PROSTHODONTICS - American College of Prosthodontists

The American College of ProsthodontistsDental implants were introduced several decades ago and in fact, when first introduce inNorth America, their use as promoted by industry was restricted to Oral Surgeons andProsthodontists. Thus, implants as a technology for tooth replacement therapy have been partof the specialty of prosthodontics since the early 1980’s and well before. In the last 10 years,several important innovations in dental implant therapy have advanced the specialty ofprosthodontics.As mentioned above, the role of CBCT imaging and the inherent need for imagingprostheses (stents/guides) involves prosthodontics and prosthodontists at the inception and endof this diagnostic procedure for dental implant placement and restoration. One further pointabout this technological change is that present advances not yet in the market place includepre-surgical planning of abutments and final prostheses. This is made available by the mergingof scanning information from the dental laboratory and the clinic and there joining in threedimensional models. The simplest way to perform this is through double scanning technologiesdeveloped for tooth replacement using implants for immediate loading protocols popularized as“teeth in a day” protocols. Prosthodontists have refined these technologies that enable thebetter implant therapy and patient care.Among the procedures in implant dentistry there has been increasing interest in early andimmediate loading of implants. Immediate loading is the process of placing an implant and animplant supported restoration at one time. There must be an integrated plan as well asintegrated thinking about the biology of implant wound healing of bone and mucosa, occlusionand esthetics. Advances in all aspect of knowledge have been achieved in this decade withwide participation of prosthodontists. The commitment of prosthodontists to Evidenced BasedDentistry is demonstrated in this field as several prospective comparative clinical trials havebeen published in support of immediate loading for specific conditions and other clinical trialsare ongoing and have been reported at national and international meetings. Systematic reviewof the literature (Jokstad 2007) supported the concept of immediate loading of implants placedin the anterior mandible but was unable to identify scientific support for immediate loading inother anatomic areas. Irrespective of the data set, immediate loading is part of the practice ofimplant dentistry. Its proper deployment as one strategy requires ongoing investigation, carefulplanning and education of the broader community of dentists. The American College ofProsthodontists is committed to support of all of these activities related to this mode of treatmentand other emerging therapies in dentistry.The spectrum of care provided for using dental implants is changing. This decade hasseen a strong push by the prosthodontic community to improve care of the edentulous patient.In the summer of 2008, the ACP with support of industry presented to the internationalcommunity at the FDI meeting in Stockholm, the current concepts and challenges in treatmentof edentulism. This information was also published in the Journal of Prosthodontics in 2009.The community of interest has developed enthusiasm for treatment of edentulism using minimalnumbers of implants for overdentures. An international consensus conference has identified themandibular implant supported overdenture as the standard of care for management of theedentulous mandible (Feine IJP 2002). Prosthodontists are now educated in thecomprehensive management of edentulism that includes the surgical placement of implants.Materials science related to Prosthodontics has been focused on ceramics. The use ofpressed and milled materials is driven by the public focus on esthetics. Diverse materials havebeen studied and among them zirconia has drawn greatest attention. Zirconia offers thepossibility for multiunit prosthesis (fixed dental prosthesis) where other materials haveinsufficient strength for broad based application. Related to the evolution of ceramics, thebonding of these different materials continues to be explored. Adhesive bonding to enamel andto a lesser degree to dentin has been reconsidered in the context of zirconia, lithium disilicateand leucite reinforced ceramic materials. Organized prosthodontics is part of this evolutionthrough its support of basic research, clinical research and dissemination of current information.For example, the ACP sponsored in April 2010 a conference entitled “The Art and Science ofModern Dental Ceramics 2010” where 20 expert clinicians offered scientific fact and expertopinion regarding these matters.Prosthodontics - 112010 CDEL Re-recognition of the Specialty Report 11 of 279