Should I accept this dentistry?

I have # 7 missing and ## 9 and 10 had large fillings. After consulting three dentists in my area I've decided to replace a lost tooth with a fixed three-unit bridge (on 6, 7, and 8) and put crowns on 9 and 10. When I arrived at my dentist for the permanent bridge and crowns to be put on, the dentist placed the five-unit fixed bridge. I noticed that this is not what we had planned. The dentist called the lab; they came and got the bridge. In about 45 minutes they had my bridge cut in 3 pieces: three-unit bridge and two crowns. The dentist was ready to fit that permanently just as everything was going the way it supposed to. It was very disturbing to observe what was happening and I asked to have it put on temporary cement for now. Should I accept this dentistry? Are individual crowns and crowns that are part of a bridge made the same? What about the fact that this dentistry was worked on after it was finished. How do I know if the dentistry I've got would look as good as individual crowns I've asked for? One more thing, I’ve paid for five individual crowns.

Should I accept this dentistry?
It appears that the lab script was written up incorrectly, meaning the lab made the correct bridge, your dentist screwed up. Otherwise the dentist would have been highly upset with the lab, would have said something to you in regard to this and also "demanded a remake" of the whole case. You would have left using this "mistake bridge" in as a temp while waiting on a new bridge and single crowns to be made. No dentist ever pays for a "remake" to be done unless it's completely obvious that it's his fault. Labs are very flexible and want to keep the "good doctors" business so they take a lot from the dentist that they really shouldn't. Dentist will always "blame it on the lab" even when it's their mistake. So it sounds to me like your dentist made the mistake writing the case up and tried to cover for it getting the lab to do a "quick fix." Which labs do all the time for dentist. I would definitely ask for the complete case to be remade while you are wearing this one as a temp. Even though they may floss well and seem to fit good, the procelain has gone through stress being sectioned as it was. It may in the future fracture and then need to be remade only at your expense. Do not settle for this bridge and these crowns, you are getting shoddy work! Check with another dentist, they will tell you it would need to be remade. I've worked in dentistry all my life and not once had any dentist even try to pull something like this. My son works in a lab and laughed when he read this. This work is completely unexceptable and you should be furious with your dentist for even trying to seat this in your mouth! You might want to look around for a new dentist if this is the type of work he does. I hope I've been of some help and that you will take my advice. Good luck!





They don't make 5 unit all porcelain bridges, only porcelain fused to metal for that large of a span.
Reply:hmm i would say no.
Reply:I would think that by being a 5 unit bridge that yu would have more strength with that treatment ,more anchor points to take stress and such? a more solid setting? just an opinion? hope it helps? good luck!! I got a raw deal once with a partial,so I feel your pain!
Reply:I'm a dentist.





First off, it is normal for some degree of work to be performed on a prosthesis after it has come back from the lab. Obviously, your case is a bit more significant.





To answer your question, I'd say that it depends on what kind of bridge was made for you initially. If it was an all-porcelain bridge, then separating teeth #'s 9 and 10 from it is acceptable provided three things: 1. teeth #'s 11, 10, 9, and 8 are in tight contact with eachother (meaning that floss "snaps" through them rather than gliding between them) and 2. that the lab has put a new coat of glaze on the cut surfaces, and 3. you are completely happy with the way it looks. This scario would be every bit as good as individually-made crowns.





If, however, the bridge was a porcelain-fused-to-metal (PFM), your situation would not be acceptable. PFM bridges have a metal framework that extends uninterupted from end to end, and is covered on the visible surfaces by porcelain. Hence, sectioning the bridge at any point would expose a small place of metal. Granted, this area of metal may still be hidden between between the teeth, but I would nonetheless consider this to be unacceptable because metal is not "normally" exposed in this area. Should your teeth shift at all or separate (as teeth move from time to time), this metal may become visible. As far as I know, it is only acceptable to have exposed metal on the back side of PFM crowns where there is virtually no possibility of anyone seeing it.





In all honesty, I am not sure who's mistake it is. This is not the kind of thing your doctor would screw up, i.e. accidentally telling the lab to make a 5-unit bridge when the two of you agreed on a 3-unit bridge and two single-unit crowns. There must have been some sort of miscommunication between the two of you. Try to keep in mind that we pay a lab to make these crowns. And when the lab has to remake them, we often have to pay for the remake. Your doctor had a very good reason for trying to get those crowns to work if he was under the impression that you changed your mind after the fact. Now, if the lab screwed up the work order, that's a different story. I'd be fuming mad with the lab.





Keep in mind, though, that even if the bridge was a PFM, it is very easy for the lab to modify the individual units and add porcelain.





Your doctor wants your business, and more importantly, he wants you to be happy. I don't think he'd seat something in your mouth if it didn't look appropriate.
Reply:well, yes, lab pieces can be worked on after they are finished, probably they only separated them on the union joint using a micro-cut bur, without major problems. they cut it and do minor adjusts at the ceramic.


As long as the crows are well fitted to you remaining teeth and the pieces are still esthetics, its OK.





maybe you could ask more information to your dentist about a dental implant to replace your missing teeth, if it is possible to do in your case. They are more efficient, esthetic, last longer then any bridge, and they dont need your teeth be prepared previously.
Reply:No.
Reply:I think that probably the dentist made a mistake. It would very doubtful that the lab made them that way. They usually follow scripts pretty well, especially for bigger cases such as yours, if they do have any questions, they would call the doctor.





A 5-unit bridge would be indicated if you needed the support for the teeth. It does not seem that was the case. The separate two crowns would make it easier for you to take care of them and also give them a more realistic appearance.





They could have been porcelain fused to metal and the lab could have repaired them or all porcelain and the lab again could have easily seperated them and polished them again. I think that they are okay. The only problem I have is that the Doctor is not taking responsibility for it and being honest about it. It could have been the lab's fault, or miscommunication with you, either way, even though it is not his fault, it is his responsibility.