Preceptorship in Prosthodontics - Curriculum

Concepts of Occlusion: Various concepts of occlusion with special emphasis on the clinical application of gnathology is the focus of this course. The laboratory phase includes the development of a functional occlusion through the cusp-fossa additive wax method and an occlusal equilibration technique.

Current Prosthodontic Journal Club: A review of the current literature, as it appears in major dental periodicals devoted to issues involving prosthetic dentistry, is fundamental to the practice of advanced prosthodontics. As such, a thorough review of the current literature is a necessary educational adjunct for the development of required theoretical and practical skills. The inclusion of the Current Prosthodontic Journal Club in the Preceptorship curriculum is essential to adequate advanced training in the specialty area of prosthodontics. Journal review will be held on a weekly basis from 7:00-8:00 am every Friday morning during the summer, fall and spring semesters.

Research Methodology: This course is an introduction to methods and techniques used in dental research. Topics will include basic assumptions and concepts of scientific research, selecting research topics, specifying objectives and hypotheses, literature reviews and experimental design.

Clinical Photography: This course is a series of practical demonstrations covering procedures and techniques related to dental clinical photography, small object close-up photography and making slides from radiographs. Guidelines for the selection and purchase of an acceptable clinical camera outfit will be reviewed.

Fixed Prosthodontics Tooth Preparations: A practical and rational approach to the preparation of teeth for fixed prostheses will be reviewed through lecture presentation, a review of pertinent dental literature, seminar discussion and practical application of concepts in the laboratory setting. The preparation of dentiform teeth will allow the student to apply concepts presented in lecture and receive critical review by faculty.

Removable Partial Denture Survey and Design: This short course will expose the student to the survey and design concepts for removable partial denture frameworks presently being taught on the undergraduate level at the UTHSCSA.

Oral and Maxillofacial Surgery/Prosthodontics Diagnostic Conference: This treatment planning conference is held monthly during the fall and spring semesters and is attended by the Prosthodontic and Oral and Maxillofacial Surgery Graduate Students and faculty. Patients with dental facial anomalies and those requiring combined surgical-prosthodontic management as well as dental implant patients will be presented during this conference.

Perio/Endo/Ortho/Prostho Graduate Diagnostic Conference: This conference is scheduled every week during the fall and spring semesters from 7:00-8:00 a.m. A prosthodontic resident will be teamed with a periodontic resident for combined treatment of individual patients. Both residents will be well prepared to discuss all diagnostic factors pertinent to each patient and present a treatment plan. Appropriate radiographs and/or slides should be used to facilitate presentation of these patients to all residents and faculty.

Advanced Prosthodontic Treatment Planning Seminars

Objective... to provide a mechanism for prosthodontic residents to present difficult clinical diagnostic or treatment planning situations to a panel of experienced prosthodontists to gain insight into appropriate diagnostic and/or treatment methodologies.

Description... the Advanced Prosthodontic Treatment Planning Seminar will provide an opportunity for residents to present thought provoking diagnostic and/or treatment planning situations encountered in the graduate clinic. A panel of board certified prosthodontists will be available to critically assess the diagnostic information and recommended treatment plan proposed by the resident, as well as offer varying opinions as to possible methods of addressing the clinical situation at hand. The resident will leave their presentation with the following: (1) confirmation that the proposed treatment plan is fundamentally correct or it is inappropriate and an alternate treatment plan is preferred, and (2) better insight into the clinical situation presented as well as a treatment rationale to be used during future encounters involving similar circumstances. Participation of other residents at the seminar during the discussion phase is encouraged.

Attendance... all prosthodontic residents and prosthodontic preceptees will be required to attend all seminar meetings. However, only four residents will be scheduled to present at any one seminar. The panel of prosthodontists will include UTHSCSA faculty, as well as guest members of the prosthodontic faculty from the Wilford Hall Residency Program.

Scheduling... the seminar will meet on a regular, monthly basis. Meetings will be scheduled during a convenient two hour block of time in the Prosthodontic Conference Room. Each resident presentation, clinical review and discussion should require approximately 20-30 minutes.

Presentation Requirements... the resident will select a clinical situation he/she encountered in the graduate clinic setting. The emphasis of this seminar is (appropriate diagnosis and treatment planning. Therefore, intricacies in this phase of patient care will be emphasized during the presentation. The diagnostic situation posed may involve comprehensive treatment problems (i.e., treatment approach for full mouth reconstruction) or localized, specific problems (i.e., restoration of an edentulous space bounded by severely compromised abutment teeth). The format of presentation will mainly involve clinical and/or laboratory slides. However, medical and dental history, radiographic information, pertinent extraoral examination findings, periodontal charting, occlusal analysis, accurately mounted diagnostic casts, diagnostic wax-ups, and any additional pre-treatment information beneficial to the presentation in encouraged. The resident should conclude with their recommendation as to the most appropriate treatment approach for the clinical situation depicted. The resident should be prepared to provide clear rationale for the treatment recommended and be able to answer questions for the panel.

Pediatric/Prosthodontic Patient Diagnostic Conference

Residents and staff from the postdoctoral pediatric dentistry program and residents, preceptees and staff from the prosthodontic residency program will meet on a monthly basis to discuss multidisciplinary aspects of pediatric patient care.

Craniofacial Anomalies Clinic: An active Craniofacial Anomalies Board meets on the second Monday of each month. This team includes head and neck surgeons, plastic surgeons, speech pathologists, orthodontists, pediatric dentists, maxillofacial prosthodontists, psychiatrists, geneticists, and audiologists. Prosthodontic Postdoctoral students and prosthodontic preceptees will attend this board and actively participate on a monthly basis according to a rotational schedule. Staffing during this board will be provided by Dr. Mark Pigno, head of the Maxillofacial Tertiary Care Clinic. Patients requiring prosthodontic care can be treated either in the Prosthodontic Postdoctoral Clinic, or in the Maxillofacial Tertiary Care Clinic.

Temporomandibular Dysfunction Course: Annually, in May, the first-year residents will attend a 5-day course held at the Dunn Clinic at Lackland Air Force Base. The course covers the identification of fibromyalgias and arthritides, temporomandibular joint anatomy, temporomandibular joint imaging technology, and advances in the care and treatment of the temporomandibular dysfunction and oral-facial pain patients. Splint therapy, alternative therapy, physical therapy, behavioral therapy and pharmacological and surgical treatment of these patients is also covered.

A thorough understanding of the complexities of the temporomandibular joint is necessary prior to treating the prosthodontic patient. All patients requiring major dental reconstruction should be thoroughly examined for temporomandibular joint dysfunction. This should include the use of a maxillary orthosis for resolution of the temporomandibular joint prior to dental reconstructive therapy.

Maxillofacial Prosthodontics Rotation: Each preceptor will be scheduled on a four-week rotation in the Maxillofacial Prosthodontic Clinic under the direction of the Department's board-certified maxillofacial prosthodontist, Dr. Mark Pigno. During this rotation the preceptor will observe patients being treated for acquired, congenital and developmental maxillofacial defects. Observation of ongoing laboratory technical support for the above mentioned clinical procedures is also recommended. The objective of this rotation is to gain an understanding of the prosthodontic principles involved in the multidisciplinary rehabilitation of this special patient population.

Advanced Prosthodontics Seminar: A Wednesday morning seminar will be scheduled with specified sessions delineated on the Preceptorship in Prosthodontics calendar. A monthly Literature Seminar, laboratory exercises, outside consultants and resident patient presentations will also be scheduled within the confines of the seminar (9:00 am to 12:00 noon) every Wednesday during the fall and spring semesters.

Advanced Prosthodontics Literature Review: Thorough understanding of the existing body of knowledge is essential to education at the postdoctoral level. Exposure to the history, theory, techniques, instrumentation and materials involved in modern prosthodontics will facilitate this understanding. As such, a topic oriented review of critical literature in the broad areas of fixed, removable and maxillofacial prosthodontics will be held during a literature seminar. In attendance at the literature seminars will be first, second and third year residents, prosthodontic preceptor students, faculty and invited lecturers possessing expertise in areas of interest.

Objectives of the literature seminar are: (1) to systematically review pertinent literature from dental textbooks, refereed periodicals, and instruction manuals, to facilitate comprehension of the basic tenets of modern prosthodontics; (2) to develop the resident's skills in library research, organization of ideas and presentation in a seminar format; (3) to facilitate maintenance of the "Advanced Prosthodontics Literature Review," which is a concise summary of the topic oriented literature review.

The immense nature of the literature pertinent to advanced prosthodontic education requires a significant effort from those individuals undertaking its study. For this reason, mandatory preparation by each participant and efficient conduct of each literature seminar is essential.

Implant Prosthodontics: The objective of this course is to offer each student an opportunity to obtain background information, knowledge and skills associated with dental implant treatment modalities.

Overview of Maxillofacial Prosthodontics: This course introduces the student to the discipline of Maxillofacial Prosthetics. Emphasis is placed on treating patients requiring prosthetic devices in the head and neck area due to surgery or trauma.

Endosseous Dental Implants: This course offers a graduate-level introduction to the basics of the osseointegrated implant surgical and prosthetic technique. Lectures on advanced concepts of osseointegration therapy related to several implant systems will be included.

Complete Denture Prosthodontics I: An introduction to the diagnostic phase in the treatment of the completely edentulous patient is presented. Lecture topics include clinical and laboratory examination and diagnosis, impressions, maxillomandibular relations, esthetics, denture occlusion, delivery of complete dentures and post insertion care of the patient.

Preclinical Complete Denture Prosthodontics Laboratory: A preclinical course providing instruction, demonstrations and exercises in the laboratory phases of the construction and repair of complete dentures. Students will be expected to reach the proficiency level required to satisfactorily perform the laboratory and clinical tasks assigned in subsequent courses and to access the procedures generally done by laboratory technicians.

Fixed Prosthodontics I: A lecture series designed to acquaint beginning dental students with basic principles of crown preparation and the techniques involved in constructing an extracoronal cast restoration.

Preclinical Fixed Prosthodontics Laboratory I: This component of Crown & Bridge involves preparing full veneer crowns on maxillary and mandibular first molars in a dentiform. Students will also have an opportunity to fabricate one full veneer gold crown using the direct technique.

Fixed Prosthodontics II: A lecture series designed to give students the opportunity to study the basic concepts and principles of fixed prosthodontics involving single and multiple restorations; rationale and methodology of full and partial veneer preparations and the fabrication of the castings; and the restoration of endodontically treated teeth.

Preclinical Fixed Prosthodontics Laboratory II: Exercises include the fabrication of anterior and posterior three-unit bridge with major emphasis on pontic design and temporization, and fabrication of an anterior metal-ceramic restoration. Principles of tooth preparation are presented and applied to the requirements of restorations having multiple abutments.

Removable Partial Denture Prosthodontics I: This course is a preclinical lecture course stressing the association of biological and mechanical principles in planning and constructing removable partial dentures. Emphasis is placed on student's establishing a proper working relationship with commercial dental laboratories.

Preclinical Removable Partial Denture Prosthodontics Laboratory: Exercises associated with the lecture course including diagnosis, treatment planning, survey and design, and the construction technique of removable partial dentures.

Complete Denture Prosthodontics II: This course offers a series of lectures designed to present more sophisticated material in areas of complete denture treatment not included in the first year courses. The course is designed to prepare students to provide several types of treatment that may be required by edentulous patients and includes discussions of preparation of the tissues for dentures, immediate dentures, overdentures, single complete dentures and relining of dentures.

Removable Partial Denture Prosthodontics II: This didactic course is designed to acquaint the student with a variety of approaches that may be used in treating the partially edentulous mouth. Lectures cover critical steps in treatment of the partially edentulous patient, stabilizing periodontally weakened teeth, intracoronal and other attachments used in partial denture construction, swinglock partial dentures, removable partial overdentures, and cancer therapy as it is related to prosthodontic treatment.

Introduction to Implantology: This didactic course, in association with a laboratory course (see Preclinical Implantology below) is a part of the comprehensive predoctoral implantology curriculum. The student will be introduced and oriented to the overall issues inherent in implant dentistry. The student will gain an understanding of how implant components are interrelated, assembled and disassembled in order to perform routine maintenance procedures on existing implant restorations. In the laboratory, the student will also gain experience in planning implant therapy, placing implants, restoring implant abutments, making implant impressions, fabricating provisional restorations and performing other implant related procedures.

Preclinical Implantology Laboratory: See the description above (Introduction to Implantology).