Shugars D A, Hayden W J, Crall J J, Scurria M S
Department of Operative Dentistry, School of Dentistry, University of North Carolina, Chapel Hill 27599-7450, USA.
J Dent Educ. 1997 Jan;61(1):22-8.
The use of crowns and their alternatives for the restoration of compromised posterior teeth is of interest to educators, purchasers, and patients. Considerable curricular time is devoted to learning these techniques, substantial amounts of money are spent on these procedures, and differences in the outcomes of these treatments may have consequences for tooth survival. To begin to understand more about the actual use of these procedures, the provision rates of these services in a sample of U.S. dental practices were examined. This study reports on the extent to which utilization patterns and subsequent costs of crowns and their alternatives were associated with certain patient and practice characteristics. Insurance claims for dental services submitted by general dental practices through an electronic claims clearinghouse were used. Crown ratios (crowns/crowns plus alternatives) were calculated for dental practices to evaluate relationships with available explanatory variables. Findings indicated that older patients were significantly more likely to receive crowns than those in younger groups, resulting in as much as a 33 percent increase in the mean per tooth cost of treatment in the oldest group. Regional variation existed in the provision of crowns and resulted in up to a 31 percent difference in the mean per tooth treatment cost between regions. Crown ratios exhibited variation beyond that accounted for by patient and practice factors, thus raising questions about the consistency of treatment recommendations among dentists. These findings support the need to examine further the consistency of crown use among general dentists and to modify current approaches for teaching treatment planning in predoctoral restorative curricula.
牙冠及其替代物用于修复后牙缺损，这一领域受到教育工作者、医疗采购者以及患者的关注。课程中会花费大量时间教授这些技术，这些治疗过程耗费大量资金，而且这些治疗结果的差异可能会影响牙齿的留存。为了更深入了解这些治疗手段的实际应用情况，研究人员调查了美国部分牙科诊所中这些服务的提供率。本研究报告了牙冠及其替代物的使用模式和后续成本在多大程度上与特定的患者和诊所特征相关。研究使用了普通牙科诊所通过电子理赔清算所提交的牙科服务保险理赔数据。计算各牙科诊所的牙冠比率（牙冠数/牙冠数加上替代物数），以评估与可用解释变量之间的关系。研究结果表明，老年患者比年轻患者更有可能接受牙冠修复，这使得最年长组的每颗牙齿平均治疗成本增加了33%。牙冠修复的提供情况存在地区差异，不同地区每颗牙齿的平均治疗成本相差高达31%。牙冠比率的变化超出了患者和诊所因素所能解释的范围，这引发了人们对牙医治疗建议一致性的质疑。这些研究结果支持进一步研究普通牙医使用牙冠的一致性，并修改博士前修复课程中当前的治疗计划教学方法。
