A Definition ofProsthetic Dentistry

Asbjarn }okstad, DDS, Dr Odont'fon Orstavik, DDS, Dr Odon^Tore Ramstad, DDS"

Purpose: A more precise and up-to-date definition of prostiietic dentistry is warranted. Tine aim ofthe present review is to presenta new core definition of the discipline on the basis of a discussionof existing definitions. Materials and Methods: Clinical textbooks in prosthetic dentistry and dentalimplantology, as well as medical and dental glossaries were reviewed. Results: 7wo tnaincategories of definitions of prosthetic dentistry were identified: first, definitions that emphasized thetechnologic aspects of the discipline, ie, the fabrication of prostheses; and second, definitions thatincorporated some reference to the objectives or aims of prosthetic treatment, ie, the restoration ofone or more aspects of oral function. Siightiy more than half of the citations contained such aim-related references, and this aspect tended to be most pronounced in recent publications.Conclusion: The following definition is ventured: prosthoduntics is the discipline of dentistryconcerned with the consequences of congenital absence or acquired loss of oral tissues and withthe methods for and assessment whether more good than harm is done by inserting artificialdevices made from ailoplastic materials. Int. ¡ Prosthodont 1998,1 i:295-301.

An updated register of scientific research origi-nating from the prosthodontic departments of

Scandinavian dental schools has recently been in-troduced on tbe Internet (httpy/www.odont.uio.no/prosthodont/sspd.htm]. An evaluation of this mater-ial revealed that much activity had been focused onsubjects that could hardly be labeled as prostho-dontic research in a narrow sense of the term. Onecould of course define prosthodontic research prag-matically as research carried out in prosthodonticdepartments. On the other hand, the organization

'Research Associate, Department of Prosthetic Dentistry andStomatognathic Physiology, Faculty of Dentistry, University ofOslo, Oslo, Norway.

'•Professor, Department of Prostiietic Dentistry and Stomstogr<athicPhysiology, Fai:uity of Dentistry, University of Osio, Osio,Norway.

^Prosthodontist, Dental Unit, Department of Plastic Surgery,Riiishospitalet, University Hospital, Oslo, Naiway.

Reprint requests: Dr Asbjarn ¡oiistad. Department of ProstheticDentistry and Stomatognathic Physiology, Facuity of Dentistry,University of Oslo, PO Box 1Í09, N-03!7 Osio, Norway,e-mail: jokstad®odont,uio.no

of clinical departments in dental schools is primar-ily the result of historic, logistic, academic, andeconomic factors and restraints. As a result, thescope of borderline disciplines will vary amongclinical departments. Accordingly, such a prag-matic definition of prosthodontic research will nec-essarily be rather vague and does not answer thequestion, "is there a common core?"

A review of several clinical textbooks and glos-saries indicated a wide spectrum of definitions ofthe discipline of prosthetic dentistry. The majorityof these definitions emphasize the discipline as aprovision of a technology rather than a form oftherapy. This reflects the outdated technocraticview of patient care as proposed in the Flexner re-ports early in this century' that has frequently beenquestioned by medical practitioners and scientists,^Finally, the various definitions reflect a semanticincoherence, and few definitions include termsused in current biomaterials science.

Prosthodontists experience the need for the ex-change of specialized knowledge in a combinedoperation with other fields of clinical dentistry. It istherefore essential that the dental community have

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A Definition of PnDstlietic Dentistry

Table 1 Definitions ot Prosthetic Dentistry Primariiy Focusing on the Technologic Aspects ot the DisciplineDefinition Reference

Dental prostheticsDeals with tfne replacement of tissues ot or pertaining to the masticatory apparatus Turner^

Dental proslheticsThat branch of dental science which treats the various methods of providing suitahle Schlosser*substitutes for the lost organs of the mouth in whole or in part, the artistic and mechanicalprocesses involved in such restoration, tcgether with a description of (he physical propertiesand peculiarities of the various materials employed.

Dental prosthetics, prosthodontics, prosthetic dentistrySubdivision which deals with its application to the mouth. It Includes the replacement of any Fenn et al,^lost tissue and therefore embraces the tilling of teeth and fitting of artificial crowns. In actual eds 1 and 2;practice, however, the term has come to mean fhe fitting cf appliances such as artifiicial MacGregor,^ ed 3dentures, bridges, obturators, and surgical prostfieses.

ProsthodonticsThe division of the science and art of dentistry concerned with the replacement of missing Dykema et aPoral structures.

Prosthodontics, prostheticsThat branch cf dentistry concerned with the design, construction, making, insertion, and FDI, Federation Dentairemaintenance of artificial appliances intended to replace one or more teeth and associated Internationale^tissues.

Dental prcstheticsBranch of dental science dealing with the artificial replacement ot one or more natural teeth Harty^or associated structures by a denture or bridge.

ProsthodonticsBranch of dental science concerned with removable dental prostheses. This definition is applicableto UK only.

ProsthodonticsThe branch of dental art or science that treats specifically the replacement ot missing dental Henderson and Steffel,'*and oral tissues. eds 3 to 8

ProsthodonticsA discipline of dentistry concerned primarily with the replacement of lost dentai parts. Manhold and Balbo' '

Prostliodontics, prosthetic dentistryBranch of dentistry dealing with construction of artificial appliances for the mouth. Thomas''A prosthodontist is a dentist who specializes in the mechanics of making and fittingartificial teeth,

Prosthodontic dentistryReplacing defective or missing teeth through the use of artificial appliancessuch as bridges, crowns, and dentures.

1907

1939

1953

1989

1969to

1994

1985

1997

a clear understanding of what the discipline ofprosthetic dentiitry includes. A more precise andup-to-date definition of prosthetic dentistry is war-ranted. The aim of this report is to present a newcore definifion of the discipline on the basis of areview of existing definitions.

Materials and Methods

Clinical textbooks in prosthetic dentistry and den-tal implantology, as well as medical and dentalglossaries, were reviewed. All publications were inEnglish and were printed in this century. The termsprosthetic dentistry, dental prosthetics, prostbodon-tics, and prostbodontia were regarded as analo-gous and their definitions were recorded. In con-trast, various definitions of maxillofacial prostheticsand implant prosthetics were not recorded.

The definitions were sorted into groups on thebasis of the formulation and content of the defini-

tion. An evaluation of the various definitions wasthen undertaken.

Based on the review a new definition of the dis-cipline of prosthetic dentistry was constructed.

Results

Two main categories of definitions of prosthetic den-tistry were identified; ID definitions that emphasizedthe technologic aspects of the discipline, ie, the fab-rication of prostheses (Table 1]; and (2¡ definitionsthat incorporated some reference to the objectiyesor aims of prosthetic treatment, ie, the restoration ofone or more aspects of oral function (Table 2).Slightly more than half of the citations containedsuch aim-related references, and this aspect tendedto be more pronounced in recent publications.

The definitions from the Glossary of Prostbo-dontic Terms (CPT)"-^^ ^,^¿ f^^^ |.| g ^ ^ ^ ^ . j ^ ^ ^ ^

Dental Association (ADAj^o were frequently used

The international Journal of Pnjsthodonlii 296

A Deiinjtior of ProBthelic tJentistry

Aspicts oMhe DÏcMDescribed in Textbooks atid Glossaries Incorporating Functional

Prosthodontics, prosthetic dentistry, prosthodontiaThat branch of Oental art and science pertaining to the restorationand maintenance of oral tunction by the replacement ot missingteeth and structures with/by artificial devices.

Prosthodontics, prosthetic dentistryThe branch of dentistry pertaining to the restoration and maintenanceot oral tunction, comtort, appearance, and health gt the patientby the restoration at natural teeth and/or the replacement ot missingteeth and contiguous oral and maxi II of acial tissues with artiticiai substitutes.

Prosthodontics, prosthetic dentistry, dental prcstheticsThat branch of dentistry pertaining to the restoration and maintenanceof oral function, comtort, appearance, and health ot the patientby the reste ration/re place ment ot natural/missing teeth and contiguoustissues with artificial substitutes.

Prosthodontics, prosthetic dentistry, dental prostheticsThe science or/and art ot providing suitabie substitutes tor the coronalportions ot teeth, or for one or more lost or missing/natural teethand their associated parts, in order that (impaired) function, appearance,comtort, and tiealth ot the patient may be restored.

Prosthodcntics. prostheticsThat branch of dentistry which is concerned with the functional and aestheticrehabilitation of the masticatory system by artificiai replacement ot missing teethand associated tissues.

Prosthetic dentistryThe discipline in dentistry concerning itself with the diagnosis, prevention, andtreatment of problems caused by tcoth less, with the aim ol maintaining atunctionai dentition for lite.

Glossary of PrcsthodonticTerms,'^ eds 1 to 4(Aoad Denture Prosthetics)

Glossary, ed 5 '*(Acad Denture Prosthetics)Glossary, ed 6 ^(Acad Prosthodontics)McGivney and Castleberry*^

Jablonski"Boucher's ed 4'^Do rl and's MedicalDictionary, ed 28'*

Dentón GB (AmericanDental Association)^"Boucher's, ed 1^'Sted man's MedicalDicticnary, ed 26^

IntemationalOrganisation (orStandardization (ISO)^

1956, 1960,1967. 1977

1987

1994

1995

199219931994

1958

19631995

1983

in various clinical textbooks on fixed and remov-able prosthodontics. None of the other definitionsof prosthetic dentistry/prosthodonîics were used inmore than one textbook. Interestingiy, the ADA de-finition appeared also in Boucher's first edition in1963^' and ¡n some of the earliest editions ofGPT,'^ but was excluded in later edit ions.Similarly, the ADA definition^° could not be identi-fied in any other clinical textbooks or dictionaries,except in the Steadman's Medicai Dictionary,--where it has remained in the various editions.

Some key terms prevailed in the definitions ofthe prosthesis itself. Three definitions used theword replacement only, without further describingthe type of substance to be used for the replace-ment. The term suitabie substitute was recorded inone instance, whereas the term artificial, ie, "notnatural, made in imitation of something natural,"was recorded in 12 definitions ¡n combination withother terms. None of the definitions included anyreference to the use of alloplasts or other termsused in current biomaterials science.

Discussion

The ultimate reason for even considering prostho-dontic therapy is the absence or lack of hard and

soft oral tissues. It would therefore seem logicalthat a large part of prosthodontic research wouldbe concerned with the consequences of absence orlack of oral tissues on, for example, appearance,stomatognathic function, comfort and social well-being, and the local and general health of the pa-tient. This assumption is supported by a review ofthe dental literature, which shows that the researchfocusing on such questions is generated mainly byinvestigators working in prosthetic dentistry depart-ments. However, these aspects are seldom in-cluded in definitions of the discipline of prostheticdentistry. Only one definition has been identifiedthat includes these research topics as part of thediscipline by including the statement "concerningitself with the diagnosis , . . of problems caused bytooth loss. . . ." '*

The definition suggested by Owall et al-"' appearsto be the most up-to-date and precise (Table 2).However, the definition refers to "problems causedby tooth loss." This is inaccurate because problemsand functional impairment related to congenital dis-orders are not uncommonly encountered in theprosthodontic clinic. Another terminology problemarises from this distinction. Prosthetic treatment afteracquired tooth loss in most cases aims to rehabili-tate, restore, repiace, or substitute something that

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A tDefinJtion of Prosthetic

has been previously present. In contrast, prosthetictherapy for patients with congenitally absent tisstjesaims to habilitate, ie, to enable the patient to per-form activities or expose structures previously ab-sent. Tbe distinction between congenital absenceand acquired loss is of clinical importance becauseseemingly similar defects may present very differenttherapeutic cballenges. Both aspects sbould there-fore be referred to in ihe definition, viewed in thelight of adaptation processes paramournt for the suc-cess or failure of prosthetic treatment. Another argu-ment for not using the term rehabilitation is that thisterm is not specific to prosthetic treatment.Rehabilitation may include any denial treatmentprogram and thus involve all disciplines of clinicaldentistry, ie, anything from the placement of a singlerestoration to a complete maxillofacial reconstruc-tion by means of orthodontic, surgical, and exten-sive prosthetic therapy.

In 1961, Krogh-Poulsen-'' published a textbookin prosthetic dentistry in which he emphasized thatthe central issue of prosthetic treatment was not toreconstruct an impaired morphology of the dentalarches, but to look upon the masticatory system asa functional unit. Accordingly, the author advo-cated that indications for prosthetic treatment werepresent when the masticatory system could not ad-equately adapt to the loss of oral tissues, and tbattbe aim of applying prosthodontic therapy was torestitute the function of tbe masticatory system.^^This close relationship between oral physiology,occlusion in the broad sense, and prostbodonticconcepts is Stil! reflected in tbe organization of de-partments in many dental schools. Some of the hy-pothetical associations between occlusion and oraldysfunction from Krogh-Poulsen's textbook areconsidered invalid today.-^ Nevertheless, the text-book was one of the first to suggest that the indica-tions for and treatment goals of prosthetic treatmentshould be determined by the patient's functionalstatus and needs, rather than by the absence ofmorphologic integrity of the dental arches.

The first edition of the CPT (1956)" included adefinition of prosthodontics that links tbe disciplineto "oral function" (Table 2). A review of the prostbo-dontic literature from that period reflects tbat limitedresearcb bad been carried out to elucidate this asso-ciation. Seemingly, tbe reference to "oral function"reflected the traditional concept that the replacementof ali missing teeth was considered a prerequisite forachieving adequate functional operations of the mas-ticatory system.^^'^^ The original definition has beenchanged several times, with major modificationsmade in the fifth edition in tSS?'" (Table 2). Theterm device (something contrived for a specific pur-

pose) was replaced by substitute. In addition, "com-fort, appearance and health of the patient" wasadded in context with "oral function." These modifi-cations reflect a change of focus from the lechno-logic fabrication of the prostbeses toward more ther-apeutic aspects of prosth odontic treatment.

However, the later versions of the GPT definitioninclude aspects of prosthetic work tbat may seemquestionable as core parts of prosthetic dentistrythat distinguish it from borderline disciplines. Thus,the introduction of "oral and maxillofacial" next to"tissues" might be regarded by some as crossingthe line between dentistry and medicine. Also theinclusion of "the restoration of natural teetb" ap-pears to present difficulties as it confuses ratherthan clarifies a distinction between prosthetic andrestorative dentistry.

It seems tbat for many years prosthetic dentistryhas been considered more as a discipline of den-tistry that concentrated on providing a tecbnologyrather than on providing a tberapy. That is, pros-thetic dentistry is the provision of foreign objectsthat, when constructed according to a number ofcriteria, could be accommodated in the oral cavity,and which tbe patient could more or less adapt to.There are probably several explanations for this sit-uation. Historically, "goldsmith dentistry" is a com-paratively recent discipline of the health sciences,witb two historic roots: medicine and handicraft.The actual making and fitting of tootb substitutes(prostheses] seem to originate from the latter. Formany years the prosthodontic literature focused onbow to optimize the technology, ie, to design andfabricate tbe prostheses. Less attention was paid tothe treatment itself or to the treatment outcome, ie,the therapeutic effects. Obviously, tbe therapeuticoutcome of a prosthodontic treatment may only beevaluated after the prosthesis has been installed inthe mouth. Only then may any sbort- or long-termbenefits derived from its fabrication and use be ap-praised. The outcome of prosthetic treatment is notonly the result of the technical quality of the endproduct, but also of the biologic, psycbologic, andpreventive factors and how these factors are inte-grated in the anamnestic, diagnostic, and postoper-ative phases of the therapy. Most dentists wouldagree that the raison d'etre for any prosthetic treat-ment is bow it will help the patients cope with thedeficiencies or absence of teeth and/or adjacentstructures. It therefore seems peculiar that so manydefinitions of prosthetic dentistry have omitted anyreferences to what prosthodontists wish to accom-plish by fabricating these "artificial substitutes." Itseems appropriate to describe a prosthodontist as adentist who bas special qualifications that enable

The International Journal of Pioslhodontics 298 Vo lumen , Number4, 7996

him or her to distinguish the optimal treatment forthe patient among many treatment modalities onthe basis of a correct diagnosis and other relevantfactors. The contrast is a dentist who is capable ofcreating, for example, 137 different and sometimesexquisite technical solutions but who cannot per-ceive the short- and long-term benefits and out-comes of the various prosthodonlic treatment alter-natives. In the authors' opinion, this way ofreasoning should also be reflected by the definitionofthe discipline prosthetic dentistry.

The notion of many years that prosthodontic treat-ment seems to have been regarded as a procurementof technology rather than therapy is also reflected bythe subdivision of some dental schools into variousdepartments. In medical hospitals the organization ofunits reflects the patient's particular type of illness orthe anatomic location of the affected body organ, eg,internal medicine, ophthalmology, ear-nose-thro at,etc. Units in dental schools are seldom organized ac-cording to this principle. In contrast, several dentalschools have organized their clinics on the basis ofthe technical treatment modality provided, eg, sepa-rate departments for fixed, removable, and implant-based prostheses. EHopefully, the patients in theseschools are scrupulously diagnosed and their treat-ment needs evaluated on a general level before refer-ral to such departments. If the aim of prosthetic den-tistry is to improve the patient's oral function, theinherent risk of losing sight of this goal by definingand organizing the discipline according to the tech-nical approach seems obvious.

An implant is "a biomaterial or device made ofone or more biomaterials, biologic or ailopiastic, thatis surgically inserted into soft or hard tissues to beused for functional or cosmetic purposes."-' Anotherdefinition of an implant is "any device which is in-tended to be totally introduced into the humanbody . . . by surgical intervention which is intendedto remain in place after the procedure."^" EHowever,an alloplast (an inert foreign body used for implanta-tion within tissue'^! introduced into living tissue is byitself nothing but a prosthesis. Therefore, a term suchas prosthetic implant is meaningless.

From a medicolegal point of view, introducingsomething into the mouth is analogous to introduc-ing something into the human body. From thisviewpoint it can be argued that dentists have al-ways "implanted" ailopiastic materials into the oralcavity. Moreover, filling materials placed in oral tis-sues such as enamel, dentin, pulp, and oral mucosacan be characterized as "implants," although someregard it practical to limit the term implanl to bio-materials inserted into jawbone. Most if not all ma-terials used in dentistry are alloplasts, and the differ-

A Definition ol Prostheiit Dentistry

ence between an implant and other biomaterialsplaced by dentists into the oral cavily can be ques-tioned. Today, several biomaterials are beingplaced both into and onto the jaw, under or overthe periosteum, to augment or reform the jaw shapeand improve the local conditions (bone substitutes,osseosynthesis devices, guided tissue regeneration,etc). Eurthermore, the distinction between inert andnoninert materials is obscure, and may even bemodified by variations in the surface treatment ofthe materials. The only totally inert material avail-able is, perhaps, diamond. There is considerablediscussion, at least in Europe, related to definitionsand use of terms such as biocompatihility, bioactiv-ity, inertness, bioacceptability, and biofunctionallty.Thus, the precision and exact meaning of the termimplant IS unclear.

Implant prosthetics is defined in the glossary of theAmerican Academy of Implant Dentistry as "that por-tion of implant dentistry that concerns itself with theconstruction and placement of a fixed or removableprosthesis on any implant device."'^'-"^ The definitionis a mere description of a technical solution with thefocus on the traditional alternatives, fixed or remov-able, applied in combination with a specific thirdtechnical means; the implant. This glossary also de-fines the terms implant dentistry, dental implan-tology, and oral implantology as "that area of den-tistry concerned with the diagnosis, design andinsertion of implant devices and restorations whichprovide adequate function, comfort and esthetics forthe edentulous or partially edentulous patient."'" It isnot surprising that the definition could have been ap-plied to define prosthetic dentistry if implant wassubstituted by proslhetic. However, this definitionnarrows the description ofthe "discipline" to the pro-curement of a technical solution to solve patients'problems. As discussed in the previous section, it isimproper to define a discipline of dentistry accordingto particular technical treatment solutions that arebeing used. The term implant prosthetics should beregarded as a technical term for fabricating a specifictype of prosthesis, in line with the terms feed and re-movable dental prosthetics. One can seriously ques-fion whether implant dentistry should be regarded asa separate discipline in dentistry at all. The only dif-ference between implant dentistry and prostheticdentistry is that one specific technical alternative isadvocated in the former, ie, the support and/or reten-tion for the prosthesis is derived from implants ratherthan from teeth or muscular and physical forces.

Maxiilofacial prostheiics has been defined as"that branch of dentistry which provides prosthesesor deyices to treat or restore tissues of the stomato-gnathic system and associated facial structures that

11, Number 4, 1998 299 The internationai journal of Prosthodontics

A Definition of Prostlielic Dentistry

have been affected by disease, injury, surgery, orcongenital absence, to provide all possible functionand esthetics."' ^ This definition differs from the def-inition of dental prosthetics by widening the scopeof tissues and structures to be considered for pros-thetic treatment. The aim is similar to prosthodontictreatment, while the difference lies in the type of tis-sues to be replaced, and accordingly, the scope ofmaterials and techniques employed. Some col-leagues regard it as important to define maxillofa-cial prosthetics as a pan of (prosthetic] dentistry. Forexample, in the latest GPT,'^ maxillofacial prosthet-ics is defined as "the branch of prosthodontics."However, maxillofaciai prosthetics encompassesalso the fabrication and fitting of devices imitatingstructures outside the oral cavity, often situatedrather far from it, and with quite different biofunc-tional tasks, eg, ears, eyes, and noses. Althoughtreatment of such defects may require skill andknowledge similar to that required for the (re)habili-tation of teeth and jaws, it does not automaticallyfollow that maxillofaciai prosthetics should be de-fined as a "branch of" (prosthetic! dentistry.

Since the primary aim of prosthetic dentistry is toprovide care for people lacking teeth and/or adja-cent structures, the discipline must be based on atborough understanding of what the lack and/orloss of these structures means in terms of patientsuffering, and/or in terms of development and pro-gression of disease. A definition should reflect thedualities inherent in lack/loss and in suffering/dis-ease, and at the same time be kept in terms as gen-eral as possible. Furthermore, a definition shouldalso refer to the fact that prostbetics can only mod-ify the consequences of tissue loss, since the inser-tion of a prosthesis will not alter the fact that bio-logic structures are still missing. Moreover, as forall other health care interventions, good versusharm must be evaluated," ie, negative as weil aspositive consequences of inserting prostheses mustalways be anticipated. Finally, in tbis age of bio-logic engineering, a definition of prosthetic den-tistry should include reference to the kind of mater-ial employed. This reference helps to distinguishdental prosthetics from related disciplines like oralsurgery and orthodontics, which may strive to-wards the same goals using different techniques.

Conclusion

A definition should reflect the activities withinprosthodontic departments focused on both the as-sessment of the consequences of lack of oral tis-sues, as weii as the outcome of modifying theseconditions. Since the primary aim of prosthodonlic

treatment is to improve the appearance, function,comfort, and oral health of the patient, emphasisshould be made on these factors in the definition.

The authors venture that a definition should beadjusted accordingly to include:

The discipline of dentistry concerned with theconsequences of congenital absence or acquiredloss of oral tissues ¡on appearance, stomatognatbicfunction, comfort, and local and general health ofthe patient], and with the methods for, and assess-ment whether more good than harm is done by in-serting artificial devices made from allopiastic ma-terials (to change these conditions).

References

1. Flexner A. Medical Education in the United States andCanada. New York: Carnegie Foundation Bulletin 4, 1910.

2. Celijns AC. Modern methods of ciinical investigation. In:Medical Innovation at the Crossroads, vol 1. Committee onTechnological Innovation in Medicine (ed). Washington:National Academy Press, 1990:1-222.

3. Turner CT. The American Textbook of Proslhelic Dentistry.Philadelphia: Lea & Febiger, 1907,

4. 5chlo55er RO. Complete Denture Prosthesis. Philadelphia:Saunclers, 1939,

S Fenn F R, Liddelow KP, GImson AP. Clinical DentalProsthetics. London: Staples, 1961,

6. MacCregor AR. Fenn, Liddelow and Cimson's Clinical DentalProsthetics, ed 3. London: Wright, 1 989.

7. Dykema RW, Cunningham DM, lohnston JF, Modern Practicein Removable Partial Prosthodontics. Philadelphia: Saunders,1969.

8. Baume L. Federation Dentaire Internationale. DémographieDentaire. Londoni Federation Dentaire Internationale, 1984.

9. Hart FJ. Concise Illustrated Dental Dictionary, ed 2, London:Wright, 1994.

10. Henderson DH, Steffel VL. McCracken's Removable PartialProsthodontics, ed 3. St Louis: Moshy, 1969.

11. Manhold |H, Balho MP Illustrated Dental Terminology.Philadelphia: Lippincot, 1985.

12. Thomas CL. Taber's Cyclopedic Medical Dictionary, ed 1B.Philadelphia. Davis, 1997,

13. Academy oí Denture Prosthetics. Glossary of prosthodonticterms, ed 1.1 Prosthet Dent l956;6:287-334.

14. Academy of Prosthodontics. Glossary of prosthodontic terms,ed5.| Prosthet Dent l987;58:713-762.

15. Academy of Prosthodontics, Glossary of Prosthodontic terms,ed6.1 Prosthet Dent 1994;7I:41-I12.

16. McGivney GP, Caslleberry D|, McCracken's RemovablePartial Prosthodontics, ed 9. St Louis: Mosby, 1995.

17. labionslci S. JablonskJ's Dictionary of Dentistry. Malahar:Krieger, 1992.

78. Zwemer T| Boucher's Current Clinical Denial Terminology;A Glossary oi Accepted Terms in All Disciplines of Dentistry,ed 4. St Louis: Mosby, 1993.

19. Anderson DM, Dorland's Illustrated Medical Dictionary, ed28. Philadelphia: Saundeis, 1994,

20. Dentón CB. The Vocabulary of Dentistry and Oral Science.Chicago: American Dental Association, 1958.

21. Boucher CO. Current Clinical Dental Terminology; A Clos-5aiy of Accepted Terms in All Disciplines of Dentistry. StLouis: Mosby, 1963.

: 11, Numbei 4, 1993

A Definition of Proilhptit Dentistry

22. Spraycar M. Stedman'ç Medical Dictionary, ed 26. Ballimore;Williams &Wilk ins, 1995.

23. International Organiïation Standardization. Dental Vocabulary,Part 1. General and Clinical Terms. Geneva: ISO, 1942-1,1989.

24. Owall B, Káyser AF, Cadssori GE. Prosthodontics, Principlesand Management Strategies, London: Mosby-Wolfe, 1996.

25. Krogh-Poulsen W. Bidfunktionsl^re og Pro(e(il<. Kabenhavn:Odontologisk Forening, 1961.

26. National Institutes of Heiilth. Conference on (echnoIoRy as-sessment of the management of temporomandibular disor-ders. Oral Surg Oral Med Oral Pathol 1997;83;49-183.

27. Levin B. The 28-tooth syndrome — Or should all teclh he re-placed? Denl Survey 1974;50:47-50.

28. Käyser A. Shortened dental arches and oral function, J OralRehahil 1981:8:457-462,

29. American Academy of Implant Dentistry. Glossary of implan-tolcgy terms, | Oral Implant 1990;16:57-63.

30. EEC. Annex IX, Classification Criteria. Definitions ¡CouncilDirective 93/42/EEC|. i European Communities, 1993;LI69/%.

51. Warren KS, Mostellet F. Doing more good than harm: Theevaluation of health care interventions. Ann NV Acad Sei1993;7r)3:1-34O.

Literature Abstract

Retentive capacity of fiber-reinforced crown- and bridgework Targis-Vectrisin relation to dental cementing.

This study evaluated the eftect of different cementing methods on the retention of fiber-rein-forced castings. The cementing systems used were phosphate cement (Harvard), ionomercement (Fuji], carboxilate cement (Durelon), and adhesive (IPS Empress). Under standard-ized conditions, 32 natural teeth were prepared with diamond burs. The preparations illu-dated natural conditions. The crowns were randomly assigned for one of the cementing sys-tems. Fabrication of the crowns and cementations were performed according to themanufacturers' recommendations. The teeth with cemented crowns were subjected to stan-dardized thermo- and load cyclings. The retention was then measured. There was no statis-tically significant difference in retention force between the phosphate and the adhesive ce-menting method. The mean values were 270 N for phosphate cement and 261 t^ for IPSEmpress. Somewhat lower mean values were found for carboxilate (185 N) and ionomer(159 N) cements.

Körber KH, Körber S. Zahnaitzlichs Welt fiundschaiy 199B:107:32-41. (In German with English sum-mary.) References; 14. Reprints: Prot Dr K. H. Korber, Dipl.-Phys. S. KôrBer, Klinik für ZahnartziicheProtetik, Propadeutik und Werkstottkurde des Klinkums der Universität Kiel, Amold-Heller-Str. 16,24105 Kiel, Gerniany.-J, Kihl

Literature Abstract

Patient satisfaction with dentures made by dentists and denturologists.

This study compared patient satisfaction with complete dentures made by dentists or bydenturologists The participants in the study had answered adverfisements for recruiting pa-tients to clinical trials. They were interviewed by telephone using a questionnaire made by adentist a dental student, and a denturologist. There were 410 subjects aged 30 to 74 years;91 treated by dentists and 319 by denturologists. No significant differences m sociodemo-qraphic characteristics were found between the two groups except a small difference inmean age Both groups had paid approximately the same amount for f heir complete pros-theses Most individuals were satisfied with their maxillary prostheses hut dissatisfied withtheir mandibular prostheses. Significantly more subjects in the der>furologist treatmentgroup compared to the dentist treatment group gave their mandibular prostheses a poor rat-ing for general satisfaction (P= .003), corr,fo,1 (P= ,04), and stability ¡P= .016).

Montreal, QC H3A 2B2, Canada.-SP

/olumen,Niimber4, I 301 hf Inte m a rio nal Joumal o( Prosthodontii