Low-cost implant overdenture option for patients treated in a predoctoral dental school curriculum.
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In an effort to make the implant overdenture more affordable for patients, a pricing package at the University of Alabama at Birmingham School of Dentistry was established. This package includes two implants, two dentures (upper and lower), and two implant abutments, all for $975. It is known as the "2-2-2" implant program. One concern regarding the program was whether patients would complete overdenture treatment or simply receive implants at this relatively low cost and have the implants restored outside the school. The purpose of this retrospective chart review was to determine how many patients in 2004 received implants as part of this program and how many of these patients completed overdenture treatment. Other data (age, distance from school, number of teeth at start of treatment, and gender) were collected to identify variables that might be associated with greater likelihood of completing overdenture treatment. In 2004, fifty-one patients received 102 implants as part of this program. Two patients had a failed implant prior to restoration (two of 102 implants), and one patient was referred to graduate prosthodontics for restoration. Of the remaining forty-eight patients, forty-one completed overdenture treatment (85 percent), and seven (15 percent) were lost to follow-up. The mean age of patients receiving this treatment was 60.7 years. The mean distance traveled to the school was 70.7 miles. While no variables showed significant predictive value, point estimates (estimate of the odds ratio) suggest that older patients and patients who travel greater distance to the school were less likely to complete treatment. The low-cost implant overdenture has been an important addition to our curriculum. The majority of patients who receive implants as part of this program complete overdenture treatment. (+info)
Survival analysis of complete veneer crowns vs. multisurface restorations: a dental school patient population.
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The purpose of this study was to compare the longevity of crowns versus large multisurface restorations in posterior teeth. The investigation used the treatment database at Virginia Commonwealth University School of Dentistry. The inclusion criteria for the final data set used for analysis were: only one restored tooth per patient, premolars with three or more restored surfaces, molars with four or more restored surfaces, molars and premolars restored with complete veneer metal crowns, or crowns veneered with metal and porcelain. The Kaplan-Meier approach was used to visualize the survival curves, and the Cox proportional hazards model was used for analysis of predictor variables. The investigation indicates crowns survive longer than large restorations and premolar restorations survive longer than molar restorations. The median survival for crowns exceeded 16.6 years, with the median survival of premolar restorations being 4.4 years and molar restorations 1.3 years. An interaction between age and treatment was discovered, with overall survival decreasing as patient age increases. The doctor supervising the treatment also affected survival with treatment supervised by specialists lasting longer than treatment supervised by nonspecialists. (+info)
Eye safety practices in U.S. dental school restorative clinics, 2006.
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This study was conducted to determine how much progress U.S. dental schools have made in providing eye protection during restorative (adult operative and fixed prosthodontic) procedures since a 1979 survey. A seven-question survey was placed at a website, and fifty-five different U.S. dental schools were asked to complete the survey. Thirty-one schools responded (56 percent). Eighty-four percent of schools had safety glasses available for patients, but only 77 percent required usage during restorative procedures. Similarly, while 87 percent of schools required dental students working in restorative clinics to wear safety glasses, just 73 percent enforced the policy. Additionally, 84 percent provided blue light protection on curing lights and required students to wear eye protection while doing lab procedures. Compared to the 1979 survey, considerable progress has been made over the last twenty-seven years in protecting dental school patients and students from ocular injuries. Because one would hope to have 100 percent compliance on this issue, there is room for improvement in promoting patient eye safety and teaching good habits to dental students. (+info)
Urgent care in the dental school setting: analysis of current environment and future challenges in emergency dental education.
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Urgent dental care education is a critical aspect of the D.D.S. curriculum as dental students must be adequately prepared to face real-world dental emergency challenges in practice. Dental emergency education is likely the most variable component of the dental curriculum. To assess potential differences in emergency education, a sixteen-question survey was sent to directors of urgent care of all fifty-six U.S. dental schools addressing clinic operation, demographics, treatment, integration into the D.D.S. curriculum, and provision of care for indigent populations. The response rate was 88 percent. Results indicate a need for earlier integration of urgent dental care education into the D.D.S. curriculum, more pediatric emergency experiences for D.D.S. students, and a more rigorous academic approach in assessing student competency while on rotation in the urgent care service. In addition, access to emergency dental care has become increasingly difficult for indigent populations due to lack of state-supported funds; further exploration of sources of external funding for such care is warranted. (+info)
The correlation of student performance in preclinical and clinical prosthodontic assessments.
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Tracking student performance in preclinical and clinical courses can be helpful in developing and refining a curriculum. Our objective was to correlate student performance on three fixed prosthodontic examinations taken by eighty junior dental students. Examinations included a knowledge-based objective structured clinical examination (OSCE), a manual skills exercise completed on a typodont (Typodont), and a competency casting exam (Casting CE) on a patient. Multiple regression analysis indicated that the OSCE and Typodont exam scores, as independent variables, were not statistically significant predictors (P=0.07; P=0.87, respectively) of Casting CE exam performance, which was the dependent variable. Correlations were weak for the OSCE (r=0.21) and nearly nonexistent for the Typodont exam(r=0.03) when compared to the Casting CE. Our results indicate a weak correlation between an OSCE-based knowledge exam measuring students' knowledge of critical errors in preparations and castings and a competency exam involving the preparation of a full veneer crown. Results also indicate virtually no correlation between a typodont preparation examination designed to provide a measure of students' clinical skill and a clinical competency exam involving the preparation of a full crown. (+info)
Carving of a master cast to obtain a posterior palatal seal of a complete maxillary denture as performed by four prosthodontists: a pilot study.
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This study was conducted to clarify the degree to which a master cast needs to be carved to obtain a posterior palatal seal according to Swenson, based on a comparison among four dental practitioners. Sections of the casts with the seal scraped were made, and an optical microscope was used to measure the sagittal and vertical dimensions. It was found that the sagittal dimension may show a smaller difference in carving of the master cast in the posterior palatal seal area. The present results also suggest that the clinical experience of the prosthodontist in applying this method seems to have an effect on the carved shape and depth of the posterior palatal seal. (+info)
Management of exaggerated gag reflex using intravenous sedation in prosthodontic treatment.
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The gag reflex is a somatic natural response in which the body attempts to eliminate instruments or agents from the oral cavity by muscle contraction. Some patients suffered from such severe retching that behavioral techniques did not sufficiently reduce gagging in dentistry. In these patients, pharmacological management was thought to be the last alternative to eliminate the reflex. However, the potential of intravenous (IV) sedation as a way to overcome problems in gagging management during prosthodontic (prosthetic) therapy has not been sufficiently explored. We examined the benefit of IV sedation to facilitate prosthodontic treatment for problematic gagging patients intolerable to dental therapy. The subjects were 10 severely retching patients (7 males and 3 females) who received prosthodontic or restorative therapy under propofol IV sedation. The number, location and prognosis of dentures/restorations were reviewed retrospectively. Eight dentures (3 removable and 5 fixed partial dentures) and 22 restorations (18 crowns and 4 inlays) were seated successfully in the oral cavity without serious complications related to IV sedation. The restored teeth were located predominantly in the posterior regions. Throughout the observation period of at least 6 months, no symptoms of postoperative pain or swelling were found. Five of the 10 patients showed improved tolerance to oral inspection, indicating a behavioral adjustment to dental care. In prosthodontic treatment extended to the posterior regions, propofol IV sedation proved useful in managing reflex control. (+info)
The impact of targeted shortened preclinical exercises on student perceptions and outcomes.
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The Harvard School of Dental Medicine (HSDM) introduced problem-based learning (PBL) into the dental curriculum in 1994 as a part of curriculum reform. During the reorganization, departments were consolidated, and courses were taught in an interdisciplinary fashion rather than in a discipline-based approach. The changes required a reduction in lecture and preclinical clock hours, which might have affected student performance and anxiety levels. The objectives of this study were to 1) compare the HSDM didactic and laboratory preclinical hours in Endodontics, Operative, and Prosthodontics before and after PBL implementation; 2) compare the HSDM didactic and laboratory preclinical hours in Endodontics, Operative, and Prosthodontics with other schools nationwide; 3) measure students' perceptions of their levels of stress and self-confidence at two time points during their preclinical and clinical years; 4) investigate the correlation between the number of preclinical hours and the students' stress level and self-confidence; and 5) evaluate the impact of shortened preclinical hours on the performance of HSDM students on the National Board Dental Examination Parts I and II. A survey regarding the students' level of stress, self-confidence, and preparation to treat patients during preclinical laboratory exercises was distributed to the HSDM classes of 2005 and 2006 (n=70). The HSDM preclinical curriculum hours were compared to national data as reported by the American Dental Association (ADA). Cross-tabulations were constructed, and the Fisher's exact test was conducted to examine the relationships between the variables. We found that HSDM preclinical hours in Endodontics, Operative, and Prosthodontics were significantly lower than at other schools. During the preclinical exercises, the Prosthodontics preclinical exercises were found to be the most stressful and provided the lowest self-confidence in treating patients as compared to the other preclinical subject areas. HSDM students' scores on the National Board Part I and II examinations continue to be among the highest in the nation and have not been affected by the change in curriculum. We conclude that the change in HSDM's curriculum that resulted in targeted, shorter preclinical exercises has not affected clinical and didactic outcomes, but may have affected the anxiety that students feel when entering the clinic. (+info)