The patient, a man in his seventies, had a partial upper chrome cobalt denture, which was dependent on two periodontally involved anterior teeth for its support. He noticed that his UR1 and UL1 were loose and complained about the fit of his denture.

The dentist felt that the lifespan of these teeth was limited and noted that the occlusion was very worn and the vertical dimension was reduced. The bone quality was also poor. Overall the dentist considered that replacing the existing denture with a complete denture against a natural lower dentition did not have a favourable prognosis. He suggested extracting UR1 and UL1 and inserting implants to provide support for either fixed bridgework or an overdenture. Written quotations for both treatments were supplied.

The dentist sought a second opinion from a specialist in oral and maxillofacial surgery and it was agreed to proceed with the implants. The surgeon inserted six upper implants then, six months later, six healing abutments. He adjusted the existing denture.

A discussion took place between the dentist and the patient as to whether the prosthetic work should comprise an overdenture or fixed bridgework and the difference in costs between the two. The patient was supplied with written quotations for both treatment plans.

The patient opted for the overdenture and underwent the various stages of impressions, jaw relations and try-ins with modifications as required.
The adjustments included altering the overbite. The overdenture was completed and fitted but the patient was unhappy with both the overjet and the overbite.

At his next appointment for review, the patient produced a written memo detailing his complaints: fit too tight; swollen lips; inability to bite; denture heavy and clumsy; front teeth protruding too much and causing headaches; bad taste and bad smell; denture cutting into palate.

On examination the dentist noted that the colletts did rub on the soft tissue but the denture was not too tight. He concluded that the patient's complaints were due to 'bedding in' problems and eased the denture. He also made impressions of the patient's old denture in an attempt to copy its tooth appearance.

In the following month the patient attended the practice twice for further adjustment to the denture because of soft tissue inflammation. He continued to report problems chewing and tenderness of the skin below his lower lip and so the dentist referred him for a second opinion.

His colleague felt the patient's symptoms would be relieved by fitting angulated abutments and a bar sleeve overdenture. The dentist proposed to remove the framework replacing the healing abutments on the implant fixture heads and to reline the patient's old half upper denture. Once the mouth had settled down he intended to proceed with a new denture on studs. The patient was notified of this treatment plan and an appointment was made. The patient missed the appointment and instigated legal proceedings.

Negligence alleged

The patient claimed the dentist had provided inappropriate treatment causing him to suffer pain, distress and cosmetic embarrassment over a lengthy period of time.

Expert opinion

The DDU sought the opinion of two experts on the dentist's behalf. They noted that the dentist had devised a treatment plan based on there being sufficient vertical height to accommodate the prosthesis. While the dentist realised that this was a borderline case he had intended to create more room by opening into the freeway space, a common technique in such situations, but one which this particular patient could not tolerate.

The experts agreed that the dentist might be vulnerable to criticism because there was no record of him fully explaining the treatment options and attendant risks to the patient at the outset. According to one expert:

"The degree of discussion that may have taken place in relation to the postponement of the decision on the appropriate prosthesis and the potential costs involved is a matter for concern. Unless the reason for this decision was fully explained to the patient and the potential costs of both fixed bridgework and an overdenture set out to him, it could be ruled that there was a defect in the consent he gave."

In addition, there were clearly flaws in the design of the denture. With the dentist's agreement it was decided to negotiate a settlement.

Outcome

The patient accepted an out-of-court settlement of £12,500 plus costs.

Denture dissatisfaction

Related articles

Membership in your pocket