DENTAL LABORATORY PRODUCTION OF PROSTHETIC RESTORATIONS IN A POPULATION IN SOFIA, BULGARIA: A DESCRIPTIVE STUDY Leave a comment
Recently published in the International Journal of Dentistry is an interesting study of a Dental patients group requiring restoration in Sofia Bulgaria for a variety of restorative needs. It is interesting as the treatments varied across the group and was considered to reflect the economic situation and the relative cost for the patients making the choice. There is very little funding provision for the Bulgarian National Health service to support the dental services available and prosthodontic replacement is not funded by the service. A total per capita annual spend for all health needs, including dentistry amounts to 132 Euro.
The study looked at the production from 5 Dental Laboratories in Sofia (the capital city. The laboratories each serviced between 10 and 40 Dental practices across the city. A varied mix of incomes and dental fees were reflected in the study. The Laboratories were one two-man laboratory and 4 of average size, with between four and ten technicians. The cases records include fixed and removable restorations. The Chief Technician in each laboratory was instructed to record, from the cast models, the standing teeth and the restorations which were completed for each case over a two-week period. The technician also recorded the age and gender of the patient, from the dentists’ prescription, and included the cost of the restoration. Only full arch models were used for this process. The technician further described, in detail, the missing teeth, the presence of restorations in the mouth and included crown preparation and post and cores. The occlusal contact for each tooth was recorded or shown as not contacted.
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 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. 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. Replacement of absent molars with the sole purpose to restore dental arch morphology irrespective of the degree of functional impairment may be considered overtreatment.
A total of 284 orders were received of which 33 did not fit the requirements. (Diagnostic wax-ups, Orthodontic cases etc) The resulting cases of 251 with a mean age of 46- 14 years with 53% Female patients. 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 analysed, 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.
The mean laboratory prices for a single crown, a three-unit fixed dental prosthesis, and an acrylic removable partial denture were €22, €75, and €30, respectively. Approximately half of the restorations were produced on 134 partial casts, while 203 dental restorations were produced on 115 complete casts (69 upper and 46 lower). Interestingly only 19 (33%) of the 58 incomplete dentitions were restored to completeness. A shortened arch restoration being accepted. When compared with other published epidemiological studies in Bulgaria this would appear to be the norm. A fixed solution is preferred but the economics would seem to limit the extent of replacement teeth and a shortened dental arch would be the normal expectation. Complete restorations are very much the minority. Perhaps an interesting comparison to restorations in the UK.
