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Dentistry/Implant Crown

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QUESTION: Hello Dr. Kaufman. I am 45 years old. I had a combined bridge/implant put in over 14 and 15 two years ago. Implants done by oral surgeon; crown by dentist. When first crown/bridge was put on, it was porcelain and cracked at the back a few hours later (it was a poor fit). Dentist sent it back to the lab and had it redone as porcelain over metal. Porcelain on side cracked this time. Dentist took out the crown/bridge and polished it himself this time, to remove the harsh edge on the side. That came out fine but he also decided to polish the edge surfaces and cut off a section from the back for a better fit. Now my bite shifted to the other side of my mouth AND the edges that he polished are rough. He refuses to see this. Doesn't he HAVE to send this back to the lab to be fixed and polished professionally? Am I stuck? Do I have any recourse?

ANSWER: Dear Chris:
I am sorry to hear about the troubles that you are having.
Yes, the dentist has the responsibility to deliver to you acceptable work that will not cause more damage to your mouth and restore you to reasonable form and function.
The dentist is also responsible for the laboratory work, since he is the one who selected the laboratory.  
What you have to do is to talk to the dentist and explain that you are uncomfortable and cannot function as it is.  He HAS to fix it.  Unfortunately, like many other things in life, you cannot MAKE his redo the work.
If you cannot get headway by a conversation, you might want to seek a second opinion from a Prosthodontist, who is the expert in this field.
If the work is not acceptable, depending on your state of residence, there are regulatory agencies, such as the licensing board, who can look into this for you.
Legally, not much that you can do, since the legal steps will take a very long time and will provide you with very little resolution.
The best thing to do in this case is to follow my suggestions and try and speak to the dentist.  If you cannot get resolution in this manner, go and see a Prosthodontist to have the work done properly.  Yes, you would have lost the money that you had paid, but this happens with many other things in life as well.  If you buy a product that does not work as promised, the best thing to do is to vote with your dollar and go to someone who will do the job right.
I am sorry that there is not much more that I can tell you.
Best of luck,
Dr. Zev Kaufman

---------- FOLLOW-UP ----------

QUESTION: Hello Dr. Kaufman, thank you for your advice. I went back to the dentist (who is also a prosthodontist) and asked him to send the implant crown back to the lab. At first he seemed willing to send it back to the lab but then saw it and said it could not be sent back to the lab for polishing as it was a metal crown and they could not re-bake metal. Is that true or is this just another excuse from him not to send it back to the lab? So he took it out and re-polished it in the office again and again when he put it in my mouth, it was even smaller than before. He said he could not make it any smaller - GOOD! And the edges were gone and it is smoother. But what about his statement that a metal crown cannot go back to the lab for re-polishing? Is this true?

Answer
Dear Chris:
I'm glad that your problem was resolved, and even more so, I'm glad that it was resolved in a civilized manner and in a proper one as well.
There is nothing magical about the laboratory.  The "laboratory" is just another human being who is NOT a dentist, but operates under the direction of the dentist to produce certain work.  Many Prosthodontist are excellent technicians themselves and some are better than others.
There is no need to send work back to a laboratory if your dentist can do the job himself.
Routinely, most crowns require minor adjustments.  As long as I can polish the metal and porcelain, there is no need to send it to make technician to do exactly the same thing.  When a crown requires lots of adjustment and I know that I cannot polish it as well in the office, I do send it to my technician to put back in the oven and re-glaze the porcelain.  If your dentist has a laboratory within the office and can have a porcelain oven and re-glaze porcelain, there is no need to send it out.
In any case, if you are happy, forget about all that and concentrate on much more important issues in life.
Best of luck,

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Zev Kaufman, D.D.S.

Expertise

I can answer any question from simple routine dentistry to very complex dentistry with emphasis on reconstructive, cosmetic, and implant dentistry. My expertise is in co-ordination of very complex treatment plans with other dental specialists or as a one-man-team, since I have extensive training in Prosthodontics, Surgical Implantology, and orthodontics.

Experience

Over a decade in private practice of Surgical Implantology and Prosthodontics. Founder and owner of Prosthodontics & Implant Surgery of Manhattan, PC. Clinical Assistant Professor at the Post-Graduate Department of Periodontics & Implant Dentistry at New York University College of Dentistry. Lecture weekly since 1999 on advanced Implant Prosthodontics at New York University College of Dentistry Post-Graduate Program in Periodontics & Implant Dentistry. Former clinical assistant professor of Dental Radiology at the NYU College of Dentistry. Former clinical and lecture faculty at Lincoln Hospital, Dental residency program. Former clinical and lecture faculty at St. Barnabas Hospital (Bronx, NY) dental residency program. Lecture nationally on Prosthodontics and Implant Dentistry.

Organizations
Memeber of the American College of Prosthodontics. Memeber of the Acacdemy of Osseointegration. Member or the Omikron Kappa Upsilon (OKU) Honors Dental Society. Member of the American Dental Education Association.

Education/Credentials
Graduated with Honors from New York University College of Dentistry. Post-Graduate training and certificate in the specialty of Prosthodontics. Post-Graduate training and ceritificate in Surgical and Prosthetic Implant Dentistry. Honors-program in Comprehensive and Applied Practice Management. Honors-program in Orthodontics.

Awards and Honors
NYU Cervice award to the community. OKU honor society. National Dean's List. National Who's Who.

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