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The black, the white and the grey

07 November 2016
What happens when experts disagree? Clinical opinion can and will differ from dentist to dentist, and as this case shows, sometimes the best option is to bring the experts together...

In a case involving a failed restoration and associated endodontic treatment, it was agreed that the claim for the loss of a tooth should be settled on behalf of the clinician. As often happens, the lawyers acting on behalf of the patient were claiming the cost of bone grafting and an implant as the treatment of choice to replace the tooth.

A settlement on this basis was resisted in view of the patient’s history of poor oral hygiene and smoking. The patient’s lawyers produced an expert report recommending implant treatment for their client. The dentist’s indemnifier instructed a further expert to examine the patient and provide another opinion on the suitability of implant treatment.

This last expert was of the opinion that a denture was the treatment of choice (the patient had other maxillary teeth missing and only six lower anterior teeth remaining). As a result, the lawyer’s demand for payment of the full amount was resisted.

Eventually, a meeting was arranged between the two experts to try to resolve their differences. It was finally agreed that the patient was not an ideal candidate for an implant and settlement was agreed on the basis of a replacement denture at a significantly lower figure than the initial claim.

Learning point:
The most expensive treatment is not always in the best interests of a patient even when they are not paying.
  • By Sean Harris on 01 March 2017 01:57

    Why had the restoration 'failed', was it not an expected clinical outcome, carious teeth can become irreversibly pulpitic, pulpitic teeth can need endodontic treatment, endodontic treatment can be unsuccessful.

    It would be useful to explain why the treating dentist was negligent and why the claim was not rejected.

    The point has been missed by focusing on the need for an implant, this case is fundamentally about why patients need fillings.

    When did we start guaranteeing 100% success? Why was it not for the patient to pay for the necessary endodontic treatment, subsequent extraction and replacement of the missing tooth.  I suppose the patient got the other missing teeth added to the denture for free also!

  • By Jane bracken on 02 November 2016 01:37

    What is the long term prognosis considering the patients history and compliance surely this needs to be taking into account 

    the protocols for implant placement clearly show smoking as a non starter 

  • By A Shakerin on 01 November 2016 06:58 Inserting/ replacing missing teeth with Implants are contraindicated
  • By A Shakerin on 01 November 2016 06:56 I agree with the first dentist , due to poor oral hygiene the replacement of a missing tooth with (implant) was contraindicated.
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