Implementation of a Laboratory Quality Assurance Program: The Louisville Experience

Abstract

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 ramiications. The University of Louisville School of Dentistry, not unlike other dental schools, has experienced remakes associated with both ixed and removable prosthodontic procedures. Limitations in faculty standardization and variable enforcement of established preclinical protocols have been identiied 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 signiicant 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.

Remake Rates for Single‐Unit Crowns in Clinical Practice: Findings from The National Dental Practice‐Based Research Network

“…Even when prescriptions are correctly written, dental laboratories sometimes fail to use prescribed materials and techniques as requested by the dentist . Other reported reasons for crown failures echo our findings, such as inaccurate impressions, poor shade selection, and inadequate die fabrication . These deficiencies manifest clinically as unacceptable crowns, with problems such as proximal misfit and marginal misfit.…”

“…Over half of the clinicians in this clinical study reported no remakes, and the other clinicians had higher remake rates. Other results on remake rates include an article detailing one US dental school that implemented a quality assurance program to reduce remakes . Of cases sent to the laboratory, 8% were considered remakes; after the quality assurance program was implemented, this dropped to 3.4%.…”

Quality of Impressions and Work Authorizations Submitted by Dental Students Supervised by Prosthodontists and General Dentists

“…After launching its program in 1994, the University of Detroit Mercy School of Dentistry's remake rate dropped from 6.3% to 2.9% 8 . Other major benefits noted from the Louisville program were cost‐effective patient care and a model for students to practice skills required for effective communication with dental technicians 7 . In addition, we have found that the QA program can be used effectively for peer review in the educational setting.…”

“…Since introducing the QA program, the annual remake rate of fixed prostheses has remained less than 5%. Similarly, when the University of Louisville School of Dentistry initiated a QA program in 2011, its annual remake rate dropped from 14.4% in 2010 to 5.7% in 2012 7 . After launching its program in 1994, the University of Detroit Mercy School of Dentistry's remake rate dropped from 6.3% to 2.9% 8 .…”

Evaluación en Contexto Dinámico, una Experiencia en Odontogeriatría

“…El propósito de una clase presencial dirigida al estudiante persigue la entrega de conocimientos de primera fuente e in situ para que el alumno logre paulatinamente la construcción de un criterio clínico mediante la reflexión personal, para que luego sea capaz de reconocer situaciones clínicas en contexto real que le permitan tomar la mejor decisión basada en la evidencia. Si bien es cierto no existe evidencia de cuál sea la modalidad pedagógica más eficiente para educar diseño protésico en contexto, sí existe evidencia de la aplicación de normas de aseguramiento de la calidad para asegurar mejores resultados de gestión con los laboratorios dentales desde la academia (Metz et al, 2014). Frente al cambio de escenario en la tercera evaluación sumativa hacia un escenario dinámico, se evidenció que solo un 1% de los alumnos es capaz de proponer 3 de 5 características clínicas que impidan ejecutar un diseño protésico (Tabla 3), un 89% no pudo proponer un nuevo diseño protésico (Tabla 4) y existe una alta omisión de respuestas, pese a que los contenidos fueron abordados en clases (Tabla 1).…”