American College Of Prosthodontists Research Articles

Evidence‐Based Guidelines for the Care and Maintenance of Complete Dentures: A Publication of the American College of Prosthodontists

The current rates of edentulism have been estimated to be between 7% and 69% of the adult population internationally. In the United States, while the incidence of edentulism continues to decline, rapid population growth coupled with current economic conditions suggest that edentulism and conventional denture use will continue at current or higher numbers. Unfortunately, evidence-based guidelines for the care and maintenance of removable complete denture prostheses do not exist. In 2009, the American College of Prosthodontists (ACP) formed a task force to establish evidence-based guidelines for the care and maintenance of complete dentures. The task force comprised members of the ACP, the Academy of General Dentistry, American Dental Association (ADA) Council on Scientific Affairs, the American Dental Hygienists' Association, the National Association of Dental Laboratories, and representatives from GlaxoSmithKline Consumer Healthcare. The review process included the assessment of over 300 abstracts and selection of over 100 articles meeting inclusion criteria of this review. The task force reviewed synopses of the literature and formulated 15 evidence-based guidelines for denture care and maintenance. These guidelines were reviewed by clinical experts from the participating organizations and were published in February 2011 issue of The Journal of the American Dental Association for widespread distribution to the dental community. These guidelines reflect the views of the task force.

A genetic association study of single nucleotide polymorphisms in FGFR1OP2/wit3.0 and long-term atrophy of edentulous mandible.

BackgroundAfter dental extraction, the external surface of alveolar bone undergoes resorption at various rates, and a group of patients develop excessive jawbone atrophy. Oral mucosa overlying the atrophied jawbone is unusually thin; therefore, we have hypothesized that excessive jawbone atrophy may be associated with abnormal oral mucosa contraction. FGFR1OP2/wit3.0, a cytoskeleton molecule initially identified in oral wound fibroblasts, has been shown to induce oral mucosa contraction after dental extraction. This study examined the genetic association between single nucleotide polymorphisms (SNPs) of FGFR1OP2/wit3.0 and excessive atrophy of edentulous mandible.Methods and FindingsFirst, the expression of FGFR1OP2/wit3.0 was determined in gingival tissues of 8 subjects before and after dental extraction. In situ hybridization revealed that all subject increased FGFR1OP2/wit3.0 expression in the post-operative oral mucosa tissues; however, significantly high levels of FGFR1OP2/wit3.0 were observed in 3 out of 8 subjects. In a separate study, 20 long-term edentulous subjects (66.4±9.4 years) were recruited. Tag-SNPs in the FGFR1OP2/wit3.0 allele were determined by Taqman-based polymerase chain reaction. The mandibular bone height was determined following the American College of Prosthodontists (ACP) protocol. Subjects with minor allele of rs840869 or rs859024 were found in the highly atrophied group by the ACP classification (Chi square test, p = 0.0384 and p = 0.0565, respectively; Fisher's Exact, p = 0.0515 and p = 0.2604, respectively). The linear regression analysis indicated a suggestive association between rs859024 and the decreased bone heights (Mann-Whitney, p = 0.06). The average bone height of the subjects with rs840869 or rs859024 minor alleles (10.6±3.2 mm and 9.6±3.2 mm, respectively) was significantly smaller than that of those subjects with the major alleles (14.2±4.5 mm, p<0.05).ConclusionsThe patients with the minor allele of rs840869 or rs859024 were associated with excessive atrophy of edentulous mandible. This study may provide the basis for a genetic marker identifying susceptible individuals to develop jawbone atrophy after dental extraction.

Private Practice of Prosthodontists: Current Conditions of Practice in the United States

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. 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). 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. 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.

Advanced Education in Prosthodontics: Residents’ Perspectives on Their Current Training and Future Goals

The purposes of this study were to identify current prosthodontic residents' demographics and to document prosthodontic residents' perspectives on their clinical training and future goals. A 52-item survey was created and distributed to prosthodontic residents in the United States on February 8, 2007. The data collected were analyzed; the means and standard deviations were calculated and ranked. Statistical analysis was conducted using Chi-square and Mann-Whitney analysis (p = 0.05). A 43% response rate was achieved, representing approximately 48% of the total population of prosthodontic residents in the United States. The majority of residents ranked clinical education as the most important factor in selecting their programs, were satisfied with their training, and planned to pursue the certification of the American Board of Prosthodontics. When asked how often they planned to work, 4 days a week was the most common answer. This is the first report identifying current prosthodontic residents' demographics and their perspectives on their clinical training and future goals. Several trends were identified, indicating a bright future for the specialty. By knowing the students' perceptions regarding their training and future goals, the American College of Prosthodontists and/or program directors will be able to use this information to improve residency programs and the specialty.

Differential Factors That Influence Applicant Selection of a Prosthodontic Residency Program

The main objectives of this study were to identify current prosthodontic resident demographics and to analyze factors that may influence applicants in selecting prosthodontics as a career, as well as a specific prosthodontic program. We also investigated the influence of age, gender, relationship status, and year in program on applicant decisions. Two questionnaires were mailed to all prosthodontic residents (N = 304) registered with the American College of Prosthodontists (ACP) Central Office. Part I assessed resident demographics and factors influencing choice of specialty. Part II assessed factors influencing the selection of a specific prosthodontic program. Completed surveys were obtained from 193 of 304 (63.4%) of all prosthodontic residents registered at the ACP Central Office. The completed surveys represented approximately 48% of the total population of prosthodontic residents in the United States. Demographic data revealed that 37% and 62% of the respondents were female and male, respectively (1% did not report gender). The mean age of the respondents was 30.3 years. More residents reported being married than either single or in a relationship. Most residents were accepted to their top choice program. Part I of the survey revealed that the complexity and challenge of treatment planning/treatment, ability to lead multidisciplinary cases, possession of skills/talents suited to the specialty, enjoyment of clinical work, and the intellectual content of the specialty were reported to be the five most influential factors in choosing prosthodontics as a career. Part II demonstrated that applicants place a high emphasis on clinical education, their impression of the program director, advice from predoctoral mentors, their impression of resident satisfaction and happiness, and the opportunity to place dental implants. The factors of least importance are climate and opportunities to moonlight, teach, and conduct research. Dental students consider the complexity and challenge of treatment planning and execution of prosthodontic treatment to be the most important factors in the decision to specialize in prosthodontics. Mentors and predoctoral instructors also strongly influence students. Applicants consider clinical education to be the most important determinant in program selection, but are also influenced by their impression of the program director and his/her philosophy of training. Faculty board certification and the opportunity to place dental implants are also important factors. Relationship status can significantly affect an applicant's choice of program. Teaching and research opportunities appear to be of minor importance to applicants. These findings can be used by the ACP and/or program directors to understand which factors are important to students, enabling them to assess the compatibility of their programs with applicants and modify existing curricula to make their programs more attractive to top candidates.

Prosthodontic Program Directors' Perceptions Regarding Implant Placement by Prosthodontic Residents: A 2004 Survey Conducted by the Educational Policy Subcommittee of the American College of Prosthodontists

In 2004, a survey regarding implant placement by prosthodontic residents was conducted by the Educational Policy Subcommittee of the American College of Prosthodontists (ACP). The aim of the survey was to assess the current trends in implant curricula at advanced graduate prosthodontics programs in the United States and Canada and determine the issues surrounding surgical implant training for prosthodontic residents. The survey was mailed to the prosthodontic/maxillofacial prosthetic program directors of the 59 prosthodontic graduate programs in the United States and Canada in 2004. Of these, 27 program directors replied, yielding a response rate of 46%. Of the replying programs, 43% either required residents to place or offered the option to have residents place implants. Forty-four percent reported that residents participate by functioning as first assistants for some of their implant patients, 40% have a specific curriculum to train residents in implant placement, 50% reported not having any institutional barriers that prevent program directors from training prosthodontic residents in implant placement, 51% provide implant training using plastic jaws, and 66% of the programs required residents to observe implant surgery in the clinic before they are permitted to place implants. Of prosthodontic residents who treated implant-related patients, the majority treated 11 to 20 patients during their residency. In 2004, 40% of program directors were not trained in the placement of dental implants, and if they did have the implant training, the majority (82%) stated that the nature of their training was 1- to 3-day course(s). This survey showed that implant dentistry has become an integral part of the postgraduate prosthodontic curriculum. The trends to incorporate implant placement into the postgraduate prosthodontic curriculum were already evident prior to 2004. To address the demand for implant treatment in patient care and enhance surgical implant knowledge, the ACP in 2005 added placement of implants to its Accreditation Standards for Advanced Specialty Education Programs in Prosthodontics.

Prosthodontists in Private Practice: Current and Future Conditions of Practice in the United States (Part I)

The purpose of this study was to use data from surveys of prosthodontists to examine the current conditions and characteristics of prosthodontists in private practice in the United States. Characteristics of prosthodontists and conditions of practice are based on the 2002 Survey of Prosthodontists and the 2005 Survey of Prosthodontists. Both surveys were conducted by the American College of Prosthodontists. Several characteristics of private practice/practitioners are estimated including age, gender, number of patient visits, hours in the practice, employment of staff, and financial conditions (gross receipts, expenses of the practice, and net income of prosthodontists) In 2004, the average age of private practitioners was 50 years. Years since graduation from dental school averaged 23.4 years, and years since completion of residency was 18.3 years. Prosthodontists spent an average of 35.7 hours per week in the office and 29.5 hours treating patients. In 2004, the average gross revenue per owner of a private practice reached $782,130, and mean net income was $258,490. The largest percentage of prosthodontist time was spent providing six procedures including fixed prosthodontics, implant services, complete dentures, operative care, diagnosis, and partial dentures. The United States spends about $1.8 billion on prosthodontic services provided by prosthodontists in private practice. Prosthodontists spend $1.1 billion dollars in expenses and treat an estimated 1.1 million patients per year.

A Survey of U.S. Prosthodontists and Dental Schools on the Current Materials and Methods for Final Impressions for Complete Denture Prosthodontics

The purpose of this study was to survey members of The American College of Prosthodontists (ACP) to evaluate current materials and methods for final impressions for complete denture prosthodontics in the United States. In addition, those methods were compared with methods and materials taught in U.S. dental schools via a second survey sent to the chairpersons of prosthodontic/restorative departments. An anonymous questionnaire was mailed to all 1762 active ACP members in the United States in 2003. A slightly modified questionnaire was also distributed to chairpersons of prosthodontic/restorative departments in the 54 U.S. dental schools. Data analysis was performed via frequency distribution and chi-square statistics. Nine hundred and forty-five questionnaires were returned by members of the ACP (54% return rate) and 42 questionnaires were returned by the U.S. dental schools (78% return rate). The majority of the reporting prosthodontists (88%) and dental schools (98%) use a border-molded custom tray for final impressions for complete denture prosthodontics. The most popular material for border molding was plastic modeling compound (67% of reporting ACP members, and 95% of the responding dental schools). Variability of the materials used for final impressions was observed, with the most popular materials being polyvinylsiloxane for the ACP members (36%) and polysulfide for the dental schools (64%). Statistically significant differences were found in the materials used for border molding by prosthodontists based on the time elapsed since completion of prosthodontic training. No differences were found in the materials used for impression of edentulous arches based on years of experience. Geographic location did not influence the materials and methods used by prosthodontists for complete denture final impressions. There was variability of the materials and techniques used for final impressions by ACP members and dental schools; however, overall there was an agreement on the materials and techniques used by prosthodontists and dental schools. Distinct trends for increasing use of polyvinylsiloxane and polyether for border molding procedures and impressions of edentulous arches were observed both in members of the ACP and in the U.S. dental schools.

2005 Research Grand and Award Programs prosthodontic Forum Organizations Prepared by Dr.Stephen Campbell Vice President, American College of Prosthodontists

2005 Research Grand and Award Programs prosthodontic Forum Organizations Prepared by Dr.Stephen Campbell Vice President, American College of Prosthodontists

Survey of recently board-certified prosthodontists on the board-certification process. Part 2: Preparation and impact.

A 2-part survey of recently board-certified prosthodontists was conducted in 2001. The first part of the survey, published in June 2003, determined the trends that assisted the candidates in attaining diplomate status. The second part of the survey was done to determine the preparation methods and resources used to prepare for the examination, the most difficult part of the examination, the most gratifying aspect of becoming board-certified, their current employment status, and whether board certification had any positive impact on their employment. A questionnaire was mailed to 176 diplomates who had become board certified between the years 1993-2001. Of these, 131 board-certified prosthodontists returned the completed survey, resulting in a response rate of 74%. Results from this survey showed that 91% of the diplomates had taken the American College of Prosthodontists (ACP) Board Preparation course; most of the diplomates (41%) prepared for the boards by reviewing prosthodontic literature, reading textbooks, using the ACP Study Guide, and seeking the help of other board-certified prosthodontists; 89% of the diplomates felt that achieving board certification had a positive influence in their employment; 39% of the diplomates indicated that Part 2 of the examination was the most difficult to prepare for, and 41% indicated that Part 2 was the most difficult section; the majority of diplomates (31%) were employed by the military, and the most gratifying aspect of becoming board-certified was personal accomplishment (83%). Trends were observed regarding prosthodontists who succeeded with their efforts to challenge the board examination. The majority of the diplomates were employed by the military. Most of the respondents indicated that they took the ACP Board Preparation course and found it helpful. The largest percentage of respondents reported that Part 2 was both the most difficult part to prepare for, as well as the most difficult to complete. The most gratifying aspect of becoming board-certified was personal accomplishment.

Presented at the annual session of the American College of Prosthodontists, Orlando, Florida, November 6-10, 2002

Presented at the annual session of the American College of Prosthodontists, Orlando, Florida, November 6-10, 2002

Survey of implant experience by prosthodontists in the United States

The paper presents results of a survey of members of the American College of Prosthodontists (ACP) conducted to determine experiences and practices with dental implants. Preliminary survey questions regarding the prosthetic and surgical use of dental implants were developed. The master list of questions was distributed to communities of interest to establish the most pertinent items of interest. The final questionnaire was distributed to all members of the ACP living or practicing in the United States and members engaged in the U.S. armed services. Responses were compiled and analyzed to determine correlation of responses using the chi-squared test for count data (level of significance alpha = 0.05). Fisher's exact test was applied to all significant responses. Surveys were distributed to 1815 ACP members. A total of 554 (31%) surveys were completed. On the basis of age distribution of survey respondents, it was determined that the respondents were representative of the ACP membership. The majority of the respondents (82%; CI, 79% to 85%) treat patients with implant-supported prostheses, while 12% (CI, 10% to 15%) surgically place implants. Of those not placing implants, 24% reported a desire to place implants, while 43% of all respondents expressed a desire for an ACP-sponsored course in implant placement. Increased age of the prosthodontist correlated negatively with a desire to place implants (p < 0.0001). Dissatisfaction with implant placement by others correlates with willingness to surgically place implants (p < 0.0001). Most prosthodontists (82%) use implant-supported prostheses in their practices, but most of the implants are placed by non-prosthodontists. There is general satisfaction with implant placement regardless of the specialty of the practitioner placing the implants. Younger prosthodontists expressed a greater desire to surgically place implants but were not statistically more likely to do so.

Classification system for partial edentulism

The American College of Prosthodontists (ACP) has developed a classification system for partial edentulism based on diagnostic findings. This classification system is similar to the classification system for complete edentulism previously developed by the ACP. These guidelines are intended to help practitioners determine appropriate treatments for their patients. Four categories of partial edentulism are defined, Class I to Class IV, with Class I representing an uncomplicated clinical situation and class IV representing a complex clinical situation. Each class is differentiated by specific diagnostic criteria. This system is designed for use by dental professionals involved in the diagnosis and treatment of partially edentulous patients. Potential benefits of the system include (1) improved intraoperator consistency, (2) improved professional communication, (3) insurance reimbursement commensurate with complexity of care, (4) improved screening tool for dental school admission clinics, (5) standardized criteria for outcomes assessment and research, (6) enhanced diagnostic consistency, and (7) simplified aid in the decision to refer a patient.

2001 Interdisciplinary Care Conference: five disciplines, one focus. Periodontics: the odyssey continues.

Specialists from 5 fields of dentistry came together on February 9 and 10, 2001, in Dallas to learn from one another and to discuss how they can work together to enhance oral health care for their patients. During a portion of the conference, leaders from the Academy of General Dentistry, the American Academy of Pediatric Dentistry, the American Academy of Periodontology, the American College of Prosthodontists, and the American Association of Orthodontists were asked to give overviews of trends in their respective fields. The presenters were James L. Walsh, Paul S. Casamassimo, Michael McGuire, Jonathan L. Ferencz, and William H. DeKock. The talks of Drs McGuire and Casamassimo are presented here. Am J Orthod Dentofacial Orthop 2001;120:232-4

Survey of Educationally Qualified and Board‐Eligible Prosthodontists on the Board‐Certification Process

A survey of prosthodontists who have not achieved diplomate status from the American Board of Prosthodontics was conducted to identify the reasons why they have or have not pursued and/or achieved board certification in prosthodontics. A survey was sent to 500 educationally qualified or board-eligible prosthodontists in the summer of 1997. A total of 364 responses were received, for a response rate of 73%. The responses and comments were analyzed. The majority of respondents listed private practice as their primary area of professional activity. Personal accomplishment was cited by 80% of the respondents as a major motivational factor. Three major impediments to taking the examination included: time away from practice (65%), time away from family (59%), and financial sacrifice (57%). More than one third of the respondents believed there was no advantage to attempting the board examination. Less than half of the respondents have attended The American College of Prosthodontists (ACP)-sponsored Board Preparation Course, and half have used the ACP Study Guide. The respondents have perceived these to be useful in their preparation efforts. The survey presented four potential changes in the exam format that might encourage greater participation in the board-certification process. Respondents showed the greatest support (64%) for the concept of a written examination only (i.e., elimination of Parts 2, 3, and 4). Personal accomplishment was the most important motivational factor in starting the examination process. The greatest impediments to pursuing board certification were the time involved and financial resources expended. The greatest interest in a potential change in the examination format was the use of a written examination only.

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 Institute of Medicine Study of Dental Education: Issues Affecting Prosthodontics

In 1993, the National Academy of Sciences' Institute of Medicine (IOM) convened a committee to study dental education and to make recommendations regarding the future of dentistry. The study was prompted by educational and professional concerns: specifically, the number of dental school closures, the high cost of dental education, the size of the dental workforce, and the role of dentistry within medicine and the health care system. In January 1995, the IOM's Committee on the Future of Dental Education concluded “Dental Education at the Crossroads—Challenges and Change”, a 345‐page report that includes eight policy and strategic principles and presents 22 recommendations.1 The unabridged text of the strategic principles and recommendations is published at the beginning of this paper.The IOM text notes impressive achievements in dentistry, and the recommendations form a foundation for the assessment of the many crucial issues that face dental education and dentistry today. The IOM report urges each dental school to review its curriculum and individually determine how best to fulfill its missions of education, research, and patient care. As dental education looks to the future, the practice of dentistry will be altered by social, economic, political, and technological developments as our consumers (students and patients) demand professional accountability and effectiveness.2 In the midst of this call for change, the specialty of prosthodontics is faced with many challenges and opportunities. This article is the response to a request from the American Dental Association (ADA) to address the IOM study on dental education as it affects the specialty and practice of prosthodontics. This article presents the position of the American College of Prosthodontists (ACP); however, some sections have been expanded to provide additional background information.