What is a work authorization? (pg 357)
- written directions for laboratory procedures to be performed for fabrication of dental restorations. It grants authority for others to act on the dentist’s behalf and specifically prescribes what is authorized.
What are the national statutory regulations regarding work authorizations? (NADL website)
This NADL regulatory guideline was designed to be a minimum standard of regulation - a type of state legislation that would be beneficial for the general public and effective for both the dental and dental laboratory professions
Work authorizations go by different names in various parts of the country, such as work order or work order form. What is it called in your state?
-Dr. Olin called it a “work authorization.”
Do state dental practice acts in your state include a requirement for work authorizations from dentists to dental laboratory technicians?
-It appears that we do, but I couldn’t locate the state statute.
Are work authorizations legal documents? (pg 357)
Properly executed work authorizations are effective channels of communication between a dentist and a dental laboratory technician. What accrues to a dentist who always furnishes the dental laboratory or dental laboratory technician a clear work authorization?(pge 357)
-They enhance quality of completed restorations by providing instruction for individually and scientifically considered prosthesis
The contents of a properly executed work authorization will include eight categories of transmtited data. What information do these eight areas include? (pg 357)
- 1-name and address of dental lab, 2- name and address of dentist who initiates work authorization, 3-Identification of patient, 4-date of work authorization, 5-desired completion date of request, 6-specific instructions, 7- signature of dentist, 8- registered license number of dentist
A dental work authorization performs four distinct functions. What are they?(pg.357)
1. It furnishes definite instructions for the laboratory procedures to be accomplished and implies an expectation of a level of acceptable quality for the services rendered.
2. It provides a means of protecting the public from the illegal practice for dentistry
3. It si a protective legal document for both the dentist and the dental lab technician.
4. It completely delineates the responsibilities of the dentist and the dental lab. Tech.
If you were a dental laboratory technician, what specific characteristics would you like to see in a work authorization from the dentist?(pg. 357-358)
- Legible, clear, concise, readily understood. Sufficient info. to allow technician to understand and execute request. Adequate written instructions. A new work authorization form should be filled out each time a prosthesis is returned to the lab for further fabrication.
A dentist has a responsibility to the patient and to the dental laboratory technician. A dental laboratory technician has a responsibility to the dentist, never to a patient. Are both statements true? Please explain your answer. (pg. 360- under delineation of responsibilities)
- True – a dentist who relegates the design of a removable partial denture to a less qualified individual accepts the possibility of an inferior removable partial denture service
If clear instructions and other information are clearly presented to a good dental laboratory technician, should quality laboratory services be received? What can be expected from vague instructions?
-Yes – If instructions are poor, a low quality and possibly incorrect prosthetic can be expected to be returned to the dentist.
Whose responsibility is it to select artificial teeth, denture base materials, and metal alloys for frameworks-the dentist or the technician? (pg 359-360)
If the definitive instructions contained on a work authorization form have been reduced to “Make partial,” is that document legal? (inferred from reading)
- Yes – the dentist wrote it out as a work authorization
Should a dentist be responsible for the physical characteristics of framework components? How does the dentist relate requirements or specifications to the dental laboratory technician? (pg360-361)
yes – the dentist is responsible for all phases of a removable partial denture service in the strict sense of the word. However, a lab tech may be requested to perform certain technical phases
Use of work authorizations
A work authorization, properly executed, will delineate responsibilities. Expand this statement in your own words. (open to interpretation)
- It states that a well written, clear and concise work authorization will explain what the dentist desires the lab tech complete
Why is a dental laboratory technician a dental health team member? (pg.361)
- Because their objective is the prevention of oral disease and the maintenance of oral health as adjuncts to the physical and mental well-being of the public
Why do states require that the dentist and dental laboratory technician retain a copy of work authorizations for certain lengths of time?
- To make sure documents are available to substantiate or refute claims and counterclaims that concern the illegal practice of dentistry or to aid in the settlement of misunderstandings between a dentist and a dental lab tech.
Do the words please and thank you have a place in writing authorizations? (pg.360)
After Carefully studying the work authorization forms illustrated in this chapter, are there any suggestions for their improvement?
- Open to anyone’s ideas.
The term adjustment has two connotations in relations to removable partial dentures. What are they? (pg.363)
1- adjustment of the denture bearing and occlusal surfaces of the denture made by the dentist at the time of initial placement and thereafter.
2- The adjustment or accommodation by the patient, both psychologically and biologically, to the new prosthesis
At what stage of treatment should any occlusal interference by a framework have been corrected? (pg 364)
- should be eliminated before or during the establishment of occlusal relationships
What is meant by adjustments to the bearing surfaces of denture bases? (pg 363)
- adjusting the denture base to be in harmony with the supporting soft tissue
How are areas of the denture base that may contribute to soreness detected? (364)
- Indicator Paste
What is a pressure indicator paste? Give a detailed procedure for the use of a pressure indicator paste. How are prospective pressure spots interpreted when a pressure indicator paste is used? (pg 364)
Paste that shows displacement when positive contact occurs with soft tissue
Dentist applies thin layer over bearing surfaces, rinse in water to prevent tissue adhesion, dentist should then apply digital pressure in a tissueward direction(vertical and horizontal)
Any area where the thin film is displaced should be relieved, and process repeated
*careful with xerostomia patients because the paste may stick to tissue
How does one interpret overextension or underextension of borders of the denture base with the use of a pressure indicator paste?
- Didn’t find the answer- should be around pg 364
What happens if the borders of either maxillary or mandibular distal extension bases impinge the pterygomandibular raphe?
- Specific adjustment must be made
Some occlusal discrepancies are bound to occur in dentures as a result of the processing of acrylic resin. True or False? (pg 364)
The dentist must correct any and all occlusal discrepancies as completely as possible before the patient is given possession of the restorations. True or False?
In placing a tooth-supported removable partial denture, how are occlusal discrepancies corrected and how is the existence of occlusal harmony ensured?(369)
It is performed by intraoral adjustments. Both tooth and plastic tooth surfaces are adjusted. Typically follows the pattern normally used for adjusting natural dentition.
Patients are recommended to return for periodic checks every 6 mos.
What is the danger in trying to correct occlusal discrepancies of distal extension dentures by an intraoral technique?(366)
- Due to the movement of the prosthesis when occluding, it is difficult to interpret interferences and bite marks.
What is a remount cast? How is it made?
- Used to adjust the occlusion on a distal extension denture base because you won’t do intraoral occlusal adjustments. Take an impression using irreversible hydrocolloid with the denture in place. Thus the denture will be stuck in your impression when you remove it.
Give a detailed procedure for correcting occlusal discrepancies by remounting distal extension removable partial dentures on an articulator. (pg367)
- Same as #12. Make remount casts, use bite registration with the teeth slightly apart, and adjust to occlusion
What are several advantages of the use of an articulator to correct occlusal discrepancies? (didn’t find a direct answer in the chapter for this one)
- don’t have soft tissue discrepancies, faster, easier to see primary and secondary contacts, easier to adjust for material discrepancies
After correction of occlusal discrepancies, should the occlusal anatomy of prosthetically supplied teeth be restored by ensuring that adequate grooves and spillways are present? How do you determine where and where not to recontour?
-Yes, anatomy, grooves, and spillways should be restored to maximal efficiency. Adjustments will be made based on chewing analysis. For example, Skinner and his banana chewing. The soft bolus will allow the patient to chew, and show markings on wax
What procedures are used to resotre the glaze on occlusal surfaces of vacuum-fired porcelain artificial teeth attached to an acrylic resin denture base?
-didn’t find answer
An informed patient will adjust to new restorations better than uninformed patient. At what phase of treatment should patient education begin?
- It’s the First Phase.
What instructions are reviewed with the patient before ending the initial placement appointment? (pg. 369)
-Before the patient is dismissed, the difficulties that may be encountered and the care that must be given the prosthesis and the abutment teeth must be reviewed with the patient.
Why should an appointment be made for 24 hours after the initial placement of restorations?
- To evaluate how the oral structures are accepting the new prosthesis, and make any necessary adjustments.
When does responsibility in the treatment of a patient end?
- It doesn’t end. The patient needs to understand that evaluations and adjustments will need to be made.
Should the dentist provide the patient with printed suggestions relative to the care and use of restorations before the initial placement appointment?
- Yes, patient education begins first.
What length of time would be scheduled for the initial placement of distal extension removable partial dentures?
- It should be a regularly scheduled appointment, not a drop by for delivery.
How would the following clasp arms be safely adjusted to make them more retentive and to remain passive? A cast circumferential clasp, a combination clasp.
A cast clasp only adjusts via movement of the tooth or restoration, or both, in a horizontal direction, and disappears only when the tooth or clasp moves back into a passive relationship.
Wrought wire clasp may be cervically adjusted and brought into a deeper undercut.
1. The need for repairing a component of a removable partial denture may arise occasionally. How may the frequency of breakage of components be minimized?
A: May be minimized through careful diagnosis, intelligent treatment planning, adequate mouth preparations, and carrying out an effective RPD design with proper fabrication of all component parts. Inform patient of proper removal/insertion, make them aware of the care.
2. For what three reasons may breakage of a direct retainer arm occur?
A: 1) from repeated flexure into and out of too severe an undercut
2) structural failure of the clasp arm itself
3) careless handling by the patient
3. An occlusal or incisal rest may fracture in use and invariably occurs at marginal ridge or incisal areas. What is the predominant reason for lack of strength at the junction of the rest and minor connector?
A: Improperly prepared occlusal rest seats are the usual cause of such weakness: an occlusal rest that crosses a marginal ridge that was not lowered sufficiently during mouth preparations either is made too thin or is thinned by adjustment in the mouth to prevent occlusal interference. Failure rarely results from a structural defect in the metal, and rarely if ever by accidental distortion.
4. What problems if any can be encountered when one tries to adjust a distorted minor connector?
A: minor connectors become weakened by adjustment. Repetitive adjustment of a major or minor connector results in loss of rigidity to the point that the connector can no longer function effectively. May either recast a new section and then reassemble the denture by soldering or making a completely new denture.
5. Other than by accident, for what reasons could a major connector become distorted?
A: Abuse by the patient, repeated adjustment
6. An abutment with a guarded prognosis is sometimes used to prevent an extension-type denture. Loss of such abutments necessitates extension of denture bases and inclusion of an artificial tooth replacing the abutment. Suppose the denture was not designed to anticipate eventual loss of the posterior abutment. Would this influence your decision to repair or remake the denture? How or Why?
A: Yes. Likely a distal rest was placed on the anterior portion of the edentulous area. The distal extension would be inadequate with no posterior abutment. Remaking would be in the best interest of the patient's health.
7. Extension of a base in replacing an abutment tooth usually necessitates relining of the entire base. True or False?
8. When a terminal abutment for a distal extension RPD is lost, can the existing denture be modified with a new clasp assembly on another abutment? How?
A: Yes, the next adjacent tooth is usually selected as a retaining abutment, and it generally will require modification or a restoration. The new restoration should conform to the old path of insertion/draw of the old RPD. A new cast assembly may then be cast for this toot hand the denture reassembled with the new replacement tooth added.
9. Porcelain artificial teeth that have been excessively ground or that were not arranged in occlusal harmony sometimes fracture in use and have to be replaced. To perform this procedure, is an impression necessary? If the replaced tooth is on an extension base, is the occlusion adjusted?
A: You would need to impression for occlusion relationships, especially if the porcelain teeth fractured due to poor occlusion. Extension bases: not sure on…since the base has slight give it has more room for error, however if error is excessive and cusp to cusp relationships are exhibited it may cause irritation to edentulous tissue as well as poor function.
10. What is a distinct advantage of electric soldering over torch soldering for the repair of a metallic element of a RPD?
A: don't think it's gonna be tested
11. Suppose a rest broke at its junction with the minor connector. How does soldering create a new rest? Would a clinical procedure on the old rest seat preparation be performed first? Why? What kind of procedure?
12. When soldering a chromium-cobalt alloy, what solder should be used? Is any special type of flux required?
A: don't think it's gonna be tested.
13. When an electric soldering unit is used, why must the carbon electrode be removed from the work last?
A: don't think its gonna be tested.
14. What is the purpose of using a flux when performing soldering operations?
A: don't think it's gonna be tested
15. Should torch soldering be attempted on a restoration with acrylic resin bases?
A: don't think it's gonna be tested
16. After either electric or torch soldering has repaired a framework, should a heat-hardening treatment be performed? Why or why not?
A: don't think it's gonna be tested
1. RPD's designed to be used for short intervals are temporary restorations and serve definite purposes. They must not be represented to the patient as other than temporary.
True or False?
2. Temporary RPD's may jeopardize the integrity of adjacent teeth and health of supporting tissue if worn for extended periods without supportive care. True or false? Why?
A: TRUE, no vertical stops…other things such as material strength, longevity
3. Temporary RPD's serve many useful purposes. Name six.
1. maintenance of appearance
2. reestablishment of occlusal relationships
3. maintenance of space
4. condition teeth and residual ridges
5. interim restoration during treatment
6. to condition the patient for wearing a prosthesis
4. In adult patients the placement of a temporary RPD to maintain a space can prevent undesirable migration and extrusion of adjacent or opposing teeth until definitive treatment can be accomplished. True or False?
5. The use of a temporary RPD as an occlusal splint to reestablish the occlusal relationship for a Kennedy Class I RPD requires broad coverage and functional basing of the tissue-supported bases. What is the best method to achieve functional basing?
A: Both broad coverage and fnctional basing of tissue-supported bases are desirable, along with some type of occlusal rest on the nearest abutments. Any tissue-supported occlusal splint should be at least relined in the mouth with an autopolymerizing reline resin to afford optimal coverage and support for the distal extension base. (p. 393)
6. One of the functions that a temporary RPD provides is to condition teeth and residual ridges. Why is it important to condition teeth and residual ridges?
A: The tissue of the residual ridge becomes more capable of supporting a distal extension RPD (from the pressure of occlusion). Abutment teeth also benefit from wearing a temporary restoration when such a restoration applies an occlusal load to those teeth, either through occlusal coverage or through occlusal rests (increase bone response). In summary, the abutment teeth and supporting ridge tissue are more capable of providing support.
7. The fabrication of temporary RPD necessitates that prosthodontic principles not be violated and that procedures be meticulously executed? True or false?
A: True. You want to make sure you maintain current space relationships and don't create an orthodontic appliance.
8. Temporary RPD's should, or should not, have occlusal rests provided. Defend your answer.
A: They shouldn't have stops…No permanent changes to teeth should occur for a temporary restoration. EXCEPTIONS: if a previous definitive RPD is made into a temporary, pre-existing occlusal stops would be ok. The important point is that no definitive changing of tooth structure should be made to temporary RPD's.
9. Periodic recalls and assessments are essential during the use of temporary RPD's. Why is this true?
Want to monitor for breakage, space maintainance, make sure that teeth aren't moving and making sure its doing its all supposed to be doing. Make sure its functional and esthetic and not damaging tissue so that the final RPD may still work as desired.