By: Negar Nasim Shaghayegh

Case 18

description
Otto Norman is a 40 year-old private businessman , who had sporadic dental care in the past but has come to our general practice because he wants to keep his teeth, for a lifetime .

Quality of life
He is in good health , all vital signs are excellent . He exercise regularly and careful about his diet His periodental health is good .

Medical indication
He has a class 1 occlusion He needs replacement of three anterior composite resins and four amalgam and five fixed prosthodontic units on the mandibular arch to replace larger , faulty restorations.

Medical indication
Endodontic and a core build-up that appears sound clinically and radiogarphicaly . He also has a partialy erupted , mesioangular class 1 crown impacted mandibular third molar , that is contact with second molar ( second molar has full gold crown ) .

Patient Preference
Mr Norman refused the extraction of third molar initialy because of his fear of oral surgery . WE initiated the amalgam and composite replacement and have complete three of the mandibular fixed units.

Contextual features
During the last two weeks ,however he developed a periocornitis ( tissue around the wisdom tooth when become inflamed because of mechanical trauma , bacteria , or poor oral hygiene ) and agreed to the surgery . Prior to the extraction , we REVIEWED and he SIGNED our standard oral surgery consent form that indicate the type of surgery.

Contextual feature
Benefits as well as risks of disloadging the adjacent gold crown has be mentioned

What did we observe ?

During procedure , a surgical sectioning of the tooth was necessary and during the elevation , the second molar crown and core dislodged revealing gross intracoronal caries that penetrataed the furcation SO : we inform Mr Norman of this discovery and the need to extract the non-restorable molar . He was upest that the tooth had to be extracted .


He also appeared to understand the circumstances . After the surgery , we even showed Mr Norman the decay in the second molar .

Consultation as patient
He calls us and said during this 2 weeks after surgery I had no complication . He appreciates for treatment but he told he wants to sue us to cover the cost of prosthetic replacement of the second molar with an implant or removable partial denture He informs us nothing personal I just dont want to pay for treatment to replace the molar, Ill drop the sue If you do it at no cost to me !

Consultation as Dentist
We think actually as a dentistry student in third year : during surgery with sectioning of the tooth if we discover other problems in adjacent tooth , we can do any treatment which is necessary for dental health of patient ., and also if we did some kind of treatment during surgery without patients permission , should have a good reason , otherwise patient can sue us ! 1) In this case maybe we could stop treatment after extraction of the third molar and postpone the second molar treatment , but because we and patient, agree about risk of dislodging , so after second molar dislodge of crown , and discovering decay we had to decided any treatment . So I think he cant sue us and I cant agree any other treatment with no cost. 2 ) in the other hand maybe we could just cement the dislodge crown then we arranged another appointment for treatment the second molar ( but Its not fair ) . Thats all .

End of story