.8% reporting a decrease. Using the Spearman correlation, there was a moderate, positive statistically significant correlation that the following factors contributed to an increase in the number of US dental graduates applying to prosthodontic programs: (1) mentoring by prosthodontists at the predoctoral level, (2) interest in prosthodontics among US dental students, and (3) society's demand for a higher level of training and credentialing, (4) data depicting current and projected income for dental specialists, and (5) number of trained prosthodontists full- or part-time faculty at the predoctoral level. Only five programs offered no financial packages to offset tuition. The remaining 34 respondents reported some financial package. Among the respondents, there were 25 state-sponsored programs, 9 sponsored by private universities, and 5 sponsored by hospitals or federal agencies. CONCLUSION: An increased applicant pool and more US-trained applicants to prosthodontics programs create a more competitive applicant pool for our specialty. Program directors reported that factors such as mentoring, society's demand for a higher level of training and credentialing, data depicting current and projected income for prosthodontists, exposure to prosthodontic faculty at the predoctoral level, the dollar value of prosthodontic training, and advances in implant, aesthetic, and reconstructive dentistry have all had some impact on increasing the applicant pool to prosthodontic training in the United States.     

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.     

Ten‐Year Survey of Program Directors: Trends,Challenges, and Mentoring in Prosthodontics. Part 1

Purpose: This study consisted of two parts. Part 1 was a survey of US program directors, and Part 2 reports on the survey findings distributed to the deans of US dental schools. Both surveys evaluated observations of trends in prosthodontic education. The first survey (2005) of program directors and deans was published in 2007. This second survey was conducted in 2009. The 2009 survey provided 10‐year data on trends in prosthodontics as reported by program directors. Materials and Methods: A national e‐mail survey of 46 program directors was used to collect enrollment data for years 1 to 3 of prosthodontics training for US and international dental school graduates, the total number of applicants and applications considered, and the trends over time of applicants to prosthodontics for US dental school graduates and for international graduates. In addition, the program directors were asked to rank 13 key factors that may have contributed to any changes in the prosthodontic applicant pool. Program directors were also asked for information on student financial incentives and whether their programs were state or federally funded, and whether their sponsoring institution was a dental school. Results: Of the 46 program directors, 40 responded, for an 87% response rate. Respondents reported that 66% of their enrollees were graduates of US dental schools. Between 2000 and 2009 the applicant pool in prosthodontics nearly doubled, with 50% of the program directors reporting an increase in US‐trained applicants, 42.5% reporting no change, and only 7.5% reporting a decrease. Using the Spearman correlation for the 10‐year survey, there was a positive, statistically significant correlation that society's demand for a higher level of training and credentialing and interest in prosthodontics among dental students contributed to an increase in the number of US dental graduates applying to prosthodontic programs. Only four programs offered no financial packages to offset tuition. The remaining 36 respondents reported some financial package. Among the respondents, there were 23 state‐sponsored programs and 6 sponsored by private universities; the remaining 9 were sponsored by hospitals or federal agencies. Conclusions: A nearly doubled applicant pool and more US‐trained applicants to prosthodontics ensure a much more competitive applicant pool for our specialty. In the 2009 survey, program directors reported that factors such as society's demand for a higher level of training and credentialing, interest in prosthodontics among US dental students, advances in implant, esthetic, and reconstructive dentistry, literature pertaining to the need of prosthodontists for the future, marketing of prosthodontics as a career, and the dollar value of prosthodontic training have all had some impact on increasing the mentored applicant pool to prosthodontic training in the United States.     

Teaching prosthodontics in general dentistry.

Because of the projected increase in the demand for high-quality prosthodontic services in the future, it will be necessary to upgrade undergraduate prosthodontics and to provide, in addition, improved prosthodontic training in the general dentistry residencies. The Federation of Prosthodontic Organizations is the unified voice of our specialty and must stand at the forefront to provide and direct this training. Every accredited program should be required to offer training in prosthodontics. We cannot expect graduate students to specialize in prosthodontics if we allow it to be downgraded, reduced in scope in our dental schools, and excluded from general dentistry residencies.     

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.     

Maxillofacial prosthetics--an international perspective of the British status quo.

Maxillofacial prosthetics is a recognized subspecialty of prosthodontics. In considering the international status of maxillofacial prosthetics it is found that this unique and superspecialized discipline has a varied implementation both in terms of educational structures employed and clinical services provided. There is a dirth of available literature on education in maxillofacial prosthetics. The available literature is reviewed and the conclusion drawn is that very little undergraduate or postgraduate curriculum time is devoted to maxillofacial prosthetics in prosthodontic curricula. This, it is felt, adds to the ignorance of this important aspect of dentistry. Educational guidelines are reviewed and from this it is evident that the North American model of prosthodontic education and training differs greatly from the British one. This dichotomy appears to have impacted on prosthodontic training in other countries. Maxillofacial prosthetics enjoys special status in the United States but does not seem to be an important aspect of training in the British model. Indeed there is little evidence that maxillofacial prosthetics is an important focus of the British Consultant in Restorative Dentistry. Given the availability of the superb skills of the British trained maxillofacial prosthetic technicians and the hospital based restorative services, it is remarkable that the Restorative Consultants have not exercised their natural opportunity to lead internationally in both clinical and research areas, in this important discipline of dentistry. This must undoubtably pose a challenge for the British dental profession as a whole in the future.     

Comparison of dental licensure, specialization and continuing education in five countries

Dental practice and education are becoming more globalized. Greater practitioner and patient mobility, the free flow of information, increasingly global standards of care and new legal and economic frameworks (such as European Union [EU] legislation) are forcing a review of dental licensure, specialization and continuing education systems. The objective of this study was to compare these systems in Canada, France, Germany, the UK and the US. Representatives from the five countries completed a 29-item questionnaire, and the information was collated and summarized qualitatively. Statutory bodies are responsible for licensing and re-licensing in all countries. In the two North American countries, this responsibility rests with individual states, and in Europe, with the countries themselves, mainly governed by the legal framework of the EU. In some countries, re-licensure requires completion of continuing education credits. Approaches to dental specialization tend to differ widely with regard to definition of specialities, course and duration of training, training facilities, and accreditation of training programmes. In most countries, continuing education is provided by a number of different entities, such as universities, dental associations, companies, institutes and private individuals. Accreditation and recognition of continuing education is primarily process-driven, not outcome-orientated. Working towards a global infrastructure for dental licensing, specialization and continuing education depends on a thorough understanding of the international commonalities and differences identified in this article.     

Aspects of Malpractice in Prosthodontics

Crowns, fixed partial dentures, and removable dentures are the popular prosthetic dental restorations in current dental practice. Prosthodontic rehabilitation of the mouth, particularly in advanced and complex cases, requires careful planning, adequate clinical skills, and exacting technical standards. While a successful outcome is the ultimate goal for any prosthodontic treatment, complications, injuries, dissatisfaction, and/or failure may occur. When such events develop as a result of negligence or violation of standards of care, they are considered under the term of malpractice and may incur ethical and medico‐legal implications. This paper reviews and highlights some aspects of malpractice in prosthodontics. The current state of prosthodontic malpractice on a global level will also be evaluated. Standards of prosthodontic care, current literature of prosthodontic malpractice, where and how prosthodontic malpractice occurs, and recommendations for the future are presented. A thorough understanding of what is quality prosthodontic care and what disrupts this care can be a useful guard against professional litigation and may protect patients from poor quality of dental prosthetic care.     

The Dental Student as Technician: An 18-Year Follow-Up of Preclinical Laboratory Programs

In 1977, a survey of American and Canadian dental schools was conducted by Weintraub to determine the delegation of laboratory procedures in preclinical and clinical complete and removable partial denture programs. This was performed in light of challenges raised to the value of requiring dental students, rather than laboratory technicians, to perform the various laboratory procedures involved in the fabrication of complete and removable partial dentures. Since 1977, the rate of edentulism has declined in the United States, and fewer edentulous patients have sought regular dental care. In addition, approximately 20% fewer curriculum hours have been spent in dental schools in removable prosthodontic instruction; a declining number of graduating dental students have felt comfortable with their level of knowledge of removable prosthodontics, especially complete dentures, and have performed fewer removable prosthodontic procedures in practice because of a perceived lack of treatment cost-effectiveness. The present study, an 18-year follow-up to the 1977 survey, was designed to determine if such trends toward a deemphasis on removable prosthodontic treatment have affected the mechanisms of instruction in and the extent to which dental schools instruct students about removable prosthodontics laboratory procedures. The 1995 survey was mailed to 53 American dental schools. Forty-six schools returned the completed survey, for a response rate of 87%. Results showed that the proportion of schools with removable prosthodontic preclinical programs, especially those in removable partial dentures, increased, as did the relative amount of material presented to students in these programs. This was accomplished primarily through the enhancement of laboratory technician support, both in-house and commercial, of student preclinical removable prosthodontic laboratory procedures. The conflict between these outcomes and the call by the dental community, as well as that of the 1995 Institute of Medicine Study, for a reduced emphasis on teaching students about the technical details involved in removable prosthesis fabrication is recognized and explored.     

The Dental Student as Technician: An 18-Year Follow-Up of Clinical Laboratory Programs

In 1977, a survey of American and Canadian dental schools was conducted by Weintraub to determine the delegation of laboratory procedures in preclinical and clinical complete and removable partial denture programs. This was performed in light of challenges raised to the value of requiring dental students, rather than laboratory technicians, to perform the various laboratory procedures involved in the fabrication of complete and removable partial dentures. Since 1977, the rate of edentulism has declined in the United States, and fewer edentulous patients have sought regular dental care. In addition, approximately 20% fewer curriculum hours have been spent in dental schools in removable prosthodontic instruction; a declining number of graduating dental students have felt comfortable with their level of knowledge of removable prosthodontics, especially complete dentures, and have performed fewer removable prosthodontic procedures in practice because of a perceived lack of treatment cost-effectiveness. The present study, an 18-year follow-up to the 1977 survey, was designed to determine if such trends toward a deemphasis on removable prosthodontic treatment have affected the mechanisms of instruction in and the extent to which dental schools instruct students about removable-prosthodontics laboratory procedures. The 1995 survey was mailed to 53 American dental schools. Forty-six schools returned the completed survey, for a response rate of 87%. Results showed that the relative amount of material presented to students in clinical removable prosthodontics programs increased, primarily through the enhancement of laboratory technician support, both in-house and commercial, of student clinical removable prosthodontic laboratory procedures. The increase was greater than in preclinical removable prosthodontic programs, which were described in a companion article. The conflict between these outcomes and the call by the dental community, as well as that of the 1995 Institute of Medicine Study, for a reduced emphasis on teaching students about the technical details involved in removable prosthesis fabrication is recognized and explored.     

The dental student as a technician: Preclinical and clinical laboratory programs in fixed prosthodontics

PURPOSE: A 2-part survey of United States dental schools was conducted. The first part of the survey was published in 1998 and determined the curricular structure, techniques taught, and materials used in predoctoral fixed prosthodontics courses. The purpose of the second part of the survey was to ascertain the delegation of laboratory procedures in preclinical and clinical fixed prosthodontic programs. MATERIALS AND METHODS: The survey was mailed to the course directors of predoctoral fixed prosthodontic programs at 53 US dental schools. Of these, 42 schools returned the completed survey, resulting in a response rate of 79%. RESULTS: Results from this survey show that certain laboratory procedures in preclinical and clinical fixed prosthodontics are completed by dental laboratories (either in-house or commercially available laboratories). CONCLUSIONS: For the preclinical programs of fixed prosthodontics, there is more student involvement in the completion of laboratory procedures in the dental schools surveyed. In clinical fixed prosthodontic programs, there is a high emphasis on patient care and less on laboratory techniques that can be delegated to laboratory technicians.     

Surgical and prosthodontic training of general practitioners for single tooth implants: a study of treatments performed at four general practitioners' offices and at a specialist clinic after 2 years

summary Both the surgical and the prosthodontic procedures will be performed by one and the same general practitioner (GP) for many implant patients, as access to specialists is limited or non-existent in a large number of places. However, treatment by GPs has not been documented to the same extent as treatment performed by specialists. This lack of knowledge was the reason for the present study, in which four GPs performed both the surgery and the prosthodontics on patients requiring single tooth implant replacements. The treatments were performed after an initial training of the GP and his/ her dental assistant for 8 days. The treatments by the GPs exhibited clinical results corresponding to those achieved at a specialist clinic. The outcome indicates that complete single tooth implant treatments might be performed by GPs who have passed an initial training and demonstrated an interest in a close cooperation with specialists in oral surgery/periodontics and prosthodontics. Such a co-operation should be based on the distribution of complicated cases to the specialists and of non-complicated cases to the GPs.     

The relevance of prosthodontics and the science of dental materials to the practice of dentistry

This article attempts by historical reference to demonstrate the present and future relevance of prosthodontics and the science of dental materials to the practice of dentistry. The historical introduction indicates the inadequacy of prosthodontic techniques and materials used in the past, so that an immediate appreciation of modern techniques may be recognized. The relevance of prosthodontics is discussed from an educational point of view, and the importance of existing techniques is emphasized with regard to the problems of today (Phillips, 1976). The future role of implant materials and prosthodontics is summarized.

The significance of dental materials science is discussed with reference to groups of materials and particular research techniques.     

International college of prosthodontists reports on post-graduate prosthodontics

The international college of prosthodontists that regards itself as a representative body of prosthodontists worldwide has been addressing the topics of graduate education for the last decade. Our research and education committee have sent out questionnaires to 250 dental schools and received 42 responses with details of programs and prosthodontics in 24 of these centers. In addition the ICP web site requesting submission of international programs has been active for the last year. Our study showed that responding countries have 3–4 year programs. ICP was involved in drafting a report of the international association of dental schools in Athens and drafting the summary report. In addition the ICP has drafted a recommended post-graduate prosthodontic program curriculum that suggests guidelines for international specialty programs in prosthodontics.     

Prosthodontics in a general practice program of advanced dental education.

The problems involved in teaching prosthodontics in a general practice program outwardly appear to be due to the lack of sufficient basic prosthodontic training dispensed by the dental schools. This lack of sufficient training is not the fault of dental school faculties. The students are not learning what they are taught. What they need is more repetition, which means more time. The problems are not insurmountable. We just must find the route.     

Introducing dental students to clinical patient care: The complete denture prosthodontics transition clinic

Using complete denture treatment as an introduction to clinical patient care for dental students, the purposes of the Complete Denture Prosthodontics Transition Clinic at the University of Colorado School of Dentistry are to reduce the time lapse between the preclinical complete denture prosthodontics course and the first denture patient experience, and to encourage development of student self-confidence and skills. In the 2002 spring semester, faculty at the University of Colorado School of Dentistry initiated the Complete Denture Prosthodontics Transition Clinic for DS-II (second-year) dental students, as an introduction to clinical patient care. Each patient was assigned to a team of two dental students. Three Division of Prosthodontics faculty members staffed each clinic session, providing a student-to-faculty ratio of approximately 6.6:1 and a patient-to-faculty ratio of approximately 3.3:1. All DS-II students in the Class of 2004 delivered their first complete dentures no later than 8 months (average, 184 days) after the last day of the preclinical complete denture prosthodontics course. The time from the diagnostic appointment through the denture placement appointment averaged 39 days for patients treated in this program, compared with an average of 98 days or more for previous classes. The program was successful in achieving the goal of reducing the time lapse between the preclinical complete denture prosthodontics course and the first denture patient experience.     

Limitation of clinical practice to prosthodontics.

Limitation of practice implies specialization and the delivery of services by a specialist who has been recognized for his expertise through formal advanced education, experience, and/or examination. Prosthodontists in limited practice are currently influenced by problems related to patient referrals, third-party payment for services, and competence certification. Perhaps the most significant problem in prosthodontics today is the need to succinctly define the parameters of prosthodontic practice in order to provide guidelines for assuring that such practices are limited to the defined specialty.     

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.     

Specialisation and specialist education in prosthetic dentistry in Europe

This presentation reports on the results of a meeting of prosthodontists from selected European countries. The aim of the meeting was to analyse and promote specialisation and specialist education in Prosthetic Dentistry in Europe. Representatives for Europe were selected from the European Prosthodontic Association (EPA) board, the Education and Research Committee of International College of Prosthodontists (ICP), countries with a legally recognised speciality, countries without a recognised speciality but organised training programmes and countries with neither of these situations. Data about specialisation and specialist training in Prosthodontics in Europe was scrutinised and discussed. The programmes for countries with specialist training had relatively similar content, mostly of three years duration. There was strong agreement that a recognised speciality raises the level of care within the discipline for both specialists and non-specialists. In several of the countries where a speciality had been introduced it had been initiated by pressure from public health planning authorities. The conclusions are that from a professional viewpoint an advancement of the speciality over Europe would develop the discipline, improve oral health planning and quality of patient care. A working group for harmonisation was recommended.     

A survey of deans: trends, challenges, and mentoring in prosthodontics. Part 2.

PURPOSE: This study consists of two parts. Part 1, a survey of program directors, was conducted to examine current trends in advanced education in prosthodontics in the United States. Part 2 reports on the findings of a survey distributed to the deans of US dental schools to evaluate their observations of trends in prosthodontic education. MATERIALS AND METHODS: A national, electronic survey of 55 dental school deans was distributed by e-mail to evaluate an interest in specialty training, an interest in specialization in prosthodontics, faculty shortages, programs to address faculty shortages, predoctoral curriculum in prosthodontics, opinions regarding dental specialties, and the administrative position of prosthodontics within the schools. RESULTS: Of the 55 deans, 44 deans responded, an 80% response rate. Only five deans reported a decrease in the number of students seeking specialty training after dental school. The remaining 39 deans reported a large increase, slight increase, or no change in those seeking specialty training. In 29.6% of the deans' responses, an increased interest in prosthodontics was reported, whereas 16 deans reported no change in the level of interest. One or more open faculty positions in prosthodontics existed at 29 dental schools, and 28 schools offered at least one incentive or a variety of incentives to recruit faculty. The respondents to the deans' survey revealed predoctoral student exposure to prosthodontists was high, and exposure to postgraduate prosthodontics students was low. A survey of internal school programs that might have an impact on an increased interest in prosthodontics revealed the presence of a predoctoral mentoring program for prosthodontics in 80% of the institutions. The clinical curriculum included treatment of a variety of cases, including complex cases as defined by a diagnostic classification system. The response to whether dental specialties should be combined or remain individual provided some interesting data. Only 40.9% of the deans responded that prosthodontics was a separate department. CONCLUSION: Dental school deans reported an increased interest in specialty training. Predoctoral student exposure to prosthodontics was high due to the nature of their clinical experience and due to the exposure to full-time prosthodontics faculty. Many dental schools have programs, such as mentoring and new technology, which might have an impact on predoctoral students' increased interest in prosthodontics.