WHEN the topic of prosthodontics is mentioned, first thoughts often focus largely on the humble denture. But this varied and challenging specialty offers much more.
Broadly speaking, it is about the restoration and replacement of teeth using fixed, removable, implant or maxillofacial prosthodontics. That includes crowns, veneers, bridges, dentures and implants.
As well as mastering complex technical procedures, prosthodontists have advanced diagnostic and analytical capabilities that allow them to identify and treat a variety of dental problems before restoration begins. Specialists also treat facial abnormalities caused by injuries, birth defects and diseases. Add to this the scope for scientific research and education and the potential career paths widen further.
Entry and training
Dentists interested in becoming a specialist prosthodontist (and being included on the General Dental Council’s specialist list) will first have to complete at least two years basic postgraduate dental foundation training. This should ideally include vocational training and experience of working in a wide variety of dental sectors. Although not essential, it is desirable for trainees to gain faculty membership such as the Joint Dental Faculties at the Royal College of Surgeons of England, the Faculty of Dental Surgery RCS Edinburgh and Royal College of Physicians and Surgeons of Glasgow, or the Faculty of Dentistry RCS Ireland.
Specialty training for prosthodontics usually lasts three years (4,500 hours) full-time, but many choose to train part-time over a longer period, allowing them to continue working part-time to help manage costs. Training is generally composed of 60 per cent clinical, 25 per cent academic and 15 per cent research, but this is flexible and can be adapted depending on the trainee’s abilities and competency.
There are various routes to learning which are set out in more detail in the Curriculum for training in prosthodontics (published June 2010). Trainees are expected to demonstrate minimum competences in key areas and can undertake learning in a range of ways, such as validated self-directed and independent study; guided theoretical learning (possibly as part of a Master’s degree in prosthodontics); technical skills development via simulation laboratory exercises that feed into a presentation portfolio; supervised clinical practice; work-place based training; or involvement in a research project.
Prosthodontics forms part of the broader field of restorative dentistry which is described by the Royal College of Surgeons of England as aiming to “restore function and ensure an aesthetic, healthy and pain-free dentition.” This encompasses a wide skill spectrum, from placing small crowns and treating snoring or sleep disorders, to managing patients with more complex treatment needs. Specialists may find themselves assisting patients affected by loss of bone and/or soft tissues, those who have suffered facial trauma, or those with congenital oral defects.
Many dentists who successfully complete specialist prosthodontic training will work as private practitioners in specialist practice within a primary care environment. Those who achieve their three-year certification of completion of specialty training (CCST) may seek to work as a consultant in prosthodontics but this may require further experience and training.
Once qualified, one way to keep professional skills and knowledge up-to-date is by joining The British Society of Prosthodontics (BSSPD). It was founded 60 years ago and has a worldwide membership of around 500 clinicians. Membership offers reduced rates for conference attendance, a free subscription to the European Journal of Prosthodontics and Restorative Dentistry as well as access to research prizes, bursaries and learning materials.
• Career pathway information for restorative dentistry – Royal College of Surgeons of England
• The British Society of Prosthodontics – www.bsspd.org
Q&A Dr Phil Smith, senior clinical lecturer and honorary consultant in restorative dentistry
What attracted you to a career in prosthodontics?
After qualifying I realised that what I enjoyed most was being able to restore and replace missing teeth to improve patients’ lives. Throughout my years as a dentist I have been very fortunate to have worked with patients and colleagues who have kept me sufficiently motivated to rehabilitate people who require help to restore oral function and appearance. I came into dentistry wanting to make a positive difference to people’s lives and prosthodontics has allowed me to do this.
What do you enjoy most about the job?
It’s a great challenge to restore and rehabilitate patients who are having difficulties with eating, chewing and their dental appearance. Over time, although there have been tremendous advances in technology and treatment possibilities, the underlying principles of prosthodontics have remained the same, it’s just that nowadays we are able to reach our objectives in different ways. The most enjoyable part of the job is meeting such a range of individuals and being able to help them. Particularly rewarding for me is being involved in the treatment of cleft lip and palate. I can make a real difference to this group of patients.
What do you find most challenging?
Being unable to meet patient expectations. Despite the great advances in technology and clinical techniques, we have to work within realistically achievable parameters, and on occasion these can fall short of what patients would like us to achieve. It is also frustrating not being able to provide more complex prosthodontic treatment for some patients. This may be because of their inability to cooperate sufficiently or as a result of other limitations, for example, systemic disease.
Have you been surprised by any aspect of the job?
I am always surprised by the adaptability, flexibility and ingenuity of human nature and prosthodontics allows you to experience this at first hand. These qualities apply to colleagues and patients I have encountered. When these coincide for the common good some amazing results, beyond what could have been predicted, are achievable.
What personal attributes do you think are important in prosthodontics?
Top of my list would be patience, closely followed by perseverance, and team working. Prosthodontics is a team game where science and art come together, although at an individual level much depends on practical skill and clinical/technical ability. It helps to lean towards being obsessive about what might be considered as fine technical details!
What advice would you give to a trainee considering prosthodontics?
It is important to make sure you have a sound base in general dentistry and that you get plenty of practise to develop your clinical skills. Make sure that you enjoy the practical aspects of dentistry and be flexible in your approach to patient management. Becoming involved with the BSSPD (British Society of Prosthodontics) would be a good idea as this long-established specialist society is relevant to anyone with an interest in prosthodontics. It has an annual meeting with keynote speakers in the field. It also makes awards and it has resources that are useful in supporting trainees. Finally, I would encourage all new dentists to be prepared to embrace change and to learn new skills throughout your practising career.