Indirect restorations such as crowns, bridges, inlays, onlays, and veneers account for a significant proportion of complaints and claims against dentists in Australia. Despite advancements in materials, instrumentation, and digital workflows simplifying many aspects of treatment, challenges persist, often stemming from deviations from fundamental principles. Addressing these basics can greatly reduce dentolegal issues and improve patient outcomes.

Evolving Expectations and the Role of Modern Dentistry

Advances in instrumentation and materials have streamlined tooth preparation, impression-taking, and temporization. Patients today are also more inclined to retain their natural teeth into later life, prioritizing longevity and restorative solutions over extractions. This has increased the demand for long-lasting restorative care, particularly among Australia's aging population.

Why Complaints Persist

Despite technological progress, complaints regarding crown and bridgework remain prevalent. These often relate to failures in adhering to foundational principles taught during dental training. Ensuring thorough case assessment, meticulous treatment planning, and strict adherence to these basics are critical in avoiding complications.

Key Considerations for Crown and Bridgework

1. Diagnosis and Case Assessment

A comprehensive treatment plan begins with a detailed medical and dental history. Special attention should be given to signs of:

• High caries rates
• Periodontal issues
• Bruxism or parafunctional habits
• History of fractures in teeth or restorations

Thorough questioning and documentation can uncover underlying conditions that may impact restorative success.

2. Baseline Charting

Baseline charting is foundational to any treatment plan. It should include:

• Precise mapping of existing restorations
• Notes on cracks, discoloration, wear, and caries
• Clinical photographs or intraoral images

This documentation is invaluable for justifying treatment decisions and defending against allegations such as unnecessary crown placement.

3. Periodontal Assessment

A periodontal assessment is essential for all teeth intended as crown or bridge retainers. Record probing depths, inflammation, mobility, and other key indicators. Preoperative radiographs can confirm bone support and identify underlying pathology, strengthening diagnostic confidence.

4. Pulpal and Periapical Assessment

Preoperative radiographs and sensibility tests help assess pulp vitality and identify potential periapical changes. Proper documentation of these assessments demonstrates a diligent approach, especially when addressing concerns about subsequent endodontic issues.

5. Occlusal Assessment

For cases involving multiple units, a detailed evaluation of existing occlusal relationships is crucial. Study models mounted on an articulator can identify potential occlusal issues, reducing the risk of fractures or TMJ disorders caused by undetected discrepancies.

6. Ensuring a Stable Oral Environment

Restorations should only be placed in a stable oral environment. Address caries, periodontal disease, or erosive conditions before proceeding with fixed prosthetics.

7. Aesthetic Considerations

For elective treatments, especially on healthy teeth, informed consent is paramount. Patients should be actively involved in decisions regarding shade, appearance, and any potential exposure of metal components.

8. Importance of Temporization

Temporary restorations are not just placeholders; they protect prepared teeth, minimize bacterial contamination, and provide an opportunity to trial aesthetic and functional changes before final placement.

9. Addressing Problems During Fitting

Issues such as marginal fit and occlusal discrepancies should be resolved before cementation. Proper evaluation minimizes risks of adjustments that could lead to patient dissatisfaction or material failure.

10. Managing Complex Cases

Practitioners should recognize their limitations and refer complex cases when necessary. Advanced training and collaboration with specialists ensure better outcomes for challenging restorations.

Consent and Communication

Clear communication about treatment costs, benefits, risks, and alternatives is vital. Informed financial consent should be documented, alongside detailed explanations of treatment procedures and expected outcomes. Failure to secure valid consent often leads to legal disputes.

Conclusion

The provision of crowns and bridges demands meticulous attention to detail at every stage—from diagnosis to final placement. While modern techniques and materials have simplified processes, adherence to fundamental principles remains critical. By approaching each case with care and thoroughness, dentists can minimize complaints, reduce costs associated with remedial work, and provide lasting restorations that benefit both patient and practitioner.

This article is sourced from: https://www.dentalprotection.org/australia/publications-resources/dentolegal-articles/articles/crown-and-bridge-a-time-for-checklists-aus