Rant: Is Dentistry Going Backwards?

RJM62 said:
Thanks. That's good to know.

For what it's worth, his office called me today and asked me to come in on Tuesday for new impressions. They didn't mention anything about money. I'm trying to think of a non-insulting way to bring up the subject of whether the prep was less-than-perfect. Any suggestions?

I believe in giving people a chance to make good. The day I become perfect, I'll start demanding perfection of others. But if whatever the doc does this time around doesn't fix the problem, I'm going to have to take a stand (and find another dentist, too). I think I've been pretty patient and polite so far, but as some point enough will be enough.

Rich
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Just ask him, tell him you were asking on a pilot forum what the problem could be and prep came up as a possible issue. Keep in mind though that the tooth may be too far gone for a proper prep, I had one where the dentist was concerned but thought it would be ok, it was. I also remember my dentist sending back a crown because it didn't fit correctly, I believe it was rocking when he dry fit it. He sent it back for rework or a new one, that was 10 years ago, no problems.
 
PaulS said:
Keep in mind though that the tooth may be too far gone for a proper prep, I had one where the dentist was concerned but thought it would be ok, it was. I also remember my dentist sending back a crown because it didn't fit correctly, I believe it was rocking when he dry fit it.
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Agreed.

If the crown fit and was stable on the tooth, but non-rentive, I would assume your dentist will alter the preparation to increase retention prior to taking an impression. Otherwise just taking another impression won't necessarily do much.

You need to understand that us dentists don't like it when our work fails. It can get just as frustrating for your dentist as it is for you. I'm sure he appreciates your patience as a......patient. I know I would.

Hope things get resolved for you.
 
I would bet its a Cad/Cam Zirconia crown. Most of those kinda sorta fit OK. Give him another shot at making it right. Don
 
I have had pretty much the wide array of processes - amalgam, gold, gold porcelain, composite and now the cad cam input via wand then a little NC mill, then off to a little firing furnace for a full crown in about 2 hours.
The new cad/Numerical milling is wonderful. No messy impressions, no temporary temp tooth waiting for the hand made gold parts to come back and the fitting cycles, or back out if it was not fitting correctly.
The last 3 have been perfect and completed in one trip to the chair.
I was worried as I had the last dentist for 30 years and the crowns and other work was just fine.

The new young guy replaced my retired dentist and brought all the new tech in. I believe he is what we would call the new artisan as he works through the process right in front of you and answers questions as to how the software takes the cad input and shows where the contact and pressure on all surfaces will be via an intuitive color stress picture on the tooth. When the color is consistent across the tooth surface and within spec so to speak it is off to the little desk top mill. The pin mounted tooth material is chucked up and the the little high speed mini mill does it's work. Hell it is an e-ticket ride to watch the process. The base material is a purple color and fires in the furnace to the final color which is chosen from a selection matched at the beginning of the process.
My wife has had a couple done as well and one was not a color she preferred. Back to the office, mill up a new one, pop it in .. no charge, want the customer to be satisfied.
About 1AU per tooth no insurance cash process.
 
PaulS said:
Just ask him, tell him you were asking on a pilot forum what the problem could be and prep came up as a possible issue. Keep in mind though that the tooth may be too far gone for a proper prep, I had one where the dentist was concerned but thought it would be ok, it was. I also remember my dentist sending back a crown because it didn't fit correctly, I believe it was rocking when he dry fit it. He sent it back for rework or a new one, that was 10 years ago, no problems.
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painless said:
Agreed.

If the crown fit and was stable on the tooth, but non-rentive, I would assume your dentist will alter the preparation to increase retention prior to taking an impression. Otherwise just taking another impression won't necessarily do much.

You need to understand that us dentists don't like it when our work fails. It can get just as frustrating for your dentist as it is for you. I'm sure he appreciates your patience as a......patient. I know I would.

Hope things get resolved for you.
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yakdriver said:
I would bet its a Cad/Cam Zirconia crown. Most of those kinda sorta fit OK. Give him another shot at making it right. Don
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Thanks again. I've gotten some good advice; and in a strange way, I find myself rooting for the dentist now.

Rich
 
https://www.pilotsofamerica.com/community/threads/meanwhile-in-mexico.79312/page-2

My root canal rant, post #43.

Dentistry doesn't come up on the board all that often so I'm pointing to this old thread in the hope someone is saved from the evil endodontists.

Is insurance covering implants yet? If not, why not?

I'm at the very end of my current cycle of work. Next Friday I'm crowning an implant, a tiny little thing front bottom. At 71 have a complete set of individual teeth but it sure hasn't been easy - mostly thanks to my ignorance of dentistry for most of my life.
 
MikeS said:
https://www.pilotsofamerica.com/community/threads/meanwhile-in-mexico.79312/page-2

My root canal rant, post #43.

Dentistry doesn't come up on the board all that often so I'm pointing to this old thread in the hope someone is saved from the evil endodontists.

Is insurance covering implants yet? If not, why not?

I'm at the very end of my current cycle of work. Next Friday I'm crowning an implant, a tiny little thing front bottom. At 71 have a complete set of individual teeth but it sure hasn't been easy - mostly thanks to my ignorance of dentistry for most of my life.
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My insurance covers implants at, I believe, 50 percent of whatever their negotiated fee is. It doesn't require that I use an in-network provider, but it will only reimburse based upon the negotiated fee. Anything above that would be on me. I don't know how they would handle a situation in which they'd already paid to crown the tooth, but the crown failed (assuming that the dentist can't get it to take). I suppose that's happened before, though, so they probably have some policy about it. They've been exceptionally accommodating overall.

For the sake of context, one reason why MetLife has been so accommodating may be that I have a VADIP policy; so although I pay for it directly, it's not really an "individual" policy. My employer is listed as "U.S. Department of Veterans Affairs" for purposes of the policy. That makes Uncle Sam the master policy holder: and I don't think they want to **** off Uncle too much. I don't know if they'd be quite as accommodating if I had a truly individual policy. I'd like to think so, but I must confess to some doubt about that.

I'd rather the implant crown stick, however, rather than having dealing with implants. Most people I know IRL who have had them have been less than overjoyed with the results. My brother has one that's come loose twice already. But then again, I suppose that many more people I know have implants, but they never came up in conversation because they didn't cause any problems. I mean, seriously, unless you're a dentist, how often do teeth come up in conversation except in the context of problems?

Rich
 
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> "My brother has one that's come loose twice already."

Crowns or implants "that's come loose"?

Just prior you say "I'd rather the implant stick, however, rather than having dealing with implants." I think you meant to say you'd rather have the "crown" stick?

If the root canal, post and core build-up have already been done then yes, better to stick with what you've got for now. Bond the crown correctly and it should stay. Eventually though, if you've had a root canal, the dead root will eventually fracture and you'll want to put an implant in. I highly recommend you put some bone material (allograph) in the vacancy first though. I'm finding the synthetic bone material integrates faster than actual bone - using synthetic also bypasses any concern with putting someone else's genetic material into your body. Whether real bone or synthetic, let it integrate well then put the implant in. Takes about six months to integrate once we are up in years.

If your brother is talking about an implant coming loose . . . I've seen that once - not that I'm in a position to know. I'm just another dumb patient that has educated myself. I have read that the failure rate on implants is ridiculously low. If people smoke and don't take care of their gums even implants can fail. In the case I know about, I took my next door neighbor down to my dentist (TJ) and introduced them. The neighbor was diabetic, overweight and in general very poor health. The implants (two) didn't integrate well and failed. In his case I think it was due to not building up the jawbone with an allograph and to not allowing sufficient time for integration before loading the implant. More than anything though was his body's failing systems. He passed away not long after.
 
Two words if you live in the Southwest or close to it.......Los Algodones.....right by Yuma. It's a dental oasis with 300 dentists. The town is the typical dirt bag Mexican village by the border, but the offices are clean and efficient and they charge from 50% to 80% less. Crowns for $200. I was fleeced by a gorgeous blonde and an upscale office up towards LA......$7,500 for work on about 4 teeth.......went to Algodones and got 6 crowns done in two days for $1,150.....you can stay at a nice casino right down the road if you want. Not a paid shill and no relatives there, PS....if you really want to score take a bag of Jack in the Box burgers over to the office......instant hero!........lol

Addendum.....Algodones is extremely busy in the winter 30,000 people a day can cross the border and you need a passport.....people fly in from all over.....Canada, Florida, Texas to this place........which is why I go in the slow season of July-Aug
 
MikeS said:
> "My brother has one that's come loose twice already."

Crowns or implants "that's come loose"?
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Implant.

MikeS said:
Just prior you say "I'd rather the implant stick, however, rather than having dealing with implants." I think you meant to say you'd rather have the "crown" stick?
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Correct. My mistake. I should have said "crown."

MikeS said:
If the root canal, post and core build-up have already been done then yes, better to stick with what you've got for now. Bond the crown correctly and it should stay. Eventually though, if you've had a root canal, the dead root will eventually fracture and you'll want to put an implant in. I highly recommend you put some bone material (allograph) in the vacancy first though. I'm finding the synthetic bone material integrates faster than actual bone - using synthetic also bypasses any concern with putting someone else's genetic material into your body. Whether real bone or synthetic, let it integrate well then put the implant in. Takes about six months to integrate once we are up in years.

If your brother is talking about an implant coming loose . . . I've seen that once - not that I'm in a position to know. I'm just another dumb patient that has educated myself. I have read that the failure rate on implants is ridiculously low. If people smoke and don't take care of their gums even implants can fail. In the case I know about, I took my next door neighbor down to my dentist (TJ) and introduced them. The neighbor was diabetic, overweight and in general very poor health. The implants (two) didn't integrate well and failed. In his case I think it was due to not building up the jawbone with an allograph and to not allowing sufficient time for integration before loading the implant. More than anything though was his body's failing systems. He passed away not long after.
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My brother doesn't smoke. In fact, he's kind of a health nut. He's also kind of OCD. It tends to run in the family. So if he was told to care for the implant in a certain way, I'm sure that he did.

I did, however, hear about his implant coming undone from my mother, who's getting on in years and doesn't always get the details right.

Rich
 
So, today I went back to the dentist. I asked him if there was enough tooth left for the crown to grip and whether the prep was adequate. He re-examined it and said, "Definitely." He also checked for inflammation, infection, sinus problems, protruding gums, bite problems, and other things that could possibly have interfered with the crown staying put, and found none.

He then told me that he couldn't come up with any reason for the crown not staying put other than that it didn't fit quite right. He said the most common reason for that is when the patient doesn't stay perfectly still while the impression is hardening, but that it could also be just a less-than-perfect job by the lab, or a less-than-perfect job of taking the impressions on his part. He then took three -- count 'em, three -- sets of impressions and told me he was ordering a new crown. I asked why so many sets of impressions, and he said he wanted to rule out things like imperfections due to air bubbles. I guess he plans to send all three to the lab. Or maybe he just didn't like the looks of the first two.

Then he re-cemented the loose crown back in using yet another kind of cement. He said something about people's mouths having different pH balances, and some cements working better than others for different people. He also said that if that's the problem, he might actually have a hard time getting the crown out to put the new one in, in which case I could choose to just leave it in if I wanted.

That sounded a bit fishy to me, but what do I know. I guess what I'll do is wait about ten days (the crowns usually come in from the lab in about 14 days) and then give it a bit of a tug or eat something chewy to see if it still feels solid. I must say that it does feel a lot more solid with the new cement, but it's only been seven hours and I haven't chewed on that side. He also told me that this particular cement takes about two hours to cure, if that means anything.

I meant to ask why he wasn't putting in a temporary instead of the crown that has been falling out, but I got sidetracked into the discussion of the different cements and the pH of different mouths, and before I had a chance to ask, he'd already stuck the crown back on. So I guess now there's nothing left to do but wait.

Oh, and he said there would be no charge for any of this. :D

All I can say is that he certainly seems to want this crown to fit happily into my mouth, and he did seem to do a pretty exhaustive investigation into why it hadn't. The thing that doesn't sit quite right with me is his mentioning that if the present crown winds up staying put with the new cement, leaving it in might be a better option. Does that make any sense? If he thinks there were imperfections, then why would it make sense to leave it in?

On the other hand, if it does stay put, then I guess it wouldn't make sense to take it out at that point. Kind of like "if it ain't broke, don't fix it." Maybe the pH thing was the problem all along. Except that the other crown he did is nice and tight.

This is giving me a headache. But at least it's not giving me a toothache. :)

Rich
 
If it doesn't fit perfect around the margins I don't care what he cements it with it will leak and you will eventually get decay under the crown over a couple of years or so. Don
 
My spelling is ridiculous. It's allograft, not allograph.

I discovered recently the correct spelling of orthoscopic (as in orthoscopic surgery) is actually arthroscopic, as in arthroscopic surgery. Siggh . . .
 
I'm about to get several implants to replace a couple bridges that have been in my mouth for nearly 40 years. Also getting a complete cosmetic full mouth rebuild. My OMF surgeon also happens to be my best friend in real life so I'm getting an extra special deal on the implant work :). The cost of the whole project is still breathtaking though, the doctor who's doing the rest of the work is also giving me a huge discount since he wants me to do some I.T. stuff for his practice. Sometimes it pays to have friends in the right places!
 
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> "I'm about to get several implants to replace a couple bridges that have been in my mouth for nearly 40 years."

Good move! Pretty amazing that your bridges have lasted 40 years and that they've not destroyed the anchor teeth during this time. That was some good work!

Just as a reference, take a look at how much an implant - just the hardware itself - actually costs. I had just spent 2K (2002 I think) for my first implant (plus another AMU for the crown) so I started researching the subject and discovered these little titanium posts could be had for less than $100. Installing it took all of fifteen minutes once the anesthetic kicked in.

After four or five root canal fractures the trend was unmistakable so I headed south to find a more affordable solution. I've been getting them done for $850, including crown. Initially I was paying $800 . . . I don't remember how it escalated up to $850. I've not had any trouble with any of the implants or crowns that I've had done in TJ, some of which are now over ten years old. I'm still with the same dentist all this time.

https://blueskybio.com/store/regular-platform_0

Blue Sky is a great site for learning about implants. There's videos, training courses, starter kits, etc.

I mention these things for reference. Your dentist friend has mucho room to give you a really good price for his materials and work. Ignoring his office and other overhead for a moment, he could charge $200 for each implant and still make a profit.
 
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