Second Opinion on Some New Crowns … WWLD a Townie Asks for Advice from His Peers About a New Patient Who Received Some Questionable Treatment from Another Dentist

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Second Opinion on Some New Crowns … WWLD A Townie asks for advice from his peers about a new patient who received some questionable treatment from another dentist. They ponder what Dr. Lane Ochi would do in the same circumstance

satchdds Member Since: 04/19/02 Introduction: Post: 1 of 40 Thirty-something with four new crowns done four months ago. Referred by another patient (her aunt). Chief complaint was that her gums bled and her mouth smelled “funky.” Reported that one month after insert #7 fractured and was reattached after root canal. Original chief complaint was that tooth #9 was off-color. #9 crown was done when she was a teenager after trauma. Treating dentist saw no issue. I think he said floss more.

48 APRIL 2018 // dentaltown.com Conclusion: There are a bunch of other issues, mainly failed ortho with crossbite. No anterior guidance or canine in occlusion. And she has posterior bracing when incisal edges touch. I sent her for ortho consult. She can’t afford at this time. n 2/15/2018

I think “L” would deprogram, and take records and socrdoc Member Since: 12/06/06 photos. n Post: 3 of 40

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Are those horizontal fracture lines across 7, 8, 9, Tom Mitchell Member Since: 02/16/04 10, or open margins? Do you know if there is any prep Post: 4 of 40 height at all? n 2/15/2018

#7 was the fractured tooth. Only post and compos- satchdds ite to hold it now. The others are just open margins. She Member Since: 04/19/02 Post: 5 of 40 was told her gums were bleeding during the impressions so that’s as good as he can do? Mind you 7, 8 and 10 were virgin teeth. n

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I love it! I’m not sure I’ve ever placed a Tom Mitchell Member Since: 02/16/04 crown on a virgin tooth! Maybe a veneer. I don’t Post: 6 of 40 know what Lane would do—something crazy is his usual modus operandi. I would first take all that crap off and place well-fitting temps. We’re now making long-lasting ones in acrylic with CAD/CAM. They fit great. After that I’d retire and let someone else deal with this. n 2/15/2018

Wow, what a mess. Strip the old stuff off, pro- mike k visionals for sure. I’d be scared to death of having Member Since: 05/01/01 Post: 9 of 40 nothing but fractured-off teeth staring at me, though. Might want to have a flipper ready too. n 2/15/2018

Perhaps some extrusion and some crown UTprosthodont Member Since: 02/18/06 lengthening to save what’s left. Sad situation and Post: 13 of 40 I bet the treating doc advertises as a cosmetic spe- cialist. Also looking at the patient’s lower teeth, and it looks like patient was not the best in compliance with a history of decalcification— probably from a long period of ortho. n 2/15/2018

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satchdds Member Since: 04/19/02 Did I mention she has no funds? She works in a local motel. I will be doing CL surgery Post: 14 of 40 for her. I was able to find the old margins to make temps and do build-ups with electrosurge. The crowns were cemented with gingival tissue pinched between the crown and margins in some areas. n 2/15/2018

mike k Member Since: 05/01/01 Just saw the reprep photos, fantastic job! Patient is very lucky to have landed in your chair. n Post: 16 of 40 2/15/2018 satchdds Member Since: 04/19/02 I just added the deconstruction photos minus my tears. She brought us preop photos. #9 was Posts: 17 and 25 of 40 slightly lighter and old-style PFM. That proves how important posts are in the world of adhesive dentistry. Still want to hear from The Geek, and the Mikes, and others. I’m planning on putting her incisal length back to preop. I only have photos to go by. I also will consider splints. Probably 7–8. 9–10. Surgery next. I showed this case to our local Spear club last night after the regular presentation. It was quite depressing. n 2/16/2018

palmers31 Member Since: 07/30/08 This makes me sad on so many levels. Not only for this lady, but what about all the ones out Post: 26 of 40 there that don’t end up in your chair to have work like this corrected? #7, even with CL, has a poor/guarded prognosis. She’ll probably come in with it in her hand after a few years. What a nightmare. At least she’s in good hands now. Good work, Satch! n 2/16/2018

SFain Member Since: 05/16/05 Low smile or high smile? Very depressing. How are we supposed to always “defend the Post: 27 of 40 profession” and not “throw the other dentist under the bus”? With those X-rays, isn’t this a malpractice case? It’s not like they missed the margin on one tooth. Maybe the patient will decide to get a lawyer involved. Maybe the treating dentist will offer a refund to settle out of court. n 2/16/2018

velogeek Member Since: 04/15/10 This type of outcome is not defendable, and in the true definition of malpractice is negli- Post: 28 of 40 gence. Not all of us take X-rays at seating, but when the endo was done, discovery of the margins should have been evident. So, if this is the reason for WWLD, I would inquire about this dentist’s standard of care in his community. If this is an example of the work that leaves his office, he needs serious remedi- ation. Start by sending him the X-ray and a short clinical presentation note and just ask what he would like you to do? His response or lack of will give you valuable insight. n 2/16/2018

satchdds Member Since: 04/19/02 I originally advised her to speak to him. Maybe it was just a flub. We all (except you, of Post: 31 of 40 course) have been there. He offered to replace everything. She declined and got a partial refund, I think. I didn’t ask specifically because it’s not my business; she paid me up front and I told her that things may change as we see how it goes. I’m not really interested in making a boat payment. (I don’t even have one, besides a few kayaks.) Anything I do from here on in is out of kindness. Things happen measure for measure. n 2/16/2018

Brett Mansfield Member Since: 08/19/05 Another reason that she was lucky to find you. Finding a great dentist isn’t as easy as it Post: 32 of 40 should be. Finding one who is compassionate is even more unlikely. I both love and hate treating

50 APRIL 2018 // dentaltown.com cases like this. It’s hard frickin’ work and oftentimes, at least for me, I don’t end up charging my usual fee because I feel bad for the patients and truly want to help them. However, if you’ve got someone who is trusting and can sit in the chair and let you do what you need to do, it makes things a whole lot easier than it could be. n 2/16/2018

Sabeexius Look, I’m not defending bad dentistry here. But I would find it very hard to believe that Member Since: 08/26/17 someone would cut up natural teeth just to make a crown for an extra buck or two. I really Post: 35 of 40 believe that there had to be some pathology there to warrant some kind of post/core/crown work. Just a guess … and some hope for humanity? To the OP, for the sake of understanding your fellow dentist’s motives, did you pull records from previous doc? All too often I find patients will come see me and trash another dentist just for the sake of it. They didn’t like the work, something really small went wrong and everything spun out of control from there. Granted, these crowns are pretty horrid. n 2/16/2018

velogeek At least he accepted responsibility for the outcome. And good on you from this point out. n Member Since: 04/15/10 2/16/2018 Post: 36 of 40 jhobgoDDS OK, OK, I get it—we don’t want to stir the pot, don’t want to throw a colleague under the Member Since: 06/15/15 bus. We’ve all had poor outcomes, but this clearly shows repeated nonsense on a whole different Post: 40 of 40 level. I mean, one bad crown with an open margin, yeah, I’m gonna give the guy the benefit of the doubt. Maybe even two. But all of these make my tummy hurt. I feel bad for the patient and hopefully you will hit this one out of the park for her, which is what she deserves! n 2/18/2018

See even more of this case online Search: “Second Opinion Crowns” Curious to see how this patient is doing? To see updated photos, read the entire conversation and offer your opinion, go to dentaltown.com and search the message boards for “second opinion crowns”—this conversation will be the top result.

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