Key Points
Enables readers to:
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Appreciate the difficulties posed by the problem of inadequate communication of design features for chrome-cobalt removable partial dentures.
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Gain an insight into the role of educational and financial factors in the development of this problem.
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Recognise the need for continuing professional development in this area of clinical practice.
Abstract
Aim Published 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% (n = 16) of respondents felt the time they had spent in VT had increased their confidence in the design of CCRPDs.
Conclusion Financial factors did not have as significant an effect on the quality of prescription and fabrication of CCRPDs as did educational factors. Serious deficiencies in the teaching of CCRPDs during vocational training were identified.
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Acknowledgements
The assistance of the British Society for the Study of Prosthetic Dentistry who provided funding for this investigation through their Research Award is acknowledged. The authors would like to sincerely thank the assistance of the various dental laboratories, and Directors of Vocational Training, who participated in this investigation. For reasons of confidentiality, these must remain anonymous.
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This article was read before the Annual Scientific Meeting of the British Society for the Study of Prosthetic Dentistry at Cardiff, Wales on Monday 21 March 2005.
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Lynch, C., Allen, P. Why do dentists struggle with removable partial denture design? An assessment of financial and educational issues. Br Dent J 200, 277–281 (2006). https://doi.org/10.1038/sj.bdj.4813309
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DOI: https://doi.org/10.1038/sj.bdj.4813309
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