Periodontics/Do you see crown lengthening ?
QUESTION: Do you see a crown lengthening in tooth number 28 ? I attached before and after treatment x-rays of tooth # 28. In the "before" x-ray, you can see a decay on the distal side of the tooth. The crown lengthening, if done, would be in the "hard tissue". Is a crown lengthening visible in the "hard tissue" (bone)?
ANSWER: Dear Nel,
The angulation of the films that were taken are slightly different, and it also looks like the crown on #28 was removed. Normally when a crown lengthening is done you want to have at least 3 mm of good sound tooth structure between the bone and the area where the filling or margin of the new crown will be placed. Looking at the after radiograph it doesn't appear that there is 3mm available. However, I am only basing this on one film having not evaluated the area clinically. I am guessing someone else feels the same way or you probably wouldn't be asking me this question. I would probably have someone look at it before having the tooth prepared for a crown and a final impression made. I think someone may have attempted to do crown lengthening, but did not remove enough bone.
---------- FOLLOW-UP ----------
QUESTION: Dear Dr. Siegelman,
Thank you very much for your reply. Here is more information on tooth # 28, explaining the reason why I posted my question here:
First, the dentist who treated tooth # 28 stated that he did a "Clinical Crown Lengthening, hard-tissue". After allegedly performing a crown lengthening surgery, he took impressions (the same day). He has already been "consulted" by the insurance company he is contracted with about the fact that crown lengthening surgery and taking impressions are never done the same day.
Second, the dentist placed a permanent crown on tooth # 28 two weeks after the alleged crown lengthening surgery. (Had he done crown lengthening surgery, he should have waited 6-8 weeks for healing.) This is indication that he either did not know how to do crown lengthening surgery, or he did not do the surgery at all.The latter seems true as when all aspects added, it appears he does not know how to do crown lengthening.
Third, the permanent crown failed in 14 months and tooth # 28 got exposed. A board certified periodontist examined the tooth and reviewed x-rays. She stated that there was no crown lengthening, and she also stated that very little tooth structure was left. Apparently the dentist damaged the tooth while preparing for a crown. This is consistent with your findings.
Lastly, the dentist still insists he did crown lengthening surgery. If you would like to, I can upload more pictures, such as the detached crown and the exposed tooth. These may aid you in seeing more details pertaining to the discussion. I would be very interested in your perspective, as you have already detected the center of the problem by looking at 2 x-rays only.
HAPPY NEW YEAR !
I agree with the findings of the board certfied periodonitst. At this point you need to do the following:
You need to have the board certified periodontist do a real crown lengthening. Then 6 to 8 weeks later have a new crown placed.
Send copies of the bill via certfied letter to the first dentist indicating that this additional work needed to be done after his work.
State that you would like a refund for his original crown lengthening and crown.
Indicate that you would like this sent with the next 2 weeks.
Let the dentist know that you will be filing a complaint to the state dental board outlining what occurred and you will be seeking compensation via the state dental board for his treatment that was outside the standard of care. Let him know that if you receive a refund you will consider the matter closed. Look on the website of your state dental board, you should be able to either file a complaint online or download a form.
In your letter do not be emotional, state only the facts. I would not ask him to pay the bill for the new crown lengthening and crown. This would have needed to be done anyway. I don't think your case merits a law suit. There is not enough money involved here to warrant hiring a lawyer and going to court. However, the dentist does not want a complaint filed against him with the state dental board, I am guessing you will receive your money back If you don't get it back, you may also want to include the opinion of the periodontist in your complaint, although they may not want to get involved, especially if the periodontist works with the dentist.
---------- FOLLOW-UP ----------
QUESTION: Dear Dr. Siegelman,
Thank you very much for your reply. More details about what happened in the past months:
I already asked him for a refund, which he refused. So I complained to the Dental Board. The complaint is now in the investigation stage. I anticipate that the dentist will be found in violation of several acts. As he refused refund, I sued him at Small Claims court and won (in October 2013). Then he retained an attorney and appealed. In January, we have the appeals hearing. As you stated correctly, the amount involved is too small for an attorney to take my case. I have the periodontist's written statement about the lack of crown lengthening, which helped me wit the case. Also, he did not obtain an informed consent, which was the second reason he lost the case.
The tooth has been restored in the meantime. But unfortunately, as the failing of the original crown by the dentist damaged the tooth, the restoring dentist did not think a crown lengthening would help the prognosis much. Rather a strong post would possibly save it at least for now, and if it would fail than an implant would be needed. Investing into a crown lengthening was risky, he stated, due to damages from the failure of the original crown. He placed a post into the tooth and cemented a new crown. So far so good.
I don't think he has a better chance in the appeal, given the fact that no crown lengthening is visible in the x-rays, which I will use as photographic evidence. The dentist is aware of the facts, I am certain, and is trying to get away with what he did. His attorney won't be able to help him in the hearing, I believe.
I thank you again very much for your feedback. I posted my questions here to obtain an additional view. I am very content that the additional view (which is yours) is identical with the view of the periodontist who saw the exposed tooth.
Nel, given all the time the time and money the dentist has put into this he would have been ahead of the game if he had just given you a refund. I have given people back their money when they didn't get the result they were looking for even when it was not my fault. It's called customer service. This dentist doesn't get it.