AN INVITED EDITORIAL

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American Board of Prosthodontics:70 years of specialty certification

Establishing the SpecialtyThe specialty of prosthodontics evolved from the deter-mination of clinicians driven toward excellence in patientcare. The small group who met in 1918 in the CongressHotel in Chicago, Illinois became the National Society ofDenture Prosthetists (NSDP) in 1919 and planted theseed for the specialty of prosthodontics and the need forboard certification. As the discipline evolved, the NSDPwas renamed the Academy of Denture Prosthetics in1940, and then the Academy of Prosthodontics in 1990.In 1946, at the request of the American Dental Associa-tion, the Academy of Denture Prosthetics elected 9members to establish the American Board of Prostho-dontics (ABP). Drs Kingery, Hooper, Dresen, McLean,Elliott, Hardy, Stansbery, Boucher, and Tench were thefirst elected to the Board.1

The ABP was officially incorporated in Illinois onFebruary 21, 1947. The first examination was conductedon February 2, 1949 in Chicago, only 4 months after theAmerican Dental Association House of Delegates votedto recognize prosthodontics as one of the dental spe-cialties, together with endodontics, oral and maxillofacialsurgery, and periodontics. The Academy of DentureProsthetics sponsored the ABP from 1947 to 1972 when itgave the sponsorship to the Federation of ProsthodonticsOrganizations. In 1994, the American College of Pros-thodontists as the recognized organization for the spe-cialty assumed sponsorship of the Board.

By recognizing clinicians who meet the standard forboard certification, the ABP provides one of the criticalaspects that define the specialty. Prosthodontics isdefined by scope of practice, educational standards, andclinicians in practice who meet the board certificationstandard. The specialty is framed by the ADA Commis-sion on Dental Education and Licensure Definition,the American College of Prosthodontists Parameters ofCare, the Commission on Dental AccreditationAdvanced Specialty Education Program Standards for

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Prosthodontics, and the ABP certifying examinationguidelines and process leading to Board Certified spe-cialists called Diplomates. ABP efforts were and continueto be a critical part of the evolution of prosthodontics andits recognition as a dental specialty.

Establishing the Educational StandardBeginning with the first examination, and for the next 35years, the American Board of Prosthodontics retaineddirect responsibility for the educational standards for thespecialty. The ABP was the sole body that set the ex-pectations for the specialty. Prior to 1954, candidateswere eligible for examination if they had formal pros-thodontic training recognized by the Board, or if they hadbeen in clinical practice for 10 years. Beginning in 1954,formal prosthodontic training was required for boardcertification thereby making specialty training the onlypath towards achievement of certification. After January1, 1965, members of the ADA wishing to announcethemselves as specialists or as limiting specialty practicewere required to complete two or more years of advancededucation as specified by the certifying boards, or topossess a state license permitting announcement in aspecialty area approved by the ADA.2 With this state-ment, the ADA continued to recognize each specialty’scertifying board as the authority for educational re-quirements. Beginning in 1975, the Commission onDental Education (CDE) issued revised specialty levelstandards across programs to which education programguidelines published by each specialty board wereappended.3-5

In 1984, the Commission on Dental Accreditation(CODA) began adopting comprehensive specialty levelstandards. Educational comments and recommendationscould be made to CODA by the ABP and other com-munities of interest. Through the CODA ProsthodonticReview Committee, which makes definitive educationalrecommendations to the Commission for consideration,

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approval and implementation, this educational standardreview, adoption and implementation process continues.

The ABP has a long history of clinical problem solv-ing, forward thinking, and innovation that directlyaffected the specialty growth and core content of the ABPcertifying examination. The general concepts for fixedprosthodontics, removable prosthodontics, occlusion,gnathology, dental implant surgery and prosthetics, es-thetics, and evidence-based decision making formulatedduring the last 100 years represent the foundationalknowledge across dentistry as a whole. Diplomates of theABP have been critical contributors to the developmentand application of these principles that support all as-pects of dentistry. ABP examination content thereforeevolved as clinical understanding progressed and scopeof practice evolved within the specialty.

Evolving Examination Format and ContentThe Board examination content changed as the spe-cialty advanced and educational standards changed.Written, oral, and active patient care was includedfrom the inception of the examinations until the lastclinical examination was conducted in June 1991. Theprocess continues to demand specialty level patienttreatment clinical documentation, which emphasizesthe specialty’s focus on comprehensive care that de-mands a combination of clinical and academic skillsand knowledge.

The early examination format was directed towardremovable prosthodontic care. In 1957, the Board initi-ated clinical examination of fixed prosthodontic patients.Maxillofacial prosthetics became a portion of the exami-nation in 1968, and, in 1974, candidates could choose aclinical examination in maxillofacial prosthetics. The 2-phase examination format that separated clinical com-ponents of the examination from oral and writtenexaminations began in 19626 and continued until 1991.Phase I included a written examination, as well as thedocumentation and presentation of a patient with onefixed prosthesis and one distal extension removablepartial denture followed by an oral examination. Phase IIwas the week-long clinical examination in fixed orremovable prosthodontics. When prosthodontic specialtytraining changed in the mid 1980s to include fixed andremovable prosthodontic training in all programs, the 2-phase examination approach continued as an appropriateexamination as the newly combined training programswere developed. The final Phase II clinical examination in1991 was challenged by 85 clinicians.

The reformatted examination implemented in 1992included the Section A written examination followed bypresentations for Section B Parts 2-4 clinicalexaminationseremovable partial denture, complex fixedprosthodontics, and complete denture, respectively. Pa-tient selection was fundamentally determined by

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diagnoses, treatment planning, and care for dentate,partially edentulous, or completely edentulous patients.

With the goal to increase examination accessibility,the ABP implemented the Section C examination in2008. The scenario examination allowed the candidatesto demonstrate their knowledge in all areas of Prostho-dontics including Implant Prosthodontics, which hadbecome a major component of the prosthodontic spe-cialty education programs. This scenario-based oral ex-amination allowed candidates to substitute the Section Cexamination for 1 of the 3 patient presentation oral ex-aminations in Section B. The Section C examinations,although straightforward in concept, proved to bethought provoking in developing agreement among theBoard members regarding concise format, questions,answers, and presentation during the examination. Thepositive result of this calibration extended to efforts to-ward the development of Section A and review of SectionB, leading to an overall more robust and fair candidateexperience.

The Board expends significant time developing anaccurate and equitable examination and carefully reviewspost-examination metrics. The psychometric analyses forSection A and Section C examinations standardize as-sessments across examinations for validity and reliability.This coordinated assessment in concert with examinercalibration leads to a high quality and objective candidateexamination with demonstrated consistency.

The ABP method of addressing the topic of dentalimplants over 30 years exemplifies examination contentevolution. The ABP examined on the topic of dentalimplants beginning in the 1980s. As prosthodontic pro-grams included didactic content and clinical experiences,the examination content grew. In the 1990s, CODAstandards included dental implant care at the in-depthlearning level together with associated implant pros-thetic clinical care. CODA standards required an increaseprogram length from 24 to 33 months to allow curriculumtime for study and clinical care experience with dentalimplants for patients. By the early 2000s, prosthodonticpractices and prosthodontic programs included the sur-gical placement of dental implants. In 2016 revisedCODA standards required student/resident competencein surgical placement of dental implants during theirprosthodontic program. CODA standards againincreased required program length from 33 to 35 monthsso that programs could provide the necessary time forlearning experiences to achieve competence.

The ABP in 2016 introduced the Section D examina-tion, which requires dental implant placement and fixedprosthetic restoration by the candidate for bounded andunbounded edentulous sites. Section D was a naturalprogression in existing ABP examination content basedon the definition of prosthodontics, advances in pros-thodontic patient care, scope of practice, and educational

Knoernschild et al

Figure 1. One quarter of all elected to the Board since 1947 pictured. All examined in February 2018. Ten past-presidents of the Board. (Front row, left-to-right) Drs Rhonda Jacob, Radi Al-Masri (Secretary-Treasurer), Kent Knoernschild (President), David Felton (Vice-President), Heather Conrad (Director-Elect). (Back row, left-to-right) Drs Donald Curtis, Thomas McGarry (Director), Steven Parel, Kenneth Malament, Dean Morton (Director), Jonathan Wiens,Thomas Taylor (Executive Director), Mathew Kattadiyil (Director), Robert Taft, David Cagna (Director), Carl Driscoll, Arthur Nimmo, Steven Eckert.

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standards. The incorporation of all components of dentalimplant treatment into the 2016 CODA prosthodonticstandards further demanded the need for a morecomprehensive assessment of knowledge and skills inimplant prosthodontics that was met through Section D.The examination reflects implant placement alreadyoccurring in private prosthodontic practice and nearly allprosthodontic specialty programs.

Past Success and Future TrendsThe Board is committed to growth in the number andpercentage of certified prosthodontist Diplomates. Sincethe first certifying examination in 1949, the number ofactive board-certified prosthodontists has grown steadilyto well over 1000. The February 18-20, 2018 certifyingexamination achieved a record number of participatingcandidates, examinations, and examiners (Fig. 1). Thenumber of board certified prosthodontists will continueto increase.

The ABP continues to develop the examinationmethods and content to ensure consistency with clinicalpractice and educational trends. Throughout ABP history,

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changes in format and content have been enacted onlyafter careful consideration. Major changes in examinationmethods or content required several years for study, re-quests for input from relevant communities of interest,development, and implementation. In consideration ofchanges in clinical practice, educational standards, andeducational theory, the ABP regularly reviews its exam-ination methodology to ensure compliance.

The Board is committed to establishing a standard ofexcellence. Scope of practice and educational standardsare not the same, and the ABP examination content willcontinue to evolve consistent with both. The definition ofthe specialty as recognized and established by theCommission on Dental Education and Licensure createsthe clinical and academic boundaries that support thescope of practice and CODA educational standards.Educational standards define minimum experiences forthe entry-level clinician. Scope of practice represents ahigher level of knowledge and clinical skill that the Boardmay examine.

While recognizing candidate variation in learning,ability, and experience, excellence from candidates

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during the ABP examination is expected. Candidateshave been, and will be, examined beyond the basicsand consistent with scope of practice to demonstrateabilities that are more advanced. In this regard, thecertification process will identify individuals who meetthreshold competence, encourage the specialty toadvance, and promote excellence in clinical perfor-mance. The objective “to be a stimulating and guidingfactor to promote progress, higher standards andmore effective service in the field of prosthodontics” iswhat the founders of the Board intended.1 The phi-losophy of advancing the specialty of prosthodonticscontinues.

Kent L. Knoernschild, DMD, MSProfessor and Program DirectorAdvanced Specialty Education in ProsthodonticsDepartment of Restorative DentistryUniversity of Illinois at ChicagoandPresidentAmerican Board of Prosthodontics

Thomas D. Taylor, DDS, MSDProfessor and HeadDepartment of Reconstructive SciencesUniversity of ConnecticutandExecutive DirectorAmerican Board of Prosthodontics

Jonathan P. Wiens, DDS, MSDPrivate practiceWest Bloomfield, MI

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andPast PresidentAmerican Board of Prosthodontics

Steven E. Eckert, DDS, MSProfessor EmeritusMayo Clinic College of MedicineRochester, MNandPast PresidentAmerican Board of Prosthodontics

Thomas J. McGarry, DDSPrivate practiceOklahoma City, OKClinical ProfessorUniversity of Oklahoma School of Dentistry-Removable ProsthodonticsandDirectorAmerican Board of Prosthodontics

REFERENCES

1. Hardy IR. History of the specialty of prosthodontics. J Prosthet Dent 1965;15:946-8.

2. American Dental Association House of Delegates. Experimentation in trainingand utilization of dental hygienists and dental assistants. ADA Transactions1961:219.

3. ADA Commission on Accreditation. Requirements for Advanced Specialty Ed-ucation Programs, As approved by the HOD, November 1974, revised 1975[ADA Archives call no. 33A:33].

4. Council on Dental Education, Annual Reports and Resolutions, ADA Trans-actions. 1982:41.

5. Council on Dental Education, Annual Reports and Resolutions, ADA Trans-actions.1984:41.

6. American Board of Prosthodontics. History, information and examination re-quirements of the American Board of Prosthodontics. J Prosthet Dent 1984;52:281-7.

Copyright © 2018 by the Editorial Council for The Journal of Prosthetic Dentistry.

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