Fatemeh S. Afshari

Patient Recall in Advanced Education in Prosthodontics Programs in the United States

PURPOSE This study surveyed program directors of Advanced Education Programs in Prosthodontics (AEPP) in the United States to determine the extent, type, incidence, and perceived effectiveness of implemented recall systems. MATERIAL AND METHODS Surveys were sent to AEPP directors across the United States to assess their programs recall protocol. This survey first identified whether an active recall program existed. For programs with recall systems, rigor in promoting ongoing oral health was surveyed by focusing on recall frequency, patient tracking protocol, involved personnel, interaction with other university departments, provided clinical procedures, and therapy completion protocol. Whether the directors perceived that their recall system was successful was also investigated. RESULTS Thirty-three of 46 programs responded, giving a response rate of 72%. Of these 33 programs, only 21 (64%) had an active recall system, although 30 (91%) believed recall to be important. Twelve (57%) directors with recall programs considered their system to be effective. CONCLUSIONS Prosthodontic program directors felt their programs recall effectiveness could be improved. Due to the numerous potential benefits of an active recall system, AEPPs should consider implementing or enhancing their recall programs. Further studies are indicated to determine specific criteria that describe an effective recall system for prosthodontic programs within the context of patient health promotion, program curriculum, and financial ramifications.

Retrospective Analysis of Implant Overdenture Treatment in the Advanced Prosthodontic Clinic at the University of Illinois at Chicago.

The aim of the present retrospective study was to evaluate the clinical outcomes of implant-supported overdenture treatment provided by prosthodontic specialty residents. Twenty-three patients with 25 implant-supported overdentures (IODs) participated in the study. Seventy-four implants were placed by periodontic, prosthodontics, or oral and maxillofacial surgery students. All prostheses were fabricated in the advanced prosthodontics clinic at University of Illinois at Chicago. The condition of the peri-implant soft tissue, implants, and prostheses were evaluated. Complications and any maintenance were documented. Patients completed an oral health impact profile-14 and semantic differential scale questionnaires. Statistical analyses were performed using SPSS statistical software. Twenty mandibular and 5 maxillary IODs were evaluated. Ninety-seven percent of the attachments were locators (Zest Anchors) and 3% ball attachments. None of the implants had lost osseointegration, but 14 implants (19%) had developed marginal bone loss in one-third of the implant length or more. Fourteen (19%) implants had developed dehiscence, which ranged from 1 to 4 mm. A variation in the width of the keratinized tissue, gingival, plaque, and calculus index was observed. There was a statistically significant relationship between the presence of plaque and the bleeding on probing on the buccal aspect of implants (P = .012). The incidence of dehiscence was significantly higher on the midfacial when the keratinized tissue was less than 2 mm (P < .0001). The majority of the complications were prosthetic in nature, such as broken denture teeth (74%) and worn or loose matrices (35%). Debris was observed in 19% of the locator abutments, and 36% of the overdentures were not stable in application of anterior force. Patients were compliant with oral hygiene protocols and their chewing ability was high (mean = 8.0). The overall experience was pleasant (mean = 7.5); the treatment provided good esthetics (mean = 8.3) and great satisfaction (mean = 8.5). From an educational and clinical perspective, IOD therapy has been documented to be a predictable and successful treatment option. Patients should be informed of the required maintenance and the possible complications related to IOD therapy.

Student-Perceived Factors for an Enhanced Advanced Education Program in Prosthodontics Recall System

Purpose: A qualitative study of Advanced Education Programs in Prosthodontics (AEPPs) students was conducted to identify best practices to effectively promote ongoing health and student learning within the context of a patient-centered recall system. Materials and Methods: Ten students from seven AEPPs nationwide were invited to participate in a focus group on recall systems within AEPPs. The discussion first identified whether an active recall program existed and then delved into benefits for patients and students, positive and negative features of existing recall systems, and factors that can be improved upon for an enhanced recall system. Results: Participants advocated the highest standard of patient care, including regular ongoing care once restorative therapy is complete. Discussion indicates that not only does regular patient recall lead to health promotion, disease prevention, and monitoring of existing prostheses for the patient, but also provides for an enhanced learning experience for the students. Recognizing this, several students from AEPPs lacking an official recall system have established a “makeshift” system, encompassing a treatment completion letter, final intraoral photographs, patient education, and regular prosthetic evaluations, for their existing patients. Conclusions: Prosthodontic program students perceived their programs recall effectiveness could be improved. Due to the numerous potential benefits of an active recall system for both patients and students, some perceived factors to be improved upon include treatment completion protocol, patient education, and establishment of a patient-centered recall system managed by a team of hygienists, receptionists, attending faculty, and residents.

An alternative approach in fabrication of fixed complete dentures using a duplicate denture.

The traditional prosthetic steps in the fabrication of a fixed complete denture after implant osseointegration include final impression, verification of implant positioning in the working cast, mounting of the working cast, and mock denture wax trial insertion prior to the laboratory fabrication of the metal substructure; however, in patient scenarios of immediate loading of implants, the interim conversion prosthesis can be used to advance from the final impression to the milling of the underlying framework in one appointment. Consistency in the initial wax trial insertion, radiographic guide, and intraoral positioning of the conversion prosthesis can result in a well-designed definitive prosthesis in less time with the use of the existing duplicate complete denture.

Women in Prosthodontics: A Brief Look at Pioneers, Leaders, and Inspirers

There are several women pioneers in prosthodontics, and each deserves recognition and admiration for all she has achieved in helping bridge the gender gap in dentistry. Women have come a long way from being first depicted as a thieving woman assistant in early 1523 to becoming award-winning, Board-certified clinicians, program directors, department chairs, and deans of dental schools. However, current female resident membership in the American College of Prosthodontists is less than 40%. Women in leadership roles are still scarce, and advancement is still needed. This article provides a brief summary of the history of prosthodontics, highlighting prominent women prosthodontists and their stories, while providing inspiration for future prosthodontists, men as well as women.

Effect of brushing and thermocycling on the shade and surface roughness of CAD-CAM ceramic restorations

Statement of problem. The effects of toothbrushing (B) and thermocycling (TC) on the surface texture of different materials with various fabrication processes have been investigated. However, studies of computer‐aided design and computer‐aided manufacturing (CAD‐CAM) ceramic restorations are limited. Purpose. The purpose of this in vitro study was to evaluate the effect of B and TC on the color stability and surface roughness of extrinsically characterized and glazed CAD‐CAM ceramic restorations. Material and methods. Lithium disilicate CAD ceramic (n=90) and zirconia ceramic (n=90) were studied. All specimens were crystallized/sintered, characterized, and glazed following the manufacturer’s recommendation. The specimens were divided into 9 different groups: B, TC, and a combination of B plus TC (B+TC). Brushing was performed at 50 000, 100 000, and 150 000 cycles, simulating an oral environment of 5, 10, and 15 years. Thermocycling was performed at 6000, 12 000, and 18 000 cycles, simulating an oral environment of 5, 10, and 15 years. Brushing plus TC was performed with the combination of the 50 000 cycles of B, then 6000 cycles of TC, and 10 000 cycles of B, then 12 000 cycles of TC, and 15 000 cycles of B, then 18 000 cycles of TC. The color and surface roughness of each specimen were measured before and after all interventions with simulated cycles. Color differences (&Dgr;E) and surface roughness (&Dgr;Ra) data were analyzed using 2‐way ANOVA, followed by the least significant difference test (&agr;=.05). The correlation between &Dgr;E and &Dgr;Ra was statistically analyzed using the Pearson correlation analysis. Results. Within the lithium disilicate CAD groups, intervention did not result in any significant differences in color change (P>.05). Within the zirconia groups, a 15‐year clinical simulation revealed significantly higher &Dgr;E values than a simulated 5‐year exposure (P=.017). Increased simulated cycles showed significantly higher Ra values for all groups. Within the zirconia groups, B revealed significantly smoother surfaces than TC (P<.001) and B+TC interventions (P<.001). For the zirconia, simulating B+TC for15 years revealed significantly higher Ra values than the groups of B+TC for 5 years (P<.001) and B+TC for 10 years (P=.003). No correlation (lithium disilicate CAD, r=.079; P=.462; zirconia, r=.001; P=.989) was found between the color change and surface roughness. Conclusions. For both lithium disilicate CAD and zirconia, color changes were below the selected clinical perceptible threshold (&Dgr;E=2.6) after all intervention and simulated cycles. All mean surface roughness measurements were below 0.2 &mgr;m. Generally, the surface of both lithium disilicate CAD and zirconia became rougher. No correlation was found between color difference and surface roughness for either material.

Patient-Reported and Clinical Outcomes of Implant-Supported Fixed Complete Dental Prostheses: A Comparison of Metal-Acrylic, Milled Zirconia, and Retrievable Crown Prostheses.

The purpose of this retrospective study was to assess the incidence of biologic and technical complications for implant-supported fixed complete dental prostheses (IFCDPs) and their relationship to oral health-related quality of life (OHQoL) and patient-reported outcomes. Metal-acrylic (MA), retrievable crown (RC), monolithic zirconia (MZ), and porcelain veneered zirconia (PVZ) prostheses were included. Patients who received an IFCDP at least 1 year prior to recall were identified. Exclusion criteria were: (1) an opposing complete denture and (2) time in service >70 months. A total of 37 patients with 49 prostheses, including 22 MA, 14 RC, 7 MZ, and 6 PVZ prostheses were recalled. Patient-reported outcomes were assessed via OHIP-49 (Oral Health Impact Profile) and a scripted interview with open-ended questions. All designs had high complication rates (12 of 22 MA, 10 of 14 RC, 2 of 7 MZ, and 5 of 6 PVZ). The most common complications were: (1) MA: posterior tooth wear, (2) RC: chipping and fracturing of the restorations, (3) MZ: wear of opposing restorations, and (4) PVZ: chipping of opposing restorations. Average OHIP-49 scores ranged from 7 to 29, indicating high OHQoL, patient satisfaction, regardless of prosthetic design ( P = .16). The standardized interview highlighted that although most patients were extremely satisfied (73%), some continued to be bothered by material bulk (14%) and felt that maintenance of oral hygiene was excessively time-consuming (16%). In the context of this study, despite high complication rates and maintenance needs, all IFCDP designs resulted in high OHQoL and patient satisfaction.

Integration of digital dentistry into a predoctoral implant program: Program description, rationale, and utilization trends

A recently revised predoctoral implant curriculum at the University of Illinois at Chicago College of Dentistry integrated digital dentistry into both the preclinical dental implant course and clinical activities. Traditionally, competence in the didactic and clinical parts of predoctoral education in single tooth implant restorations has emphasized the analog impression technique and subsequent mounting of soft tissue working casts. However, computer-aided design/computer-aided manufacturing (CAD/CAM) implant restorations can play a significant role in predoctoral dental education utilizing digital technologies. The goal of the curriculum expansion is to transition from analog to partially digital and, finally, complete digital workflow. The aim of this article is to describe the specific components, implementation, and rationale for the new digitally integrated implant curriculum and present short-term clinical utilization trends.

Prosthodontics Treatment Considerations for Methamphetamine‐Dependent Patients

Overt dental disease is a distinguishing comorbidity associated with methamphetamine abuse, necessitating the need for special management to maximize treatment benefits. As this highly addictive stimulant increases in popularity, it has become imperative that clinicians are equipped to thoughtfully provide comprehensive care for these patients. This article reviews the impact of methamphetamine to systemic and oral health and proposes a comprehensive treatment plan and sequence for the methamphetamine-dependent patient. A multidisciplinary approach is recommended. Destructive oral and psychological changes must be identified and controlled. A thorough risk assessment, caries control, and preventative plan should be established before initiating prosthodontic treatment. Patient motivation, support, and a timely recall schedule are integral for dental longevity.