The Competence of Practicing Dentists Ghana. Progress and Challenges.

1. The Competence of Practicing Dentists Ghana. Progress and Challenges. Dr G.A. Ankrah MSc (London), FDSRCS(England), FGCS

2. Crown and bridge prosthodontics

3. Definition • Competence is fitness for the purpose or the ability to do a task to a predetermined standard. Competencies describe the series of abilities that together make up a competent person (Galasko1999).

4. The General Dental Council (1997) in its booklet on The First Five Yearsbreaks down competence in to a series of desirable attributes: • knowledge of appropriate sorts • clinical skills and abilities • practical or technical skills and abilities • attitudes

5. Attitude can be broken down into a number of discrete areas including the following: • clinical judgment • interaction with patients and relatives • ethics • reliability • professional development • teamwork • image or appearance.

6. Measuring clinical competence in advanced restorative dentistry, including crown and bridge • The dentist demonstrates clinical competence in: • creating an appropriate design for the restoration • using an appropriate core with adequate tooth reduction, axial taper with well-defined finish line and margin placed in appropriate position

7. protecting dental pulp, periodontal tissues and adjacent teeth • using post cores of adequate design and placement • using temporary crowns of appropriate material with adequate retention, finish, form, comfort, and appearance • completing the final restoration with adequate retention, contour, margins, contacts, and occlusal form • meeting the patient’s functional needs and aesthetic expectations.

8. OBJECTIVE: • assess the quality of impressions for crown and bridge work.

9. DESIGN AND SETTING: • This retrospective study included the audit of all impressions for crown and bridge work which had been sent to one commercial dental laboratory in Accra. They were assessed by one examiner.

10. MATERIALS AND METHODS: A sample of 300 impressions were randomly selected and examined for clinical errors in a six month period, from January to June, 2016. All impressions were included in the study.

11. The impressions were categorised based on criteria by Winstanley, 1999, and Carrotteet al 1993. • unusable • unsatisfactory • acceptable • satisfactory

12. The following were also noted • type of impression material • type of impression tray • opposing arch impressions • occlusal records • Instructions to technicians: these were assessed for completeness and clarity.

13. RESULTS What were we looking for? According to criteria by Winstanley. 1999 and Carrotteet al 1993: • clinical error such as drags • indefinite finishing lines in impressions • Bubbles in impressions • Obvious taper in impressions

14. Categorisation of impressions • unusable 97 • unsatisfactory 75 • acceptable 58 • satisfactory 70

15. Categorization of impressions

16. Categorisation of impressions as a percentage of total • unusable 32.5% • unsatisfactory 25% • acceptable 19.3% • satisfactory 23.3%

17. Categorization of impressions in percentages

18. More than half of the specimens inspected were categorized as unusable or unsatisfactory 172 (57.3%)

19. Standard: Shillingburget al 1997 propose Polyvinylsiloxane impression material • Alginate impression material was used for 195 (65%) of the cases.

20. Standard: Clear and complete instructions to technicians. Only 81 (27% )of specimens were accompanied with instructions; of these 18 (22%) were graded poor.

21. Standard: Provision of occlusal records. Davies et al 2001 No occlusal records were available with 162 (54% )of the specimens.

22. Standards: Semiadjustable articulators should be used together with a facebow record Randall et al 1998 No semi adjustable articulator or facebow were used. Not even average value articulators. What I will term a simple hinge articulators or occludators were used.

26. Standard: Use stainless steel full coverage trays for crown and bridge work. Winstanleyet al 1997 • Flexible plastic trays were used for the majority of working impressions for crown and bridge work in general dental practice 246 (82%).

27. Standard: Flexible plastic trays are single use items. Guidelines for Infection Control in Dental Health-Care Settings 2003 www.cdc.gov/mmwr/PDF/rr/rr5217.pdf • Many had been re-used 42 (> 14%).

28. Standard: absence of air bubbles or any defects Shillingburget al 1998 • Defects in the recording of the prepared teeth were common 172 (57%).

29. Standard:Institute policies and procedures to minimize the risk of spreading infections, in oral health care facilities. Kearns et al 2001 • Cross infection control was not routine 300 (100%).

30. CONCLUSIONS: • Quality standards for impressions for crown and bridge work in general dental practice in Ghana are a cause for concern if the sample of cases seen in this study is typical.

31. CONCLUSION: • The quality of abutment preparation and impressions were unsatisfactory and unusable in 172 (57.3%) of cases. 128 (42.7) were acceptable and satisfactory.

32. Progress • From AFM to PFM • Digital Dentistry Cadcam • Zirconia

34. The numbers of dentists using digital resources in 2014

36. Challenges • Economy • Human resource • Equipment

41. Thank You