ORIGINAL ARTICLES
A surveyed diagnostic cast should be submitted with the various components carefully located and outlined. When this is accomplished by concise, written data, a work authorization meets both legal and professional requirements.
A work authorization format for removable partial dentures
E. A. Travaglini, DD S L. B. Jannetto, O DS, M D S, W ash in g to n , DC
T h e legal re q u ire m e n ts o f a ‘ ‘w o rk a u th o riz a tio n ’ ’ to a co m m ercial d e n ta l la b o ra to ry a re m e t by th e su bm issio n o f a signed re q u e s t fo r th e c o n stru c tio n o f p ro s th e tic a p p lian ces. T o b e effectiv e an d “ p ro fe ssio n a l,” h o w e v e r, th e w o rk a u th o riz a tio n req u ires fu rth e r e x p la n a to ry d a ta . A lth o u g h it is n e c e ssa ry fo r th e d e n tist to su b m it a c c u ra te c a sts and m ax illo m an d ib u lar re c o rd s in all in sta n c e s, th e in fo rm atio n o n rem o v ab le p a rtia l d e n tu re s dif fers g re a tly fro m th a t given fo r th e co m p le te o r fixed p a rtia l d e n tu r e .1 S pecific d ire c tio n s are n e ed e d b e c a u se th e su p e rv isio n an d re sp o n sib il ity fo r th e la b o ra to ry p ro c e d u re s in rem o v ab le p a rtia l d e n tu re serv ice re q u ire m o re a tte n tio n .2 T o c o n s tru c t a rem o v ab le p a rtia l d e n tu re th a t will b e re h a b ilita tiv e , th e la b o ra to ry m u st k n o w th e
u n iq u e c h a ra c te ristic s o f th e p re sc rip tio n a n d be given su fficien t in fo rm atio n w ith th e o ral im p res sio n s, re c o rd s, and re g istra tio n s.3 T h e d e n tist should su b m it a su rv e y ed d iag n o s tic c a s t w ith th e v ario u s co m p o n e n ts carefully lo ca te d an d ou tlin ed (F ig 1). W hen th is is a cc o m pan ied b y co n c ise , w ritte n d a ta , a w o rk a u th o riz a tio n m ee ts b o th legal an d p ro fessio n al re q u ire m en ts. H e re is a su g g ested fo rm a t fo r subm itting w rit ten in fo rm atio n in a m a n n e r th a t is effectiv e and easily u n d e rsto o d . Ite m iz e d b locks fo r p o sitiv e c o n te n ts (n am es, d a te s, m a teria ls, sh a d es, a n d so fo rth) c an b e in c o rp o ra te d into p rin te d form s th a t req u ire only ch eck in g o r filling in th e sp a ces (F ig 2). T h e inJADA, Vol. 96, M arch 1978 ■ 429
Fig 1 » C le a r draw ings should be made on accurate diagnostic casts.
stru c tio n a l d a ta can be given in o u tlin e form and c o n sist o f th re e p arts: — A o n e -se n te n c e d e sc rip tio n o f th e p ro sth e sis req u ired . — A listing o f th e te e th o r sp a c e s, o r b o th , inv o lv ed in th e design in n u m erical o rd e r, to g e th e r w ith th e u n it fo r th a t to o th o r sp ace. — P h ra se s d en o tin g e x c e p tio n s to u su al la b o ra to ry p ro c e d u re s. E xam ple: 1. C o n s tru c t a c a s t m an d ib u lar p artial d e n tu re a s d esig n ed o n en clo sed d iag n o stic c a st, w hich includes a lingual b a r, acry lic a tta c h m e n ts, and th e follow ing u nits: 2. T o o th no. 21: b ar-ty p e b u ccal re te n tiv e arm , distal re s t, and c ircu m feren tial-ty p e recip ro cal a rm ; to o th no. 22: m esial-o cclu sal re st; to o th no. 28: m esial-o cclu sal re st; to o th no. 29: b ar-ty p e buccal re te n tiv e arm , distal re s t, and v ertical re cip ro cal arm in m esial em b ra su re . 3. K eep su p e rio r edge o f lingual b a r 3 mm below gingival m argin. R e tu rn fram ew o rk fo r tryin. T h e o rd e re d listing has c e rta in a d v a n ta g es o v er sta te m e n ts such as “ b ar-ty p e clasp s on right and left seco n d b icu sp id s; distal re st; circu m feren tial recip ro cal arm on right b icu sp id ; v ertical re cip ro cal arm in m esial e m b ra su re o f left b icuspid; m esial re s ts o n right an d left first b ic u s p id s.” T h e list allow s th e tech n ic ia n to sy stem atically co m p are th e draw in g on th e d iag n o stic c a st w ith th e d e sc rip tiv e m aterial, to o th by to o th seq u e n tially, in ste a d o f h ap h a z a rd ly . It also se rv es as a c h e c k fo r th e d e n tist subm itting th e in fo rm ation, as w ell as th e re c ip ie n t, b e c a u se he m u st a d d re ss h im self to ea c h to o th invo lv ed in th e design. 430
■ JADA, Vol. 96, March 1978
W hen all th e inform ation is clu ste re d into one sta te m e n t, item s can be easily m issed. T h e third p a rt o f the in stru ctio n m ay need a d d i tional in fo rm atio n , dep en d in g on how w ell the individual la b o rato ry p erfo rm s usual and c u sto m ary p rac tic es. E x am p les o f e x p la n ato ry ph rases: 1. P lace leading edge o f palatal stra p in the d e p th o f th e rugae. 2. (a) D o n o t relieve lingual b a r. (b) O r, relieve b a r w ith 30 gauge w ax. 3. B ead p o ste rio r unit o f A -P b a r to dep th o f 1 m m , and so forth. T h e w o rk a u th o riz a tio n should be p rese n ted in den tal term inology th a t is un iv ersally acc ep ted and u n d ersto o d . T e ch n ic al e x p re ssio n s should be ta k en from th e G l o s s a r y o f P r o s t h o d o n t i c T e r m s 4 o r the te x t, C u r r e n t C l i n i c a l D e n t a l T e r m i n o l o g y ,5 T h e draw ing on th e c a st is an invaluable a sse t to th e te c h n icia n s and e a sie r to u n d e rsta n d th an draw ings m ade on flat pages. B ecause the c a st is m u ltidim ensional, th e design is d e p ic ted clearly, and the u n its can be p o sitio n ed a c c u ra tely in rela tion to th e to o th su rfaces and the soft tissu es. T h e draw ing on th e c a st can also be acco m p an ied by d escrip tiv e c a p tio n s. W h en a p ro p e r w o rk o rd e r is su b m itted , th e tech n ician has specific, readable in stru c tio n s on th e c h a ra c te r o f the u n its, th eir lo catio n , and any ex ce p tio n s to usual p ra ctice s. C e rta in tech n ical p h a se s o f p ro sth etic c o n stru ctio n can be d elegated to o th e rs by the d e n tist, as long as the d e n tist m ain tain s sufficient ad v iso ry c o n tro l.6-7
THE AUTHORS
TRAVAG LINI
JANNETTO
Dr. Travaglini is d ire cto r ot the Veterans A d m inistration Dental T raining Center, 50 Irving St, NW, W ashington, DC 20422. Dr. Jannetto is a prostho don tist at the VA Hospital in tha t city. Address requests fo r reprints to Dr. Travaglini.
DR .J
E i A ì ^ A § .E ^ J l. ______________ADDRESS: .^T J L J L * t¥ //Ì
______
DAY
MO.
TRAYS
Acrylk O Bom flot« Procot— d tow
□
G O LD
D
Transfer C oping
□ O
Veneer Crown Intoy
D
Full Cast Crown
O
Die
BITES
E l A crylic Attachments
□
Q
A ll M e tal
Q
N obil-H inge
O
O
Precision Attachment»
D
G old*A crylic G o ld with Luxene
□ □
Tube Tooth Steele'I Facing
__________
Q □
Trupontic O th e r.
□ Finish L J Fini
Q
G o ld Connection
StobiRzed
D tegvlor FINISH
FIXED BKIDOi
C l Inloye d Clasps
O
Acrylic
□
Swkt
D
□
Anatomico! Carving
□
CWor Palate
Luma« CD In te m o l C lip-Bor
I
□
Toch-E-Z
□
Sotwp
TIME W ANTED
«
US'- 77
C3 Trays
Q
_ J^TT_
v .Y M \ M O IO
OOLD CASTINGS
M NTURIS
D D
IS-
(o
JACK ITS-FACIN O S O
Porcelain O Luxene
i~1
A c ry lic
O
T e m p orary
FUSS-ON TECHNIQUES □
G O LD
□
CO PIN GS
□
PLAT.
□
PONTICS
□
C O N N E C T IO N S
PORCELAIN CD Biscuit Boke □ Q
G la te S pecial Staining
SENT WITH CASE Shade G uide B
A rtie
O
Towels
0 C Ls J C & - ^¿ e L L > f
j& tA + J u , &
s rn J L & C s Ó T tA tS
a ^ Â jâ -d s rn ts H s t' 0 y \ s
y iJ lX u n Z i^ y O
+
r
^ y r iX ^ C A y t
v- C^rt
y ijC L fC C t^ O
et^yyu V- y u d t^ X
i^
s
Um J -
~ ^n '
J
y
.
Fig 2 ■ W ork autho rization with item ized blocks and concise, w ritten description.
P ro p e rly e x e c u te d w o rk a u th o riz a tio n s a re an im p o rta n t fa c to r in th e co m m u n icatio n b e tw e e n th e d e n tis t an d his la b o ra to ry an d c a n h elp im p ro v e th e q u ality o f serv ice. T h is e n ab les th e d e n tist to fulfill his obligation— p ro te c tio n o f his p a tie n t’s o ral h e a lth .8
Prosthet Dent 13:295 M arch-A pril 1963. 3. Klein, I.E. Bew are— dang er ahead fo r prosthodontics (edito rial). J Prosthet D ent 3 6:1 2 2 Aug 1976. 4. The academ y of d e n tu re prosthetics: glossary of prosthodontic term s, ed 3. St. Louis, C. V. M osby C o., 1968. 5. B oucher, C .O .,(ed). C urrent clinical dental term inology, ed 2. S t. Louis, C. V . M osby C o., 1974. 6. Lytle, R.B.; A tw ood, D.A.; and B eck, H.O. M in im u m standards of adequate prosthodontic service. J Prosthet D ent 19:108 Feb 1968.
1. H enderson, D. W riting w ork autho rizations fo r rem ovable par tial dentures. J Prosthet Dent 16:696 July-Aug 1966. 2. S m ith, G.P. T h e responsibility of th e dentist tow ard laboratory procedures in fixed and rem ovable partial denture prosthesis. J
7. A pplegate, O.C. T h e rationale of th e partial d entu re choice. J Prosthet D ent 10:891 S ept-O ct 1960. 8. B oucher, C .O. Forw ard to investm ent in the future. J Prosthet D ent 18:189 S ept 1967.
Travaglini— Jannetto: W O RK A U TH O R IZA TIO N S FO R R EM O V A B L E PARTIAL D EN T U R E S ■ 431
A surveyed diagnostic cast should be submitted with the various components carefully located and outlined. When this is accomplished by concise, written data, a work authorization meets both legal and professional requirements.
A work authorization format for removable partial dentures
E. A. Travaglini, DD S L. B. Jannetto, O DS, M D S, W ash in g to n , DC
T h e legal re q u ire m e n ts o f a ‘ ‘w o rk a u th o riz a tio n ’ ’ to a co m m ercial d e n ta l la b o ra to ry a re m e t by th e su bm issio n o f a signed re q u e s t fo r th e c o n stru c tio n o f p ro s th e tic a p p lian ces. T o b e effectiv e an d “ p ro fe ssio n a l,” h o w e v e r, th e w o rk a u th o riz a tio n req u ires fu rth e r e x p la n a to ry d a ta . A lth o u g h it is n e c e ssa ry fo r th e d e n tist to su b m it a c c u ra te c a sts and m ax illo m an d ib u lar re c o rd s in all in sta n c e s, th e in fo rm atio n o n rem o v ab le p a rtia l d e n tu re s dif fers g re a tly fro m th a t given fo r th e co m p le te o r fixed p a rtia l d e n tu r e .1 S pecific d ire c tio n s are n e ed e d b e c a u se th e su p e rv isio n an d re sp o n sib il ity fo r th e la b o ra to ry p ro c e d u re s in rem o v ab le p a rtia l d e n tu re serv ice re q u ire m o re a tte n tio n .2 T o c o n s tru c t a rem o v ab le p a rtia l d e n tu re th a t will b e re h a b ilita tiv e , th e la b o ra to ry m u st k n o w th e
u n iq u e c h a ra c te ristic s o f th e p re sc rip tio n a n d be given su fficien t in fo rm atio n w ith th e o ral im p res sio n s, re c o rd s, and re g istra tio n s.3 T h e d e n tist should su b m it a su rv e y ed d iag n o s tic c a s t w ith th e v ario u s co m p o n e n ts carefully lo ca te d an d ou tlin ed (F ig 1). W hen th is is a cc o m pan ied b y co n c ise , w ritte n d a ta , a w o rk a u th o riz a tio n m ee ts b o th legal an d p ro fessio n al re q u ire m en ts. H e re is a su g g ested fo rm a t fo r subm itting w rit ten in fo rm atio n in a m a n n e r th a t is effectiv e and easily u n d e rsto o d . Ite m iz e d b locks fo r p o sitiv e c o n te n ts (n am es, d a te s, m a teria ls, sh a d es, a n d so fo rth) c an b e in c o rp o ra te d into p rin te d form s th a t req u ire only ch eck in g o r filling in th e sp a ces (F ig 2). T h e inJADA, Vol. 96, M arch 1978 ■ 429
Fig 1 » C le a r draw ings should be made on accurate diagnostic casts.
stru c tio n a l d a ta can be given in o u tlin e form and c o n sist o f th re e p arts: — A o n e -se n te n c e d e sc rip tio n o f th e p ro sth e sis req u ired . — A listing o f th e te e th o r sp a c e s, o r b o th , inv o lv ed in th e design in n u m erical o rd e r, to g e th e r w ith th e u n it fo r th a t to o th o r sp ace. — P h ra se s d en o tin g e x c e p tio n s to u su al la b o ra to ry p ro c e d u re s. E xam ple: 1. C o n s tru c t a c a s t m an d ib u lar p artial d e n tu re a s d esig n ed o n en clo sed d iag n o stic c a st, w hich includes a lingual b a r, acry lic a tta c h m e n ts, and th e follow ing u nits: 2. T o o th no. 21: b ar-ty p e b u ccal re te n tiv e arm , distal re s t, and c ircu m feren tial-ty p e recip ro cal a rm ; to o th no. 22: m esial-o cclu sal re st; to o th no. 28: m esial-o cclu sal re st; to o th no. 29: b ar-ty p e buccal re te n tiv e arm , distal re s t, and v ertical re cip ro cal arm in m esial em b ra su re . 3. K eep su p e rio r edge o f lingual b a r 3 mm below gingival m argin. R e tu rn fram ew o rk fo r tryin. T h e o rd e re d listing has c e rta in a d v a n ta g es o v er sta te m e n ts such as “ b ar-ty p e clasp s on right and left seco n d b icu sp id s; distal re st; circu m feren tial recip ro cal arm on right b icu sp id ; v ertical re cip ro cal arm in m esial e m b ra su re o f left b icuspid; m esial re s ts o n right an d left first b ic u s p id s.” T h e list allow s th e tech n ic ia n to sy stem atically co m p are th e draw in g on th e d iag n o stic c a st w ith th e d e sc rip tiv e m aterial, to o th by to o th seq u e n tially, in ste a d o f h ap h a z a rd ly . It also se rv es as a c h e c k fo r th e d e n tist subm itting th e in fo rm ation, as w ell as th e re c ip ie n t, b e c a u se he m u st a d d re ss h im self to ea c h to o th invo lv ed in th e design. 430
■ JADA, Vol. 96, March 1978
W hen all th e inform ation is clu ste re d into one sta te m e n t, item s can be easily m issed. T h e third p a rt o f the in stru ctio n m ay need a d d i tional in fo rm atio n , dep en d in g on how w ell the individual la b o rato ry p erfo rm s usual and c u sto m ary p rac tic es. E x am p les o f e x p la n ato ry ph rases: 1. P lace leading edge o f palatal stra p in the d e p th o f th e rugae. 2. (a) D o n o t relieve lingual b a r. (b) O r, relieve b a r w ith 30 gauge w ax. 3. B ead p o ste rio r unit o f A -P b a r to dep th o f 1 m m , and so forth. T h e w o rk a u th o riz a tio n should be p rese n ted in den tal term inology th a t is un iv ersally acc ep ted and u n d ersto o d . T e ch n ic al e x p re ssio n s should be ta k en from th e G l o s s a r y o f P r o s t h o d o n t i c T e r m s 4 o r the te x t, C u r r e n t C l i n i c a l D e n t a l T e r m i n o l o g y ,5 T h e draw ing on th e c a st is an invaluable a sse t to th e te c h n icia n s and e a sie r to u n d e rsta n d th an draw ings m ade on flat pages. B ecause the c a st is m u ltidim ensional, th e design is d e p ic ted clearly, and the u n its can be p o sitio n ed a c c u ra tely in rela tion to th e to o th su rfaces and the soft tissu es. T h e draw ing on th e c a st can also be acco m p an ied by d escrip tiv e c a p tio n s. W h en a p ro p e r w o rk o rd e r is su b m itted , th e tech n ician has specific, readable in stru c tio n s on th e c h a ra c te r o f the u n its, th eir lo catio n , and any ex ce p tio n s to usual p ra ctice s. C e rta in tech n ical p h a se s o f p ro sth etic c o n stru ctio n can be d elegated to o th e rs by the d e n tist, as long as the d e n tist m ain tain s sufficient ad v iso ry c o n tro l.6-7
THE AUTHORS
TRAVAG LINI
JANNETTO
Dr. Travaglini is d ire cto r ot the Veterans A d m inistration Dental T raining Center, 50 Irving St, NW, W ashington, DC 20422. Dr. Jannetto is a prostho don tist at the VA Hospital in tha t city. Address requests fo r reprints to Dr. Travaglini.
DR .J
E i A ì ^ A § .E ^ J l. ______________ADDRESS: .^T J L J L * t¥ //Ì
______
DAY
MO.
TRAYS
Acrylk O Bom flot« Procot— d tow
□
G O LD
D
Transfer C oping
□ O
Veneer Crown Intoy
D
Full Cast Crown
O
Die
BITES
E l A crylic Attachments
□
Q
A ll M e tal
Q
N obil-H inge
O
O
Precision Attachment»
D
G old*A crylic G o ld with Luxene
□ □
Tube Tooth Steele'I Facing
__________
Q □
Trupontic O th e r.
□ Finish L J Fini
Q
G o ld Connection
StobiRzed
D tegvlor FINISH
FIXED BKIDOi
C l Inloye d Clasps
O
Acrylic
□
Swkt
D
□
Anatomico! Carving
□
CWor Palate
Luma« CD In te m o l C lip-Bor
I
□
Toch-E-Z
□
Sotwp
TIME W ANTED
«
US'- 77
C3 Trays
Q
_ J^TT_
v .Y M \ M O IO
OOLD CASTINGS
M NTURIS
D D
IS-
(o
JACK ITS-FACIN O S O
Porcelain O Luxene
i~1
A c ry lic
O
T e m p orary
FUSS-ON TECHNIQUES □
G O LD
□
CO PIN GS
□
PLAT.
□
PONTICS
□
C O N N E C T IO N S
PORCELAIN CD Biscuit Boke □ Q
G la te S pecial Staining
SENT WITH CASE Shade G uide B
A rtie
O
Towels
0 C Ls J C & - ^¿ e L L > f
j& tA + J u , &
s rn J L & C s Ó T tA tS
a ^ Â jâ -d s rn ts H s t' 0 y \ s
y iJ lX u n Z i^ y O
+
r
^ y r iX ^ C A y t
v- C^rt
y ijC L fC C t^ O
et^yyu V- y u d t^ X
i^
s
Um J -
~ ^n '
J
y
.
Fig 2 ■ W ork autho rization with item ized blocks and concise, w ritten description.
P ro p e rly e x e c u te d w o rk a u th o riz a tio n s a re an im p o rta n t fa c to r in th e co m m u n icatio n b e tw e e n th e d e n tis t an d his la b o ra to ry an d c a n h elp im p ro v e th e q u ality o f serv ice. T h is e n ab les th e d e n tist to fulfill his obligation— p ro te c tio n o f his p a tie n t’s o ral h e a lth .8
Prosthet Dent 13:295 M arch-A pril 1963. 3. Klein, I.E. Bew are— dang er ahead fo r prosthodontics (edito rial). J Prosthet D ent 3 6:1 2 2 Aug 1976. 4. The academ y of d e n tu re prosthetics: glossary of prosthodontic term s, ed 3. St. Louis, C. V. M osby C o., 1968. 5. B oucher, C .O .,(ed). C urrent clinical dental term inology, ed 2. S t. Louis, C. V . M osby C o., 1974. 6. Lytle, R.B.; A tw ood, D.A.; and B eck, H.O. M in im u m standards of adequate prosthodontic service. J Prosthet D ent 19:108 Feb 1968.
1. H enderson, D. W riting w ork autho rizations fo r rem ovable par tial dentures. J Prosthet Dent 16:696 July-Aug 1966. 2. S m ith, G.P. T h e responsibility of th e dentist tow ard laboratory procedures in fixed and rem ovable partial denture prosthesis. J
7. A pplegate, O.C. T h e rationale of th e partial d entu re choice. J Prosthet D ent 10:891 S ept-O ct 1960. 8. B oucher, C .O. Forw ard to investm ent in the future. J Prosthet D ent 18:189 S ept 1967.
Travaglini— Jannetto: W O RK A U TH O R IZA TIO N S FO R R EM O V A B L E PARTIAL D EN T U R E S ■ 431
