Dental Laboratory Production of Prosthetic Restorations in a Population in Sofia, Bulgaria: A Descriptive Study

Hindawi Publishing Corporation International Journal of Dentistry Volume 2010, Article ID 286192, 6 pages doi:10.1155/2010/286192 Research Article Dental Laboratory Production of Prosthetic Restorations in a Population in Sofia, Bulgaria: A Descriptive Study Nikola D. Damyanov,1 Dick J. Witter,2 Anneloes E. Gerritsen,2 and Nico H. J. Creugers2 1 Department of Prosthetic Dental Medicine, Faculty of Dental Medicine, Medical University-Sofia, 1, Georgi Sofiiski Boulevard, 1431 Sofia, Bulgaria 2 Department of Oral Function and Prosthetic Dentistry, College of Dental Science, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500HB Nijmegen, The Netherlands Correspondence should be addressed to Nico H. J. Creugers, Received 6 September 2010; Accepted 27 October 2010 Academic Editor: Michael E. Razzoog Copyright © 2010 Nikola D. Damyanov et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To describe prosthodontic production related to mutilated dentitions in Sofia, Bulgaria. Methods. Prosthodontic production from 5 dental laboratories was recorded during a 14-day period. Production was related to dentitions as noted from casts. Dentitions were classified as edentulous, interrupted/reduced, slightly interrupted, shortened, and complete. The representativeness of the laboratory sample was verified trough comparison with a Sofia population sample using proportions of crowned or replaced teeth per dental region. Results. The total production consisted of 243 crowns, 16 post and cores, 82 fixed dental prostheses, and 41 removable dentures. Proportions of crowned teeth were significantly different between the samples; proportions of replaced teeth were not. Of the 58 incomplete dentitions analyzed, 19 were restored to the level of completeness, 15 resulted in slightly interrupted, and 24 in shortened dentitions. Conclusions. Predominantly fixed restorations were provided to restore mutilated dentitions to a functional level and not necessarily to complete dentitions. 1. Introduction The demand for restorative treatment is generally triggered by various oral conditions that affect masticatory performance, appearance, and psychological comfort [1]. When tooth replacement is indicated, clinicians must decide which of the available prosthetic restorations will meet patients’ demands at best. These restorations are fixed and removable dental prostheses retained and supported by either natural teeth or dental implants. As dental implants are not affordable for a vast majority of patients, the choice is often limited to conventional tooth supported prostheses. In general, fixed dental prostheses are preferred as they offer better function and acceptance [2]. Nevertheless, when several teeth are missing and financial means are limited, removable partial dentures might be indicated. Thus, the decision-making process is usually based on numerous clinical, subjective, and economic considerations related to prevailing health care systems [3, 4]. In Bulgaria, the health care system suffers from considerable financial inadequacy with a total expenditure on health care of 4.3% of the gross domestic product (C132 per capita per year including dentistry) [5, 6]. Financial limitations in the health care system, together with other factors, are expected to have a negative impact on the oral health of the population. The scarce available data on the oral health of the Bulgarian population indicated high prevalence of missing permanent teeth ranging from 1.3 (20–24 years age group), through 5.3 (35–44 years age group), to 13 (55–64 years age group) [7]. Since the prevalence of missing teeth is substantial and (oral) health budget is restricted, it is crucial that viable and appropriate management strategies, such as the shortened dental arch concept, are utilized [8]. Being a minimal intervention approach, the shortened dental arch concept advocates for a “wait and see” period of monitoring function and stability of the dentition instead of immediate replacement of absent molars [9]. Replacement of absent molars with the sole purpose to restore dental 2 arch morphology irrespective of the degree of functional impairment may be considered overtreatment. Data on the prevalence of missing teeth, that indicate the need for prosthodontic services, are generally available. The same is not true for data on the provision of prosthetic restorations. The latter can be used to appraise the effective demand for prosthodontic care and to determine utilizable treatment modalities. As part of a larger comprehensive epidemiological study on oral function in reduced dentitions and the feasibility of the shortened dental arch concept within the existing health care system in Bulgaria, the purpose of the present study was to explore prosthodontic production as delivered by dental laboratories. 2. Material and Methods 2.1. Laboratory Sample. Five commercial dental laboratories in the city of Sofia participated in the study. One of the laboratories was considered small (2 technicians) and four were of average size (4 to 10 technicians). Output from these laboratories was considered representative for Sofia because their clientele (10 to 40 dental practitioners per laboratory) practiced widely in the city. The chief dental technician of each laboratory was asked to record structured information regarding the status of teeth from gypsum casts and all restorations delivered during a two-week period. Additionally, age and gender of patients as reported by the dentists in charge and cost of each restoration, produced were recorded. The teeth of the gypsum casts were described as absent, present (including existing fixed replacements), crown preparation/abutment, or as tooth root. After accomplishment of the restoration the presence or absence of occlusal contact for each tooth was recorded, as well. For relating prosthetic restorations with dental arch and dentition conditions, only sets of complete upper and lower casts were considered. Dental arches (representing either mandible or maxilla) were classified as edentulous, interrupted (2 groups: interrupted/reduced and slightly interrupted), shortened, or complete based on number and type of teeth (Table 1). Dentitions (representing mandible plus maxilla) were classified as edentulous (2 groups: one jaw edentulous and both jaws edentulous), interrupted (2 groups: interrupted/reduced and slightly interrupted), shortened, or complete based on number and type of teeth, and occluding regions (Table 1). Complete sets of casts were assigned according to this classification before and after accomplishment of the restorations. A total of 284 laboratory orders were received, of which 33 were excluded due to various reasons (e.g., incompleteness of the registration form or no prosthodontic appli (...truncated)