U.S. Maxillofacial Prosthetics Programs: Fellows' and Directors' Perspectives.

Maxillofacial prosthetics (MFP) programs in the U.S. select only a limited number of applicants for fellowship positions. The aims of this study were to survey MFP fellows about which factors influenced their choice of programs and to survey MFP directors about what they considered critical factors in the selection process. Surveys were sent to all eight directors and 13 fellows at all eight U.S. MFP programs in June 2015. The directors' questions asked about general information, resident selection process, letters of recommendation, interview process, and decision process. The fellows' questions addressed their demographics, program-related factors, and future goals. The directors' surveys were sent directly to the directors, and the fellows' surveys were sent to the directors for distribution. The survey response rate for the directors was 87.5% (N=7), and that of the fellows was 53.8% (N=7). In selecting fellows for programs, responding directors reported the interview process was most important, followed by letters of recommendation, personal statement, and prosthodontic program grades. Responding fellows reported that location, variety of treatment, patient volume provided, and clinical education were crucial components in their choice of program. This information may be useful to MFP programs and fellows in the continuing development of this specialty.

Maxillofacial prosthetics training and practice profiles in the United States.

STATEMENT OF PROBLEM: The motivation of maxillofacial prosthodontists to go into fellowship training and specific procedures in maxillofacial prosthetics practice once they have completed training has not been previously evaluated. PURPOSE: The purpose of this study was to survey maxillofacial prosthodontists in the United States to investigate their reasons for pursuing maxillofacial prosthetic training and their practice profiles. MATERIAL AND METHODS: In June 2015, a survey was sent to all US maxillofacial prosthodontists asking for descriptive demographics, their reasoning as to what prompted entrance into a maxillofacial prosthetic program, and their practice pattern. Frequencies, percentages, means, and standard deviations were calculated and reported. RESULTS: The survey response rate was 60.4%. The main reason for pursuing maxillofacial training was primarily personal satisfaction, prosthodontic residency exposure, and mentorship rather than media exposure and compensation. The time spent in prosthodontic practice varied among practitioners, with the majority of practice time spent accomplishing standard prosthodontic procedures (65.59%) versus maxillofacial (25.53%) or surgical procedures (9.67%). Of 12 clinical maxillofacial procedures inquired about, the most prevalent were obturators, dental oncology, and mandibular resections. CONCLUSIONS: This study reveals that personal satisfaction, mentorship, and prosthodontic residency exposure were the reasons most prosthodontists pursued an additional year of maxillofacial prosthetic fellowship. Most were very satisfied with their training and chosen career path and would recommend an additional year of training. The majority of maxillofacial prosthodontists provided maxillofacial prosthetic treatment for approximately one fourth of their practice time. The most common procedures performed were obturators, dental oncology, and mandibular resections.

Survey of Advanced Education in Prosthodontics Directors and Residents on Practices in Esthetic Dentistry.

The aim of this study was to determine the difference between the intended education by advanced education in prosthodontics (AEP) program directors and the perceived education received by AEP residents with respect to concepts of esthetic dentistry. Residents' confidence levels and current practices were also determined based on program level, with first- and second-year residents combined into "junior residents" and third- and fourth-year residents combined into "senior residents." Surveys were distributed to all U.S. and Canadian AEP program directors (N=52) in 2014 and residents (N=393) in 2015. The seven questions asked of directors and 20 asked of residents assessed resident training. The response rate for directors was 59.6% and for residents was 27.3%. Statistically significant results were found between the responding program directors' perceived education on esthetic principles and the responding residents' perceived education. The senior-level residents were more confident in each of the categories than residents at the junior level, although the difference was only significant for selecting porcelain systems to match inherent translucency, transfer of information to the laboratory, and surface staining or characterization. There was a difference between the program directors' intended teaching and the residents' perceptions with regards to bleaching, shade matching, selection of porcelain systems, transfer of information to the laboratory, and surface staining or characterization. The residents' confidence levels were higher at the senior level than those at the junior level in selecting porcelain systems, transfer of information to the laboratory, and staining/characterization. Faculty members in advanced prosthodontics programs may be able to use these findings to improve their residents' education in these areas.

The effect of phosphoric acid pre-etching and thermocycling on self-etching adhesive enamel bonding.

STATEMENT OF PROBLEM: When inserting a resin-bonded prosthesis, it is not known whether pumicing, rinsing, and using a self-etching primer (SE) on prepared surfaces is sufficient or whether the use of an additional conventional acid etchant is warranted due to the increased time and risk of contamination. PURPOSE: The purpose of this study was to evaluate the effects of pre-etching with phosphoric acid (PA) and thermocycling (TC) on the enamel shear bond strength (SBS) of an autopolymerizing adhesive system on ground enamel. MATERIAL AND METHODS: Human teeth were embedded in phenolic rings with methyl methacrylate resin, and their enamel surfaces were ground flat to a 600 grit surface. The teeth were then divided into 4 subsets (n=22): 1) PSN, PA pre-etch with SE, no TC; 2) PST, PA pre-etch with self-etching primer and TC; 3) SEN, self-etching primer alone, no TC; and 4) SET, self-etching primer and TC. A multifactorial study design was used to evaluate 2 factors (pre-etching with PA and TC) at 2 levels (presence or absence) by grouping different subsets. Pre-etch consisted of teeth being etched for 30 seconds with PA, rinsed, re-etched, and rinsed. Self-etching consisted of 60 seconds with ED Primer. Rods of Rexillium III, airborne-particle abraded with 50 µm aluminum oxide, were bonded to enamel surfaces with Panavia 21 OP under a 19.6 N load. Thermocycling consisted of alternating between water baths of 5 ± 2°C and 55 ± 2°C for 5000 cycles. Shear bond strength (SBS) was determined by loading the specimens to failure at a crosshead speed of 1 mm/min. Mean values were analyzed with a 2-way ANOVA (factors were surface treatment and TC) at α=.05. RESULTS: Pre-etching with phosphoric acid showed greater SBS to enamel (P=.028) than the self-etching primer alone. Thermocycling did not have a significant effect (P=.424). CONCLUSIONS: There was a significant difference in SBS between pre-etching enamel surfaces with phosphoric acid in addition to the self-etching primer and using the self-etching primer exclusively. Thermocycling did not significantly affect SBS.

Predoctoral implant education: the Creighton experience at 20 years.

The landscape of predoctoral implant education has changed dramatically in the short span of two decades. Documented success and increased patient demands have driven heightened expectations upon the educational community. Predoctoral education must play a pivotal role in preparing the profession to meet these new opportunities. The evolution of implant education in the predoctoral sector is examined, and a typical implant program is described.

Accuracy of a fixed value nasion relator in facebow design.

PURPOSE: This study examined whether a fixed value nasion relator accurately locates the orbitale in a patient population. MATERIALS AND METHODS: The mean value for the vertical distance between soft tissue nasion and orbitale was determined through the analysis of cephalometric radiographs of 114 adult patients. This value was then compared to a facebow design, which uses a fixed value of 25.4 mm. RESULTS: In this study, the mean distance between the orbitale and nasion was found to be 26.8 mm. The values ranged from 15.9 to 39.4 mm with a standard deviation of 3.87 mm. CONCLUSION: The difference between the calculated mean and the 25.4 mm fixed value was less than 2.0 mm and presumed to be clinically irrelevant; however, an accumulation of design errors combined with the variation within the patient population was asserted to be clinically relevant and makes the use of a fixed value nasion relator impractical.

Cement selection for cement-retained crown technique with dental implants.

PURPOSE: The purpose of this study was to assess and compare the retentive nature of common dental cements that have been adapted for use in the implant abutment cement-retained crown (CRC) technique with those specifically formulated for this purpose. MATERIALS AND METHODS: Ten regular diameter implant analogs were embedded in stainless steel disks. Unmodified CRC abutments were attached and torqued to 30 Ncm. Test crowns were waxed and cast with base metal alloy. Castings were fitted, cleaned with aluminum oxide, and steam cleaned prior to application of the cement. The cements used were: (1) Temp Bond, (2) UltraTemp, regular, (3) UltraTemp firm, (4) ImProv with petroleum jelly coating of crown, (5) ImProv without petroleum jelly, (6) Premier Implant with KY Jelly coating of abutment, (7) Premier Implant without KY jelly, (8) TR-2, (9) Fleck's, (10) Ketac Cem Aplicap, and (11) Fuji Plus Capsule. After cementation, assemblies were stored for 24 hours. Each sample was subjected to a pull-out test using an Instron universal testing machine at a crosshead speed of 5.0 mm/min. Loads required to remove the crowns were recorded, and mean values for each group determined. A one-way ANOVA and a post hoc least square difference (LSD) test were done for pairwise comparison at a confidence interval of 95%. RESULTS: The mean values (+/-SD) of loads at failure (n = 10) for various cements were as follows (N): Ultratemp, regular 358.6 (+/-38.2) (Group A), ImProv without petroleum jelly 172.4 (+/-59.6) (Group B), Fleck's 171.8 (+/-62.2) (Group B), Ketac Cem 167.8 (+/-69.1) (Group B), UltraTemp firm 158.8 (+/-62.7) (Group BC), Fuji Plus 147.5 (+/-69.7) (Group BC), Premier without KY jelly 131.6 (+/-31.8) (Group BC), ImProv using petroleum jelly 130.8 (+/-42.5) (Group BC), Temp Bond 117.8 (+/-48.3) (Group C), TR-2 41.2 (+/-16.6) (Group D), and Premier with KY jelly 31.6 (+/-24.8) (Group D). Groups with the same letter were not significantly different. CONCLUSIONS: Within the limitations of this in vitro study, it is not suggested that any one cement is better than another at retaining cement-retained crowns (CRCs) to implant abutments or that a threshold value must be accomplished to ensure retention. The ranking of cements presented is meant to be a discretionary guide for the clinician in deciding the amount of desired retention between castings and implant abutments.