Audit to assess the quality of 916 prosthetic prescriptions of removable partial dentures

doi:10.7518/hxkq.2023.2021565

Abstract

Abstract:

Objective The objectives of this study were to assess the quality of prosthetic prescriptions of removable partial dentures (RPDs) and to analyze the current situation of the communication and information delivery between clinicians and technicians. Methods All RPD prosthetic prescriptions received by a major dental laboratory in 4 weeks were involved in a quality audit, and the prescriptions were divided into three groups in accordance with the grades of clients. The filling of prosthetic prescriptions was recorded. The items in the prescriptions for audit included the general information of the patient, the general information of the clinician, the design diagram information, other detailed information, and the return date. The prescriptions were categorized into four levels on the basis of their quality by two quality inspectors who have been working for more than 10 years. Results A total of 916 prescriptions were collected and assessed. The names in the general information of the patient and the clinician were filled out best, both at the rate of 97.6% (n=894). The return date was filled out worst, only at the rate of 6.4% (n=59). Of those prescriptions, 86.8% (n=795) exhibited inadequate design diagram information. The results of the quality assessment demonstrated that 74.2% of prescriptions were assessed as noncompliant ones and failed to meet the acceptable clinical quality standard. Conclusion At present, the overall quality of RPD prosthetic prescriptions is poor. The responsibilities of clinicians and technicians are unclear, and the communication between them is not ideal.

Key words: removable partial dentures, prosthetic prescription, communication, dental laboratory

CLC Number:

R 783.6

Zhang Na, Mao Bochun, Dai Yunhan, Chen Shengkai, You Ziying, Zhang Junjing, Chen Xin, Dong Haoyue, Yue Li, Yu Haiyang. Audit to assess the quality of 916 prosthetic prescriptions of removable partial dentures[J]. West China Journal of Stomatology, 2023, 41(3): 315-322.

Figures/Tables 10

Tab 1

Fig 1

Tab 2

Fig 2

Tab 3

Fig 3

Tab 4

Fig 4

Fig 5

Tab 5

References 21

1	Stewart CA. An audit of dental prescriptions between clinics and dental laboratories[J]. Br Dent J, 2011, 211(3): E5.
2	Lynch CD, Allen PF. Quality of communication between dental practitioners and dental technicians for fixed pro-sthodontics in Ireland[J]. J Oral Rehabil, 2005, 32(12): 901-905.
3	Christensen GJ. Improving dentist-technician interaction and communication[J]. J Am Dent Assoc, 2009, 140(4): 475-478.
4	Evans JL, Henderson A, Johnson NW. Interprofessional learning enhances knowledge of roles but is less able to shift attitudes: a case study from dental education[J]. Eur J Dent Educ, 2012, 16(4): 239-245.
5	Owall B. Design of removable partial dentures and dental technician education[J]. Sven Tandlak Tidskr, 1974, 67(1): 21-32.
6	Lynch CD, Allen PF. A survey of chrome-cobalt RPD design in Ireland[J]. Int J Prosthodont, 2003, 16(4): 362-364.
7	Alammari MR. Shortened dental arch concept: investigation of the quality of written prescription by dentists to dental technicians in Jeddah, Saudi A[J]. Life Sci J, 2016, 13(8): 1-7.
8	Koodaryan R, Hafezeqoran A. The quality of written prescriptions received at dental laboratories in Tabriz, Iran[J]. Glob J Health Sci, 2016, 8(12): 266-275.
9	The British Society of Prosthodontics. Guides to standards in prosthetic dentistry‑complete and partial dentures[EB/OL]. [2021-10-05].
10	中华口腔医学会. 口腔医学行业标准规范及指南(2005-2015)[M]. 北京: 人民军医出版社, 2015.
	Chinese Stomatological Association. Standards and gui-delines for the stomatology profession (2005-2015)[M]. Beijing: People’s Military Medical Press, 2015.
11	Parry GR, Evans JL, Cameron A. Communicating prosthetic prescriptions from dental students to the dental la-boratory: is the message getting through[J]. J Dent Educ, 2014, 78(12): 1636-1642.
12	Sui L, Wu X, Wu S, et al. The quality of written instructions for dental prostheses in China[J]. J Prosthodont, 2014, 23(8): 602-609.
13	Al-AlSheikh HM. Quality of communication between dentists and dental technicians for fixed and removable prosthodontics[J]. King Saud Univ J Dent Sci, 2012, 3(2): 55-60.
14	Kilfeather GP, Lynch CD, Sloan AJ, et al. Quality of communication and master impressions for the fabrication of cobalt chromium removable partial dentures in general dental practice in England, Ireland and Wales in 2009[J]. J Oral Rehabil, 2010, 37(4): 300-305.
15	杨煦, 徐天舒. 医技交流中义齿加工单填写情况对义齿成功率的影响[J]. 北京口腔医学, 2013, 21(3): 165-167.
	Yang X, Xu TS. Effect of the communication between dentist and dental technician on denture fabrication success[J]. Beijing J Stomatol, 2013, 21(3): 165-167.
16	Lynch CD, Allen PF. Quality of written prescriptions and master impressions for fixed and removable prosthodontics: a comparative study[J]. Br Dent J, 2005, 198(1): 17-20.
17	冯晋, 于海洋. 2 317例定制式固定义齿工作授权书调查研究[J]. 华西口腔医学杂志, 2009, 27(4): 390-393.
	Feng J, Yu HY. Investigation on 2317 working authorizations of fixed partial dentures[J]. West China J Stomatol, 2009, 27(4): 390-393.
18	隋磊, 李蕊, 刘忠武, 等. 可摘局部义齿修复中的医技交流质量评估[J]. 口腔颌面修复学杂志, 2009, 10(5): 275-279.
	Sui L, Li R, Liu ZW, et al. Quality of communication between dentists and dental technicians for removable partial denture[J]. Chin J Prosthodont, 2009, 10(5): 275-279.
19	Stheeman SE, Van der Stelt PF, Mileman PA. Expert systems in dentistry. Past performance—future prospects[J]. J Dent, 1992, 20(2): 68-73.
20	Siegel MA, Firriolo FJ, Finkelstein MW. Computer app-lications in oral diagnosis[J]. Dent Clin North Am, 1993, 37(1): 113-131.
21	陈昕, 毛渤淳, 解晨阳, 等. 一种逐次多级专家系统辅助的可摘局部义齿支架修复技术[J]. 华西口腔医学杂志, 2020, 38(4): 475-478.
	Chen X, Mao BC, Xie CY, et al. A technique to design the framework of removable partial denture by multi-stage expert system[J]. West China J Stomatol, 2020, 38(4): 475-478.

调查项目	未填写/例	完整填写/例	未填写率/%	完整填写率/%
患者基本信息	22	382	2.4	41.7
医生基本信息	15	531	1.6	58.0
设计图信息	416	121	45.4	13.2
其他详细信息	16	80	1.7	8.7
出件时间	857	59	93.6	6.4

调查项目		填写数/例	填写率/%
患者基本信息	姓名	894	97.6
	性别	489	53.4
	年龄	384	41.9
医生基本信息	姓名	894	97.6
医生基本信息	电话	538	58.7
设计图信息	缺牙位置	307	33.5
	卡环设计连接体设计	316	34.5
	卡环设计连接体设计	309	33.7
其他详细信息	咬合设计	546	59.6
	基托范围支架材料	264	28.8
	基托范围支架材料	799	87.2
	人工牙选择	777	84.8
	比色	426	46.5
出件时间		59	6.4

调查项目		A（n=202）		B（n=169）		C（n=545）
调查项目		填写率	完整填写率	填写率	完整填写率	填写率	完整填写率
患者基本信息	姓名	98.0	29.7	95.9	46.7	98.0	44.6
	性别	38.6		59.2		57.1
	年龄	30.2		46.7		44.8
医生基本信息	姓名	99.5	33.2	96.4	69.2	97.2	63.7
医生基本信息	电话	33.7	33.2	69.2	69.2	64.8	63.7
设计图信息	缺牙位置	31.7	16.3	39.6	18.3	32.3	10.5
	卡环设计	34.2		40.2		32.8
	连接体设计	29.7		36.1		34.5
其他详细信息	咬合设计	57.9	10.9	60.4	6.5	60.0	8.6
	基托范围	27.2		36.7		27.0
	支架材料	92.1		84.6		86.2
	人工牙选择	88.1		82.8		84.2
	比色	54.0		37.9		46.4
出件时间		7.9	7.9	3.6	3.6	6.8	6.8

作者	年份	国家	方法	结果	质量评估
Stewart^[1]	2011	英国	50份来自牙科专业本科生和合格牙医的设计单	无医生姓名：25%；无签名：51%；无患者信息：19%；无日期：26%；没有下次预约时间：16%；无材料类型：45%；无设计图：53%	一级：36%；二级：16%；三级：8%；四级：40%
Koodaryan等^[8]	2016	伊朗	300份来自15个合作牙科实验室的设计单	患者年龄和性别均有：41.3%；无患者个人信息：11.6%；送件消毒：8.3%；提及卡环：47.7%；标注连接体：30.7%	一级：17%；二级：26%；三级：43%；四级：14%
Sui等^[12]	2014	中国	800份来自5个著名商业牙科实验室的问卷	患者年龄和性别均有：32%；无患者个人信息：30%；送件消毒：5%；有卡环要求：90%；有连接体要求：88%；有人工牙要求：68%	一级：24%；二级：45%；三级：17%；四级：14%
Al-AlSheikh^[13]	2012	沙特阿拉伯	160份来自大学里牙科实验室的问卷	包含患者年龄：69.1%；包含患者性别：78.7%；提及出件时间：83.1%；送件消毒：81%；有设计图：95%；显示比色：82%；指示咬合设计：64%	一级：49.6%；二级：40.8%；三级：7.2%；四级：2.4%
Kilfeather等^[14]	2010	英国	210份来自21个牙科实验室的问卷	送件消毒：76%；提供咬合记录：42%；要求技师设计RPD：54%；有设计图：37%；连接体设计：43%	一级：30%；二级：21%；三级：12%；四级：37%

职责	牙医	牙科技师
临床检查	√
诊断及治疗计划	√
修复前治疗（牙体预备、牙周治疗、正畸治疗等）	√
印模制取	√
支架设计	√
颌位关系记录	√
根据设计图制作RPD		√
支架试戴	√
戴牙	√
个性化托盘	√	√
上??架		√
后处理		√
联系对方进行讨论		√