Competency Standards for Dental Technology. U.S. Marketplace. (Copyright 2002) 325 John Knox Road #L103. Tallahassee, FL 32303

Transcription

1 Competency Standards for Dental Technology U.S. Marketplace (Copyright 2002) 325 John Knox Road #L103 Tallahassee, FL / Phone 850/ Fax

2 2 Foreword The U.S. Dental Laboratory industry is a vibrant and growing industry employing over 40,000 technicians operating in approximately 11,000 commercial laboratory locations across the nation. In an effort to ensure product efficacy and the manufacture of quality prosthetics for the dental client and ultimately the dental patient, the National Association of Dental Laboratories has developed the following Competency Standards document for use by the industry. The process of developing such a document began in the late 1990 s through the establishment of a Competency Standards/Skill Standards Committee under NADL. The most recent work on this significant project was done under the auspices of an Ad Hoc Task Force on Competency Standards. NADL would like to thank the following individuals for their work on this monumental endeavor during the several years in fulfilling this project: Elizabeth Curran, CDT, Project Chair; Mark Jackson; Gerry Mariacher, CDT; Walter Tieck, CDT; Nick Azarra; Tammy Jakubik; Rod Jakubik; Vinni Abate, CDT; Larry Galsky, CDT; Glenn Thom, CDT; Robert Berger, CDT, FNBC; Roosevelt Davis, CDT; Albino Perez, CDT, Donna Hood Karney, CDT, Dr. Robert Schneider, MS, DDS, and Dr. William Westrick, CDT. Additionally, special thanks go out to the Dental Laboratories Association of the United Kingdom and the Skills for Health Institute in Bristol, United Kingdom for their generosity of sharing information on the UK National Occupational Standards (NOS) and their formal permission to utilize the United Kingdom template of standards. The development of this document was comprehensively based by reviewing similar documents and processes employed by the industries in Canada, the United Kingdom and Australia and followed U.S. Air Force frameworks. Where appropriate, within the unit designations, the reference codes from the ADA Code on Dental Procedures and Nomenclature, 2002 CDT3 version are incorporated. We hope you find these Competency Standards easy to use, valuable to you as a professional and adaptable to the current industry environment. Explanation and Overview Competency Standards is the term used to describe the skills, knowledge and performance, which are required by people working in a specific industry. Competency Standards includes all aspects of the work including: Skills to perform all the different tasks of the job Managing a range of different task and activities required by the job responding to problems, the unexpected and non-routine events dealing with all aspects of the workplace, the organization and colleagues

3 3 Competency Standards do not directly relate to any particular job classification or to the work in any one organization, nor are the standards an attempt to force all workers to do the same thing. Competency Standards are national and are written in a way, which allows flexibility required by different operational structures. The main aim of national competency standards is to identify the nature of the work performed in dental technology and the standards required by technicians to achieve quality. This document provides the basis for the design of training and detailed specifications for worker and workplace assessment. Competency standards are a complex combination of skills, knowledge and attitudes and no part of the standards components should be seen in isolation from the combined picture of the full competency described. Competency standards are limited to the work actually performed and demonstrated by the workers, not performance management regime of the organization or the complex combination of measures applied to determine the quality outcomes of an organizational service which includes all components of the service provision and outcomes. However, competency standards will provide a valuable ingredient in performance management and quality endorsement. This document will undergo a formal review process conducted by the National Association of Dental Laboratories every 24 months to encompass any relevant process oriented or technological changes that need to be reflected to keep the standards current. Parties are invited to submit items directly to the NADL that are deemed valuable for review consideration. This document is provided as a service to members of the industry by the National Association of Dental Laboratories and is available for download for free at HTwww.nadl.orgTH, it is also available at cost as a bound publication; and at cost in either a CD-Rom or disk version.

4 4 Index to U.S. Dental Technology Competency Standards General Initial assessment DT01 Assess the feasibility of meeting client requirements for custom-made dental devices DT01.1 Prepare and maintain environments, materials and equipment for reviewing client prescription, work authorization and oral instructions DT01.2 Determine client requirements for custom-made dental devices DT01.3 Produce casts (D0470) as the basis for manufacturing custom-made dental devices DT01.4 Evaluate the feasibility of producing custom-made dental devices to meet client requirements. Providing technical advice DT02 Provide technical advice on the feasibility and design of custom-made dental devices DT02.1 Provide chairside advice to clients on the design options for custom made dental devices within individual treatment plans DT02.2 Contribute to the design of custom made dental devices for patients DT02.3 Monitor and coordinate the progress of custom-made dental devices through the manufacturing process. Removables DT03 Produce custom-made trays, casts (D0470), baseplates and occlusal registration rims for the design and manufacture of removable prostheses DT03.1 Prepare and maintain environments, materials and equipment for the design and manufacture of removable prostheses DT03.2 Produce custom-made trays to take impressions for removable prostheses DT03.3 Produce and prepare casts (D0470), baseplates and occlusal registration rims for removable prostheses. DT04 Design and manufacture basic complete removable prostheses DT04.1 Design and manufacture trial basic complete removable prostheses DT04.2 Manufacture basic complete removable prostheses DT04.3 Trim, polish and finish basic complete removable prostheses. DT05 Design and manufacture complex complete removable prostheses DT05.1 Design, manufacture and modify trial complex complete removable prostheses DT05.2 Manufacture final complex complete removable prostheses DT05.3 Trim, polish, finish and evaluate complex complete removable prostheses

5 5 DT06 Design and manufacture basic partial removable prostheses DT06.1 Design, manufacture and modify trial basic partial removable prostheses DT06.2 Manufacture basic partial removable prostheses DT06.3 Trim, polish, finish and evaluate basic partial removable prostheses. DT07 Design and manufacture complex partial removable prostheses DT07.1 Design, manufacture and modify trial complex partial removable prostheses DT07.2 Manufacture complex partial removable prostheses DT07.3 Trim, polish, finish and evaluate complex partial removable prostheses DT08 Design and manufacture cast and wrought alloy components and cast frameworks for removable prostheses DT08.3 Manufacture wrought components for removable prostheses DT08.4 Design and manufacture burn-out patterns for cast alloy frameworks DT08.5 Devest, trim, finish and evaluate alloy structures for removable prostheses. DT09 Reline, (D5730-D5761), Rebase (D5710-D5721), repair and modify removable prostheses DT09.1 Prepare and maintain environments, materials and equipment for the relining, rebasing, repair and modification of removable prostheses DT09.2 Reline, (D5730-D5761) and Rebase (D5710-D5721) removable prostheses DT09.3 Repair polymeric components for removable prostheses DT09.4 Repair alloy and ceramic components of removable prostheses DT09.5 Modify removable prostheses DT09.6 Trim, polish, finish and evaluate removable prostheses, which have been repaired, Reline, (D5730-D5761)d, Rebase (D5710-D5721)d or modified.

6 6 Fixed/Restorative devices DT10 Produce custom-made trays, casts (D0470) and dies for the design and manufacture of restorations DT10.1 Prepare and maintain environments, materials and equipment for the design and manufacture of restorations DT10.2 Produce custom-made trays to take impressions for restorations DT10.3 Produce casts (D0470) and dies for the design and manufacture of restorations. DT11 Design, manufacture and finish single and integral alloy restorations DT11.1 Design and manufacture single and integral alloy restorations DT11.2 Trim, polish, finish and evaluate single and integral alloy restorations DT12 Design, manufacture and finish single full cast restorations and copings (D6975) for the application of tooth colored materials DT12.1 Design and manufacture single full cast restorations and copings (D6975) for the application of tooth colored materials DT10.2 Finish and evaluate single full cast restorations and copings (D6975) for the application of tooth colored materials. DT13 Design and manufacture single tooth colored restorations DT13.1 Design and manufacture single tooth colored restorations DT13.2 Assure the quality of single tooth colored restorations DT14 Design and manufacture alloy substructures and alloy bridge components DT14.1 Design and manufacture alloy substructures and alloy bridge components DT14.2 Assure the quality of alloy substructures and alloy bridge components DT15 Design and manufacture single tooth colored restorations based on alloy substructures DT15.2 Apply tooth colored materials to alloy substructures DT15.3 Assure the quality of single tooth colored restorations on alloy substructures. DT16 Design and manufacture tooth colored bridge restorations based on non-alloy substructures DT16.4 Design and manufacture non-alloy bridge substructures DT16.5 Apply tooth colored materials to non-alloy bridge substructures DT16.6 Assure the quality of tooth colored restorations on non-alloy bridge substructures.

7 7 Orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) DT17 Prepare, and produce casts (D0470) and records for the design and manufacture of orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) DT17.1 Prepare and maintain environments, materials and equipment for the construction of functional orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) DT17.2 Produce and prepare casts (D0470) and records for the design of functional orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220). DT18 Design and manufacture functional orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) DT18.1 Design, manufacture and position components of functional orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) DT18.2 Assemble and manufacture functional orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) DT18.3 Join components to construct functional orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) DT18.4 Trim, finish polish and evaluate functional orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220).

8 8 DT19 Design and manufacture fixed orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) DT19.1 Design, manufacture and position components of fixed orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) DT19.2 Assemble and join components to manufacture fixed orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) DT19.3 Trim, finish polish and evaluate fixed orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220). DT20 Design and manufacture conventional removable orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) DT20.1 Design, manufacture and position components of conventional removable orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) DT20.2 Assemble and manufacture conventional removable orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) DT20.3 Join components to construct conventional removable orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) DT20.4 Trim, finish polish and evaluate conventional removable orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) DT21 Design and manufacture complex removable orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) DT21.1 Design, manufacture and position components of complex removable orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) DT21.2 Assemble and manufacture complex removable orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) DT21.3 Join components to construct complex removable orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) DT21.4 Trim, finish, polish and evaluate complex removable orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220). DT22.1 Design, manufacture and modify trial obturators DT22.2 Manufacture obturators DT22.3 Trim, polish, finish and evaluate obturators.

9 9 General Standards for Client Interaction and Manufacturing Processes

10 10 UNIT DT01 Assess the feasibility of meeting client requirements for custom-made dental devices Information about this unit Summary This unit describes the role of the technician in reviewing clients prescriptions and instructions, identifying the client s requirements, producing casts (D0470) and assessing the feasibility of meeting the client's requirements. The technician may be undertaking this evaluation at various stages in the manufacturing process (e.g. on first receipt of a prescription or request, after a tryin). The technician will be working at a level of responsibility where they are making decisions for their laboratory about the feasibility of making devices and also the technical and production capacity of the laboratory. The technician will need to communicate with the client where there is insufficient information on which to make a decision, or concern about the feasibility of meeting their requirements (in which case they should suggest options to the client). The accountability for the overall assessment and treatment planning process remains with the clinician although the technician who is assessing the feasibility of meeting their requirements is responsible for the quality of the information and advice they provide. The technician needs to prepare environments, materials and equipment ready for reviewing client prescription, work authorization and oral instructions whether these are on initial receipt or on return to the laboratory. Each time information is received client requirements need to be evaluated, or re-evaluated, to confirm the nature of the request, the quality of information provided, the extent to which the information is sufficient to allow the technician to proceed with the design and manufacture. Depending on the custom-made dental device, which is to be made, casts (D0470) may go on to become working casts (D0470) or further casts (D0470) may need to be made. The term client is used to mean the member of the oral health care team who has prescribed the custom-made dental device. Clients may be external to the laboratory (such as other laboratories, dental practitioners, training schools) or internal (e.g. within a dental practice). The patient is the individual for whom the custom-made dental device is being made. There are four elements DT01.1 Prepare and maintain environments, materials and equipment for reviewing client prescription, work authorization and oral instructions DT01.2 Determine client requirements for custom-made dental devices DT01.3 Produce casts (D0470) as the basis for manufacturing custom-made dental devices DT01.4 Evaluate the feasibility of producing custom-made dental devices to meet client requirements. Detailed descriptions of the knowledge, skills and judgement (KSJ) needed to meet the standards set out in this unit are also included.

11 11 Who this unit is aimed at This unit is designed to be applicable to technicians in all settings where custom-made dental devices are manufactured, be they prostheses, orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220) or restorations/. Due to the level of evaluation and decision-making that is required in this unit, it is likely that the technician will be at a senior level. Principles of good practice In this unit, there is a need for effective communication with clients to achieve the best possible solution to meet the patient s needs. This may involve detailed discussions with the client regarding the feasibility of their requirements and might involve suggesting options, or alternative designs, to meet the patient s needs. Relationship to other units Unit DT02 describes the role of technicians who may be called upon by clinicians to provide technical advice on the feasibility and design of custom-made dental devices. Units DT03 - DT21 describe the next steps in the process - the design and manufacture of custom made dental devices.

12 12 Element DT01.1 Prepare and maintain environments, materials and equipment for reviewing client prescription, work authorization and oral instructions Performance criteria The technician will need to: 1 review the prescription, work authorization and oral instructions and correctly identify the materials and equipment, which will be required 2 assess correctly the risks to the technician and others involved in undertaking the design and manufacture of the custom-made dental device 3 use working methods and systems throughout the process which: - promote health and safety - reduce the risk of infection and cross contamination - are consistent with the assessed risks 4 confirm that the environment in which the work is to be undertaken is in a fit state ready for use and if it is not, take any corrective action 5 use suitable personal protective equipment and take the necessary precautions 6 select the correct type application and quantity of materials that will be required 7 confirm that the required equipment is: - clean - in working order - calibrated as appropriate 8 resolve or report to the appropriate person if your position does not encompass authority to do so, as soon as possible, if any problems arise with equipment and materials 9 move and handle equipment and materials in a safe manner, which is consistent with current regulatory and laboratory requirements 10 dispose of waste in a suitable container and in an environmentally safe manner.

13 13 Range 1 Materials and equipment for: a) disinfecting b) preparing casts (D0470). 2 Problems: a) with equipment b) with materials and supplies c) with the information supplied by the client.

14 14 Element DT01.2 Determine client requirements for custom-made dental devices Performance criteria The technician will need to: 1 record requests and specifications for custom-made dental devices - as soon as they are received in accordance with the laboratory s exposure control program - accurately and completely in the appropriate documentation - in a manner which is consistent with regulatory and laboratory requirements 3 assess case contents received to ensure records are accurate and contain information in accordance with appropriate state regulatory guidelines. 4 assess the quality of: - the impression for their ability to form accurate casts (D0470) - The occlusal registration for its ability to relate casts (D0470) properly 5 assess the technical feasibility of the client s prescription 6 determine a laboratory flow that is capable of completing the prescription 7 contact clients using agreed procedures when: - there is insufficient information to accurately identify what is required - the case contents are in question - there are concerns as to the technical feasibility of the prescription 8 discuss issues with the client in ways that promote effective working relationships, reach agreement with them on how to proceed and record the agreed changes and cost.

15 15 Range 1 Impression and occlusal registration relating to: a. diagnostic casts (D0470) B. working casts (D0470) C. materials

16 16 Element DT01.3 Produce casts (D0470) as the basis for manufacturing custom-made dental devices Performance criteria The technician will need to: 1 handle the impression in a manner which limits the risk of cross contamination and distortion 2 confirm that the impression matches the case data 3 prepare the impression appropriately to pour the cast material 4 select material for making the cast, which is capable of meeting the technical requirements of the case 5 prepare material according to the manufacturers reporting information (MRI) 8 remove the cast from the impression ensure the cast provides: - is an accurate positive image of the impression - includes the detail and area that is required to manufacture the dental device - is free from voids, defects and debris 9 trim the cast: - to meet the technical requirements of the case - to maintain required anatomical detail 10 make appropriate adjustments to the cast when this is necessary for the next stage of the process 11 correctly identify the case contents with the patient s unique reference 12 confirm the quality of the cast using documented quality control procedures

17 17 Range 1 impression of: a. diagnostic casts (D0470) b. working casts (D0470) c. materials 2 relating to casts (D0470): a. working casts (D0470) B. opposing casts (D0470) C. general diagnostic casts (D0470) d. orthodontic diagnostic casts (D0470) e. quadrant or small section casts (D0470) f. maxillofacial casts (D0470)

18 18 Element DT01.4 Evaluate the feasibility of producing custom-made dental devices to meet client requirements Performance criteria The technician will need to: 1 visually examine the casts (D0470) for their quality in meeting prescription requirements 2 select and prepare an articulation system that is appropriate for: - the prescription - the required method of articulation - the occlusal registration 3 remove any material from the casts (D0470) which is likely to prevent their accurate positioning 4 position the casts (D0470) on the articulator, fix them securely, articulate the casts (D0470) consistent with the occlusal registration information supplied by the client according to MRI 5 assess the articulated casts (D0470) and make an initial evaluation of: - the quality of the occlusal registration information - the technical feasibility of meeting the prescription requirements 6 confirm that the casts (D0470) and articulator are free of inaccuracies and debris 7 evaluate casts (D0470) and identify those custom-made dental devices that the laboratory has the capability to produce given: - the acceptability of the cast for manufacturing purposes - the cost and time of producing an effective device - the resources available - possible outsourcing of cases - laboratory commitments and direction and take them forward into the planning, design and manufacturing phase 8 contact the client without delay if it is not possible to produce the custom-made dental device explaining the reasons for the decision and proposing other options.

19 19 Range 1 Articulator: a) basic hinge b)fixed guide c) semiadjustable d) fully adjustable 2 Occlusal registrations: a)centric occlusion (co) b) centric relation (cr)

20 20 Description of (KSJ) needed to perform the standards contained in this unit A Prescriptions, work authorizations, and specifications for custom made dental devices 1 the range of information that is needed from clients and why each item is required 2 the nature and purpose of impressions and the correct methods of handling them 3 how to assess the acceptability of impressions and occlusal registration data and common problems which are found with them 4 how to assess casts (D0470) and occlusal registration data by visual methods, and with or without an articulator 5 the importance of correct identification of received impressions and the implications of not doing this 6 laboratory systems for recording patient impression details 7 how to interpret the requests for various designs and hybrids/modifications to standards designs 8 sources of information related to various aspects of the design process. B Making casts (D0470) 1 how to prepare equipment and materials for the manufacture of casts (D0470) 2 types of cast materials and how they are used according to MRI 3 methods of manufacturing casts (D0470) for different purposes and from different materials 4 how to select the most effective materials for the identified work requirement in line with operating procedures and laboratory policy 5 methods of trimming casts (D0470) and how these might need to vary to meet special requirements 6 the importance of checking the surface accuracy of the prepared cast prior to further work 7 factors affecting the accuracy of casts (D0470) and the actions to be taken if cast inaccuracies are identified, how to skillfully modify the cast if minor inaccuracies are identified 8 how to record essential information on the cast to enable ongoing design, manufacture, modification and location 9 methods of marking casts (D0470) with patient identity 10 the physical and chemical processes used in the manufacture of cast materials and the ideal properties of the materials used 11 methods for achieving suitable material consistency and eliminating defects 12 setting reactions, working times and dimensional changes 13 how to judge setting times for different mixes according to MRI 14 reasons why casts (D0470) may need to be retained and the importance of their correct storage.

21 21 C Articulating casts (D0470) 1 the different kinds of articulators, the purpose of face bows and jigs, what each are used for and how to select the most appropriate ones to use for the case concerned 2 how to adjust and use the different kinds of articulator 3 how to mount casts (D0470) on articulators with and without occlusal registrations 4 methods and mediums of articulating casts (D0470) D Materials 1 manufacturing processes of materials 2 physical and chemical properties of cast materials and their nature 3 the nature and importance of manufacturers instructions and working procedures for cast materials 4 the nature and type of occlusal registration materials and factors affecting accuracy 5 the nature and type of disinfection materials and solutions and the effect of these on impressions, casts (D0470), occlusal registrations, bacteria, viruses and operators. E Anatomy and physiology 1 relevant anatomy and physiology of the mouth sufficient to allow for the identification of anatomical features on the cast and further analysis 2 structure of the oral tissues related to casts (D0470) and the design and manufacture of custom made dental devices 3 the nature and function of hard and soft tissues 4 distortion of oral tissues during impression taking 5 occlusal relationships, what they are, their classifications, methods of recording occlusal registration and how this is used in the design and manufacture of custom-made dental devices. F Health and safety and the infection control 1 methods of protection against cross contamination when handling received impressions and other items which may have been in the mouth, or which are intended to be placed in the mouth; why it is important to do so 2 the importance of hygiene and maintenance of a clean and safe working environment and equipment 3 personal hygiene, the use of personal protective equipment and safety 4 disposal of waste, how to assess and minimize the environmental impact of waste disposal 5 the laboratory s requirements and procedures in relation to health and safety and proper infection control G Effective communication and relationships 1 the importance of establishing effective working relationships with clients, both in terms of future orders for work and improving the quality of service to patients 2 methods of maintaining and improving communication and providing information related to the manufacture of custom-made dental devices 3 methods of communicating with the client

22 22 H Regulatory policies and procedures 1 act in compliance with appropriate regulations and guidelines as determined. 2 regulatory requirements related to third party insurance.

23 23 UNIT DT02 Provide technical advice on the feasibility and design of custom-made dental devices Information about this unit Summary This unit focuses on the contribution which oral health technicians make to the planning of programs of oral healthcare by providing specialist technical advice to clinicians (e.g. general and specialist dentists) on the feasibility and design of custom-made dental devices (prostheses, restorations or orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220)). This unit is designed to cover situations where a clinician seeks specialist advice from those skilled in designing and manufacturing dental devices. This may occur when patients present complicated design problems (e.g. due to esthetics, function or retention), where a non-standard device is required, or where there are different options for meeting the patients needs and the clinician needs advice on those which are likely to be most effective. The accountability for the overall assessment, decision-making and treatment planning processes remains with the clinician. The technician from whom specialist technical advice is sought is responsible for the quality of the information and advice they provide to the clinician. The term client is used to mean the member of the oral health care team who has prescribed the custom-made dental device. Clients may be external to the laboratory (such as other laboratories, dental practitioners, training schools) or internal. The patient is the individual for whom the custom-made dental device is being made. There are three elements DT02.1 serve as a resource to clients on the design options for custom-made dental devices within individual treatment plans DT02.2 Contribute to the design of custom-made dental devices for patients DT02.3 Monitor and coordinate the progress of custom-made dental devices through the manufacturing process. Detailed descriptions of the knowledge, skills and judgement (KSJ)needed to meet the standards set out in this unit are also included. Who this unit is aimed at This unit is designed to be relevant to any technician who provides technical advice to clients on the design of custom-made dental devices (prostheses, restorations or orthodontic appliances (D7997,D8210,D8220) (D7997,D8210,D8220)). the technician is likely to have considerable experience in the design and manufacture of custom-made dental devices.

24 24 Principles of good practice In this unit, there is a need for effective communication with clients to achieve the best possible solution to meet the patient s needs. Issues related to confidentiality and consideration of who has access to certain information may also be required. Relationship to other units Unit DT01 is about assessing the feasibility of meeting client requirements for custom-made dental devices, including reviewing clients prescriptions and instructions, identifying their requirements, producing casts (D0470) and assessing the feasibility of meeting the client's requirements. Units DT03 - DT21 focus on the design and manufacture of dental devices to meet the needs of clients and patients. This may include the design and manufacture of those devices upon which they have provided specialist technical advice, as described in this unit.

25 25 Element DT02.1 serve as a resource to clients on the design options for custom-made dental devices within individual treatment plans Performance criteria The technician will need to: 1 agree with clients on: - the technician s role in contributing to treatment planning - the way in which the assessment and planning is to be carried out 2 obtain sufficient and appropriate background information on the case prior to interacting with clients and patients 3 interact with the client and patient in a professional manner: - respect the patient s privacy and dignity - consistent with relevant regulatory and practice guidelines 4 obtain appropriate and sufficient information from the patient as to the functional and esthetic requirements of the device 5 identify in discussion with the client: - the purpose of the treatment program - how this will meet the needs of the patient - the esthetic and functional requirements of the device 6 balance the additional information gained throughout the assessment process against the overall picture of the patient s needs to advise on possible design options 7 follow reasoning processes, which are: - capable of justification given the information available at the time - are likely to result in the optimum outcome for the patient 8 seek advice and support from an appropriate source when the needs of the patient and the complexity of the case are beyond the role and capability of the technician 9 offer alternative design options to the patient and client and discuss with them their benefits and limitations 10 agree with the client how any further work should be taken forward and the timing of it 11 make complete, legible, accurate records of the process and the advice offered and structure them in a way, which allows others to use them easily.

26 26 Range 1 Advice on: a) type of device b) type of materials c) solutions to patient allergies d) feasibility of particular course of action e) preparation needed f) how design can be altered in response to the progress of the treatment.

27 27 Element DT02.2 Contribute to the design of custom-made dental devices for patients Performance criteria The technician will need to: 1 develop realistic, justifiable design options for addressing the patient s needs and make recommendations on how to proceed 2 evaluate the identified design options and discuss with the client those, which are most likely to achieve the best possible balance between: - esthetics - function - cost - msri 3 contact the client if: - further information is needed from them - it is not possible to meet all of their requirements, and propose options for the design of the device 4 evaluate the selected design and make an accurate and realistic assessment of: - the sequencing of activities - the length of time that will be needed to manufacture the device - the people who will need to be involved - other work demands 5 provide the client with an accurate and realistic assessment of the time that a trial and a finished device will be available 6 make complete, legible, accurate records consistent with regulatory and laboratory requirements of: - the device to be constructed - the materials and processes to be used - any idiosyncrasies - the agreed timelines.

28 28 Range 1 Design options: a) type of device b) any modifications to standard device design c) materials to be used d) techniques and processes to be used F) The agreed timelines.

29 29 Element DT02.3 Monitor and coordinate the progress of custom-made dental devices through the manufacturing process Performance criteria The technician will need to: 1 schedule the manufacture of the custom-made dental device consistent with: - other work demands - the patient s treatment plan - client requirements - regulatory obligations 2 develop plans for the manufacture of the custom-made dental device, which can be monitored for the quality of outcomes and processes 3 check the availability of other people to contribute to the production and agree with them how the work will be organized 4 record and explain clearly to those involved in the production process: - the planned design - the materials to be used - the processes to be used - the functional and esthetic requirements of the device - the work to be undertaken and the roles and responsibilities of those involved - the timelines within which the work is to be completed 5 monitor the progress of the device through the manufacturing process, identify correctly any problems and take any corrective action that is required 6 evaluate the finished device and confirm that it: - is free of defects - meets the requirements of the planned design - complies with the prescription - is fit for purpose 7 ensure that laboratory records relating to the identification, components, materials and manufacture of the device are accurate, up-to-date and stored in the correct location in compliance with regulatory guidelines.

30 30 Range 1 Processes: a) preparing casts (D0470) b) manufacturing components c)finishing devices.

31 31 Description of (KSJ) needed to perform the standards contained within this unit A Providing technical advice 1 the type of background information which is necessary to undertake the role properly 2 the potential difference between the patient s views of the services they need and those of people working in the team 3 the particular requirements which different clients and patients may have and how these can be managed within the planning process 4 recognize that oral health treatment programs may have different purposes for different patients 5 how the services the technician is able to offer are affected by prescription, work authorization and oral instructions and resource limitations 6 why final decisions should be recorded and disseminated to the appropriate people 7 the role of others who are providing technical advice and the particular features and benefits which each brings 8 from whom advice and guidance should be sought when the technician has concerns about the needs of patients, the complexity of the case or the role and capability of the technician 9 the range of services that are available to patients and which members of the team will provide the service 10 the principles of interdisciplinary working 11 the disagreements, which might arise between those, involved in the planning and ways of ensuring consensus of treatment 12 how to present views and suggestions constructively and effectively 13 principles of, and methods, materials and techniques used in the design and manufacture of dental devices 14 methods to identify and evaluate the feasibility and likely effectiveness of potential design options 15 rationale of removable prostheses 16 the manufacture of removable prostheses; retention and stability, esthetics and phonetics; articulation; 17 materials used in the manufacture of custom-made dental devices including casts (D0470) and mold materials, waxes, dental polymers, artificial tooth materials, dental alloys, refractory, impression, duplicating and disinfection materials: - the classification and sub-classification of materials on the basis of chemical composition and internal structure - the mechanical, physical, thermal, chemical and biological properties of materials - the effects of storage on the properties of the materials used in the manufacture of custom-made dental devices - the properties of materials during use - the properties of materials during setting - the effects of processing on the properties of the materials used in the manufacture of custom-made dental devices

32 32 - indication and contraindication and management of materials to meet client requirements, functional requirements and esthetic requirements B Work role and boundaries 1 the role and responsibilities of each member of the team to whom the technician is providing advice 2 the purpose of clarifying technicians role and that of others when working with different patients 3 the purpose of keeping records of the assessment process 4 the technician s responsibility to keep records C Health and safety and infection control 1 methods of protection against cross contamination and cross-infection when handling impressions and other items which may have been in the mouth, or which are intended to be placed in the mouth; why it is important to do so 2 the importance of hygiene and maintenance of a clean working environment and equipment 3 personal hygiene and the use of personal protective equipment 4 disposal of waste, how to assess and minimize the environmental impact of waste disposal 5 the requirements and procedures of the technician s employing laboratory in relation to health and safety and the control of infection. D Anatomy and physiology 1 relevant anatomy and physiology of the head, neck and mouth sufficient to allow for the identification of anatomical features 2 structure of the oral tissues related to the design and manufacture of dental devices 3 the nature and function of hard and soft tissues 4 the structure, function, and movement of the oral-facial musculature (including the tongue) and temporomandibular joint 5 disorders and conditions affecting the oral cavity 6 tooth morphology and the form of the natural anterior and posterior teeth 7 distortion of oral tissues during impression taking 8 occlusal relationships, what they are, the etiology and classifications of Malocclusions (D8000-D8999), methods of recording occlusal registration and how they are used in the design and manufacture of custom-made dental devices. e Effective communication and relationships 1 the importance of establishing effective working relationships with clients, both in terms of future orders for work and improving the quality of service to patients 2 methods of maintaining and improving communication and providing information related to the manufacture of custom-made dental devices 3 methods of communicating with the client

33 33 f Regulatory policies and procedures 1 act in compliance with appropriate regulations and guidelines as determined. 2 regulatory requirements relating to third party insurance.

34 34 Standards for Fixed/Restorative Dental Technology

35 35 UNIT DT03 Produce custom-made trays, casts (D0470), baseplates and occlusal registration rims for the design and manufacture of removable prostheses Information about this unit Summary This unit focuses on preparing for the design and manufacture of removable prostheses. The technician needs to prepare and maintain environments, materials and equipment for the design and manufacture of the prosthesis; produce working casts (D0470) and custom made trays, baseplates and occlusal registration rims. This unit complements units DT04 to DT08 in which the technician designs and makes removable prostheses. The term client is used to mean the member of the oral health care team who has prescribed the custom-made prosthesis. Clients may be external to the laboratory (such as other laboratories, dental practitioners, training schools) or internal. The patient is the individual for whom the custom-made prosthesis is being made. There are three elements DT03.1 Prepare and maintain environments, materials and equipment for the design and manufacture of removable prostheses DT03.2 Produce custom-made trays to make impressions for removable prostheses DT03.3 Produce and prepare casts (D0470), baseplates and occlusal registration rims for removable prostheses. Detailed descriptions of the knowledge, skills and judgement (KSJ)needed to meet the standards set out in this unit are also included. Who this unit is aimed at This unit it applicable to anyone who is responsible for the design and manufacture of removable prostheses. Principles of good practice In preparing for the design and manufacture of a removable prosthesis, the technician has an important role to play in maintaining the health and safety of themselves, other technicians and the patient. This includes ensuring the control of cross contamination and cross-infection; that equipment and materials are safe and fit for purpose and that they prepare trays, casts (D0470), baseplates and occlusal registration rims which are accurate so that a prosthesis can be made which meets the client s fit, function and esthetic requirements.

36 36 Relationship to other units Unit DT01 is about identifying, and assessing the feasibility of, the client s requirements. Unit DT02 describes the role of technicians who may be called upon by clinicians to provide technical advice on the feasibility and design of custom-made dental devices. Units DT04 - DT08 are about the design and manufacture of removable prostheses and alloy components for them. DT09 is about re-lining, re-basing, repairing and modifying removable prostheses.

37 37 Element DT03.1 Prepare and maintain environments, materials and equipment for the design and manufacture of removable prostheses Performance criteria The technician will need to: 1 review the prescription, work authorization and oral instructions and correctly identify the materials and equipment, which will be required 2 assess correctly the risks to the technician and others involved in undertaking the design and manufacture of the custom-made dental device 3 use working methods and systems throughout the process which: - promote health and safety - reduce the risk of infection and cross contamination - are consistent with the assessed risks 4 confirm that the environment in which the work is to be undertaken is in a fit state ready for use and if it is not, take any corrective action 5 use suitable personal protective equipment and take the necessary precautions 6 select the correct type application and quantity of materials that will be required 7 confirm that the required equipment is: - clean - in working order - calibrated as appropriate 8 resolve or report to the appropriate person if your position does not encompass authority to do so, as soon as possible, if any problems arise with equipment and materials 9 move and handle equipment and materials in a safe manner, which is consistent with current regulatory and laboratory requirements 10 dispose of waste in a suitable container and in an environmentally safe manner.

38 38 Range 1 Removable prostheses: a. Complete b. partial c. cast partial frameworks d. wrought wire components 2 Materials and equipment for: a) producing custom-made trays b) producing and preparing casts (D0470), baseplates and occlusal registration rims c) relining, rebasing, repairing and modifying removable prostheses. 3 Problems with : a) equipment b) materials.

39 39 Element DT03.2 Produce custom-made trays to make impressions for removable prostheses Performance criteria The technician will need to: 1 evaluate the casts (D0470) and the prescription to determine what needs to be incorporated into the design of custom-made trays for: - the patient's dentition - the intended impression material and technique 2 apply appropriate spacer materials to the cast to: - eliminate undercuts - provide the correct amount of space for the impression material selected by the client 3 apply a separating medium to the cast that is appropriate to the cast material and the processing method to be used 4 select materials that are appropriate to the nature and construction requirements of the custom-made tray and prepare them in the correct manner and quantity 5 form the tray over the cast in accordance with the prescription 6 process materials according to MRI 7 separate the tray from the cast in a manner that prevents damage or distortion 8 smooth all surfaces as prescribed 9 confirm that the finished tray: - is clean - is free of defects - conforms to the prescription 10 effectively clean and disinfect the custom-made tray, correctly identify it with the patient s unique reference and date of production and return it to the client at the correct time 11 make complete, accurate and up-to-date records relating to the identification, components and manufacture of the custom-made tray and store the records in the correct location consistent with relevant regulations.

40 40 Range 1 Removable prostheses: a. Complete b. partial c. cast partial frameworks d. wrought wire components 2 Materials: a) heat cure polymeric b) self cure polymeric c) light cure polymeric d) thermo-formed materials.

41 41 Element DT03.3 Produce and prepare casts (D0470), baseplates and occlusal registration rims for removable prostheses Performance criteria The technician will need to: 1 handle the impression in a manner which limits the risk of cross contamination and distortion 2 confirm that the impression matches the case data 3 prepare the impression appropriately to pour the cast material 4 select material for making the cast, which is capable of meeting the technical requirements of the case 5 prepare material according to the manufacturers reporting information (MRI) 6 remove the cast from the impression ensure the cast provides: - is an accurate positive image of the impression - includes the detail and area that is required to manufacture the dental device - is free from voids, defects and debris 7 trim the cast: - to meet the technical requirements of the case - to maintain required anatomical detail 8 make appropriate adjustments to the cast when this is necessary for the next stage of the process 9 survey the cast to identify the position and size of undercuts and block out as needed 10 apply prescribed materials to the relevant cast according to MRI 11 separate the baseplate from the cast in a manner that prevents damage or distortion 12 smooth all surfaces as prescribed 13 form a wax occlusal rim, place it in the correct position of the baseplate and apply additional wax to attach the rim firmly to the baseplate

42 42 14 Smooth and shine the wax occlusal rim and make sure that the peripheral edges conform to the patients anatomy and are smooth and free of debris 15 confirm that the finished baseplate: - is clean - is free of defects - conforms to the prescription 16 effectively clean and disinfect the occlusal registration rim, correctly identify it with the patients unique reference and the date of production, prepare and package it safely for delivery to the client 17 correctly identify the cast with the patient s unique reference 18 store the casts (D0470) in an appropriate safe manner and place when they are not in use

43 43 Range 1 Casts (D0470): a) master casts (D0470) b) opposing casts (D0470) c) duplicate casts (D0470). 2 Produce and prepare casts (D0470) for: a) complete removable prosthesis b)partial removable prosthesis c) cast and wrought alloy components and cast frameworks for removable prostheses. 3 Produce and prepare baseplates and occlusal registration rims for: a) complete removable prosthesis b)partial removable prosthesis