Implementation of a laboratory quality assurance program: the Louisville experience.

Remakes, or the refabrication of dental prostheses, can occur as a result of inherent inaccuracies in both clinical and laboratory procedures. Because dental schools manage large numbers of predoctoral dental students with limited familiarity and expertise as related to clinical prosthodontic techniques, it is likely these schools will experience an elevated incidence of laboratory remakes and their ramifications. The University of Louisville School of Dentistry, not unlike other dental schools, has experienced remakes associated with both fixed and removable prosthodontic procedures. Limitations in faculty standardization and variable enforcement of established preclinical protocols have been identified as variables associated with the high percentage of remakes documented. The purpose of this study was to introduce the implementation of a new multidepartmental quality assurance program designed to increase consistency and quality in both information provided to commercial dental laboratories and the prostheses returned. The program has shown to be advantageous in terms of cost-effectiveness and treatment outcomes. A statistically significant decrease in remake percentages has been recorded from inception of this program in December 2010 until December 2012. Furthermore, this program has resulted in more consistent communication between the dental school and commercial dental laboratories, among faculty members, and between faculty and students.

Reproducibility of an assessment scale of denture quality.

Assessment of denture quality is important in prosthetic research. The aim of this investigation was to determine the intra- and interexaminer reliability of denture quality assessment. Three groups of patients with full maxillary and mandibular dentures and two dentists participated. The patients in group 1 (n = 195) were examined by the two dentists independently, in group 2 (n = 35) twice by one of the dentists and in group 3 (n = 20) twice by the other dentist. A denture quality scale was constructed containing nine variables. The internal consistency (coefficient alpha) of this scale was 0.60. The intra- and interexaminer reliability was between 0.59 and 0.86. For individual items of this scale these values were between 0.22 and 1.00.

Alloys for crown and bridgework.

The requirements of alloys for metal-ceramic crowns and bridgework are examined. The functional requirements and manipulative behaviour and cost of cheaper alternatives to high gold alloys are discussed. All types use--high gold, reduced gold, silver palladium and base metal--appear to function satisfactorily in the mouth. Nickel and beryllium do not appear to be health hazards. Dental laboratory procedures and materials must be chosen to suit the type of alloy employed, although all alloy types appear suitable for crown and bridgework. The cost of alloy must be carefully examined in the context of total cost to the patient, and the use of alternatives to gold alloys in many cases may not warrant the required changes to laboratory procedures, but the saving is real, and can make permanent restorations available to greater proportion of the community.

[Liability claims for prosthetic treatment]. / Haftpflichtansprüche aus prothetischer Behandlung.

Liability claims of 153 patients receiving prosthetic treatment were organized according to damage and were discussed on the basis of the known decisions and judgements of the courts.

The integration of technical services into dental restorative procedures.

A protocol for improved dentist-laboratory relations is presented. The mutual responsibilities and obligations of dentist and technician are outlined. Each step of the procedure is developed and projected at the level of case planning and diagnostic wax-up.

[Findings on the functional planning of dentures]. / Erhebungen zur befundbezogenen Planung von Zahnersatz

Analysis of over 20,000 prosthetic treatments carried out in the area of one association of dentists working under the compulsory public health insurance plan shows that prior to the conclusion of the new financial agreements on prosthetics, a treatment plan based on the findings and aiming at appropriate functional rehabilitation had been prepared in half of all the cases only.