Dr Richard Hartley, Dentolegal Consultant, Dental Protection
Estimated read time: 5 mins
65-year-old lady attended the dentist as she was unhappy with the appearance of
her upper anterior teeth, given they were no longer as visible when she smiled.
On examination it was noted that the upper six anterior teeth were veneered;
the patient advised that they had been in situ for 17 years.
dentist was keen to improve the situation for her and offered to replace the
veneers with longer ones, although he advised he would also need to replace the
lower partial denture in order to create some inter-occlusal space and
stabilise the posterior support. Radiographs showed that the upper anterior
teeth had approximately 25% horizontal bone loss, although the periodontal
status was stable and oral hygiene good.
patient agreed and the treatment proceeded without incident; the patient was
pleased with the outcome. Unfortunately, the veneers on both upper laterals
fractured after two weeks and the dentist replaced all six veneers, as the
patient then decided she wanted them slightly longer and a lighter shade.
veneers were fitted and the patient was delighted with the appearance, although
she returned after one month as the veneer on the upper left lateral had
fractured and the tooth was now slightly mobile. A periapical radiograph showed
no pathology or fracture, so the dentist replaced the veneer and advised the
patient that he would provide her with a bite guard to wear at night while the
lower denture was removed. Before this could be fitted the patient lost
confidence and attended another practice for a second opinion, where it was
identified that the upper left lateral incisor was Grade II mobile and likely
to be lost, that the veneers on all upper incisors had an unfavourable crown to
root ratio and there were occlusal interferences on lateral and protrusive excursion.
patient then put in a formal complaint, stating that she would never have
agreed to the treatment had she been made aware of the possible consequences.
She said she would have been happy simply to accept the lower lip line, as her
new dentist had explained that it was a natural consequence of ageing.
dentist contacted Dental Protection, admitting that although he was very
experienced, he had perhaps been persuaded by the patient’s enthusiasm to
provide treatment that was inappropriate. He accepted that his initial
assessment and treatment planning was less than ideal as he had failed to carry
out a full occlusal assessment, or considered articulated study models or a
Dental Protection’s assistance he was able to cover the cost of a referral to a
local dentist with a special interest in aesthetic dentistry for remedial
treatment, which satisfied the patient.
dentist acknowledged that the lack of initial assessment and planning had
compromised the consent process, and subsequently carried out targeted professional