Complete denture prescription--an audit of performance

Does periodical department audit really works to make things fall in place: A Geriatric/General Oral Health Assessment Index based audit in prosthodontics

Purpose:

The purpose was to assess the outcome of improved staff supervision on the efficiency and quality of complete dentures delivered by clinical students.

Materials and Methods:

The audit was performed in two parts. In the first cycle, retrospective analysis for complete dentures delivered by clinical students was undertaken, and patient's satisfaction was graded using Geriatric/General Oral Health Assessment Index (GOHAI). All the impeding factors encountered in the first cycle were identified, and corrective measures were implemented. Subsequently, a prospective analysis for the dentures delivered under strict staff supervision was undertaken in the second cycle. Patient satisfaction was graded again using GOHAI.

Results:

Improved staff supervision increased the patient satisfaction significantly.

Conclusions:

The quality of care had improved in leaps and bounds compared to the first cycle due to increased level of supervision and strict adherence to the recommendations made at the end of the first cycle.

Creating natural-looking removable prostheses: combining art and science to imitate nature

Patient awareness of dental appearance has increased, resulting in more demanding esthetic requests. There is also strong evidence that increased esthetics is highly significant for complete denture acceptance and success. Taking notice of patients' perceptions of natural appearance and esthetics, the clinician can incorporate their preferences in the construction of individualized dentures that will be harmonized with their facial characteristics. Despite the evolution of materials and techniques, the vast majority of dentures still fail to look natural. Thus, producing prostheses that defy detection and successfully restore the appearance of edentulous patients remains a challenge for the clinician. This paper presents a clinical case where immediate loading of implants supporting a mandibular overdenture was combined with an opposing conventional maxillary denture to satisfy the high functional and esthetic demands of the patient. It also emphasizes the individualized esthetic performance through customization during their fabrication while taking into consideration the various clinical parameters affecting rehabilitation of the edentulous jaw.

CLINICAL SIGNIFICANCE

Implant-retained overdentures can significantly improve the patients' function. The esthetic performance of these restorations however, may not be satisfying the patients' expectations and demands. Customizing the artificial gingival areas and individual staining of the prefabricated acrylic teeth may improve the esthetic performance creating natural-looking removable prostheses.

Removable Prostheses Revisited: Challenges for Primary Dental Care. 1. Complete Dentures

The provision of removable prostheses remains a significant aspect of primary dental care. In the recent past and in the near future, there have been and will be significant new influences on how removable prostheses are provided for patients in the UK. In this paper, the first of a series of three, the trends in edentulousness in the UK will be summarised, and important changes that are likely to influence complete denture provision will be outlined. The paper will then go on to provide an update of clinical procedures in complete denture provision. A second paper will consider partial denture provision, and a third paper will deal with overdentures.

Specifications provided by practitioners for fabrication of removable acrylic prostheses in Tanzania

This study aimed at determining the standard of communication between practitioners and dental laboratory technicians in fabrication of removable acrylic prosthetic appliances using written prescriptions. Three hundred and seventy-nine prescriptions submitted to the Dental Laboratory of Muhimbili National Hospital (January 1998-May 2004) were assessed for their instructive quality. Only specifications necessary for the fabrication of a removable acrylic prosthesis were considered. Analysis was according to type of appliances and indicated specifications by practitioners. EPI 6 was used with chi-square test for statistical analysis at a 0.05 level of significance. All 379 prescriptions had designation of practitioner and type of appliance indicated and most were authorized by doctors (67%; n = 254) and for partial dentures (86.5%; n = 328). The majority of the complete dentures (13.5%; n = 51) were authorized by students (49%; n = 25) in comparison with partial dentures (86.5%; n = 328) that were authorized mainly by doctors (71.9%; n = 236). Teeth required (83.4%; n = 316) was the most indicated specification and interns were the most instructive of practitioners. For complete dentures, the only significantly indicated specification was appointment date for occlusal registration. The most significantly indicated specifications for partial dentures was teeth required followed by appointment date for fitting, shade, claSPS and secondary impression. The standards of communication between practitioners and dental laboratory technicians in the fabrication of removable acrylic prostheses are generally inadequate as most required specifications were not indicated by practitioners. Work undertaken by technicians should be accompanied by a detailed written prescription, completion of work authorization be included in the curriculum and Dental Laboratory Vouchers in use be evaluated.

Chairside options for the treatment of complete denture problems associated with the atrophic (flat) mandibular ridge

This article outlines a number of simple clinical steps which should enable general dental practitioners to diagnose and treat the majority of complete denture problems in patients with atrophic mandibular ridges. The guiding principle is the reduction of forces transmitted to the denture-bearing area via the lower denture. Methods of optimising the size of the denture bases and/or the occlusal tables are discussed and illustrated.

The design and use of special trays in prosthodontics: guidelines to improve clinical effectiveness

This paper looks at how carefully prescribed special trays can be helpful in everyday dental practice. Guidelines are suggested for the design of custom trays, that will, hopefully, lead to improvements in the quality of working impressions.

Survey of prosthodontic impression procedures for complete dentures in general dental practice in the United Kingdom

STATEMENT OF PROBLEM

Anecdotal evidence suggests impression techniques used in general dental practice may vary from those taught at dental schools. There is little published information on this topic.

PURPOSE

This study identifies the materials and methods used by general dental practitioners for recording impressions for the provision of replacement of complete dentures.

METHODS

A total of 905 questionnaires were sent to general dental practitioners in the Greater Manchester area to identify current clinical practices.

RESULTS

The results revealed that 88% of respondents use only irreversible hydrocolloid for primary impressions. If multiple responses are included, 99% of respondents mentioned irreversible hydrocolloids as an option for primary impressions. In response to the same question for secondary impressions, 94% of respondents mentioned irreversible hydrocolloids as an option. Other material mentioned as an option for secondary impressions included zinc oxide-eugenol (29%) and polyvinyl siloxane (13%). With regard to special trays, 75% of respondents routinely used laboratory constructed special trays to take definitive impressions. Questions on the requisite spacing, perforation, handle design of special trays, and on disinfection showed a diversity of opinion among practitioners.

CONCLUSIONS

Although this survey reflected a diverse range of clinical preferences, it is clear that irreversible hydrocolloid dominates the impression market for complete dentures. The use of special trays is normal practice for complete dentures in general dental practice in the United Kingdom.