What can a lost tooth cost? Dr RAJ KUMAR looks at some issues of concern to general dental practitioners
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ACCORDING TO EMINENT EXPERT in teeth can be damaged or lost from trauma or geriatric dentistry Poul Holm-Pedersen: “If a road traffic accidents. patient is free from periodontal disease and Root resorption of teeth that have caries, then the teeth can be for life.” undergone fixed orthodontic treatment can However, unfortunately many patients also reduce their life expectancy, as William suffer from periodontal disease and lose teeth R Proffitt found. prematurely. Periodontal disease is a silent The loss of a tooth usually leads to bone loss disease, as many patients do not recognise as well as cosmetic and aesthetic challenges. anything is wrong until the teeth have lost If a patient wants a like-for-like replacement, their supporting bone and are mobile. It is then a fixed dental implant and crown are the usually then that the patient consults with ideal solution. Implants avoid the unnecessary a dentist and finds out that they have a trimming down of natural teeth for conventional progressive disease. crown and bridgework – which would reduce At each examination the dentist is required their life-expectancy. to carry out a basic periodontal examination. Implants are usually made of sterile Many do; but, equally, the Faculty of General titanium, which is placed into the bone in Dental Practitioners has found that many do a sterile environment. Within three to four not. Radiographs (X-rays) are taken every months the bone will have successfully two to three years to assess for caries or integrated with the titanium surface and bone levels around teeth. Patients may have the crown or bridge can be attached. The Internal root resorption after car accident attended for many years and not know they average cost of an implant crown placed by a and fractured tooth had bone loss associated with periodontitis. specialist or oral surgeon is £3,000. If the disease goes unchecked by the dentist, then the patient has a The medical history of the patient must be considered, as it is right to make a claim for dental clinical negligence. known that immunocompromised, diabetic and smoker patients have Caries is sometimes different, in that a patient may suffer pain or a reduced success rate with implants. toothache and the symptoms force the patient to attend the clinic. In most cases the tooth can be saved. In a small percentage of cases, How long should an implant last? Implants can suffer from infection of the supporting bone, known as peri-implantitis. Bone loss and implant failure leads to a larger defect of the supporting tissues. According to published papers, most studies cite implant success rates of up to 10-15 years. Some patients will suffer periimplantitis, but not lose the implant; others, however, will lose the implant completely. Again, HolmPedersen quotes that an implant crown may need to be replaced every 20 years due to peri-implantitis. The replacement of a failing implant would require added bone grafting to restore the supporting bone and soft tissue volume. Bone grafting is a complex procedure and is known to fail. The average fee for bone grafting and a Implant crowns to replace central incisors second implant crown can be £4,000-£5,000. The replacement of a failed implant within 20 years would require a more complex procedure and added costs. It is not uncommon in medico-legal reports to quote for two or three cycles of implant replacement during a patient’s lifetime. Orthodontic medical negligence cases may therefore run to £100,000-£300,000. In summary, once a tooth is lost it becomes a very expensive and complex procedure to have a like-for-like replacement. q
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