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EP3
Jaw Registration Audit

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An audit on occlusal registrations for partial dentures in general practice.

Definition

A occlusal registration is a record of the positional relationship of opposing teeth, arches or jaws to each other.

•It allows accurate record of occlusal vertical dimensions, prevents occlusal interferences, and enable final dentures to provide optimum function, comfort, aesthetics and satisfaction.
•Retention, chewing ability and aesthetics are the most important factor for partial denture acceptance.
•A conformative approach has been advocated. 
 

The BSSPD guidelines state for greater accuracy, jaw relationships should be recorded using occlusal rims (if appropriate)₁.

•These casts should be mounted and studied on an articulator₁.
•The base of the registration rim should be a rigid material₁. 
•Ideally they should lie on the saddle areas and be level with the remaining standing teeth₁. 

The BDJ suggests additional guidelines for good occlusal practice. These include;

•A complete examination of the patient.
•Recording pre-treatment occlusion.
•Using a simple 2D system to record occlusion mid and post-treatment₂.
 

Aims and Objectives 

•Are Occlusal Registrations carried out routinely for dentures?
•If so, what methods are dentists using to complete Occlusal registrations?
•If Occlusal registrations are not completed, does it impact the dentures made for the patients?
•To gauge Dental Lab Technicians preferred method of Occlusal Registration. 
 
1.Pilot audit carried across 4 NHS practices in NE London.
2.First cycle of audit retrospectively evaluated a random sample of 106 partial dentures made in the last six months by 16 dentists across the same 4 practices. Data collection via clinical records using a standardised collection sheet.
3.Short telephone interviews were conducted to establish five dental laboratories' technicians' preferred methods for occlusal registrations for partial dentures.
 
Design of Pilot Audit
 
•Design: Retrospective
• Sample size: 106 dentures
• Preferred Material: occlusal wax rims
• Lab Technician Preference: squash-bite wax record  block, ideally with centre and canine lines clearly  marked and cast models being tied with elastic bands.
• Results for dentures with occlusal registration: Of the 71% of dentures, 77% did not need any adjustment appointments following denture fit. 
• Results for dentures without occlusal registration: Of the 29% of dentures, 84% needed denture adjustment appointments after final denture fit, of which 55% needed two or more appointments. 
 
Interventions to overcoming barriers in practice:
 
1.Occlusal registrations discussed at practice meetings.
2.Construction of an evidence based protocol  and presentation for GDP’s.
3.To re-check wax rims once cooled and ensure conformation.
4.Read specific manufacturers guide for material.
5.Set up practice policy and lab performa.
6.Update staff on guidelines.
 
Design of second stage audit: 
 
•Design: Prospective
• Sample size: 104 dentures
• Preferred Material: occlusal wax rims – 100%
•Results for dentures with occlusal registration:  Of the 80% dentures, 93% did not need any denture adjustment appointments following denture fit and the remaining dentures that needed adjustment, did not need more than 1 appointment. 
•Results for dentures without occlusal registration: Of the 20% dentures, 57% needed denture adjustment appointments after final denture fit, of which 10% needed two or more denture. 
 
Conclusions: 
 
•Occlusal registration should to be carried out in practice.
•Results show dentures constructed without an occlusal registration, were more likely to need adjustments. This suggests an inadequate denture and low patient satisfaction.
•Dentists were more likely  to not carry out an occlusal registration when the number of units replaced were low, in this case 20% were not completed when 1-3 teeth were to be replaced.
•Occlusal wax rims are still the material of choice.
•Good communication with the laboratory is essential to ascertain the best way of recording patient’s occlusion which in this case was a wax squash bite record.
•However, if the technician does not require a occlusal record it was found they would not send wax rims despite the dentists request to do so. If this is the case, this depends on the dentist’s / technician’s techniques and the patient’s occlusion. 
 
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