Prosthodontics: The Complex Science Behind a Simple Smile

Prosthodontists at Walter Reed National Military Medical Center and the Naval Postgraduate Dental School employ sophisticated technology to provide patients with quality care and complete oral rehabilitation. It’s not an easy specialty to pronounce, but prosthodontists play an important part in the well-being of military patients.

“A prosthodontist is a dentist who specializes in the restoration and replacement of teeth,” explained Navy Capt. Robert Taft, chairman of the Prosthodontics Department at NPDS, located at Walter Reed Bethesda. “There’s a lot that goes into your smile – your teeth, your cheeks, your lips. Everything owns some space. The biggest complexity to what we do is when that is out of alignment … we have to work with all those features, to realign everything. We’re responsible for the rehabilitation, at all levels of complexity, to re-establish one’s smile and function.”

Roberto Carrera, who works in the Prosthodontics Department of the Naval Postgraduate Dental School, prepares crowns for casting. (Photo: Sarah Marshall, Walter Reed National Military Medical Center Public Affairs/Released)

Roberto Carrera, who works in the Prosthodontics Department of the Naval Postgraduate Dental School, prepares crowns for casting. (Photo: Sarah Marshall, Walter Reed National Military Medical Center Public Affairs/Released)

The complex nature of a simple smile requires prosthodontists to be highly trained. They complete four years of college, four years of dental school, and then work as dentists for at least five years before going on to complete an additional three years of specialized training, Taft added. Their role involves creating oral prostheses or surgical implants to replace missing teeth, or to correct a deformation of the mouth and jaws, where teeth are missing. It could be from trauma, cancer, or the way a person was born, he explained.

To meet the needs of their patients, prosthodontists also interact throughout the hospital with a number of other specialties in dentistry and medicine, such as neurology and plastic surgery, depending on the individual’s needs, said prosthodontist Cmdr. Tony Petrich.

“It’s a team effort between us and other specialties,” Petrich said. Prosthodontists are considered the “bus driver” or the “hub,” as a referral specialty, sending patients to other specialists for further types of treatment, he said.

Advanced technology now available allows them to be at the cutting-edge in their field, working with digital x-rays, 3D printing technology, and ceramic milling machines to make veneers, bridges and crowns. They also use computer-aided design programs to produce oral prostheses, dental implants and dentures.

“We have the capability to digitally manipulate a reconstruction before the patient even shows up, and have everything pretty much worked out… if they were injured in the field,” Taft explained. “We can make all the manipulations of bone and soft tissue that we need to, and then design either a surgical template, or actual restoration, to rehabilitate. It’s all done remotely.”

In addition to seeing patients with varying needs and complexities, they’re busy training residents, Taft added. These include dental officers preparing for their board certification while conducting research and training to manage specialty or advanced general dentistry practices.

The eight prosthodontists on staff at the dental school and Walter Reed Bethesda share similar sentiments as to why they enjoy their work – using their ingenuity to help solve problems. Petrich said it’s like an “evolution,” working with the patient to find the best solution and “making it work for every person who comes in the door.”

“It’s the ultimate creativity … Probably 85 percent of what we do is making a solution to a physical puzzle, and just figuring it out,” Petrich said. “That’s physically a big part of what we do, but what it’s actually about is figuring out why and how we make it work for a patient.”

Cmdr. Chris Hamlin agreed, adding he has always been artistic and, as a prosthodontist, uses his creativity to help find resolutions for his patients, each with unique needs.

“I like working through a problem to find a solution,” Hamlin said. “It’s an interpersonal specialty. You spend a lot of time with the patient, getting to know them. For me, that’s what I enjoy.”

Navy Capt. Dan Ellert, a prosthodontist in NPDS, also enjoys being able to work through complex cases, looking at the bigger picture to ultimately make an impact on a patient’s overall well-being.

“Being able to provide that for the patient is something that drew me in,” Ellert said. “It’s tying the arts and sciences together.”

Story and information provided by Walter Reed National Military Medical Center
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