Why do dentists struggle with removable partial denture design? An assessment of financial and educational issues

Abstract

AimPublished studies in the international dental literature illustrate that the quality of prescription and fabrication of cobalt-chromium removable partial dentures (CCRPDs) by general dental practitioners frequently fail to comply with ethical and legal requirements. The reasons cited for this in the past have broadly related to either financial or educational issues. The aim of this investigation is to determine the effect of financial and educational factors on the quality of CCRPD design and fabrication by general dental practitioners. Materials and methods This investigation was completed in two parts. (1) A pre-piloted pro-forma was distributed to a number of dental laboratories throughout the UK and Ireland. These sought information relating to the quality of written instructions for CCRPDs received by these laboratories, and details of the remunerative scheme under which they were being provided. Three categories of remunerative scheme were considered, private CCRPDs in Ireland, private CCRPDs in the UK, and CCRPDs being provided by salaried NHS practitioners. (2) A pre-piloted questionnaire was distributed to vocational dental practitioners in the UK and Ireland. This sought information relating to their attitudes, opinions, and educational and clinical experiences of CCRPD design and fabrication. Results (1) Three hundred completed pro-formas were returned from dental laboratories, 100 of which related to each of the three remunerative schemes. Poor or no written instructions were provided in 47% (n = 47) of CCRPD cases funded privately in the UK, 46% (n = 46) of CCRPD cases funded privately in Ireland, and 50% (n = 50) of CCRPDs being provided by salaried NHS practitioners. (2) One hundred and seven completed questionnaires were returned from vocational trainees. Vocational dental practitioners had completed fewer CCRPDs during VT than in dental school (dental school: median = 4, inter-quartile range = 3 to 5; VT: median = 2, inter-quartile range = 1 to 4). One-fifth of respondents (n = 22) had not completed any CCRPDs during VT. Nine per cent of VT practices (n = 10) had a surveyor on their premises. Only 15%

UK dental laboratory technicians' views on the efficacy and teaching of clinical-laboratory communication

“…[8][9][10][11][12][13][14][15] They reported specifically on the quality of written prescriptions in the construction of both fi xed and removable partial prostheses. Lynch and Allen 8 stated that the 'literature has highlighted the poor quality of written prescription for removable partial dentures (RPD) and that the problem still exists'.…”

The teaching of removable partial dentures in Ireland and the United Kingdom

“…In 2006, the authors published the fi rst study which sought to investigate the role of fi nancial and educational factors on the design process for cobalt-chromium removable partial dentures. 12 We found, by comparing samples of written instructions for cobalt-chromium removable par tial dentures provided under a number of different fee struc tures, that there was little difference between the quality of written instructions. 12 This finding is consistent with a simi lar study of endodontic practice in the UK, which found that increased fees did not equate to increased treatment quality.…”

“…12 We found, by comparing samples of written instructions for cobalt-chromium removable par tial dentures provided under a number of different fee struc tures, that there was little difference between the quality of written instructions. 12 This finding is consistent with a simi lar study of endodontic practice in the UK, which found that increased fees did not equate to increased treatment quality. 13 However, when we investigated the significance of the educa tional factors, the picture was far more revealing.…”

Partial denture design comparisons between inexperienced and experienced undergraduate students and the teaching staff of a UK dental school

“…Equally there have been a number of surveys which show that in many cases the technicians are asked to design the RPD by the clinician 3,10 and this appears to have been a long standing problem. 14 Previous studies 15 have been carried out which compared the qualifi ed dental surgeons' ability to design partial dentures and communicate the design to the dental technician.…”