A middle-aged female patient had badly imbricated lower incisor teeth.
She responded to an advertisement placed by a dentist who declared a special interest in cosmetic dentistry.
After an initial consultation, various options were outlined in her treatment plan, ranging from orthodontic treatment and crowns, to the most conservative option of reshaping the tooth using enamel reduction and the selective addition of bonded composite.
The patient was unsure about using fixed orthodontic treatment, even though it could achieve more than selective reshaping, so she opted to have the four lower incisor teeth crowned.
After having the crowns fitted, the patient was still unhappy with the appearance of her lower incisors. Although the buccal aspects of the teeth were now aligned, any view from above the incisal edges (the patient was short in stature so this became an important consideration) would reveal a strikingly excessive lingual to buccal width of the two teeth that had previously been instanding.
As a result, the patient refused to pay for the crowns and threatened to escalate a formal complaint.
The dentist contacted Dental Protection for advice. On investigating the background to the case, it transpired that the patient had been shown several ‘before’ and ‘after’ pictures of cases where crowded and badly angulated teeth had been corrected into normal alignment. In none of these cases had there been any instance where a tooth ended up with excessive buccal to palatal width, and nor had there been any discussion of this possibility in the pre-treatment consultation between dentist and patient.
An expert opinion was sought, which stated that given the original position of the teeth it was never likely to be possible to create well- aligned teeth of normal dimensions without devitalising the teeth and placing posts and cores. This fact had not been considered or discussed with the patient and as a result the dentist was open to criticism given that treatment had been provided without informed consent. Dental Protection assisted the dentist to achieve an amicable resolution.
Learning points
- Whatever the treatment plan, all options need to be given to the patient in order for them to provide valid consent to the treatment that is finally selected. If the information provided by the clinician to the patient is incomplete or not accurate, the consent process is very likely to be challenged if the patient is dissatisfied with the outcome.