20 Work Authorizations For Removable Partial Dentures

20
C HA P T E R
Work Authorizations for Removable

Partial Dentures
CHAPTER OUTLINE WORK AUTHORIZATION
Work Authorization A work authorization contains the written directions for lab-
Content oratory procedures to be performed for fabrication of dental
Function restorations. The responsibility of a dentist to the public and
Characteristics to the dental profession to safeguard the quality of prosth-
Definitive Instructions by Work Authorizations odontic services is controlled in part through meaningful
Legal Aspects of Work Authorizations work authorizations. If work authorizations are properly
Delineation of Responsibilities by Work Authorizations completed, they provide a means for increased professional
quality assurance and satisfaction in a removable partial den-
ture service.
A work authorization completed by a dentist is similar to
granting power of attorney. It grants authority for others to
act on the dentist’s behalf and specifically prescribes what is
authorized.
When properly executed, work authorizations are effec-
tive channels of communication. They enhance the quality
of the completed restorations by providing instructions for
individually and scientifically considered prostheses.
Content
Information contained in a work authorization should
include the following: (1) the name and address of the den-
tal laboratory; (2) the name and address of the dentist who
initiates the work authorization; (3) the identification of the
patient; (4) the date of work authorization; (5) the desired
completion date of the request; (6) specific instructions;
(7) the signature of the dentist; and (8) the registered license
number of the dentist. All these requirements can be accom-
modated in a simply designed form (Figure 20-1).
Function
The following four important functions are performed by a
work authorization:
1. It furnishes definite instructions for laboratory proce-
dures to be accomplished and implies an expectation of a
level of acceptable quality for the services rendered.
283
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284 Part II Clinical and Laboratory
Removable Partial Prosthodontics
Patient name: Patient number:
Student name: Student number:
Treatment plan Laboratory instructions
7 8 9
10
6 11 Design specifications:
5 1. Rests
12
4
13
3
14
2 2. Retention
15
Copyright Attachments International, Inc.
1 16
R L
3. Reciprocation
R L 4. Major connector
32 17
31 18
5. Indirect retention
30 19
29 20
28 21
6. Guide planes
27 22
26 25 24 23
7. Base retention
Color code:
Blue: Cast metal

Red: Resin base and wrought wire
Green: Areas to be contoured 8. Areas to be modified or
contoured
Instructor:
Approval to send to laboratory: Date:
Figure 20-1 Work authorization form, designed specifically for removable partial dentures, to furnish detailed information to the
laboratory technician. Form used to specifically plan framework design and to designate mouth alterations and preparations.
2. It provides a means of protecting the public from the il- must be included in a work authorization to enable the tech-
legal practice of dentistry. nician to understand and execute the request. Many dentists
3. It is a protective legal document for both the dentist and are overly presumptive in assuming that a request can be
the dental laboratory technician. acceptably fulfilled without proper directions.
4. It completely delineates the responsibilities of the dentist It is sound practice to provide the dental laboratory
and the dental laboratory technician. technician with adequate written instructions for each lab-
oratory service required in the fabrication of a restoration.
Characteristics Therefore a new work authorization should accompany the
A work authorization must be legible, clear, concise, and material returned to the laboratory for continuing progress
readily understood. It is unreasonable to assume that labora- to complete the restoration. In a modern dental practice,
tory technicians are decoding experts. Sufficient information it is highly improbable that a one-trip laboratory service
Chapter 20 Work Authorizations for Removable Partial Dentures 285
Removable Partial Prosthodontics
Patient name: John Doe Patient number: 158390
Student name: Joe Smith Student number: 1234
Treatment plan Laboratory instructions
7 8 9
10 Design specifications:
6 11
5
12 1. Rests
4 Cingulum rests #22, #27
13 MO occlusal rest #20
3
14 MO occlusal rest #28
2 2. Retention
Copyright Attachments International, Inc.
15
I-bar clasp #28
1 16 I-bar clasp #22
R L
3. Reciprocation
Lingual plate #22, #27, #28
R L 4. Major connector
12 ga Lingual bar
32 17
18 ga 18 ga loops
loops 31 18
5. Indirect retention
19
Cingulum rest #22, #27
30
29 20
Cast I-bar 28 21 6. Guide planes

27 Cast I-bar Distal #20, #22, #27
22
26 25 24 23 Mesial #20
7. Base retention
Color code: 18 ga. loops, 12 ga. inferior border
Blue: Cast metal

Red: Resin base and wrought wire 8. Areas to be modified or
Green: Areas to be contoured contoured
Metal tooth to replace #21
Instructor:
Approval to send to laboratory: Date: 2/15/09
Figure 20-2 This work authorization accompanies a master cast on which the dentist has designed and drawn an outline for a remov-
able partial denture framework. It is simple and is not time-consuming to execute, yet it furnishes detailed information so the request
can be properly fulfilled.
DEFINITIVE INSTRUCTIONS BY WORK

will be adequate to provide a truly professional removable
AUTHORIZATIONS
restoration.
No single work authorization form is adequate to furnish Work authorization forms may be designed so that only
detailed instructions for accomplishing the laboratory phases a minimum of writing is necessary to provide thorough
in the fabrication of removable partial dentures, crowns, and instructions (Figure 20-2). The form can contain printed
fixed partial dentures, or complete dentures, or for accomplish- listings of materials and specifications that require either a
ing orthodontic laboratory procedures. Inherent differences checkmark or a fill-in for authorization of their use.
in the many types of restorations themselves and differences Another effective means for communicating, which pro-
in the laboratory phases necessary for their fabrication estab- vides anatomical detail not available when drawing on paper,
lish a requirement for individual work authorization forms. includes drawing the design on a diagnostic cast. Exact location
Patient name Denture identification

Date submitted Date required
Laboratory name
Laboratory address
Metal type Shade Guide
7 8 9 10
6 11
5 12
4 13
3 14
2 15
1 16
32 17
31 18
30 19
29 20
28 21
27 22
26 25 24 23
Indicate characterizations
Pontic design (circle)
Modified Conical Hygienic

ridge lap
Signature
Metal design (circle)
License number
Metal coping
All porcelain coverage
Metal occlusal
excluding buccal cusp
Metal occlusal
including buccal cusp
WHITE – Department YELLOW – Lab PINK – Patient Record

A
Figure 20-3 A. This work authorization will accompany design and master casts. The dentist will submit a design cast with an outline
for the removable partial denture frame. It is simple and is not time consuming, yet it furnishes detailed information so the request can
be properly fulfilled.
of rests, proximal plates, major/minor connectors, and clasps Space is reserved on the work authorization form to fur-
augment the written work authorization request (Figure 20-3). nish the technician with information on the dentist’s selec-
A reminder space is included to designate the choice of tion of teeth. The responsibility for tooth selection must
metal for the framework. Frameworks for removable par- remain with the dentist. The success of the removable partial
tial dentures are usually cast in type IV gold, chromium- denture depends in part on the consideration given to the
cobalt alloy, or a titanium alloy. The nature of the material size, number, and placement of the artificial teeth and to the
of the denture base may also be indicated by a checkmark. material from which they are made.
It is difficult to elicit this information from the markings on A display of courtesy deserved by and a demonstra-
master casts. tion of respect for the laboratory technician are indicated.
Chapter 20 Work Authorizations for Removable Partial Dentures 287
Figure 20-3 Cont’d B. Occlusal view of the design cast, with the outline of the removable partial denture framework drawn. The
path of placement is indicated on the cast, as well as the height of contour and location of retentive clasp undercuts, and location of
guide planes, rests, and clasp locations.
The general request is prefaced by “please” and the specific eliminates confusion in interpreting the markings on the
instructions are ended with “thank you.” Do any other three master cast.
words promote better relations? Specifications for waxing the framework components for
A good work authorization form not only ensures clar- gold, chromium-cobalt, or titanium alloy castings must be
ity but also simplifies correct execution. Figures can be pro- furnished for the technician and are an integral part of the
vided on which diagrams may be drawn to enhance written work authorization form. Specifications that are adequate for
descriptions when necessary. These diagrams may show the most removable partial denture frameworks may be listed.
occlusal and lingual surfaces of the posterior teeth and the This feature alone saves time and effort in preparing the work
lingual surfaces of the anterior teeth. The palatal region of authorization and serves as a handy reference for the labora-
the maxillary arch and the lingual slopes of the mandibular tory technician. The listing of average specifications does not
alveolar ridge can also be included. These features allow a preclude altering a specification when the situation necessi-
clear, diagrammatic representation of the locations of major tates other characteristics in a given component.
connectors, which will complement the outline of the frame- The specific instructions provided in a work authorization
work on the master cast. must be so constructed that they will be a constant source
A color-code index can be used to explain the markings of direction and supervision for the laboratory phases of a
on the master cast when it is submitted to the laboratory for removable partial denture service. Instructions should leave
the fabrication of a framework. For example, a green pen- no doubt about the dentist’s requirements in a request for
cil can be used to outline the framework; red to designate laboratory services. It is foolish to use undercut dimensions
the desired location of finishing lines on the framework; and of 0.01 or 0.02 inch when a master cast is surveyed, unless
black lines to denote the height of contour on teeth and soft written directions are included to incorporate these dimen-
tissue created during the survey of the cast. The color code sions into the finished framework.
Work authorization blanks should be available in such a between dentist and some dental laboratory technicians
manner that a duplicate can be conveniently made and thus are in part a result of many individual dentists who impose
a copy can be supplied for both the dentist and the dental unrealistic responsibility on laboratory technicians. Further-
laboratory technician. The original may be a different color more, this unwelcome relationship may have been caused
than the duplicate for ready identification. by the submission of poor impressions, casts, records, and
instructions to the laboratory technician, with the demand of
impossible quality in the returned restoration under threat of
LEGAL ASPECTS OF WORK AUTHORIZATIONS
economic boycott.
Although the National Association of Dental Laboratories Most dental laboratory technicians are ethical and ear-
(NADL) provides guidelines for statutory regulation, it is the nestly desire to contribute their talents to the dental profes-
inherent right of each state to implement its own regulation. sion. The dental profession is vitally interested in increasing
Fortunately, all states exercise this control. Interpretations of the number of serious-minded dental auxiliary personnel to
acts that constitute the practice of dentistry are moderately share in providing oral health care. However, until the dental
uniform. However, statutory restrictions on dental labora- profession elevates itself in the eyes of laboratory technicians
tory operations vary from state to state. Properly executed and also elevates the stature of dental laboratory technology,
work authorizations serve to document communication and greater availability of responsible auxiliary personnel is more
protect the professional relationship between the dentist and fancied than real.
the dental laboratory. The dental laboratory technician is a member of a team
Many states require that work authorizations be made in whose objectives are the prevention of oral disease and the
duplicate and that both the dentist and the dental labora- maintenance of oral health as adjuncts to the physical and
tory technician retain a copy for a specified period from the mental well-being of the public. A good dental laboratory
date of work authorization. Thus, documents are available to technician is a valuable team member working with the den-
substantiate or refute claims and counterclaims that concern tist and contributes much to the team effort in providing oral
the illegal practice of dentistry, or to aid in the settlement of health care for patients. The degree and quality of the team
misunderstandings between a dentist and a dental laboratory effort are the responsibility of the dentist and depend on the
technician. dentist’s knowledge, experience, technical skill, administra-
tive ability, integrity, and ability to communicate effectively.
A dentist may delegate much of the laboratory phase of
DELINEATION OF RESPONSIBILITIES BY WORK
a removable partial denture service. Work authorizations
AUTHORIZATIONS
help fulfill the moral obligation to supervise and direct those
The dentist is responsible for all phases of a removable partial technical phases that can be accomplished by dental labora-
denture service in the strict sense of the word, although the tory technicians. Substantial indications suggest that many
dental laboratory technician may be requested to perform members of the dental profession either are not cognizant
certain technical phases of the service. However, the labora- of the rewards of writing good work authorizations or are
tory technician is responsible only to the dentist and never to not proficient in their execution. It is not a secret that some
the patient. A dentist who relegates the design of a removable dentists do not submit instructions when availing themselves
partial denture to a less qualified individual accepts the pos- of commercial dental laboratory services.
sibility of and responsibility for an inferior removable partial If the practice of prosthodontics is to remain in the con-
denture service. trol of dentists, each member of the dental profession must
A dentist who imposes on auxiliary personnel those avoid delegating responsibility to those who are less qualified
responsibilities that legally and morally belong with the to accept the responsibility. Movements to allow denturism
dentist does a great injustice to the patients, the technicians, are seemingly becoming more prevalent and possibly are
and the dental profession. There is little doubt that the ille- related to poor laboratory communication regarding remov-
gal practice of dentistry and the presently existing impasse able prosthodontics.

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20

Work Authorizations for Removable

Removable Partial Prosthodontics

Patient name: Patient number:

Student name: Student number:

Treatment plan Laboratory instructions

Blue: Cast metal

Approval to send to laboratory: Date:

Removable Partial Prosthodontics

Patient name: John Doe Patient number: 158390

Student name: Joe Smith Student number: 1234

Treatment plan Laboratory instructions

Cast I-bar 28 21 6. Guide planes

Blue: Cast metal

Approval to send to laboratory: Date: 2/15/09

DEFINITIVE INSTRUCTIONS BY WORK

Patient name Denture identification

Pontic design (circle)

Modified Conical Hygienic

WHITE – Department YELLOW – Lab PINK – Patient Record

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