Periodontal Prosthesis is not an easy entity to explain to the non-dental professional person. It is a hybrid sub-specialty of prosthetic dentistry (crowns, bridges, dentures, implants) that employs treatment methods modified from traditional prosthetic techniques to address the complex problems associated with mouths that have suffered destruction from advanced periodontal disease. Periodontal disease is the disease process by which teeth lose their gum and bone support through the effect of undisturbed accumulating bacteria and excessive bite pressures. Teeth that have lost bone support are looser than they once were and bite pressures can cause them to drift out of alignment. Periodontal disease first became treated as a specialty in the 1950's and 60's and, to a large part, through the efforts of two pioneer clinicians at The University of Pennsylvania School of Dental Medicine, Drs D. Walter Cohen and Morton Amsterdam. As the techniques to "save" periodontally involved teeth developed, they brought with them a whole new set of prosthetic problems concerning how to use them in function, because most "saved" teeth exhibited some degree of looseness, drifted position, and most often had neighboring teeth that were equally weak or even missing. The "engineering" requirements needed to use these weakened teeth resulted in the creation of extensive bridgework, more often than not requiring all the teeth to be joined together in full upper and lower bridges, referred to as a full mouth reconstruction, or elaborate highly precision partial dentures. Adult orthodontics was often incorporated to straighten teeth that had drifted out of their position. These techniques became the basis for the name of this very specialized treatment as Periodontal Prosthesis. Dr's Cohen and Amsterdam developed the system to teach these principles through a 3 year Periodontal Prosthesis / Periodontics graduate program at Penn. It required not only the prosthetic training in Periodontal Prosthesis, but also required achieving a specialty level certificate in Periodontics ( gum and bone surgery), because it was felt that the in depth knowledge and skills of both areas were integral to the successful management of the periodontal patient case.
Dr. Phillips graduated from that program in 1980, being mentored by Drs Cohen and Amsterdam near the end of their teaching careers, along with a host of their trained faculty. What happened to Periodontal Prosthesis next is an interesting turn of events in dental history. Dental implants emerged in the early 80's as a result of some landmark studies published by a team of Swedish researchers. There then occurred a rapid shift in treatment strategies where many teeth that had been previously "saved" by periodontal therapy and restored via periodontal-prosthetic techniques were now considered expendable and slated for extraction in preference of a dental implant with a perceived better prognosis. The word "perceived" is used because, statistically, the first decade or so of implants in clinical practice did not live up to the results that were anticipated from the Swedish studies, and the profession found itself entering into a decade or more long learning curve attempting to understand the finer points of using implants. Periodontal Prosthesis was caught in the middle. Enough had been seen of implants to know that they were here to stay, but there was certainly additional experience needed to comfortably rely on them. Periodontal Prosthesis was in an identity crisis, as was the entire profession concerning treatment planning principles around implants. The Periodontal Prosthesis program at Penn was discontinued for several years. As the story turns out, as knowledge and clinical experience accumulated throughout the 90's and 2000's in the growing field of implants, new areas of concern developed on how implants interrelate with neighboring teeth, how the gum can be managed for optimum esthetic results and how complex implant prosthetic restorations are designed and constructed. With some modifications, these concerns were found to be well within the skill sets previously taught in the Periodontal Prosthesis curriculum. This whole process was a bit of a deyjavu going back in dental history when periodontal treatment conditions prompted the need for the development of the original periodontal prosthesis concept. So, as this new relationship between implant engineering and established Periodontal Prosthesis concepts was recognized, the Penn program re-emerged into a new re-tooled four year program and, once again, is one of the premier educational authorities in the field, now incorporating periodontal tooth concepts and dental implants and their interrelationship.