What does the Society for Dental Ceramics quality assurance project offer?
Last but not least, we would like to introduce a valuable quality-assurance aid for the ceramic user. The SDC is the organizer of the quality-assurance project “Ceramic Success Analysis” (CSA). The goal of the CSA is to make it easier for dentists to work safely and confidently with all-ceramic restorations.
This follow-up field study, which was originally begun for Cerec users, has been given a broader basis through the efforts of the Society for Dental Ceramics. Further all-ceramic systems, such as Empress and Empress 2, HeraCeram, VITA In-Ceram, Everest, Procera, and Lava have been integrated, i.e., practically all all-ceramic single-tooth restorations are now included. In addition, it is planned to expand the CSA to processes in the dental laboratory.
This initiative lends the much-quoted “evidence-based dentistry” a new dimension. By participating in the CSA with his/her own records, the dentist – often a “lone warrior“ in his/her daily practice – can translate his own evidence-based findings into an individual treatment concept which does not rely on speculation and approximations, but on reliable data. This makes it possible to determine indications and evaluate treatment with certainty.
To be exact, participation in the CSA requires that the dentist take three steps:
– Draw up an insertion protocol for 50 patients
– Keep protocols of follow-up exams and results
– Evaluate one’s own results by comparing them to the averages of other dentists.
This does not require much time. In the easy-to-use program (on CD-ROM), the different materials, treatments, or causes of failure are documented via drop-down list fields. These data are sent on a diskette or per e-mail to the Dental Ceramics Association for evaluation. As an alternative tor those who would rather work with paper, a “follow-up form” is available, which can be inserted in the patient’s file. Using this method, too, data can be continually sent to the CSA.
The SDC then sends the dentist the evaluation of the inserted-restoration data presented as a graph. The individual practice’s data and the average values are shown. The individual data categories, such as initial clinical situation, clinical procedure, special steps, restoration size, and tooth type are color-coded into groups. Particularly striking differences between the individual practice’s data and the average are commented. With the help of this evaluation, the dentist can come to valuable conclusions for his/her practical work. Additionally, the SDC can be contacted directly, should important subsequent questions arise. Thus, concrete feedback and an exchange of information and experience are available. All of this occurs among colleagues, anonymously, voluntarily, and on an international level.
Experience from a pilot study (200 dentists have been at the forefront of this project for over 7 years, documenting 4000 cases) shows how many consequences can result just from the analysis of the insertion protocols. Not only the various indications, but also the unimaginable spectrum of possibilities in clinical procedures were surprising.
The follow-up analyses conducted to date have yielded excellent clinical results. These results served the CSA participants as feedback for their competent implementation of clinical procedures. At the same time, the results presented them with the opportunity to recognize peculiarities of their own practice in comparison to the average, and from that, possibly ideas for working more efficiently.
Looking at the graphs in the example below, it is obvious that great differences in the follow-up results from the individual practices can arise. For instance, the follow-up averages for “loss of vitality“ or “post-operative complaints“ are in the very good clinical range of 1 to 3%; however, the analysis shows that there are individual practices with far worse results for certain parameters (see below). For the dentist and patients concerned, it is irrelevant whether the average values are acceptable. The evaluation of the dentist’ data and any remarks or recommendations sent along with it can help provide inspiration and suggestions for treatment alternatives – e.g., a better dentin adhesive or more frequent use of rubber-dam.
Moreover, important conclusions can generally be drawn from the failures (< 0.5% per years), both for indications and treatments, even if failures are rare. Most failures occurred in molars; fractures were the leading cause, and were more frequent in certain practices.
The overall positive feedback from the current 200-plus project participants confirms that the evaluations and results are highly relevant for the dental practice, and that the SDC’s quality-assurance project has become an important forum for collegial information exchange. Admittance to the CSA is granted unbureaucratically and quickly: one phone call to the Society for Dental Ceramics office is enough – and the necessary papers (including software) will be sent immediately. Quality assurance can start tomorrow.
It’s a good feeling to know what you’re really doing and what results from it.
Dr. Bernd Reiss
Chairman Society for Dental Ceramics
If you’re interested in quality assurance for your practice, please contact:
Society for Dental Ceramics - Arbeitsgemeinschaft Keramik
