Section IV - Extra Coronal Restorations

• Materials used for indirect restorations should be recorded in the patient record.

4-(a) Stainless Steel Crown and Provisional Crown/Bridge (per unit)

• Stainless steel crowns and provisional crowns are all part of the same item as the process of preparing and cementing a stainless-steel crown is similar to that of a provisional crown.
• Stainless steel crowns can be claimed for use on:
  • deciduous molar teeth
  • permanent 1st molars as part of orthodontic treatment
  • permanent 1st molar teeth with hypomineralisation as provisional restoration
  • provisional measure on molars for patients undergoing palliative care.
• A laboratory made crown or bridge may be used, at the practitioner’s discretion, only as a necessary palliative.
• It should be noted that a temporary crown or bridge cannot be claimed under item 4-(a) as part of the normal process of constructing an indirect restoration.
• A claim for the replacement of a failed temporary bridge or crown cannot be made where the original temporary crown was provided by the same dentist (see same dentist interpretation in Section XII – Interpretation) within the last 11 complete calendar months, unless repair or replacement is required as a result of trauma.
• Any appropriate material is allowable for provisional crowns and bridges.
• Prior approval submissions regarding bridgework should contain information regarding the design of the proposed bridgework including the relative abutment and pontic units.

4-(b) Crown Placement

• Tooth coloured crowns may not be placed on teeth distal to the second premolar.
• The only exception to this is if it is a first permanent molar tooth that occupies the position of the second permanent premolar tooth in that quadrant.
• Normally only provided for patients who are 17 years or over.
• More clinical freedom in choosing crown materials:
  • Cast metal
  • Porcelain bonded to metal
  • Ceramic/porcelain
• Crowns can be constructed using appropriate laboratory services or in-house design and construction services registered with the Medicines & Healthcare products Regulatory Agency (MHRA).

4-(c) Post and/or Core Retention for Crowns or Bridges

• Item 4-(c) covers all post and/or core retention for crowns and bridges.

4-(d) Inlay/Onlay Placement

• Tooth coloured inlays/onlays may not be placed on teeth distal to the second premolar
• The only exception to this is if a first permanent molar tooth that occupies the position of the second permanent premolar tooth in that quadrant.
• Normally only provided for patients who are 17 years or over
• Can use any suitable material deemed clinically necessary
• For cases requiring prior approval, the material used should be detailed in observations.
• Inlays/onlays can be constructed using appropriate laboratory services or in-house design and construction services Registered with the Medicines & Healthcare products Regulatory Agency (MHRA).

4-(e) Replacement Veneer

• Veneers can only be claimed as replacements to existing veneers that have failed and only on upper canines and incisors. A veneer may not be placed as a new restoration. The appropriateness of providing a replacement for a failed restoration is subject to the dentist’s clinical judgment.

4-(f) Conventional Bridge (per unit); 4-(g) Resin-Retained Bridge (per unit)

• There is no change to the principles around provision of bridges under NHS arrangements.
• Subject to the conditions:
  • Normally for patients 17 years or over
  • At least 6 months after extraction of any tooth to be replaced by the bridge
  • Satisfactory periapical condition of the abutment teeth
  • Satisfactory periodontal status
  • Satisfactory general standard of oral hygiene
  • Satisfactory occlusion
• Bridges to replace molar teeth should only be provided where they are required for the stability of the occlusion.
• If the total value of the treatment plan exceeds £600, prior approval will be required. Appropriate radiographs and study models should be available
• Bridges can be constructed using appropriate laboratory services or in-house design and construction services registered with the Medicines & Healthcare products Regulatory Agency (MHRA).
• There is no longer a distinction between retainers and pontics, however, prior approval submissions that include bridgework should contain information regarding the design of the proposed bridgework including the relative abutment and pontic units.
• It is important that you ensure that the dental charting submitted to Practitioner Services is accurate to ensure efficient processing of claims and Prior Approval requests.
• Post and core, under item 4-(c), is claimable alongside claims for bridge retainers, where appropriate. This is the same fee for crowns.

Recementing a Conventional Bridge

• Claimed under item 1-(c)
• Cannot be claimed by the same dentist* (see same dentist interpretation in Section XII – Interpretation) who claimed the original bridge within the previous 11 complete calendar months.

4-(h) Recementing of a Resin-Retained Bridge

• Cannot be claimed by the same dentist* (see same dentist interpretation in Section XII – Interpretation)* who claimed the original resin retained bridge within the previous 11 complete calendar months.