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Background: Inadequate daily oral hygiene care of dental prostheses could worsen general health of frail older people. The index of Augsburger and Elahi is often recommended to assess maxillary dental prosthesis plaque (DPP)., Objective: To assess the reliability of an expanded and standardised DPP index of Augsburger and Elahi in trained and untrained examiners, and to determine the applicability of the index in community-dwelling frail older people., Methods: Ten community-dwelling frail older persons with complete and partial removable dental prostheses (RDPs) (mean ± SD age = 87.9 ± 8.4 years) participated. Seven persons were revisited after 3 months. The index was expanded with mandibular RDPs. Standardisation was achieved with a specially designed reference sheet. The RDPs were photographed after plaque colouring. Two trained examiners scored the photographs; thereafter, two untrained examiners. One trained examiner scored the photographs again after 3 weeks. Changes in DPP over the 3-month period were assessed with Wilcoxon signed-rank test. Inter- and intra-examiner reliability was assessed with intraclass correlation coefficients (ICCs)., Results: The DPP scores did not change significantly over time (Z = -0.594, p = 0.553). Inter-examiner reliability was excellent in the trained examiners (ICC = 0.859-0.947), and fair-to-good in the untrained examiners (ICC = 0.671-0.703). Intra-examiner reliability was excellent (ICC = 0.941-0.962)., Conclusion: The proposed expansion and standardisation of the DPP index has an excellent inter- and intra-examiner reliability when performed by trained examiners, and a fair-to-good inter-examiner reliability by untrained examiners. Therefore, the index could be recommended for application in dental prostheses-wearing older persons and could be useful for awareness and education of professional and informal caregivers and the older persons themselves., Trail Registration: The Netherlands Trail Register NTR6159., (© 2024 The Author(s). Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.)

Objective: To determine the morphological features in the anterior mandibular region, the presence of lingual foramen and canal dimensions in Saudi subjects that would interfere with standard implant placement., Methods: CBCT scans of patients seeking implant treatment were examined. Based on the dentition status, patients were categorized into edentulous (group I) and dentulous (group I). On the panoramic view, the distance between the two mental foramina was divided into vertical segments of 10 mm width. In each segment, vertical bone height and buccolingual thickness at three levels (alveolar crest, 5 mm, and 10 mm apical to the crest) were assessed. The lingual foramen prevalence and canal features were assessed as well. Comparisons between the two groups regarding the assessed parameters were performed using the t -test. The percentage of edentulous mandibles with thickness <6 mm corresponding to the standard implant diameter was also calculated., Results: Following the inclusion and exclusion criteria, group I consisted of 45 subjects and group II comprised 26 subjects. Bone height and thickness at the crestal level were significantly less in edentulous (I) than dentate mandibles (II) ( P < 0.0001). The lingual foramen was detected in 90% of patients. In both groups, males had significantly greater mandibular height than females ( P =0.02 and 0.005). At the crestal level, the thickness was <6 mm in 50% of the anterior mandibular segments., Conclusion: Half of the edentulous patients may receive normal size implants in the anterior interforaminal segments, while the other half will be limited to narrow implants (3.5 mm and less). The lingual foramen location, canal size, and position may represent another limitation for implant placement in that segment., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Shaimaa M. Fouda et al.)

Introduction: Dental treatment aims at correction of existing disease; prevention of future disease with rehabilitation of patient's lost functional capacity and aesthetics. Fixed dental prosthesis is any prosthesis that is cemented to a natural tooth or dental implants abutments that cannot be removed by patient. The success of prosthodontic treatment is related to prosthesis survival, with its ability to fulfil biologic and patient-evaluated objectives with patient satisfaction. This study is aimed to find the patient satisfaction with fixed prosthodontic treatment., Methods: This descriptive cross-sectional study was done in a tertiary care hospital among 102 patients rehabilitated with fixed dental prosthesis from August to September 2019 after taking ethical approval from Institutional Review Committee of Kathmandu Medical College. (IRC No. 1207201918). Convenience sampling was done. The questionnaire assessed patient's satisfaction of fixed prosthesis on the basis of appearance, chewing ability, cleansibility, speech and awareness of oral hygiene measures for cleaning of the prosthesis. Data entry was done in Microsoft excel and analysed using Statistical Package for Social Sciences (SPSS)version 20.0, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data., Results: The majority of the patients 87 (85.3%) were satisfied with their fixed prosthesis, at 95% confidence interval (93.5- 81%). Eighty one (79.4%) were satisfied with their chewing ability; 99 (97.1%) satisfied with their speech, 78 (76.4%) satisfied with appearance of fixed prosthesis. Ninety eight patients (96.1%) were aware of oral hygiene measures, out of which only 66 (67.3%) used interdental aids for cleaning of their fixed prosthesis., Conclusions: Several factors (chewing ability, appearance, speech, cleansibility of fixed prosthesis) had positive impact on overall satisfaction in majority of the patients. Dentists should continue to emphasise on the significance of maintaining good oral hygiene and use of interdental aids for the longevity of fixed prosthesis.

Introduction: Adult patients are seen more frequently in our orthodontic offices. Unlike the adolescent, the adult patient will often need a multidisciplinary approach due to tooth migrations secondary to extractions or periodontal disease., Materials and Methods: This article will address the indications and orthodontic solutions to various restorative problems relative to the adult patient. Specific orthodontic mechanics aimed at facilitating and improving the prosthetic outcomes will be described and illustrated with clinical cases., (© EDP Sciences, SFODF, 2018.)

This study estimated whether continued programming of a highly specialized four-year dentistry residency training in Saudi Arabia was cost-beneficial. We utilized a purposive sampling to administer a survey to trainees in major cities. Additionally, we used publically available market information about general practitioners. We employed Benefit-Cost Analysis accounting approach as a conceptual framework. Using general practitioners as the base category, we grouped overall social analytical perspectives into resident trainees and rest of society. The residency program was cost-beneficial to trainees, realizing an estimated return of SR 4.07 per SR 1 invested. The overall societal return was SR 0.98 per SR 1 invested, slightly shy of a bang for the buck, in part because the public sector largely runs the training. Benefits included increased earnings and enhanced restorative dentistry skills accruing to trainees; increased charitable contributions and programming-related payments accruing to programs and the public; and practice-related payments accruing to governmental, professional, and insurance agencies. Rest of society, notably government underwrote much of the cost of programming. A sensitivity analysis revealed the results were robust to uncertainties in the data and estimation. Our findings offer evidence to evaluate whether continued residency training is cost-beneficial to trainees and potentially to overall society., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Manufacturing of custom-made dental devices such as removable dentures, fixed prosthodontics and orthodontics are subject to the requirements of the Medical Devices Directive (MDD). Many dental laboratories often enhance these requirements by implementing quality assurance procedures that then provide enhanced consistency. this paper provides a dental technologist's view of some of the systems currently being used in dental laboratories to provide a quality assured product and associated issues.

Purpose: The aim of this study was to assess and compare quality as well as economic aspects of CAD/CAM high strength ceramic three-unit FDP frameworks ordered from dental laboratories located in emerging countries and Switzerland., Material and Methods: The master casts of six cases were sent to five dental laboratories located in Thailand (Bangkok), China (Peking and Shenzhen), Turkey (Izmir), and Switzerland (Bern). Each laboratory was using a different CAD/CAM system. The clinical fit of the frameworks was qualitatively assessed, and the thickness of the framework material, the connector height, the width, and the diameter were evaluated using a measuring sensor. The analysis of the internal fit of the frameworks was performed by means of a replica technique, whereas the inner and outer surfaces of the frameworks were evaluated for traces of postprocessing and damage to the intaglio surface with light and electronic microscopes. Groups (dental laboratories and cases) were compared for statistically significant differences using Mann-Whitney U-tests after Bonferroni correction., Results: An acceptable clinical fit was found at 97.9% of the margins produced in laboratory E, 87.5% in B, 93.7% in C, 79.2% in A, and 62.5% in D. The mean framework thicknesses were not statistically significantly different for the premolar regions; however, for the molar area 4/8 of the evaluated sites were statistically significantly different. Circumference, surface, and width of the connectors produced in the different laboratories were statistically significantly different but not the height. There were great differences in the designs for the pontic and connector regions, and some of the frameworks would not be recommended for clinical use. Traces of heavy postprocessing were found in frameworks from some of the laboratories. The prices per framework ranged from US$177 to US$896., Conclusions: By ordering laboratory work in developing countries, a considerable price reduction was obtained compared to the price level in Switzerland. Despite the use of the standardized CAD/CAM chains of production in all laboratories, a large variability in the quality aspects, such as clinical marginal fit, connector and pontic design, as well as postprocessing traces was noted. Recommended sound handling of postprocessing was not applied in all laboratories. Dentists should be aware of the true and factitious advantages of CAD/CAM production chains and not lose control over the process., (© 2015 by the American College of Prosthodontists.)

Statement of Problem: Titanium implants have been successfully used to support fixed dental prostheses. Zirconia implants have been suggested as support for crowns, but information on their use to support partial fixed dental prostheses is limited., Purpose: The purpose of this finite element study was to evaluate the maximum principal, minimum principal, and von Mises stresses and their distributions on zirconia and titanium implant-supported, partial fixed dental prostheses located in the anterior maxillary region., Material and Methods: Zirconia and titanium implants (4 mm in diameter and 11. 5 mm in length) and prostheses made from 2 different materials (lithium disilicate and zirconia) were simulated, and 4 models were generated: Titan-IPS, Titan-Lava, Zircon-IPS, and Zircon-Lava. The maxillary bone was modeled as type 3 bone. The load was applied obliquely (534 N) and horizontally (76.5 N), and the stress values and distributions were examined., Results: Under horizontal loading, stresses generated on the cortical bone in the Zircon models were lower than those in the Titan models. Under oblique loading, stress values were similar in the same implant material and stress type. For all types of stress among the models, the stress values that occurred on the trabecular bone were found to be similar under both horizontal and oblique loading. The maximum stress values on the bones, implants, cores, and veneers did not exceed the strength of the structures., Conclusions: Different stress values resulted from the different implant types. The prosthetic materials did not change the stress distributions in bone., (Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

This report describes a straightforward technique for verifying the accuracy of a definitive cast by using a maximal intercuspation record fabricated from polyvinyl siloxane occlusal registration material. This precise verification method detects inaccurate casts before the dental prosthesis is fabricated, thus saving chairside and laboratory time while reducing the number of costly prosthesis remakes., (Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this in vitro study was to evaluate the effect of the type and design of the impression copings on the accuracy of implant impressions in 2 different conditions., Materials and Methods: A reference model with 2 implants inserted in bilateral mandibular canines was fabricated. The posterior teeth were inserted as tilted to simulate intra-oral undercuts. The teeth were eliminated to create an edentulous condition. Three different impression techniques were performed (open high retentive [OH], open low retentive [OL], closed [C]) for each condition. Total of 48 casts were made. Two scan-bodies were secured on each cast, scanned by an optical scanner. Then, they were compared to the scan of the reference model, and the calculated mean errors were analyzed with a 2-way ANOVA and Tukey test., Results: There was no significant difference between the complete and partially edentulous groups (F = 3.252, P = 0.079). There was significant difference between the different designs of the impression copings (F = 31.789, P < 0.001) but the interaction between the dependent variables was not significant (F = 0.511, P = 0.603)., Conclusions: The design of the impression copings was more important than the undercuts. The accuracy of the closed tray coping was greater than the low retentive coping and equal to the high retentive coping.

State dental associations are showing increased interest in maintaining current standards and regulations affecting the dental laboratory industry as mandated by the Food and Drug Administration. The domestic dental laboratory industry is being significantly stressed by foreign competition, rapid technology development and unprecedented consolidation, which are changing the way that prosthetic devices and restorations are manufactured and delivered to dentists. Of paramount importance to the prescribing dentist is the accurate documentation of the source and materials being used in prostheses being delivered to patients.

As is the case in the field of medicine, as well as in most areas of daily life, digital technology is increasingly being introduced into dental practice. Computer-aided design/ computer-aided manufacturing (CAD/CAM) solutions are available not only for chairside practice but also for creating inlays, crowns, fixed partial dentures (FPDs), implant abutments, and other dental prostheses. CAD/CAM dental practice can be considered as the handling of devices and software processing for the almost automatic design and creation of dental restorations. However, dentists who want to use dental CAD/CAM systems often do not have enough information to understand the variations offered by such technology practice. Knowledge of the random and systematic errors in accuracy with CAD/CAM systems can help to achieve successful restorations with this technology, and help with the purchasing of a CAD/CAM system that meets the clinical needs of restoration. This article provides a mechanical engineering viewpoint of the accuracy of CAD/ CAM systems, to help dentists understand the impact of this technology on restoration accuracy.

The evolution and development of CAD/CAM systems have led to the production of prosthetic reconstructions by going beyond the use of traditional techniques. Precision adjustment of prosthetic elements is considered essential to ensure sustainable restoration and dental preparation. The purpose of this article was to summarise the current literature on the fitting quality of fixed prostheses obtained by CAD/CAM technology., (© 2014 John Wiley & Sons Ltd.)

Occlusal surfaces of teeth and restorations wear by repeated antagonistic contact. Two-body wear is the result of direct contact between occlusal surfaces. In cases of three-body wear, food is found between antagonistic teeth. Contact wear is expressed predominantly by abrasion and material fatigue. Erosion is a type of wear which does not involve direct antagonistic contact. Qualitative methods exist for registering occlusal tooth wear. Wear of restorations can be measured using casts. An obvious method for comparing rates of wear of restorative materials is laboratory research. This method has demonstrated that the wear rates of composite and enamel are similar. Cast metals and in particular ceramic wear less than enamel. The relation between oral factors and the rate of tooth wear is not always clear. Wellpolished surfaces of restorations wear less quickly and have less effect on the wearing of antagonistic teeth than rougher restoration surfaces.

Purpose: The purpose of this study was to evaluate data collected in University of Illinois at Chicago College of Dentistry (UIC COD) laboratory quality assurance (QA) forms, analyze the collected data, and create a report of the findings. The goals of the study were to (1) identify the most common mistakes occurring during laboratory and clinical procedures when performing prosthodontic treatment, (2) note the incidence and trends of mistakes made by D3, D4, and IDDP2 students, and (3) observe any differences in the types of mistakes made by D3, D4, and IDDP2., Materials and Methods: QA data from June 1, 2007 to May 31, 2009 were evaluated based on forms gathered from the QA dental laboratory from all D3, D4, and IDDP2 students' submissions. All students had graduated from the UIC COD at the time of collection. Data were recorded for type of errors made in submission of laboratory work (Indirect Restorations [IR], Removable Partial Dentures [RPD], Complete Dentures [CD]), year of student in dental school (D3, D4, IDDP2), and frequency of rejection for each respective student. The frequency of common mistakes were pooled, evaluated, and reported by respective class year., Results: The five most common laboratory submission errors for D3, D4, and IDDP2 students were nearly the same among student years for IR, RPD, and CD. D4 students had disproportionately higher numbers of work rejections compared to D3 and IDDP2 students., Conclusions: D4 students had a higher percentage of laboratory submission errors compared to D3 students for all laboratory procedures. There were similar types of errors noted between foreign-trained students (IDDP2) and domestically trained students (D3, D4)., (© 2012 by the American College of Prosthodontists.)

For many years, dental technicians were largely self-regulated and left to work without any undue interference from, or legislation by, outside authorities. This situation has changed somewhat dramatically in recent years, primarily as a result of a) mandatory General Dental Council (GDC) registration of UK-based dental technicians and b) the requirement to comply with certain EC directives governing the provision of dental appliances. There seems to be some confusion, however, about these various changes and the ensuing ramifications for dental practitioners. The purpose of this paper is firstly to clarify the various regulatory issues currently surrounding technician registration and the provision of laboratory work ('Made in Britain' or otherwise) and secondly to explore the various internationally-recognised quality assurance standards that can be applied to the production of such work in order to assist dentists in gauging quality-related claims made by dental laboratories, both in the UK and overseas.

The purpose of this prospective cohort study was to assess the performance of tooth-supported, extended zirconia, fixed dental prostheses (FDPs). Thirty FDPs with span-lengths between 36 and 46 mm (mean: 40.33 mm), four to seven units and with connector dimensions of approximately 9 mm(2) were inserted (19 in the posterior region, 11 including anterior teeth) using glass-ionomer cement and assessed (aesthetic evaluation, failures, hypersensitivity/tooth vitality, secondary caries, pocket depth, decementation and chipping) at baseline and after 2 years. Differences between baseline and 2-year recall were analysed using the Wilcoxon signed-rank test for matched pairs. There were five failures. One FDP revealed a core fracture at the base of the connector, probably caused by a damage induced during fabrication. Two FDPs had to be recemented, one abutment tooth had to be treated endodontically and one cohesive failure of the veneer was observed. There were no significant changes of pocket depth and hypersensitivity between baseline and 2-year recall. The aesthetics were rated as excellent by the patients at both baseline and recall. Two year clinical results of extended zirconia based FDPs with 9 mm(2) connectors are promising.

A global transformation is taking place in dentistry with the use of CADCAM based technology. Whilst the headlines in the dental press continue to be dominated by precision fitting ceramic dental prostheses it is reasonable for us to ask--how well do they fit and how good are they? These questions of course cannot be answered in the absence of any benchmarked standards. Throughout manufacturing industry, process controls are designed to deliver constant improvement and eliminate failure--everything has to be measured. The best companies retain their competitive advantage by developing and selling products that are all made within an envelope of excellence. Likewise we must be able to measure clinical excellence objectively and demonstrate the benefits to our patients.

The marginal fit of 14-unit fixed dental prosthesis retainers and single-crown copings fabricated by the same computer-aided design (CAD)/computer-aided manufacturing (CAM) system were evaluated in vitro hypothesizing that the marginal opening might be independent of the type of restoration. Eight ivorine maxillary teeth (FDI locations 27, 25, 23, 21, 11, 13, 15 and 17) were prepared to accommodate a 14-unit prosthesis. Ten fixed dental prosthesis retainers and 40 single-crown-copings were fabricated using Zeno CAD/CAM on 20 master dies. Four cross-sections were made from each tooth and the marginal gap dimensions were measured. One-way anova was used to test the difference between the experimental groups and two-way anova and a post hoc test (Student-Newman-Keuls) were carried out to determine the influence of the location of the abutment tooth and the measurement location within the abutment tooth in the experimental groups (P < 0.05). Mean marginal gap dimensions and standard deviations for fixed dental prosthesis retainers and single-crown copings were 25 +/- 29 and 13 +/- 12 microm, respectively. The type of restoration showed a significant influence (P < 0.001) on the marginal gap. The location of the abutment tooth (P < 0.001) and the measurement location (P < 0.001) exhibited significant influence on marginal gaps of fixed dental prosthesis retainers while no influence on single-crown copings could be detected. The highest marginal gaps were found at the palatal surface of the incisor and canine of the 14-unit fixed dental prosthesis retainers. Fourteen-unit fixed dental prosthesis showed significantly higher marginal openings than single crowns fabricated under the same conditions. However, both restorations showed clinically acceptable marginal openings.

The resorption and atrophy of the prosthodontic prosthetic field via the mobile restorations made of flexible acrylate, constitutes a controversial problem in the specialty literature, determining the interest of the clinicians with regard to the counterattacking or improving this process inherent to the indentation evolution. The study aims at analyzing the biological behavior of the silicon type RUBBER RS 330T-RTV, a material often used in the creation of the maxilo-facial prosthetics. The method proposed by us has the object of lining the prosthetics made of flexible acrylic type Valplast with this type of silicon. The practical aspects have been forwarded by the biocompatibility studies, applied to the silicon test-tubes, made in the dental technique laboratory, or to the hypodermic implants at the rodent laboratory animals. At the macroscopic examination it can be observed that the silicon fragment maintains it's almost parallelepiped form. The microscopic exam reveals structural mending phenomena, initially mainly the lymphohistocyte cells, and then mainly the fibrous cells. Biocompatibility aspects certifiable at the RUBBER RS 330T-RTV silicon material are fully according to the biocompatibility notions afferent to the silicon materials. Key words:

Purpose: This article reports on a retrospective study on patients with a diagnosis of amelogenesis imperfecta and on their prosthodontic management, oral health status, and attitudes toward their condition., Materials and Methods: The study comprised 15 patients and consisted of a clinical evaluation and questionnaire. Clinical examination included records of types of restorations and cements used, rating of restoration quality, as well as complications and periodontal variables., Results: The 15 patients had a total of 213 prosthetic restorations. The median age of the restorations was 60 months. Following the California Dental Association's system, all restorations were rated as acceptable to excellent, with one exception. During the follow-up period, four (2%) restorations had been recemented and 16 (8%) restorations had been redone, five (2%) because of porcelain fractures and 11 (5%) because of caries; two (1%) endodontic treatments were performed after prosthetic restoration. Plaque and Bleeding Indices were 28% and 21%, respectively, while pocket depths of more than 3 mm were found at 7% of all tooth surfaces. All patients judged their condition as having affected them negatively. However, after prosthodontic rehabilitation, patients experienced an improvement in self-esteem., Conclusion: Patients with severe clinical manifestations of amelogenesis imperfecta obtained extensive prosthodontic treatment at an early age. The restorations had in general performed well, and all patients were affected positively as a result.

The introduction of laboratory-processed composite systems and fibre reinforcement techniques have increased the possibilities for the prosthetic replacement of missing tooth tissues. Laboratory fabrication variables may significantly influence the properties of the final prosthesis. During the construction of a fibre-reinforced bridge it is necessary to place the fibre at some distance from the fitting surface of the restoration in the pontic region. No guidelines are available for optimal fibre placement in this respect. The purpose of this study was to assess the influence of placing ultra high molecular weight polyethylene (UHMWPE) fibre at five different distances from the tensile side of test samples on flexural properties and the strain energy stored within the dental composite. The results of this investigation showed that whilst moving the fibre reinforcement away from the tensile side by up to 1.5 mm led to a significant reduction in flexural strength, there was no significant decline in the increase in strain energy stored within the tested composite until this distance was exceeded.

To statistically evaluate the factors that influenced masticatory performance following Maxillectomy, masticatory performance was measured in 43 patients with a post-operative prosthesis by means of a spectrophotometer using adenosine triphosphate (ATP) granules. Our statistical analysis revealed that the number of occluding post-canine teeth and the patient's sex were factors that influenced masticatory performance and demonstrated that it was most important to improve occlusion in the pre-molar/molar region.

Unlabelled: Functional diversity and biopsychosocial state is a significant issue, which greatly influences elderly oral health and state of fixed and removable prostheses., Objectives: The goal of the investigation was to evaluate the quality of fixed and removable prostheses in a group of elderly home residents in relation to the ADL index., Methods: The group consisted of 175 institutionalised elderly, mean age 76.8 years. Special care need was assessed on ADL scale. To evaluate the quality and need for replacement of fixed and removable prostheses Karlsson's and modified Nevalainen et al. indices were used., Results: Spearman's correlation analysis showed significant correlation of ADL index scores and both Karlsson's index values (rho=-0.468, p<0.01) as well as for modified Nevalainen's indices (rho=-0.572, p<0.01). Lower ADL score was correlated with poorer oral hygiene and condition of fixed or removable dentures. It was determined that 87% of the examined patients were in objective need of fixed, removable or combined prosthodontic treatment., Conclusions: The study showed that lower ADL index scores of functionally dependent elderly patients correlate with poorer condition of fixed and removable prostheses and greater need of fixed, removable or combined prosthodontic treatment.

Objectives: The aim of the study is to assess the reliability and validity of a schedule to determine the normative denture treatment needs of older people., Design: The design used assessed inter-examiner reliability (criterion validity), test-retest reliability, and content and face validity of the schedule., Setting: The inter-examiner reliability study took place in a Department of Prosthetic Dentistry, the remainder of the work took place in a community setting., Results: The results showed that the schedule in terms of an index performed well with reasonable inter-examiner and test-retest reliability. Difficulties however were encountered with regard to subjective judgements about denture quality and design; consequently, there was modest inter-examiner agreement for stability, retention, and occlusal balance., Conclusions: The findings from this preliminary work suggest that the schedule may be useful in the assessment of normative denture treatment need in a community setting. Nevertheless more work will be required to obtain further information on the validity of this new assessment measure.

Objectives: Standardized measures to assess clinical aspects of the performance of managed dental care plans are not available. This project sought to develop and evaluate measures for effectiveness of care and use of services that could be calculated using a plan's administrative data., Methods: Two panels of stake holders representing dental plans, purchasers, and dental providers participated in a modified Delphi process to refine initial sets of effectiveness of care and use of services measures modeled after HEDIS measures for medical care. The refined measures were then pilot tested in two dental health maintenance organizations., Results: The development process resulted in specification of seven effectiveness of care measures assessing disease activity classification, and prevention and outcomes for caries, periodontal disease, and tooth loss. Six use of services measures focusing on prophylaxes, third molar surgery, preventive, restorative, prosthetic, surgical, and endodontic care also were specified. Pilot testing of the measures indicated reasonable reliability and sensitivity, but also demonstrated the need for supervision or auditing of the process., Conclusions: These standardized measures for dental care plan performance are available for immediate use. However, because the measures depend on diagnostic information (periodontal probing data and diagnoses associated with restorative treatments) in the administrative data set, their adoption will require changes in most plans' data systems and data collection policies.

In the last 10 to 15 years, privatization has been used as a policy instrument to reduce the involvement of the public sector in the provision of a variety of services. The purpose of this paper is to discuss models of privatization in the dental technician market and to report on the findings of an analysis of the functioning and efficiency of such services within the framework of the Israel Defence Forces (IDF). We also develop a method for assessing the quality and efficiency with which such services are produced and assess the need for privatization of the service. Currently, the IDF employs a mixed model of privatization whereby some dental technician services are produced in-house and others are contracted out to the civilian private market. A comparative quantitative analysis of the efficiency, quality, and cost of services indicates that the civilian labs are able to produce prosthetic services at a lower cost per unit of output and at a higher level of quality than are the IDF labs. The highly competitive nature of the industry as well as the relative ease with which the IDF could monitor the quality of service further supports the case for privatization of the entire service. The analysis and method described in this paper can serve as a paradigm for evaluating dental technician services in a variety of settings.

Debonding of plastic teeth from its denture base has been frequently experienced in our prosthetic practice. Three of nine products investigated have fulfilled the requirements for bonding according to ISO test 3336. Loading forces necessary to produce fractures varied between 170-810 N within the tooth and 80-230 N at the tooth-denture base interface. Comparative significances were noted for the mean breaking force against fracture and debonding when comparing the resistance of "Acry Rock" to the other eight materials tested. Maximizing the extension of the polymerization surface through a larger surface area of individual teeth seemed to be a significant factor in the determination of the debonding force necessary to produce fracturing.