III. Goals and Requirements

Prosthodontic lecture seminars:

The prosthodontic lecture seminars are conducted once a week, for one and one-half hours from August through May. Material is presented from the following selected topic areas. Lectures will include Power Point/Keynote presentations, handouts, and any other items that will help convey the information. These lectures are given by residency staff, dental school professors, private practitioners, residents, and members of the Armed Forces stationed in the area. These include multiple specialties in addition to prosthodontics. The use of digital technology may be included in any or all of these presentations.

Fixed Prosthodontic Discussion Areas

1. Diagnosis and Treatment Planning
2. Preparations
3. Soft Tissue Management
4. Impressions
5. Interim Restorations
6. Crown Contours, Pontics
7. Articulator Selection, Rehabilitation Techniques, Functionally Generated Path
8. Centric Position, Interocclusal Records
9. Mandibular Movement and Recording
10. Implants
11. Cementation, Failures
12. Ceramics
13. Temporomandibular Disorders
14. Endodontic Considerations, Build-ups and Posts

Removable Partial Denture Discussion Areas:

1. Introduction
2. Diagnosis and Treatment Planning
3. Design Principles
4. Components and Clasping
5. Distal Extension RPDs
6. Occlusion
7. Fitting and Insertion
8. Swinglock RPDs
9. Rotational Path
10. Miscellaneous

Complete Denture Discussion Areas:

1. Diagnosis and Treatment Planning
2. Impressions
3. Centric Relation Records
4. Vertical Dimension
5. Denture Occlusion
6. Anterior Tooth Selection and Esthetics
7. Overdentures
8. Immediate Dentures
9. Miscellaneous

Maxillofacial Discussion Areas:

1. Management of the Irradiated Head and Neck and Oncologic Patient
2. Prosthodontic Rehabilitation of Acquired Maxillary and Mandibular Defects
3. Prosthodontic Rehabilitation of Congenital and Developmental Defects
4. Palatopharyngeal Function, Disabilities, Speech Therapy and Speech Aids

Implants:

1. History
2. Diagnosis
3. Treatment Planning/Options
4. Materials

Temporomandibular Dysfunction:

1. Anatomy
2. Diagnosis
3. Treatment

Other related topics:

1. Periodontics
2. Endodontics
3. Oral and Maxillofacial Surgery
4. Orthodontics
5. Esthetics

Resident Lecture Seminars

1. Objectives:
   1. Provide formal instruction in a variety of topic areas relative to prosthodontics and related basic sciences. This presentation will include a Power Point/Keynote presentation and a written handout.
   2. Establish an In depth/Understanding knowledge as dictated with skills necessary in lecture preparation and presentation. Emphasis is on communicative ability development and subject content.
   3. Disseminate information pertinent to the training of specialists in prosthodontics.
2. Guidelines:
   1. Residents will be assigned topics for presentation each academic year.
   2. Residents will lecture in rotation, one lecture during the first year, two in the second, and two or three in the final year.
   3. Each presentation will be evaluated by a member of the teaching staff.

Staff Lecture Seminars

1. Objectives:
   1. Provide formal instruction on a variety of prosthodontic subject areas.
   2. Disseminate information pertinent to the training of specialists in prosthodontics.
2. Guidelines:
   1. Each mentor will select topics in their specialty for presentation to the residents.
   2. All lectures will include the latest advances in their specialty area.

Biomaterial Science

Biomaterial subjects are emphasized throughout the didactic and clinical phases of the residency and are integral to an In depth/understanding of prosthodontics.

1. Objectives:
   1. To develop an In-depth/understanding of biomaterial science with emphasis on the clinical application of materials utilized in restorative dentistry and prosthodontics.
   2. Provide current information pertaining to the development of new materials/techniques in prosthodontics.
2. Guidelines:
   1. Formal presentations in dental materials and statistics are given by members of dental school.
   2. Residents are assigned material topics for presentation and discussion throughout the year as part of the Lecture Seminar and Mock Board Question Review.
   3. A wide range of materials will be utilized by the residents in the clinical practice of prosthodontics.
   4. Supplemental knowledge will be provided by literature reviews, consultants and textbook assignments.

Biomedical Science Seminar:

1. Objectives:
   1. To provide the resident with sufficient knowledge of the basic sciences for appropriate application to prosthodontic principles and techniques.
   2. To prepare the resident for the written and oral portions of the American Board of Prosthodontics specialty certification exam in applied basic science.
   3. To encourage supplemental reading in scientific journals and basic science texts to provide a broader base for patient care.
2. Guidelines:
   1. Residents are assigned representative questions in the basic sciences taken from past Mock American College of Prosthodontists written questions. Topic areas include: head and neck anatomy, growth and development, embryology, oral pathology, histology, biochemistry, pharmacology, microbiology, immunology, wound healing, and physiology.
   2. The questions are thoroughly researched and answered in a written format for reference by the staff and residents. The presentation will include a comprehensive discussion of the topic area as well as the specified answer to the question.
   3. Seminar material will be supplemented by resident and staff lectures, consultants, and formal courses.
   4. Formal courses in Statistics and Research, Microbiology, Head and Neck Anatomy, Pain Mechanisms, Oral Pathology, and Oral Motor Skills are provided by their representative specialist from the dental school.

Occlusion Seminars

The occlusion seminar consists of several modules, as outlined in your 2017-2018 program guide

Module 1 - Basic Principles of Occlusion

Module 2 - Theories of Occlusion

Module 3 - Articulation and Instrumentation

Module 4 - Occlusal Analysis, Equilibration:

1. Objectives:
   1. Module 1 - Develop an in-depth knowledge of the anatomy, physiology, and function of the masticatory system.
   2. Module 2 - Develop a thorough understanding of the different theories and philosophies of occlusion, and of past and current literature.
   3. Module 3 - Establish a thorough working knowledge of a wide range of articulator systems and associated devices. Critically evaluate articulator systems and their practical selection for specific clinical situations.
   4. Module 4 - To develop knowledge in the area of occlusal analysis equilibration
2. Evaluations:

   Residents will be evaluated through formative exams given throughout each module. Lab exercise will be critically evaluated.

Module 1: Basic Principles of Occlusion

Our Seminar will begin with lectures and hand on class activity based on Huffman and Regenos’ Principles of occlusion: Laboratory and Clincial Teaching Manual

Section I: Part A: Introduction to the Study of Occlusion:

Goals and Objectives:

By the end of this section, it is expected that residents will:

1. Understands the 3 anatomical planes
2. Have an introduction to the TMJ
3. Understand the three types of levers and how they relate the dentition
4. Understand Thielmann’s Formula
5. Understand the relationship between incisal angle and angle of eminentia
6. Be able to define the terms: orbiting/rotating condyle; understand the difference between mediotrusive/laterotrusive
7. Be aware of the difference mandibular movements in the 3 anatomical planes
8. Be introduced to different types of occlusion
9. Understand the difference in waxing techniques: tooth to two teeth & tooth to tooth

Anatomy, Physiology and Function:

Goals and Objectives:

By the end of this section, it is expected that residents will have an:

1. In depth understanding of the muscles of mastication, their origins and insertions
2. In depth understanding of the infrahyoid and suprahyoid muscles
3. In depth understanding of the ligaments associated with the TMJ

Lab Component:

1. Taking proper diagnostic casts
2. Using different facebow systems
3. Introduction to Cadiax Compact
4. Setting semi-adjustable articulators

Section I Part C: A Study of Determinants of Occlusal Morphology:

Goals and Objectives:

By the end of this section, it is expected that residents will understand the determinants of occlusal morphology to include:

1. Facial Position of the teeth in relation to the rotational center
2. Direction of Rotating condyle in the horizontal plane
3. Bennett Movement
4. Intercondylar Distance
5. Angle of Eminentia
6. Direction of Rotating condyle in the vertical plane
7. Overlap of maxillary teeth
8. Occlusal Plane VS angle of Eminentia
9. Curve of Spee

Lab Component:

1. Acetate tracings based on Huffman and Regenos’

Module 2: Theories of Occlusion

Section I: Part B: Theories of Occlusion:

Part B of Huffman and Regenos’ will be augmented with further readings and/or seminar presentations

Goals and Objectives:

By the end of this section, it is expected that residents will:

1. Have an introduction to the history and broad philosophies of occlusion:
2. Triangular Theory –Bonwill 1858
3. Spherical Theory-Monson 1920
4. Gnathology – B.B.Mccollum 1926
5. Functionally Generated Path –Myer 1934
6. Pankey-Mann (Schuyler) 1955
7. Anterior Guidance- Schuyler 1950
8. Transographics – H. Page, 1956
9. Neurophysiologic/Electromyographic, R. Jankelson 1953
10. Mutual Protection Concept-Stuart and Stallard 1963
11. Modern Concepts

Lab Component:

1. T-scan

Module 3: Articulation and Instrumentation

Goals and Objectives:

By the end of this section, it is expected that residents will:

1. Understand the different classification of articulators;
   1. arcon VS Non-arcon
   2. Fully adjustable VS Semi Adjustable
2. Understand the limitations of each articulator and how to account of them
3. Be able to critically evaluate articulator systems and their practical selection for specific clinical situations
4. Understand how occlusal morphology in vivo may differ based on the limitation of each articulator
5. Understand the pantographic tracings and the data collected
   1. Using D5A articulator
6. Understand the importance of Fischer’s angle, and what information this provides
7. Understand the importance of a custom incisal table.
8. Understand the integration of cross mounting of casts for full mouth rehabilitation
9. Understand the limitation of using a facebow

Lab Component:

1. Residents will have the opportunity to use different face/earbows
2. Demonstration of the KIOS system where residents will understand its advantages and limitations

Module 4: Occlusal Analysis and Equilibration

Goals and Objectives:

By the end of this section, it is expected that residents will:

1. Be able to critically evaluate different methods of registration CO/CR
2. Understand the objectives of occlusal equilibration
3. Understand MICP and variants (Tooth to Tooth, Tooth to two teeth)
4. Understand the difference between IN-OUT-IN and OUT-IN-OUT techniques of occlusal equilibration

Lab Component:

1. Residents will have the opportunity to use different methods of CR registration
2. Residents will use their mounted casts from Module 1 and perform a mock up occlusal equilibration of themselves.

Literature Review Seminars

1. Current Literature – Weekly

   Each resident will be assigned articles for review and discussion. The articles will be from the most recent issues of the Journal of Prosthetic Dentistry (JPD), Journal of Prosthodontics (JP), International Journal of Prosthodontics (IJP), International Journal of Oral and Maxillofacial Implants (JOMI), and selected articles from other major journals.

2. Classic Literature – Weekly

   Each resident will be assigned articles for review and discussion. The articles will be grouped by subject and arranged in notebooks so as to better understand the why of prosthodontics.

3. Objectives:
   1. To maintain a current level of knowledge and understanding relating to recent advances in prosthodontic techniques and materials.
   2. To develop skills to critically evaluate scientific literature.
   3. Establish an awareness of research techniques and analysis.
4. Guidelines:
   1. Each resident is responsible for presenting a summary of the selected articles from the above prosthodontic journals. Supplemental articles from other journals are also reviewed throughout the year.
   2. The presentation will include a statement of purpose, materials and methods, and summary of the results. The discussion will include a review of the statistical methods and relevance to the specialty of prosthodontics.
   3. The Prosthodontic staff will provide overall guidance in review and discussion and clarify technical/theoretical areas.

Practice Management / Ethics / Administration

1. Objectives:
   1. Provide information on the administrative methods and requirements related to the practice of prosthodontics.
   2. To expose residents to the process of entering private practice.
   3. To expose residents to the process of becoming involved in an academic career.
2. Guidelines:
   1. Topics will be presented to include finding the right practice situation, patient management, workload reporting, assistant and laboratory management, and supply acquisition.
   2. Seminars will be presented by private practitioners and academicians, who will discuss the how’s and why’s of entering that facet of prosthodontics.

Visiting Consultants and Guest Lecturers

Residents are required to attend presentations by visiting consultants and guest lecturers. Residents will also have the opportunity to attend selected consultant presentations at the Prosthodontic Program and at Walter Reed National Dental Center at Bethesda, Bethesda, MD. Residents will be assigned specific duties to support consultant’s visits.

Basic Life Support/Medical Emergencies

The staff and residents must remain current in basic life support techniques. Classes leading to certification and renewal are provided by the Dental School.

Research Project

Each resident will be required to engage in an investigative project and complete a manuscript for publication as a requirement for graduation. Residents will coordinate the project with the Program Director and the research advisor.

1. Objectives:
   1. To provide knowledge and understanding of scientific methodology, statistics, research design, and scientific writing.
   2. To create an atmosphere for better interpretation of scientific literature and a desire for continual study.
2. Guidelines:
   1. Research may take the form of a clinical or laboratory investigation. Surveys are not sufficient to meet his objective.
   2. Residents will adhere to the listed time schedule in preparation of the research paper.
   3. The completed paper must be in a format acceptable for publication by the specified journal prior to graduation from the program.

Poster Presentations

Residents will develop a technique or item of interest suitable for table clinic presentation twice during the program and present at a local or national meeting.

Standards of Care Examination

The Standards of Care examinations are formal evaluations of clinical performance for a specific series of patient treatment situations and are conducted on all patients throughout the program. Residents are graded on reference based procedure steps acceptable, as needing improvement, or unacceptable standards of care. The standards are an outcome assessment measure designed to evaluate teaching methods and the student’s clinical performance and understanding of a comprehensive treatment procedure.

The areas of evaluation include:

1. Fixed Prosthodontics
2. Removable Prosthodontics
3. Implant supported Prosthodontics Prostheses
4. Temporomandibular Disorders
5. Maxillofacial Prosthodontics

Written Examinations

Written examinations, patterned after the American Board of Prosthodontics Section A exam are given two times a year. They are primarily designed to allow the resident to identify weak areas in recall and understanding of the material. As an outcome assessment measure, they also give the teaching staff important information on resident comprehension and allow for reinforcement in these selected areas. Third year residents, who successfully pass Section A of the American Board of Prosthodontics Certification Examination are exempt from this requirement.

Oral Examination

Two, one hour oral examinations are given twice a year and are patterned after Section B of the American Board of Prosthodontics exam. The exam is designed to assess the resident’s knowledge and comprehension in the broad field of Prosthodontics and to help better prepare the resident to challenge the American Board of Prosthodontics examination. Each resident is required to take all three oral exams of Section B prior to graduation. Oral quizzes are given weekly, if not daily throughout the program.

Resident Teaching

The opportunity for organized teaching experience exists throughout the program. The resident lecture presentations, demonstrations and "mentoring" of the new residents prepare them well for future teaching responsibilities. The poster presentation at a State or National level provides good exposure and experience to large audiences. The third year residents will also present to the Maryland Section of the American College of Prosthodontists and to the residents and staff of the Navy’s PG Prosthodontic Residency.