Should I change dentists in the middle of my dental implant procedure?

Good Morning Dr. Hall,
I recently visited my local Dentist to have a price quoted to repair a cracked #5 tooth (upper right first premolar), while at the same time, have the #7 tooth in front redone (upper right lateral incisor), which had been ground down and “capped” back in 1978. For the #5 tooth I was quoted a cost to me, the patient, of $4,736.00 which includes the extraction of the #5 tooth, the bone graft, to provide me with a Lava Crown and one custom implant abutment. This cost also covers the Implant Specialist and absorbs additional misc costs passed onto me, the patient as well.

For the #7 tooth I was quoted a cost to me of $4,736.00 also, which includes the same breakdown as above. I agreed to the price and the procedure began with the extraction of both my #5 and #7 teeth, including bone grafts completed on both teeth, immediately following with the installation of a Maryland Bridge to stay in place for a period of 3 months while both surgery sights heal. Once they have both healed properly,the Lava Crowns and Implants will be installed which will complete the procedure.

However, since I’ve had the Maryland Bridge installed 3 weeks ago, I’ve had to have it replaced 3 times and wonder if that’s unusual. If not, I would appreciate knowing if the reason is due to the fact that a neighborhood Dental Office, practicing General Dentistry did the work instead of a Cosmetic Dentist? If so, at this point, would you recommend that I find a Cosmetic Dentist to complete the procedure on both teeth, picking up where the General Dentist’s Office left off? Or would you recommend that I stick with the General Dentist and trust that aside from their not being able to perfect the Marilyn Bridge on the #5 and 7# teeth and keep one in my mouth for more than just a few days at a time without it breaking apart, that they are capable of completing the work and providing me with the professional results that a price tag totaling $9,472.00 should buy? I appreciate and thank you in advance for the time and effort(s) you put into providing me with accurate answers to the questions I’ve asked herein. My email address is: Hollywoodnights@cox.net and I look forward to hearing from you soon Dr. Hall.

– Holly from Arizona

Holly,

Yes, I would agree that the inability of your dentist to keep this Maryland bridge in place is troubling. And it would tend to indicate a lack of training or experience in dealing with esthetic dentistry technology. If I were in your shoes, I would switch dentists.

A Maryland bridge is made of a false tooth or teeth suspended between two metal wings. The wings are etched, and the backs of the adjacent teeth are etched, and then a bonding composite is sandwiched between the wings and the backs of the teeth. If it comes off prematurely, there is a flaw either in the design or the technique or both. The flaw needs to be fixed and then the metal needs to be re-etched by the laboratory for it to re-adhere. I’m guessing that your dentist doesn’t know that, and also may be clueless about the flaw that caused the de-bonding in the first place.

And not only are the esthetics of your case very important, but implant dentistry is not for beginners either. If your dentist had much experience replacing anterior teeth with dental implants, he or she would have settled on a reliable temporary technique. But no, it appears that he or she is in unfamiliar territory – a second troubling aspect to your case.

It is an ethical obligation of all dentists to cooperate any time you want to change dentists. So when you tell your dentist you want to switch, he or she should provide the new dentist with any information needed to properly complete the procedure. And since you are at a good stopping place in the procedure. there shouldn’t be any extra costs for anything having to be re-done. Except possibly for the cost of the temporary tooth. If the Maryland Bridge technique isn’t one that appeals to your new dentist, he or she may want to create a new temporary. Most implant dentists would probably lean toward a dental flipper as a temporary tooth replacement in this situation.

Dr. Hall