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Development of Subsidized Prosthodontic Care: Socio-Economic Problems and Opportunities
... This results in a fact that people may (partially) lose a number of vital functions, including tooth loss due to various reasons [3][4][5]. In some cases, this problem is solved by application of removable complete dentures (RСDs), the warranty period of which is varied from one to five years, depending on the country [5][6]. First of all, it is limited by worn out of cosmetic teeth in dentitions and failure of the RСD bases [7][8][9][10]. ...
The paper presents the results of computer simulation of a hybrid removable complete dentures (RCD) of a maxilla and analysis of its stress–strain states (SSSs) under typical operational loads. For improving their strength and stiffness, it was proposed to reinforce a base made of polymethylmethacrylate (PMMA) with a perforated framework (technological holes for enhancing adhesion) made of polyetheretherketone (PEEK). In total, the SSS for 10 different models were analyzed, simulating the presence or absence of a reinforcing framework as well as its perforation, location in the base, adhesion between the components, and the deformation of the alveolar ridge. The key difference of the conducted computer simulation was the application of a virtual support of the RCD. Its deformation imitated changes in the alveolar ridge height, as well as the presence of more rigid areas corresponding directly to both alveolar ridge and a torus. The SSSs for the FE-models were calculated by the finite element method using the ‘ABAQUS’ software package. The effect of the PEEK framework position on the mechanical properties of the RСD was assessed. It was shown that the main reason for the base’s failure was its bending under the applied loads. However, the load-bearing capacity of the RСD could be increased by 20–40% by embedding of the PEEK framework as an additional layer of the base dome. The effect of variation in the base support conditions, simulating the degradation of the alveolar ridge caused by the bone tissue resorption, was analyzed. It was found that the load-bearing capacity of the RСD could vary within 10% in such cases. The perforation in the PEEK framework did not reduce significantly the mechanical properties of the RСD, but its adhesion to the PMMA base exerted a decisive effect on the operational performance.
... This results in a fact that people may (partially) lose a number of vital functions, including tooth loss due to various reasons [3][4][5]. In some cases, this problem is solved by application of removable complete dentures (RСDs), the warranty period of which is varied from one to five years, depending on the country [5][6]. First of all, it is limited by worn out of cosmetic teeth in dentitions and failure of the RСD bases [7][8][9][10]. ...
The paper presents the results of computer simulation of a hybrid removable complete dentures (RCD) of a maxilla and analysis of its stress–strain states (SSSs) under typical operational loads. For improving their strength and stiffness, it was proposed to reinforce a base made of polymethylmethacrylate (PMMA) with a perforated framework (technological holes for enhancing adhesion) made of polyetheretherketone (PEEK). In total, the SSS for 10 different models were analyzed, simulating the presence or absence of a reinforcing framework as well as its perforation, location in the base, adhesion between the components, and the deformation of the alveolar ridge. The key difference of the conducted computer simulation was the application of a virtual support of the RCD. Its deformation imitated changes in the alveolar ridge height, as well as the presence of more rigid areas corresponding directly to both alveolar ridge and a torus. The SSSs for the FE-models were calculated by the finite element method using the ‘ABAQUS’ software package. The effect of the PEEK framework position on the mechanical properties of the RСD was assessed. It was shown that the main reason for the base’s failure was its bending under the applied loads. However, the load-bearing capacity of the RСD could be increased by 20–40% by embedding of the PEEK framework as an additional layer of the base dome. The effect of variation in the base support conditions, simulating the degradation of the alveolar ridge caused by the bone tissue resorption, was analyzed. It was found that the load-bearing capacity of the RСD could vary within 10% in such cases. The perforation in the PEEK framework did not reduce significantly the mechanical properties of the RСD, but its adhesion to the PMMA base exerted a decisive effect on the operational performance.
... The author considers these outdated prostheses, highlights their low quality, which, in his opinion, leads to inevitable bone atrophy under the prosthesis, and notes the insufficient strength of the dental materials from which the construction is made. Porfiryev et al. [11] recommend a 3-year warranty period for removable plate dentures, with subsequent necessary replacement due to the aging of the polymer material and the inevitable destruction of the surface of the prosthetic construction, even if it remains fully functional. According to many authors [12][13][14], the aging of dental materials creates favorable conditions for the increased adhesion of microorganisms and the formation of microbial biofilms, particularly in individuals with a genetic predisposition. ...
According to the World Health Organization, the global prevalence of complete tooth loss is estimated to be 7% among individuals aged 20 years and older, while for those aged 60 and over, this rate significantly increases to 23%. This study is relevant due to the psychological trauma, social challenges, and functional limitations caused by tooth loss, as well as the uneven availability of dental care worldwide. The goal of this research is to develop and implement a new model to assess the socioeconomic feasibility of investing in digital technologies for diagnosing and treating patients with complete tooth loss using removable polymer prostheses produced through additive 3D printing. The study employs scenario analysis, the clustered rankings coordination method, statistical methods, expert opinion assessment using Kendall’s coefficient of rank concordance, system analysis and design, questionnaires, sociometry, and functional modeling. The practical significance of this research lies in providing a quantitative assessment of economic opportunities for effectively using RPDs in three groups: RPDs without additional fixation means; those with special adhesive agents for improved fixation; and implant-supported prosthetics with conditionally removable dentures similar to RPDs. The scientific novelty of this study is the development of a new evaluation model that justifies the choice of prosthetic treatment technology for patients with complete tooth loss, enabling the most rational use of resources. Doi: 10.28991/ESJ-2024-08-05-014 Full Text: PDF
... The analog protocol for manufacturing the RCDs is associated with significant time costs (including waiting for a patient) and manual labor of a dental technician [14]. However, it also has a number of distinct advantages. ...
In this study, a methodology was developed for ranking manufacturing technologies of removable complete dentures (RCDs) according to the results of their full-scale mechanical tests. The actuality of the study is motivated by establishing the advantages and drawbacks of 3D-printed RCDs in contrast with ones manufactured via an analog protocol. The RCDs were fabricated via four technological routes that included various combinations of subtractive technologies (hot polymerization/HP and CAD/CAM milling) and additive manufacturing (digital light processing/DLP) ones and the installation of commercially available cosmetic denture teeth (DT). In the mechanical tests, different blocks of teeth (incisors, canines, premolars and molars) were loaded. To solve the ranking problem, it was proposed to interpret the results of the mechanical tests in terms of the reliability, durability and compliance/stiffness criteria. For this purpose, the combined AHP-VIKOR method was applied. In addition, a computer simulation of the mechanical loading conditions and the response of the RCDs was performed based on the finite element method (FEM). As the key conclusion, it was stated that additive manufacturing (AM) methods are competitive and cost-effective techniques for the fabrication of RCDs.
Разработка современных технологий дезинфекции и стерилизации инструментов медицинского назначения является крайне актуальной задачей, что определяется агрессивным воздействием используемых физических и химических агентов. Для повышения срока службы инструментов медицинского назначения в последние годы применяются защитные покрытия на основе нитрида титана, которые существенно повышают стоимость изделия по сравнению с аналогами без покрытия. Цель исследования — сравнительная оценка коррозионной стойкости образцов с защитными покрытиями под влиянием щелочных дезинфектантов с учетом оценки применения оригинальной методики микробной адгезии и конфокальной электронной микроскопии в эксперименте in vitro. Исследовали варианты формирования оптимальных металлокерамических покрытий, устойчивых к коррозионному действию дезинфектантов на основе TiC-NiCr, с использованием метода электроискрового лигирования для образцов стоматологических инструментов. Были использованы щелочные дезинфектанты «Венделин», «Мегадез Орто», «Трилокс» отечественного производства. Для контроля эффекта дезинфектантов до и после воздействия проводили стандартное исследование микробной адгезии со штаммами S. aureus, B. cereus, C. albicans, C. glabrata. Шероховатость и рельеф поверхности оценивали с помощью сканирующей электронной микроскопии. Установлено, что сформированные защитные покрытия не подвергаются коррозии при воздействии изучаемых растворов ДС при комнатной температуре. Напротив, на контрольных образцах (без покрытия) определяли увеличение микробной адгезии и признаки, указывающие на деструкцию и коррозию, зависимые от концентрации ДС. Оптимальные результаты по показателям микробной адгезии S. aureus и C. albicans были получены с III образцом (Ra=3,26 мкм), и, напротив, худшие показатели оказались у IV образца, который отличался самой значительной толщиной (40 мкм) и степенью шероховатости покрытия (Ra=3,73 мкм). Защитные покрытия из твердых растворов на основе железа: Fe241Ti9, Fе47C3, Cr-Ni-Fe-C и упрочняющей фазы карбида титана TiC на поверхности образцов обеспечивают их коррозионную стойкость при воздействии рабочими растворами щелочных ДС, а при использовании ДС «Трилокс» также концентратом.
The development of modern technologies for disinfection and sterilization of medical instruments is an extremely urgent task, which is determined by the aggressive effects of the physical and chemical agents used. In recent years, titanium nitride-based protective coatings have been used to increase the life of medical instruments, which significantly increase the cost of the product compared to uncoated counterparts. The purpose of the study is to compare the corrosion resistance of samples with protective coatings under the influence of alkaline disinfectants, taking into account the assessment of the use of the original microbial adhesion technique and confocal electron microscopy in an in vitro experiment. . Options for forming optimal cermet coatings of TiC-NiCr-based corrosion-resistant disinfectants using the electrospark ligation method for dental instrument samples were investigated. Have been used alkaline disinfectants “Wendelin”, “Megadez Orto”, “Trilox” of domestic production were used. To control the effect of disinfectants before and after exposure, a standard microbial adhesion study was performed with strains of S. aureus, B. cereus, C. albicans, C. glabrata. Surface roughness and topography were evaluated by scanning electron microscopy. . It was found that the formed protective coatings are not subject to corrosion when exposed to the studied ET solutions at room temperature. In contrast, the control samples (uncoated) showed an increase in microbial adhesion and signs indicating degradation and corrosion dependent on the concentration of ET. Optimal results for the microbial adhesion of S. aureus and C. albicans were obtained with sample 3 (Ra=3.26 μm), and on the contrary, the worst results were obtained with sample 4, which had the most significant thickness (40 μm) and the degree of roughness of the coating (Ra=3.73 μm). . Protective coatings made of solid solutions based on iron: Fe241Ti9, Fe47C3, Cr-Ni-Fe-C and the strengthening phase of titanium carbide TiC on the surface of samples ensure their corrosion resistance when exposed to working solutions of alkaline ET, and when using ET “Trilox” also with concentrate.
The aim of this study is to compare in the theoretical aspect the advantages and problems of dental health facilities of various forms of ownership, their strengths and weaknesses, as well as opportunities and threats, using SWOT-analysis method. Material and methods. Dental care is considered from the point of view of triad: 1) material and technological equipment of medical facility, which is the most important resource, providing the availability and quality of dental care (service), 2) qualification of medical and auxiliary personnel and 3) quality of treatment, estimated by the number of return visits during the warranty period. Results. From this perspective, the commercial dental sector is more attractive for patients than the public sector, while the latter is more accessible. Conclusion. The balanced integration of listed factors is transformed into an improvement of dental care quality for the population of the Russian Federation.
The advancement of medicine has reduced the rate of mortality and older adult population is increasing. Among the 7,700,000,000 world population in 2019, 1 in 11 people were at the age of 65 or more. The population is expected to increase to 1 in 6 people by 2050. Older adults have degenerative changes that become more severe with age. This study used the World Health Organization’s websites and PubMed and Google Scholar databases to review current global oral and systemic health issues. Studies generally reported that many older adults have no regular dental checkup. Common oral diseases such as dental caries particularly root caries and periodontal disease are highly prevalent among them. These oral diseases are often interrelated with their systemic problems. A meta-analysis reported diabetes increases the incidence and progression of periodontitis by 86%. A decrease in salivary output is common among older adults having polypharmacy. A review reported the caries risk in older adults increases by 60% with low resting pH and low stimulated salivary flow rate. Many older adults suffer from dementia and depression which complicates the delivery of dental treatment. Proper oral hygiene practice and dental care at supine position are often difficult to be carried out if they have rheumatoid arthritis. With the increasing need of elderly dental care, dentists and other dental personnel should understand interlaced oral and general health in order to provide a successful dental care plan for older adults. The aim of this study is to give an overview of the common medical conditions and dental problems and their impacts on older adults.
Analysis of the sources of literature both Russian and foreign, points to the need to create and implement comprehensive strategies aimed at improving the quality of dental care, minimizing errors, ensuring a decent quality of life. The economic costs of eliminating health-care deficiencies are also a huge problem, especially if the funding source is the budget or the funds of the MLA and VMI.
A structural analysis of the decisions and definitions of courts of General jurisdiction in cases involving substandard medical dental care for 25 years. Identifies main tendencies of court practice on civil cases related to medical errors and defects of dental care.
Since the creation of the National Health Service (NHS) in Portugal, in 1979, dental care is neither provided nor funded by the NHS. Thus, most dental care is paid through out-of-pocket payments, either by patients themselves or through voluntary health insurance or health subsystems. In 2008 the government created the dental voucher targeting children, pregnant women, elderly who receive social benefits, and certain patient groups (HIV/AIDS patients and those who need early intervention due to oral cancer), to be used in private dentists who contracted with the programme. The reform was well received by the different stakeholders, especially dentists and beneficiaries, and the impact of the dental voucher in access and coverage of dental care in Portugal is positive: from May 2008 until December 2017, dental voucher reached 3.3 million NHS users in Portugal and dental care indicators have dramatically improved over the last ten years. Aiming to implement dental care provision within the NHS, the Ministry of Health has announced the foreseen integration of dentists in primary healthcare units, although the current budget constraints might hamper this possibility.
Background
Dental care is extremely costly and beyond most people means in developing countries. The primary aim of this study was to determine the impact of out-of-pocket payments for dental care on household finances in 40 low and middle income countries. A second aim was to compare the burden of payments for dental care with that for other health services. Methods
We used data from 174,257 adults, aged 18 years and above, who reported their total and itemized household expenditure in the past four weeks as part of the World Health Surveys. The financial burden on households was measured using the catastrophic health expenditure (CHE) and impoverishment approaches. A household was classified as facing CHE if it spent 40% or more of its capacity to pay, and as facing impoverishment if it fell below the country-specific poverty line after spending on health care was subtracted from household expenditure. The odds of experiencing CHE and impoverishment due to expenditure on dental care were estimated from two-level logistic regression models, controlling for various individual- and country-level covariates. ResultsHouseholds that paid for dental care had 1.88 (95% Confidence Interval: 1.78-1.99) greater odds of incurring CHE and 1.65 (95% CI: 1.52–1.80) greater odds of facing impoverishment, after adjustment for covariates. Furthermore, the impact of paying for dental care was lower than that for medications or drugs, inpatient care, outpatient care and laboratory tests but similar to that of health care products, traditional medicine and other health services. Conclusion
Households with recent dental care spending were more likely to use a large portion of their disposable income and fall below the poverty line. Policy makers ought to consider including dental care as part of universal health care and advocate for the inclusion of dental care coverage in health insurance packages.
This study has been conducted in order to examine the oral health status and dental prostheses status, and the effects of dental prostheses to the oral health related quality of life among the elderly using social welfare centers.
Objective. To evaluate the effectiveness of dental orthopedic treatment in patients with complete absence of teeth using removable plate prostheses applying integral qualitative and evaluative indicators. The relevance of the study is dictated by the need to improve the quality of orthopedic treatment in patients with complete absence of teeth, through the introduction of new composite materials, the use of which provides high strength of prosthetic structures. For an objective assessment of the effectiveness of dental orthopedic treatment of patients using removable plate prostheses, integral approaches based on the calculation of qualitative and evaluative indicators have been modified. Materials and methods. In order to improve the quality of orthopedic treatment of patients with complete absence of teeth, a design of a complete removable plate prosthesis with a combined basis and a method of its manufacture based on the use of digital technologies was developed. In the course of the work, the evaluation of the effectiveness of treatment in patients with complete absence of teeth in the long-term follow-up using integral qualitative and evaluative indicators was carried out. Results. Clinical and laboratory stages of manufacturing a new design combining analog and digital metols were developed and tested. As a result of clinical studies, it was found that the type of construction of a complete removable plate prosthesis does not significantly affect the indicator of the integral assessment of the quality of orthopedic treatment, with the exception of the criterion of the prosthesis integrity. Conclusions. To conclude, it was found that the type of construction of a complete removable plate prosthesis does not significantly affect the integral assessment of the quality of orthopedic treatment, except for the criterion of the integrity of the prosthesis; the introduction of a composite material based on fiberglass into the design of a combined prosthesis allows to improve the strength properties of the prosthesis basis and increase the performance characteristics of the structure. The use of CAD / CAM technologies provides the possibility of using high-strength composite materials, gives sufficient accuracy in the manufacture of the frame of a combined full removable plate prosthesis. Due to satisfactory physical and mechanical properties, the application of the developed design contributes to the predicted increase in the durability of prostheses.
Statement of problem
Comparative cost-analysis related to different manufacturing workflows for removable complete denture fabrication is seldom performed before the adoption of a new technology.
Purpose
The purpose of this study was to compare the clinical and laboratory costs of removable complete dentures fabricated with a conventional (workflow C), a partial digital (workflow M), and a complete digital (workflow D) workflow and to calculate the break-even points for the implementation of digital technologies in complete denture fabrication.
Material and methods
Clinical and laboratory costs for each of the investigated workflows and the manufacturing options related to denture base and denture teeth fabrication were collected from 10 private Italian dental laboratories and clinics. The selected variables included the clinical and laboratory manufacturing time needed to complete each workflow (opportunity cost); costs for materials, labor, packaging, and shipping; and capital and fixed costs for software and hardware, including maintenance fees. The effect of manufacturing workflows and their options on the outcomes of interest was investigated by using generalized estimated equations models (α=.05). Cost minimization and sensitivity analysis were also performed, and break-even points were calculated for the equipment capital costs related to the implementation of workflows M and D.
Results
From a laboratory standpoint, workflows M and D and related manufacturing options significantly (P<.001) reduced manufacturing time (5.90 to 6.95 hours and 6.30 to 7.35 hours, respectively), and therefore the opportunity cost of each denture compared with workflow C. Workflow M allowed variable costs savings between 81 and 169 USD, while workflow D allowed for an additional saving of 34 USD. The sensitivity analysis showed that the break-even point related to the capital investment for the equipment needed to implement workflows M and D could be reached, depending on the manufacturing options adopted, between 170 and 933 dentures for workflow M and between 73 and 534 dentures for workflow D. From a clinical standpoint, workflows C and M were almost identical. Conversely, workflow D, which included intraoral scanning, required 1 fewer appointment, saving 0.6 hours of chairside time and about 14 USD for materials compared with M.
Conclusions
Digital workflows (partial and complete digital workflows) were more efficient and cost-effective than the conventional method of fabricating removable complete dentures, with workflow D showing the lowest opportunity and variable costs and break-even point. Savings increased when stock denture teeth were replaced with milled denture teeth and still further with the adoption of 3-dimensionally (3D) printed denture teeth. Milling equipment and materials for denture base fabrication were more expensive than those for 3D-printing. Milling monobloc dentures reduced opportunity and labor costs but increased material cost.
The article presents a review of scientific domestic and foreign literature and regulatory legal documentation, which allowed to identify problems in the organization of and payment for dental care and to determine possible directions of scientific research on the stated topic. Dependence of availability of specialized dental care on the income level, limited availability and late medical assistance in the rural regions, measures to increase availability through use of the programs of preferential prosthetics are shown. The problems of low coverage of dental services by mandatory medical insurance programs are considered. The levels of provision of population of RF with medical care, methods and difficulties of payments to specialists, of use of conventional units of labor inputs, of correction factors for children and adults, the issues of standardization of primary dental care, ambiguous attitude to the classifier of basic medical dental procedures and technologies that changed the established principle of remuneration in dental practice, are described. The method of payment for primary dental care provided on an outpatient basis for a completed case of treatment in terms of cost of clinic-statistical groups, as well as the per capita principle of payment for outpatient dental care and the difficulties with its implementation within compulsory health insurance in most regions are considered. An important role of automation of the working place for filling the medical documents, of improvement of organizational and medical technologies with use of new materials and equipment, is indicated. Analysis of the scope of medical care demanded by the population within the programs of the state guarantees is given. An emphasis is placed on the priority of the development of the modern dentistry as governmental-private partnership in terms of high adaptation to the market conditions. A complex character of issues of prophylaxis, screening, improvement of organization of and payment for dental care is emphasized, salvation of which will permit to considerably improve the quality of medical care and to guarantee its availability.
The article presents the calculation of multiplier effects in the modern economy of Russia. The output multipliers by different sectors of the economy have been estimated using a method based on a static input–output model. The article has analyzed the limitations and possibilities of applying a method of calculating the multiplier effects.
Impairment of oral health has a negative impact on the quality of life (QOL) of the elderly. Activities of daily living (ADL) are known to be an important determinant of their QOL. A controlled study was conducted between September and November 2007 to determine the effects of dental treatments on the QOL and ADL among 30 institutionalized Japanese elderly who were allocated into two groups, an intervention group and a control group. Their mean age was 80+/-9 years. Outcome data were collected 6 weeks after baseline in both groups. QOL and ADL were assessed using General Oral Health Assessment Index (GOHAI) and Functional Independence Measure (FIM). The intervention group, which had received dental treatment, showed significant increases in GOHAI scores between baseline and 6 weeks (p=0.04), whereas no significant difference was found between baseline and 6 weeks in the control group. The differences in the changes in the FIM scores for expression were significant in the model adjusted for covariables (p=0.03). Our findings showed that dental treatments increased the oral health-related QOL and the expression function in the ADL. Promoting dental care service at nursing facilities may be beneficial for maintaining the residents' QOL.
Forecasting the needs of the population of the Russian Federation in orthopedic dental treatment of complete absence of teeth
- I S Kitsul
- I Yu
- S D Lebedenko
- Arutyunov
Prosthetics in the complete absence of teeth with prostheses with two-layer bases. Modern view on the problem
- I Yu
- A P Lebedenko
- S D Voronov
- Arutyunov
- I. Yu. Lebedenko
Psychological rationale for the tactics of treating elderly dental patients using removable dentures
- M G Amiryan
- D I Grachev
Guide to Practical Classes in Orthopedic Dentistry. Part 1 (Vseross. Uchebno-Nauchno-Metod
- B P Markov
- I Yu
- V V Lebedenko
- Erichev
Quality of life of patients with partial and complete absence of teeth, Candidate’s Dissertation in Medical Sciences
- A M Abramovich
Economic efficiency of digital transformation of fixed prosthetics technology in the management of dental services
- O O Yanushevich
- S D Arutyunov
- I V Zolotnitsky
- G G Bagdasaryan
- L G Kirakosyan
- E V Sokolov
- E V Kostyrin
Sociological assessment of the organization of dental care provided on an outpatient basis
- A I Babenko
- S A Kostrubin
Improving the effectiveness of orthopedic treatment and the quality of life of patients with complete absence of teeth in the lower jaw, Candidate’s Dissertation in Medical Sciences
- D I Grachev
Analysis of the reasons for repeated requests of patients for dental care
- K A Koshelev
- N N Belousov
- S B Ivanova
Orthopedic Treatment of Patients with Complete Absence of Teeth. Study Guide
- A P Voronov