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Opinions of Dentists on an Integrated Fixed and Removable

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Opinions of Dentists on an Integrated Fixed and Removable M. A. I. (Lex) MacNeii, DDS Assistant Professor Assistant Dean, Ctinical Affairs M, I. MacEntee. PhD, LDStI), Dip Prostb, FRCDiO opinions of Dentists on an Professor and Chair Division of Proithodonlics Integrated Fixed and Department of Clinical Dental Sciences Removable Prosthodontic Faculty of Dentistry University of British Columbia Curriculum Vancouver, British Columbia, Canada Dentists in practice from 3 to 5 years who were exposed to an integrated fi>;ed and removable prosthodontic curriculum as students al the tjniversity of British Columlîia responded to a survey on the relevance of their prosthodontic education to current dental practice. The majority of the respondents reported fhat the integrated curriculum prepared them adequately for general dental practice, although many felt fhat they would have benefited from a greater emphasis on specific treatments, mosf notably cast metal inlays and onlays, all-ceramic restorations, and implant-supported prostheses. In! I ProsthodonI 1997,10:14-18. he Commission on Dental Accreditation in 9. Single-unit ceramic and metal ceramic resto- TCanada uses the Curriculum Guidelines devel- rations oped by the American Association of Dental 10. Fixed partial dentures Schools to assess and approve the quality of dental 11. Restoration of nonvital teeth professional education in Canada.^ The guidelines 12. Partial denture abutments for prosthodontics state that students "must under- 13. Resin-bonded restorations stand and demonstrate competence in "a wide 14. Implant-supported fixed prostheses (when range of procedures, from complete dentures to available). various intracoronal and extracoronal restorations." Graduates must demonstrate competence in: Graduates must also have an understanding of: 1. Complete dentures 1. Attachments for removable prostheses 2. Removable partial dentures 2. Principles ol restorations witb dental implants 3. Immediate complete dentures and immediate complete overdentures These guidelines were established in 1980, and 4. Complete dentures opposing removable partial they remain unaltered apart from a recent refer- dentures ence to overdentures, implants, and resin-bonded 5. Single complete dentures and all-ceramic restorations. 6. Interim and/or transitional dentures The educational goals of an accredited program 7. Relining, rebasing, and repairing a removable imply that a new dentist must be able to examine prosthesis and manage patients requiring any of these prosthe- 8. Single-unit cast-gold restorations (partial or ses. However, a survey of dentists in British complete coverage) Columbia about 15 years ago found that a large pro- portion of the respondents, educated in Candida or Reprint requests: Dr M, A. /. (Lex) MacNeil, Faculty of DanUitry,the United States, provided few complete oi imme- University of Brifish Coiumbia, 2199 Wesbrook Mill, Van- diate dentures, and they did not adhere to ih(^^ re- couver. Briusfi Caiurr)bÍ3, Cenaría V6T !Z3. movable prosthodontic principles taught in dental The Irlernalional lourna! of Prosl 14 Volume 10, Number 1,1997 Opinions o( Denlisis on Prosliindonlic Curricuium schools.-' For example, nearly two thirds of the re- Table 1 Prosthodontic Services Offered Frequently spondents admitted ihai they did nol use a dental by Recent Denfai Graduates surveyor, and about one quarter of ihe dentisis did Percentage nol provide a detailed prescription lo a dental tech- distribution Sen/ice (n = 55) nician when designing removable partial dentures. In fact, about half of the respondents said ihat they Cast metai and meial ceramic crowns 95- Restoralions ol endodonficaily Irealed teeth 80- routinely accepted designs developed solely by den- Partial dentures tal technicians. hxed 66- removable About 25 years ago there was a move in post- Mainfenance procedures (eg, denture reiine) 611 graduate dental education in North America to im- Compiete dentures prove the scope of specialty services by combining sefs 33t fixed and removable prosthodontic programs. In singie 311" Cast mefal inlays/onlays 24 keeping with this move, and because of the re- immediate denf ures/overd enture s 19 sponse to a 1980 survey of dentists in British Ceramic crowns/in i ays/on lays/veneers ^2 Columbia, the Faculty of Dentistry at the Implan t-supporfed prostheses 2 University of British Columbia (UBC) integrated the "Combined dislributior = 53%. tCombirea disiriButior ^ 24%. fixed and removable undergraduate prosthodontic programs.'' The integration drew from the mixture of clinical and nonclinical sciences as specified by the accreditation guidelines.' This paper presents the opinions of dentists who graduated from the integrated program 3 lo 5 years previously to identify: (1) the scope of prosthodon- tic services they felt competent to provide; ¡2) the were allowed to choose to remain anonymous. The change in practice that they anticipated in the fore- response rate was improved by randomly accessing seeable future; and (3> their feelings about the potential participants who did nol respond on first prosthodontic education they received. The 51 responses were reviewed upon return Methods and divided into two groups: those from dentists who identified themselves (n = 23); and ihose from The authors developed a structured questionnaire demists who did not (n - 28). Subsequently, a ran- in three sections and tested it on a small group of dom selection was made from the combined pool dentists to reduce ambiguity. Section One focused of 28 anonymous respondents and 54 nonrespon- on practice characteristics, year of graduation, and dents to yield an additional 49 potential partici- prosthodontic training since graduation. Section pants. Telephone conlaci was made with 39 of Two addressed the current and anlicipated scope those anonymous respondants or nonrespondenls, of prosthodontics in practice, and requested an as- of whom 14 said that they had returned the ques- sessment of the prosthodontic education received. tionnaire anonymously, another 14 offered to an- Section Three asked for a self-rating of prosthodon- swer the questionnaire and return it hy mail, while tic skills, and an assessment of the prosthodonlic the remaining 11 answered an abbreviated form of education as a basis for further learning. Responses the questionnaire directly on ihe telephone. This to the questionnaire slatements were solicited on a strategy produced an additional seven question- 10-point scale indicating the extent of agreement naires, providing for a total of 58 written responses or disagreement. and 11 verbal responses, for a combined response One hundred seventeen dentists graduated from rateof ñ6%of the 105 available graduates (Fig 1). University of British Columbia between 1989 and Measurements on the 10-point scale were trans- 1991, and the questionnaire was maiied lo the 105 formed into dichotomous (agreement/disagree- who were in general practice and who could be ment) scores with an arbitrary cut-off between five contacted (Table 1). The survey was restricted and six to produce a reasonably balanced distribu- to graduates from this 3-year period because it tion of the data for further analyses. Bivariale tables seemed reasonable that dentists with 3 to 5 years in and chi-square tests were constructed to compare practice would have the experience necessary to respondents with nonrespondents, and to test for judge the significance and practical impact of the associations between opinions on the integrated educational program, and that they would respond.-' prosthodontic program and the scope of prostho- Return postage was provided, and the respondents donlic practice. , Numbcri, 1997 15 The lnlerr)alional loiirnal of Proslhodontk Graduates (117) .(12) Available (105) Response (51] No response (54) J Unidentified (28) I Not randomly Randomly selected (49) selected (33) Contact by phone (39) No contact (10) (43) Previous Interview Offered response by response telephone (14) Previous No response response Response No response Fig 1 Selection of respondents. 'Total respondents = 69. "Tolal nonrespondents = 48. Results The change anticipated in the demand for prosthodontic services was highest for single-tooth Characteristics of the Sample restorations, fixed partial dentures, and, most no- tably, for implant-supported dentures, accompanied Response rales from the three graduating years var- by a drop in demand for complete and immediate ied considerably (39% from 1989; 31% from 1990; dentures or overdentures (Table 2). 26% from 1991; and 4% unknown), but, as ex- Almost two thirds (62%) of the respondents were pected, the majority (70%) of the 58 respondents satisfied with both the didactic and clinical educa- practised in a large metropolis. Over half (53%) of tion they received for crowns and fixed and remov- the 58 respondents provided crowns, fixed partial able partial dentures in contrast to intracoronal and dentures, and endodontic post/cores as frequent ser- implant-related restorations (Table 3). They felt vices in practice, whereas less than one quarter competent to plan and perform most treatment in- (24%) of them offered complete and removable par- volving dentures alone or combined with other tial dentures frequently (Table 1). However, nearly prostheses, but they were less confident in chang- everyone (91 %) reported that they used a dental sur- ing the occlusion or providing dentures on im- veyor to design removable partial dentures. There plants (Table 4), Overall, respondents felt that the was substantially less involvement in cast metal or integrated
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