preclinical removable partial dentures curriculum survey

ACADEMICS AND EDUCATION

Preclinical Removable Partial DenturesCurriculum SurveyBehnoush Rashedi, DMD, MS, MSEd,1 and Vicki C. Petropoulos, DMD, MS2

Purpose: In 2001, a survey of U.S. dental schools was conducted to determine the curricularstructure, teaching philosophies, and techniques used in preclinical removable partial denture(RPD) courses and to also establish what newer educational techniques and materials are currentlybeing used by U.S. dental schools.

Materials and Methods: The questionnaire was mailed to the chairpersons of the prosthodontic/restorative departments of 54 U.S. dental schools. Of these, 43 schools returned the completedsurvey, resulting in a response rate of 80%. The mean, median, and range of responses were computedwhere applicable.

Results: Results from this survey show that the mean student-to-faculty ratio in the preclinicalRPD course was 12:1, with a median of 10:1 and a range of 6:1 to 27:1. The mean number of laboratoryhours was 55, with a median of 50 and a range of 13.5 to 120. The mean number of lecture hoursreported was 21, with a median of 20.5 and a range 10 to 60. The mean number of practicalexaminations was 2, with a median of 3 and a range of 0 to 8. The mean number of writtenexaminations given was 2, with a median of 2 and a range of 1 to 6. Ninety-five percent of the schoolshave prosthodontists teaching this course. The mean number of months that this course is taught is4.4 months, with a median of 4 and a range of 1.5 to 10. Fifty-five percent of the schools used theHanau semiadjustable articulator. One hundred percent of the schools teach students to use asurveyor when designing an RPD, and 84% percent of the schools teach the Krol or the Kratochvil RPIdesign or a combination of the 2 designs.

Conclusions: Preclinical RPD educational programs vary from school to school, yet a largepercentage of schools agree on certain topics. Only 19% of dental schools are incorporating newtechnologies, such as the use of the internet, in their preclinical RPD curriculum.

J Prosthodont 2003;12:116-123. Copyright © 2003 by The American College of Prosthodontists.

INDEX WORDS: preclinical dental education, removable prosthodontic education, survey, cur-riculum, removable partial dentures

IN 1995, the Institute of Medicine (IOM) pub-lished a report emphasizing the need for dental

educators to reassess the predoctoral prosthodonticcurriculum to make it more relevant to clinicalpractice for the general practitioner.1 Such a cur-riculum is important, considering that millions ofindividuals without complete dentitions will require

prosthodontic treatment well into the 21st cen-tury.2

The introduction of preventive dentistry in themiddle of the 20th century brought the realizationthat natural teeth can be retained for life. The past2 decades has seen a steady decline in the preva-lence of tooth loss and edentulism in the UnitedStates,3 along with a rapidly growing number ofpeople who are retaining their natural teeth.4,5

Although there has been recent speculationamong prosthodontists and dental educators that acontinuing decline in edentulism and tooth willdecrease the need for prosthodontic services, a re-cent report demonstrated a large and growing needfor prosthodontic treatment that will exceed theavailable supply in the years 2005, 2010, and 2020.3This report estimated that the need for fixed andremovable partial dentures (RPD) would actuallyincrease due to the substantial growth of the U.S.

From the Department of Restorative Dentistry, University of Pennsyl-vania School of Dental Medicine, Philadelphia, PA 1Assistant Professor,Course Director of Removable Prosthodontics 2Assistant Professor, CourseDirector of Fixed Prosthodontics.

Accepted December 13, 2002Correspondence to Dr. Behnoush Rashedi, University of Pennsylvania

School of Dental Medicine, Department of Restorative Dentistry,4001 Spruce Street, Philadelphia, PA 19104-6003. E-mail:[email protected]

Copyright © 2003 by The American College of Prosthodontists1059-941X/03/1202-0001$30.00/0doi: 10.1016/S1059-941X(03)00005-6

116 Journal of Prosthodontics, Vol 12, No 2 ( June), 2003: pp 116-123

population and the extended life expectancy of thepopulation. A review of the literature, however,indicates only 1 survey published in 1984 thatbriefly examined U.S. removable prosthodontic cur-ricula.6

Therefore, removable prosthodontic programsmust continually evaluate their portion of the den-tal education curriculum to ensure that the dentalhealth needs of society and the goals and objectivesof the commission on Dental Accreditation of theADA are being met.7 Prosthodontic curriculum andlaboratory delegation surveys are useful tools inassessing prosthodontic education.7

The aim of this survey is to determine the cur-rent trends in predoctoral RPD curricula and todetermine what newer reported educational tech-niques and materials are being used by U.S. dentalschools.

Materials and MethodsIn November 2001, a questionnaire (Fig 1) was

mailed to the chairperson of the prosthodontic/restorative departments of 54 U.S. dental schoolsrequesting information on their predoctoral pre-clinical RPD curricular content. After a secondmailing to schools that had not returned the surveywithin a 3-month period, 43 of the 54 schools re-sponded, yielding a response rate of 80%.

The survey comprised 22 multiple-choice ques-tions and asked the respondents to circle all re-sponses that applied to their programs. The optionof providing a specific answer other than the listedchoices was available for each question. Some of thequestions for this survey were originally designedand developed in an effort to evaluate other pro-grams with regard to curricula, techniques, andteaching materials used. Some of the questionsdealing with curricular structure were similar to aprevious survey on fixed prosthodontic curricula.4The questions were pilot-tested on-site and ap-proved by faculty members before the survey wasmailed to other schools.

ResultsPreclinical Removable Partial DentureCurricula

Is there a separate removable partial den-ture course as part of the curriculum? (Ques-tion 1)

Thirty-seven schools (86%) reported that a sep-arate RPD course was offered as part of the remov-able prosthodontic curriculum; 6 schools (14%) re-ported that there was no separate RPD course andthis material was part of the preclinical removablecurriculum.

Are students taught to use a surveyor whendesigning removable partial dentures? (Ques-tion 2)

All responding schools (100%) reported that thestudents are taught to use the surveyor when de-signing a RPD.

What is the student-to-faculty ratio? (Ques-tion 3)

Nine schools (21%) reported a 10:1 student-tofaculty ratio, 7 schools (16%) reported an 8:1 ratio,3 schools (7%) reported a 6:1 ratio, 2 schools (5%)reported a 7:1 ratio, 2 schools (5%) reported an 11:1ratio, and 1 school (2%) reported a 9:1 ratio. Nine-teen schools (42%) reported “other.” These in-cluded 9 schools (21%) that reported a 12:1 ratio, 2schools (5%) that reported a 13:1 ratio, 2 schools(5%) that reported a 14:1 ratio, 2 schools (5%) thatreported a 20:1 ratio, 1 school (2%) that reported a16:1 ratio, 1 school (2%) that reported an 18:1 ratio,1 school (2%) that reported a 25:1 ratio, and 1school (2%) that reported a 27:1 ratio. The overallmean was 12:1, the median was 10:1, and the rangewas 6:1 (minimum) to 27:1 (maximum).

Do students process their removable partialdenture setups which are done in the course?(Question 4)

Thirty-nine schools (91%) reported that the stu-dents do not process their RPD setups done in thecourse; 4 schools (9%) reported that the students doprocess the setups. Some comments included thatthe students learn the technique through the lec-tures.

How many laboratory hours are in thecourse? (Question 5)

Twenty-six schools (60%) reported less than 60laboratory hours given for the RPD preclinicalcourse; 11 schools (26%), between 61 and 80 hours;5 schools (12%), between 81 and 100 hours; and 1school (2%), between 101 and 120 hours. The over-all mean was 55 hours, with a median of 50 hoursand a range of 13.5 (minimum) to 120 hours (max-imum).

What is the total number of lecture hoursgiven? (Question 6)

Sixteen schools (36%) reported between 10 and15 lecture hours for their preclinical RPD course;

117June 2003, Volume 12, Number 2

14 schools (33%), between 16 and 25 lecture hours;9 schools (21%), between 26 and 35 lecture hours;and 1 school (2%), between 36 and 45 hours. Threeschools (7%) responded “other,” with 11 hours, 45hours, and 60 hours. The overall mean was 21lecture hours, with a median of 20.5 hours and arange of 10 hours (minimum) to 60 hours (maxi-mum).

What is the total number of practical exam-inations given? (Question 7)

Twelve schools (28%) reported that 2 practicalexaminations are given for the RPD course; 9schools (21%), 3 practical examinations; 9 schools(21%), 1 practical examination; 7 schools (16%), 4practical examinations; 3 schools (7%), 5 practicalexaminations; 1 school (2%), 8 practical examina-tions; and 1 school (2%), 0 practical examinations.One school (2%) did not respond. A comment froma school that reported no practical examinationswas that “all steps are graded during the course.”The overall mean was 3, the median was 2, and therange was 0 (minimum) to 8 (maximum).

What type of articulator do the students use?(Question 8)

Twenty-three (55%) of the schools use theHanau modular semiadjustable articulator (Tele-dyne Water Pik, Fort Collins, CO); 14 schools(31%) use the Whip Mix semiadjustable articulator(Whip Mix, Louisville, KY); and 1 school (2%) usesthe Denar semiadjustable articulator (TeledyneWater Pik). One school (2%) responded “other,”indicating that it uses the Hanau H2 articulator(Teledyne Water Pik). Four schools (9%) responded“none,” meaning that they do not use an articulatorfor this course.

Does the course meet throughout the aca-demic year? (Question 9)

Thirty-eight schools (88%) replied that thecourse did not meet throughout the academic year;5 schools (12%) replied that it did.

In what year of dental school is the preclin-ical RPD course given. And please indicate thenumber of months the course is in session.(Question 10)

Thirty-seven schools (86%) reported that thiscourse is offered during the sophomore year. Thecomplete results are summarized in Table 1. Theoverall mean number of months that the course isoffered is 4.4 months, the median is 4 months, andthe range is 1.5 to 10 months.

Are any of the faculty who teach this courseprosthodontists? (Question 11)

Forty-one (95%) of the schools indicated thatsome of the faculty who teach RPDs are prosth-odontists; 2 schools (5%) reported that they are not.Of the 41 schools indicating that some of the fac-ulty are prosthodontists, the overall mean was 52%,the median was 63%, and the range was between5% to 100%. The schools that have prosthodontiststeaching the course responded as follows: 12 schools(28%) indicating that 51% to 75% of their faculty

Table 1. Year and Duration of the RPD Course

Answers(year(s) with number of months)

Number ofSchools

(%)*

Freshman only (4 months) 1 (2)Freshman Year only Total 1 (2)Sophomore only (6 months) 2 (5)Sophomore only (3.25 months) 1 (2)Sophomore only (2 months) 2 (5)Sophomore only (3 months) 11 (26)Sophomore only (10 months) 1 (2)Sophomore only (4 months) 7 (16)Sophomore only (3.5 months) 2 (5)Sophomore only (5 months) 6 (14)Sophomore only (4.25 months) 1 (2)Sophomore only (7 months) 1 (2)Sophomore only (9 months) 1 (2)Sophomore only (8 months) 1 (2)Sophomore Year Total 36 (83)Junior only (1.5 months) 1 (2)Junior only (4.5 months) 1 (2)Junior only (4 months) 1 (2)Junior only (5 months) 1 (2)Junior only (7 months) 1 (2)Junior Year Total 5 (12)Sophomore (5 months), Junior

(2.5 months) & Senior year2.5 months 1 (2)

Total 1 (2)

NOTE. Numbers in parentheses indicate percentage of schools.*Rounding error, does not equal 100%.

Table 2. Textbook(s) used for the RPD Course

AnswersNumber of Responding

Schools (%)*

(a) only 22 (51)(b) only 6 (14)(c) only 1 (2)(d) only 1 (2)(e) only 4 (9)(a) and (b) 5 (12)(a) and (d) 1 (2)(b) and (e) 1 (2)(a) and (e) 1 (2)(a), (b), (c), (d), and (e) 1 (2)

*Rounding error; does not equal 100%.

118 Preclinical Removable Partial Dentures Curriculum Survey ● Rashedi and Petropoulos

are prosthodontists; 11 schools (26%), between 76%and 100%; 6 schools (14%), between 5% and 10%; 5schools (12%), between 11% and 25%; 4 schools(9%), between 36% and 50%; and 3 schools (7%),between 26% and 35%.

How many written examinations are given(does not include quizzes)? (Question 12)

Nineteen schools (43%) indicated that 2 writtenexaminations are given; 11 schools (26%), that 1examination is given; 6 schools (14%), that 3 writ-ten examinations are given; 1 school (2%), that 6examinations are given. The overall mean was 2examinations, the median was 2 examinations, andthe range was 1 to 6 written examinations.

Which textbook(s) is(are) used for the RPDCourse (Question 13)

Table 2 summarizes the responses to this ques-tion.

Is(are) the textbook(s) required for thiscourse? (Question 14)

Thirty-seven of the schools (86%) indicated thatthe textbooks are required, and 6 schools (14%)indicated that they are not required.

Do you have live demonstrations of the lab-oratory procedures? (Question 15)

Thirty-seven schools (86%) indicated that livedemonstrations are provided in the laboratory forthe procedures taught in the course; 6 schools(14%) indicated that laboratory demonstrations arenot provided.

Do you use prerecorded video demonstra-tions for the laboratory procedures? (Question16)

Twenty-three schools (55%) indicated that theyuse prerecorded demonstrations for the laboratoryprocedures taught in this course; 20 schools (45%)indicated that they do not.

Are any of the lectures available on the In-ternet for the students to review? (Question17)

Thirty-four schools (79%) indicated that theirlectures are not available on the Internet; 8 schools(19%) indicated that they do. One school (2%) didnot respond to the question.

Which laboratory steps are part of the prac-tical examination? (Question 18)

Table 3 summarizes the responses to this ques-tion.

Who grades the practical examinations?(Question 19)

Twenty-six schools (61%) indicated that severalinstructors grade the practical examinations for the

RPD course. Seven schools (16%) indicated thatonly the course director grades the practical exam-inations. Three schools (7%) indicated that 2 in-structors grade the practical examinations. Fiveschools (12%) responded “other”; of these, 3 schools(7%) indicated that all instructors are involved ingrading the practical examinations; 1 school (2%),all instructors as well as the course director; and 1school (2%), 2 instructors and the course director.One school (2%) responded that it does not give anypractical examinations and that the daily lab workis graded. One school (2%) responded that severalinstructors grade and the course director assignsthe overall grade.

Which RPI designs are you currently teach-ing? (Question 20)

Eighteen schools (42%) reported that studentsare taught the Krol RPI design; 11 schools (26%),the Kratochvil RPI design; and 7 schools (16%),both the Krol and Kratochvil designs. Four schools(9%) responded “other”; of these, 1 school (2%)taught both the Kratochvil and the Demer designs,1 (2%) taught the Demer design, 1 (2%) taught thecircumferential (Roach) clasp, and 1 (2%) taught across between the Krol and Kratochvil designs. Twoschools (5%) did not respond, and 1 school (2%)responded “none.”

Are you teaching the dual/rotational pathRPD? (Question 21)

Twenty-four schools (57%) indicated that theyare not teaching the dual/rotational path RPD; 19schools (43%) indicated that they are teaching thistype of RPD.

Table 3. Preclinical Laboratory Steps Included in thePractical Examinations

Laboratory Steps

Number ofRespondingSchools (%)

Surveying and designing an RPD 10 (23)Rest seat preparation 0 (0)Altering guide planes and height of

contours0 (0)

Rest seat preparation and altering guideplanes and height of contours

1 (2)

Surveying and designing an RPD andrest seat preparation

1 (2)

Surveying and designing an RPD, restseat preparation/and altering guideplanes and height of contours

29 (68)

No practical examinations given 2 (4)


DiscussionThe results of this preclinical RPD curriculum

survey of U.S. dental schools show that prosthodon-tic education varies among schools, although sometrends in curricular formats and content are evi-dent.

Thirty-seven dental schools (86%) reported hav-ing a separate RPD course as part of the curricu-lum. The student-to-faculty ratio varies amongschools. More than 1⁄2 of schools (60%) reportedoffering less than 60 hours of preclinical RPD lab-oratory hours; only 5 schools (12%), between 81 and100 RPD laboratory hours. This is a sharp contrastto a previous survey that looked at the number ofcomplete denture laboratory hours8 and reported35% of schools offering between 81 and 100 hours ofcomplete denture preclinical laboratory hours. Theadvent of osseointegration has perhaps fostered aperception among educators that RPD prosthodon-tics will not be used as widely in the future, and,consequently, curriculum hours devoted to the lab-oratory portion have decreased. The current trendappears toward more work being delegated to thelaboratory technician, with student involvement notneeded in every laboratory step. This result was alsofound by Weintraub et al in 1997.9

The schools reported a wide range of the num-ber of laboratory practical examinations given aspart of the RPD course. Most dental schools fell inthe range of 1 to 3 practical examinations.

Most of the schools (68%) reported that thefollowing preclinical laboratory steps are includedas part of a practical examination: surveying anddesigning an RPD, preparing the rest seat, andaltering guide planes and height of contours. Twoschools (4%), however, reported not having anypractical examinations in this course. Most of thedental schools (61%) reported that several instruc-tors grade the practical examinations.

Thirty-nine dental schools (91%) reported thatdental students do not process their RPD setups inthe course. The majority of schools (55%) reportedusing the Hanau modular semiadjustable articula-tor in the RPD course; another large group (31%)reported using the Whip Mix semiadjustable artic-ulator. Four schools (9%) reported not using anyarticulator. All schools (100%), however, reportedusing a surveyor when designing RPDs.

Most schools reported having live demonstra-tions of laboratory procedures (86%) as well asprerecorded video demonstrations for these proce-

dures (55%). However, most schools (79%) do nothave their lectures available on the Internet. There-fore, most dental schools are still using more tradi-tional techniques to teach RPD prosthodontics.

The total number of lecture hours for the RPDcourse varied across the country. Approximately 1/3(36%) of the dental schools reported between 10and 15 lecture hours; another third (33%) reportedbetween 16 and 25 lecture hours. The trend amongU.S. dental schools appears to be that the meannumber of RPD lecture hours (21 hours) is lessthan both the complete dentures lecture hours (28hours)8 and the fixed prosthodontic lecture hours(42 hours).10

A large majority of schools (95%) reported thatthey have prosthodontists teaching the RPD course.However, there was variability in the number ofprosthodontists among schools.

The number of written examinations given alsovaried across the country, with a range of 1 to 6examinations. The most commonly used textbookin the RPD course was McCracken’s Removable PartialProsthodontics, used by 51% of the respondingschools). The Removable Partial Denture Design text-book was used by 14% of the schools. The currenttrend appears to be that most dental schools (86%)require the assigned textbook(s).

The type of RPI design taught among schoolsalso varied. Many schools (42%) teach the Krol RPIdesign; only 26% teach the Kratochvil RPI design.Perhaps more notably is that 84% of schools re-sponding to this survey include 1 or the other orboth RPI design philosophies.

Most schools (57%) do not teach the dual/rota-tional path RPD design. The question of whetherstudents arrange artificial denture teeth was notasked. However, Weintraub and Weintraub9 indi-cated a trend toward delegation of the arrange-ment of artificial teeth to the dental laboratory.

ConclusionsA survey was conducted on preclinical removable

partial denture prosthodontics curriculum in allU.S. undergraduate dental schools. The responserate to this survey was 80%. Information obtainedfrom the responding schools included quantitativecurriculum structure, materials used, and educa-tional techniques applied. The responses were tab-ulated. The findings show some variability fromschool to school on certain aspects of the curricu-lum structure and materials used. They also show


Figure 1. Questionaire sent to American Dental Schools Removable Partial Denture Preclinical Course Survey


Figure 1. (continued)


some similar trends, indicated by the large percent-age of schools agreeing on:

1. A separate RPD course in the curriculum2. Quantity of laboratory hours3. At what point in the students’ curriculum the

course was offered4. Type of articulator used5. Use of a surveyor6. Qualifications of the faculty7. Use of laboratory demonstrations8. Steps included in the practical examinations

and their grading9. Processing of RPD setups

10. Teaching of the dual/rotational path RPD.

The following questions elicited the most widelyvarying responses:

1. Student-to-faculty ratio2. Quantity of lecture hours3. Number of practical examinations4. Number of written examinations5. Percentage of prosthodontists teaching6. Type of RPI design taught.

Other topics of great interest to educators mightinclude type of occlusion taught, interocclusal reg-istration records used, altered cast impression tech-nique and materials taught, and insertion protocolfor RPDs used. These topics were not covered inthis survey, and further research is needed to inves-tigate them.

AcknowledgementThe authors wish to thank the schools that generouslydevoted their time and effort to completing these ques-tions for the survey.

References1. Institute of Medicine: Dental Education at the Crossroads

Challenges and Change. Washington, DC, National Acad-emy, 1995

2. Meskin LH, Brown LJ: Prevalence and patterns of tooth lossin U.S. employed adult and senior populations 1985-86. JDent Educ 1988;52:686-691

3. Douglass CW, Watson AJ: Future needs for fixed and re-movable partial dentures in the United States. J ProsthetDent 2002;87:9-14

4. Weintraub JA, Burt BA: Oral health status in the UnitedStates: Tooth loss and edentulism. J Dent Educ 1985;49(6):368-378

5. Meskin LH, Brown LJ, Brunelle JA, et al: Patterns of toothloss and accumulated prosthetic treatment potential in U.S.employed adults and seniors, 1985-86. Gerodontics 1988;4(3):126-135

6. Taylor TD, Aquilino SA, Matthews AC, et al: Prosthodonticsurvey. Part II: Removable prosthodontic curriculum survey.J Prosthet Dent 1984;52:747-749

7. Goodacre CJ: Predoctoral fixed prosthodontics education. JProsthet Dent 1990;64:319-325

8. Rashedi B, Petropoulos V: Preclinical complete denturescurriculum survey. J Prosthodont 2003;12:37-46

9. Weintraub AM, Weintraub GS: The dental student as tech-nician: An 18-year follow-up of preclinical laboratory pro-grams. J Prosthodont 1997;6:128-136

10. Petropoulos VC, Weintraub A, Weintraub GS: Predoctoralfixed prosthodontics curriculum survey. J Prosthodont 1998;7:183-191


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