Should my dentist be (partly) responsible for my dental implant cost

[cybervic]

My lower molar on the right needs a implant. It had a RCT 15 years ago and a new crown (gold base/porcelain surface) was replaced 2 years ago.

What happened was that the opposite molar at the top had a lava crown fitted July 2008, and because the lava crown was somehow not the right size in the first place, it had kept hitting/grinding the lower molar very hard and then caused a fracture on the wall of the root canal of the lower molar. (this was recently found out in a microscope RCT after taking antibiotics 3 times in 6 months.)

I have Danplan but implant isn't included so I now have to pay £2400 for the implant (if I go for my dentist's referral)

I am feeling quite angry because if my dentist had got the crown right, non of this would have happened. The lava crown on the upper molar was also a re-made because the first time round, it wouldn't fit onto my tooth and it just broke when my dentist asked me to bite on it.


So the questions are:

1. Should my dentist be partly or fully responsible for the implant cost of my lower molar?

2. If so, how do I go about telling him? I fear that telling him what I thought may cause a tension and he won't treat me well in future. Also, if he's got nothing to do with it, then is there any insurance plan that covers implants or at least contribute to like half or more of the total implant cost!?

3. I have been calling around in my local area (Brighton & Hove) and the quotes I got ranges from £1000 to £2200. unfortunately I don't know anyone who's got an implant so no way of telling who's decent. Should I be worried about cheaper price = lower quality?
What should I be looking for when looking for a good implant dentist?

I would appreciate any opinions/suggestions.

Thanks.

[Toothsmith]

I would go with the person your dentist recommends.

As to it being the 'fault' of the top crown - that would be very difficult to prove.

15 years is a good life-span for a root filled molar, and it could have gone at any time. It's even possible that a bit of early inflammation from the fractured but symptomless root filled molar could have raised the lower tooth slightly (and it would only have to be 100ths of mm for you to feel it) which was why the new crown felt high.

It is always bad for a dentist/patient relationship if bad things happen to coincide, but in this case, whilst not impossible, I feel the crown won't be the thing to blame.

You could push it, but how well have you got on with this dentist previously, and is it worth looking for another one if you do persue this and he contests it?

You might just casually ask one visit if he thinks the crown being high might have caused the fracture, and see where that leads.

[cybervic]

Hi toothsmith, Thanks for your reply, although I'm still not convinced that the fracture was bad luck because it just seems to much of a coincidence.

I went to dentist regularly and the lower molar showed no signs of problem in any way before the upper molar crown was fitted. I complained about the upper molar crown being too high the day it was fitted, and to my surprise, my dentist grind off the porcelain crown on lower molar. Although I could feel the biting wasn't right, the infection didn't happen until 2 month later when I was eating my dinner and suddenly a very loud and uncomfortable grinding took place. It was a Friday night and the infection came very quickly that I had to have an emergency treatment in NHS on Sunday morning.

Of course I then went to see my dentist as soon as he's available and he agreed that the lava crown was still too high (so he again took off more height on the lower porcelain crown), and he also mentioned that RCT may be failing and we just have to wait and see. This was October last year.

Ever since then, the infection never went away. although I could always feel a dull pain when I bite hard with my tooth, I was still reluctant to re-do another RCT because the procelain crown was only made 2 years ago. This was why I had had antibiotics 2 more times in the following 4 month, secretly hoping that it will go away.


so in February 09, I finally accepted that antibiotics is of no use. When a root canal was being cleaned by a microscope specialist, a fine line of vertical fracture on the wall of root canal was seen and then there's tiny amount of blood when she tried to expand the canal with her equipment.

To be honest, I am not sure what to think. From a patient's point of view, I think my dentist sould've been more careful when I told him the crown was too high. Then there's also a trust issue coz if I am convinced he should be responsible to a degree, then I am not sure if I can trust him do look after my tooth when I need more work done in future. What do you think toothsmith? maybe it's difficult to pinpoint where the fault is exactly but surely a fracture wouldn't happen on its own?

[Toothsmith]

They don't happen on their own, but 15 years of chewing is a lot of force to go through a tooth that would have been badly broken down in the first place.

I really don't know what to suggest here.

It could easily be having a crown too high, but then again, it might not.

Both sides could argue their point for ages and ages, and that could easily cost more money and stress for both parties than the cost of the implant.

It might be that the dentist will realise this and not fight, it might be that you accept things and don't push it. In an ideal world, you may well go 50/50 on it.

But it could easily blow up into a long and expensive fight.

I don't know.

[cybervic]

Thanks toothsmith for inputting some thoughts. I'll give it a long and hard though about if I want to take it further. cheers! :)

[donteatthat]

I would think that if the Lava crown was too high in the bite the failure would occur by the porcelain fracturing off the Lava crown and not likely to cause a fracture under a bonded crown. Root filled teeth get notoriously brittle, and can crack just due to normal wear and tear even though protected by a crown.