Expert: Zev Kaufman, D.D.S. - 2/19/2009

Question
Brief History: On November 11th of 2007, I was scheduled for a dental
implant (tooth #12).  The same dentist removed the original tooth a month or
so before.  X-rays had been taken, molds made.  Days prior, I
found out I was pregnant and decided to postpone the surgery until after my
baby was born.

On February 10th, 2009 I went in for a prep appointment to get the process
moving again.  They took new molds, examined my mouth and scheduled the
implant surgery.  No new x-rays were taken.

Today, February 18th, 2009, I went in to have the implant placed.  Prior to
surgery, the assistant said "Oh.  Did we not take an x-ray last time you were
here?  Oh well, that's okay".  Unfortunately, after drilling the hole for the
implant, they determined that there was not enough bone to complete the
process and that I would require a bone graft.  They placed a temporary
synthetic graft and told me I'd need to come back in two weeks to undergo a
bone graft.

I'm left feeling like, had they followed proper protocol with an x-ray, they
may have noticed the bone issue and saved me from even having to undergo
today's attempted surgery.  Am I wrong in this assumption and what are my
rights as a patient?  Perhaps I'm way off here, but I feel that if they did put
me through an unnecessary procedure, they should, at the very least, make it
right by finishing the process for me at no cost.  Is this a reasonable request?

Again, I could be way off, and I'm not trying to get a "free ride", but I feel like
something is not right here.

Answer
Dear Amy:
I am sorry to hear about your implant problem.  It is not uncommon.  Implants are man (or woman) made and have problems just like any other medical/dental treatment modality.
It is, unfortunately, impossible for me to comment on the procedure that you had had done, since I do not have any clinical/radiographic information available to me.  However, I can tell you that proper preparation prior to surgery is key to any complex procedure.  
Nevertheless, even with the best of preparation, hopefully rarely, a procedure might not turn out as planned and has to be modified.
It is hard for me to judge your doctor, since many times, even if the x-ray was taken, a problem might have occurred during the surgery itself and necessitated a change in the plan.
I think that even if the X-ray was taken prior, the need for graft would have still been there, since clinically there was not enough bone for the implant (from your description).
The only thing that bothers me is the fact that this was not known prior to surgery.  Usually if I know that there might not be enough bone to place the implant, I do inform my patients PRIOR to the surgery that we might have to change plans, if I cannot stabilize the implant in the bone present.
I think that you should speak to the doctor.  I am sure that he/she will be more than happy to give you details of the treatment.  However, I do not think that any thing was done improperly (at least form your description).  The only thing that might have been better is if they informed you before the procedure that there might be a chance that a graft might be necessary, and that seems to be the only mistake made.  
As far as payment is concerned, the work would have had to be done anyway, so you probably were not over charged, but you can always ask the doctor about it.   He/She might accommodate you.
I wish you well and good luck with your treatment,
Sincerely,
Dr. Zev Kaufman