Prosthodontic and restorative care in the 21st century.

In a recent report on oral health, Surgeon General Satcher reminded us of the need to change the attitudes of families concerning the importance of oral health. In prosthodontics and restorative dentistry, remarkable developments are occurring daily. Specialties are changing, and different types of dental practices are emerging. The introduction of computer technology has greatly affected the way the restorative dentist practices, and the evolution of cyberschools are no longer a fantasy. Adhesive dentistry has replaced the manner in which we prepare, restore, and bond restorations to teeth. The entire field of ceramics and methods of fabricating esthetic restorations are entering a new era. The exceptional prognosis of various implant systems has changed the way we think about maintaining hopeless teeth. Through tissue engineering, the 21st century may be revolutionary in the way we replace missing teeth and lost tooth structure.

Clinical and microbiological aspects of the Sargon immediate load implant.

A maxillary lateral incisor with severe periodontal destruction was extracted after forced eruption and was replaced with a Sargon Immediate Load Implant. The clinical and microbiological results of the case are reported. The Sargon Immediate Load Implant is an apically expandable, quintapodal, root-form dental implant, designed to be loaded immediately with a provisional fixed restoration in normal occlusion.

Microscope-assisted precision (MAP) dentistry. A challenge for new knowledge.

The purpose of this paper is to acquaint the dentist with the learning needs associated with the use of microscope-assisted precision dentistry (MAP) and identify certain concepts that will assist in the education process. Although the learning curve is considered to be lengthy and often difficult, the authors believe that the clinical benefits of MAP dentistry are well worth the necessary effort to achieve a level of competency with this methodology.

Problem-based learning at the University of Southern California School of Dentistry.

Responding to the recent Institute of Medicine report on dental education, the Center for Craniofacial Molecular Biology (CCMB) of the University of Southern California School of Dentistry has developed a parallel track program in dental education leading to the D.D.S. degree. This program was proposed in May of 1995, and the first class of twelve students was admitted in September of that year. Currently two classes are enrolled and plans to admit a further twelve students (Class of 2001) are in place. The educational strategy for this program is totally problem-based. Students work in groups of six with a faculty facilitator, not necessarily a content expert. Facilitators are largely drawn from the multidisciplinary pool of research faculty at the center. All learning is mediated through biomedical and biodental problem cases. No formal lectures or classes are scheduled. The learning of clinical dental skills is promoted through focussed dental patient simulations in which students review clinical charts, radiographs, medical reports and then explore identified, hands-on learning needs using patient simulators in a clinical context. Early patient exposure is obtained through dental office visits and other special patient clinics. Initial experience with this program suggests that the problem-based learning (PBL) students learn as well (if not better) than their traditional program peers and develop excellent group and cognitive analytical skills. The absence of a pool of dentally related biomedical cases suitable for a PBL program has necessitated the use of innovative approaches to their development and presentation. It is believed that this educational approach will produce dental clinicians equipped with the self-motivated, life-long learning skills required in the ever-changing world of bio-dental sciences in the twenty-first century.

Dental education and practice in the 21st century: opportunities for excellence.

This study describes the environment that can be expected for dental education and dental practice as the 21st century approaches. The study uses data from many sources, including the recent report from the Institute of Medicine, which provides a comprehensive analysis of the variables that will affect dental education and practice in the next decade. Dental education and practice will be able to thrive if the new forces are carefully examined and the challenges are met promptly.

Understanding occlusion as it relates to the temporomandibular joint--the fourth molar paradigm.

In the typical dental office, at least one third of the patients present with indications for an occlusal appliance. Eighty percent of craniomandibular patients observed in general practice can and should be treated by the general practitioner. Unfortunately, because of time constraints in dental school curricula and prevailing controversies concerning occlusion, many dentists lack the skills and confidence necessary to provide these services. In this article, the authors use the Fourth Molar Paradigm and the Dental Joystick Paradigm to facilitate an understanding of how occlusion relates to the temporomandibular joint and craniomandibular disorders. This knowledge is necessary to correctly interpret temporomandibular radiographs, diagnose and treat craniomandibular disorders, and plan and execute any dental therapy that alters the mandibular position. In addition, in the absence of scientific research to confirm or disqualify the Occlusion Hypothesis, which states that malocclusion is a risk factor for craniomandibular disorders, the authors offer the stated paradigms to support the Occlusion Hypothesis.

The influences of fear, anxiety, and depression on the patient's adaptive responses to complete dentures. Part III.

The iatrosedative interview is an effective method of helping patients who are unable to adapt to dentures because of fear, anxiety, and depression. It creates an indispensable trusting relationship in the process of determining the factors responsible for the maladaptiveness and offers a solution to the problem.

The influences of fear, anxiety, and depression on the patient's adaptive responses to complete dentures. Part II.

The classification system of maladaptability presented in a previous paper was reviewed in the present one. Three major sources that significantly influence patient responses to tooth loss and subsequent dentures were discussed. They are parental influences, the symbolic significances of teeth, and current life circumstances. Each of the maladaptive categories is represented by these histories.

The influences of fear, anxiety, and depression on the patient's adaptive responses to complete dentures. Part I.

Loss and body image can result in anxiety, depression, or both and can affect a patient's adaptive capacity to accept edentulism and complete dentures. A specific classification system has been presented to identify responses by individuals who are made edentulous. Three types of maladaptive responses are considered as probable consequences of fear, anxiety, and depression associated with tooth loss and complete dentures. In maladaptive class 1, the patient adapts physically but is maladaptive psychologically; thus suffering some impairment of the quality of life. In maladaptive class 2, the so-called "difficult patient" is maladaptive physically and psychologically and keeps the doctor involved technically and emotionally for a protracted period of time. The maladaptive class 3 patient collapses with the loss of teeth. Physical and emotional maladaptibility is accompanied by much suffering and social withdrawal.

Perceived or actual overlap between the scope of prosthodontics and other recognized dental specialties.

Prosthodontics does not overlap with other specialties but is integrated with them. This essential difference between "overlap" and "integration" should be made abundantly clear. No one denies that most of the population's dental needs must be served by the general practitioner, and no specialist can be completely capable within even his or her own specialty. Nevertheless, the prosthodontist, as all specialists, must assume the role of treating patients who require unusual care. It is the prosthodontist who most frequently assumes the primary role in the management of patients who require complex, demanding restorative care, and it is the prosthodontist who has the most intimate understanding of the proper diagnosis, treatment planning, integration of therapy, patient management, and aftercare for these patients.