Chapter 3 – Health Care Operations

3.3.2.10 Fixed Prosthetics (Crown and Bridge)

• Policy

  • Fixed prosthetic services, (i.e., lab processed crowns and bridges), shall be considered an excluded service and shall not be routinely provided to patients by dentists employed by the California Department of Corrections and Rehabilitation (CDCR).

• Purpose

  • To define fixed prosthetics as an excluded service and to establish guidelines for the provision of such treatment procedures when no other treatment modalities can provide the desired outcome.

• Procedure

  • Fixed prosthetics shall not be routinely provided to patients.  CDCR dentists who wish to provide fixed prosthetics for a patient must receive prior authorization from the Dental Authorization Review (DAR) Committee.  (Reference the Health Care Department Operations Manual, Section 3.3.4.5(c)(3) and (4)).

  • Fixed prosthetics:

    • Shall not be utilized to restore missing or defective teeth if an adequate restoration can be placed, (e.g., a stainless steel crown or an amalgam with cuspal coverage), or if a removable partial denture can be fabricated to replace the missing teeth.

    • May be provided if all of the following criteria are met:

      • All the teeth involved in fixed prosthetic therapy have adequate periodontal support, with no mobility other than normally occurring physiologic movement.

      • All the teeth involved have a good prognosis of restorability and long term retention.

      • All Dental Priority Classification (DPC) 1, 2 and 3 dental care has been completed prior to commencing fixed prosthetic treatment.

      • The patient has demonstrated a Plaque Index score of 20% or less for two consecutive months after the completion of all DPC 3 dental care.  At the end of this two-month period a request for fixed prosthetics may be submitted to the DAR Committee.

      • The patient has a minimum of six months of verifiable, continuous incarceration time remaining on their sentence, after approval by the DAR Committee.

    • The above criteria shall apply for all instances in which fixed prosthetics are requested including DPC 5 Special Dental Needs Care.

  • Laboratory processed crowns shall be utilized only for teeth that a CDCR dentist determines are critical for maintaining the integrity of the patient’s arch and only when a stainless steel crown or bonded amalgam/composite restoration has failed or is contraindicated.

  • Non-precious metals shall be utilized for fixed prosthetics unless the patient has a documented allergy to those commonly used for crown and bridgework.

  • Bonded bridges, (i.e., Maryland Bridges), shall not be utilized.

  • Patients undergoing fixed prosthetics that are in progress but not completed at the time of their incarceration, shall have their dental needs met with CDCR authorized restorative materials and procedures only, (e.g., removable prosthetics, stainless steel crowns).

• References

  • Health Care Department Operations Manual, Chapter 3, Article 3, Section 3.3.4.5, Dental Authorization Review Committee

• Revision History

  • Effective: 04/2006
    Revised: 11/2017, 11/2020, 02/2022