Dr. Frank Tuminelli on Prosthodontics' Present and Future

For National Prosthodontics Awareness Week (April 12-18), Inside Dentistry spoke with Frank Tuminelli, DMD, FACP, president of the American College of Prosthodontists (ACP) for an insider’s perspective on what’s happening in the field.

Inside Dentistry: What are some of the changes and advancements you’ve seen in the field during your career?

Frank Tuminelli: My career spans about 25 years, and I have seen and experienced advances that have basically transformed the specialty to a different place from where it was when I received my education. There have been game changes. Dental implants are the first one; they transformed all of our treatment models. Our basic training theories have stayed the same, but the evolution of materials, advances in diagnostic capabilities, the rise of digital technology, and improvements in instrumentation, the ability to harvest bone and biologic tissues, have provided options we never imagined. As prosthodontists, today we have the ability—with all of these advancements—to bring patients back to a sense of well being wellness, function to feel complete as human beings again.

ID: Can you tell us more about the impact that digital dentistry is having in prosthodontics?

FT: The most rapid changes that are happening in prosthodontics are due to the digital revolution and design in the virtual world. In the recent past we did everything manually. From waxing on a die and then casting the restoration. Today, we create high-quality restorations digitally. They fit extremely well, are very precise, beautiful, and provide years of function and esthetic. The most amazing part is, they can be completed in one appointment. The ability to take a video impression, eliminating the goopy stuff in the mouth that patients complain about, is a huge advancement.  

With the ability to then put it on a screen in front of the patient and design the restoration as they watch is redefining the care delivery model.  We can magnify over 1000 times what would be able to be seen with conventional methods. The result is the creation of a very precise restoration that is also beautiful. If you have the capability to mill the restoration in your office, which a lot of prosthodontists do, in 10 to 15 minutes you can have the final restoration, and then place it, completing the process. The patient is in your office for one visit, and there is no laboratory downtime. Patients are actually thrilled, watching their tooth being milled out. Thus we provide an expedited return to normal function and esthetics for these patients.

On the grand scale, placing implants and placing teeth in the same day is really exploding in the clinical delivery models. This is no longer the exception; it’s becoming the norm for our patients. Patients are coming in with no teeth and leaving that same day with full-fitted teeth. What does it mean? On a grand scale, it gives them an overall sense of wellness. There are fewer healing issues and overall fewer complications.

ID: “Evidence-based dentistry” is a concept that gets a lot of buzz. How are prosthodontists incorporating it into practice?

FT: Prosthodontists are using data from evidence-based models for making treatment outcomes better for patients. That means we no longer simply do things one way; there are multiple ways to provide proven treatment options to a patient. It leads us to use better materials. We share information. For example, we are sharing information through our ACP website Prosthopedia, and enabling all clinicians, regardless of specialty, to have the best information available right now. Even with our journal, Journal of Prosthodontics, now through the end of April there is free access to articles that focus on evidence-based model of treatment, so all dental professionals can utilize this powerful resource.

ID: What do you think is going to be the next big leap for prosthodontists?

FT: When we look at the replacement of tooth structure with an alloplastic or an artificial material, there is a pretty amazing possibility that we will someday be able to harvest ones own DNA and grow your own enamel. That’s the ultimate endpoint of care delivery, because we are now putting back the exact biological material. I honestly don’t think that’s too far away. I think the point in time is coming where we might not use metal implants anymore and instead replace a tooth with a tooth that you grew from your own DNA. It’s interesting to me.

I remember in the early 80s I was sitting with my Graduate Program Director after coming back from the Toronto Symposium. I said, “Dr. Lucia, now there are dental implants. It seems like we’ve invented everything that needed to be invented.” He looked at me and said, “Yeah, I thought the same thing in 1936 when they invented compound. You have no idea what’s coming.”

With what’s happened in the past 25 years, we now practice a different specialty than we did even 5 or 10 years ago. It’s like Star Wars; it’s so different, so exciting, and so full of promise.

ID: Where do you see the field going as a whole then?

FT: I think you have to look at dental care delivery and prosthodontics as now being integrated into the medical model. In the US especially, with the advent of Medical Home and Dental Home, which are these large care delivery centers that are now focused on patient-centered care as opposed to provider-centered care. The providers are now going to come to the patient instead of the other way around. In this model, dentistry is the gatekeeper in terms of getting patients into the system. Dentists see their patients pretty regularly on a recall basis of 3, 4, or 6 months. In terms of our elderly population and prosthodontics, we see that specific population more frequently than others, because of their very complex medical conditions. Merging the dental component into the medical component—that’s going to be good for patients. Going forward, I think you are going to see increased alignment of the dental profession, and especially the specialty of prosthodontics, with medicine. This will be the focus of patient-centered wellness care.