Removable prosthesis dilemma

[Deucalion Dental]

So here is my story feel free to comment. I have a Nobel procera scanner and do many implants with it, now Nobel promised marketing of which they totally failed at but that's another issue, some time about five months ago the rep from Nobel introduced me to a new dentist who wanted me to make a denture over a bar the bar was to be fixed but the denture removable. The previous lab wanted nothing to do with the case I assumed they didn't want to outsource a bar. I get the impression in a stock tray should have been a custom tray well worse has happened we realise there isn't much space so I design a bar meeting the specs according to Nobel, we make the denture over the bar, it gets fitted and they are happy. A week later I get a call from the dentist saying the bar is too flexible and that has caused the denture to fracture.please make another bar different design. The original bar cost $1500 Au plus acrylic work cost me 900. A remake of a bar to a different type means an extra 1500 plus 1200 for my mistake of gold attachments instead of plastic. So we retrofit to the new bar. I get a call telling me my acrylic tech is an idiot. It's undercut he says. He has no idea how to fit the attachments either. Well it's easy to fix. By the way the denture was 3500 so I'm down 400 let's forget I ordered the costly attachments by mistake. I tell him we will sort it out then he tells me he doesn't want a bar anymore but ball abutments. This costs me an extra 1200. In the mean time I'm doing another case for him the same as the first it looks good fits well but due to the angle of the implants we had to leave the buccal acrylic a few mill short of the tissue. Now he changes his mind on the second job too so no more bar. He paid 3500 owes me 3500 for the second case. I called for payment but have not heard back from him. Now do I send him the bill for the rest of the components? Oh also the first patient told me he dropped the denture that's why it fractured and a tooth broke as well, and he superglued an attachment back in when it came out of place not recommended by me, this cause the denture to not seat well and rock and flex. Am I to blame. I don't think so. This has me angry I don't want to touch these dentures again and want to cut my loss.

 

[2thm8kr]

The doc sounds like an improviser rather than a case planner. You could try to bring him out of the dark ages by coaching him along. If the other lab doesn't want to do cases like this for him, maybe they have good reason. I'd be cautious about letting him get into you for more money.
My $.02

 

[droberts]

Any photos of this case? Just curious of bar design, when a doctor makes a comment of too flexible. What type of attachments did you use that cost $1200?
All in all, there was no treatment plan of either case. You need to approach him and sort these issues out, or move on.

 

[zero_zero]

We where approached by the Nobel rep a few years ago promising new accounts and marketing if we'd jump on their bandwagon and buy a scanner... looked too good to be true, so asked to try a month or two with a loaner before we commit. Sure enough he couldn't do that, so told him to take a hike... few weeks later talked with another local lab to find out that they were persuated the same way at the same time as I...

 

[Deucalion Dental]

https://www.dropbox.com/s/lb31yhvrho1igi1/2013-08-01 21.17.19.jpg
https://www.dropbox.com/s/madp83o9gmjl2jv/2013-08-01 21.17.57.jpg

The attachments were gold attachment that need to be activated. Nobel makes them the have an outer shell ti I think and three sleeves of gold inside. I forget what they are called but they go over the 2mm ball

 

[Deucalion Dental]

I added links to photos of the first bar design

 

[Deucalion Dental]

It's a hader bar round thickness can't be modified

 

[dmonwaxa]

What I've done on large casses like these is to have them pay 1/2 estimated cost up front. Does a few things: makes them think twice about the request, it establishes a commitment by them,and increases your cash flow. Doing it this way decreases some of the loss if that were to happen.

 

[2thm8kr]

There is at least an ethical responsibility to taking half the bread up front to finish the case. My approach is to get pre-operative models, bite, face bow, etc.and DX the case.
(I charge by the hour for this) this fee is paid before the final case is started. With the end in mind then we start the case. This step usually weeds out the non planning slackers.

 

[rkm rdt]

Speaking of non planning slackers.

3rd week of holidays winding down. ...just got up...:bored:

 

[2thm8kr]

Speaking of non planning slackers.

3rd week of holidays winding down. ...just got up...:bored:

Lucky basterd! Been up since 4

Are you catching anything fishing besides a beer buzz?

 

[AJEL]

It's hindsight but I don't care for the Nobel adjustable ball attachments, You mentioned they milled it at 2mm I thought they were 2.24mm and I have used the preciclick in their place, that screw in Nobel gold activated clip has all the problems of the ole Ceka. Which actually might have been a nice choice for this bar. You mentioned using Hader clips Did you do also with the Ti Housings?, looks like a dolder bar, stateside hader bars have tails to tissue.. In reduced vertical cases like this again in hind sight I would have shot Vinyl 1180, Maybe you call it Luxene vinyl. For those with Ivocap Doug has a cartridge that I understand works just fine., for thin or delicate cases I have yet to find a patient breaking one (except dropping and fracturing a tooth.) If a DDS wants an overdenture with ball attachments, and those implants looked pretty diverse 3M pickup bonds fine to vinyl, the vinyl will flex without fracture as that is one of the greatest strengths of vinyl, it does have a drawback in my experience Nicotine addicts cause some staining.
your other prose sounds like a DDS to stay away from, I hope you got paid.

 

[dmonwaxa]

There is at least an ethical responsibility to taking half the bread up front to finish the case. My approach is to get pre-operative models, bite, face bow, etc.and DX the case.
(I charge by the hour for this) this fee is paid before the final case is started. With the end in mind then we start the case. This step usually weeds out the non planning slackers.

That's what I was getting at. It kinda forces them to do the right thing like treatment plan and provide all the necesssry requirements for the case. The 1/2 up front is just not to have all that money tied up in the case and have the doc bail. As it relates to the cautionary advice that was given. I agree 100% r egarding ethics and your approach in handling cases like these. No wrorries here.

 

[Deucalion Dental]

Yes you right it is a round dolder bar my bad was tired not thinking. Yes the clips had ti outer housing. I will take in everyone's advice and I really appreciate it. Looks like half up front is fair and by the hour as well. Maybe things also need to be written in stone like the Ten Commandments lol. See how it goes down under these guys are touchy if us lowly technicians make suggestions/advice. I'm only 33 and he is 50 and I feel there is the suggestion that he knows better than me. My mate who works at Nobel got pissed when he heard all this because the dentist was not open to suggestions and planning.

 

[kcdt]

So here is my story feel free to comment. I have a Nobel procera scanner and do many implants with it, now Nobel promised marketing of which they totally failed at but that's another issue, some time about five months ago the rep from Nobel introduced me to a new dentist who wanted me to make a denture over a bar the bar was to be fixed but the denture removable. The previous lab wanted nothing to do with the case I assumed they didn't want to outsource a bar. I get the impression in a stock tray should have been a custom tray well worse has happened we realise there isn't much space so I design a bar meeting the specs according to Nobel, we make the denture over the bar, it gets fitted and they are happy. A week later I get a call from the dentist saying the bar is too flexible and that has caused the denture to fracture.please make another bar different design. The original bar cost $1500 Au plus acrylic work cost me 900. A remake of a bar to a different type means an extra 1500 plus 1200 for my mistake of gold attachments instead of plastic. So we retrofit to the new bar. I get a call telling me my acrylic tech is an idiot. It's undercut he says. He has no idea how to fit the attachments either. Well it's easy to fix. By the way the denture was 3500 so I'm down 400 let's forget I ordered the costly attachments by mistake. I tell him we will sort it out then he tells me he doesn't want a bar anymore but ball abutments. This costs me an extra 1200. In the mean time I'm doing another case for him the same as the first it looks good fits well but due to the angle of the implants we had to leave the buccal acrylic a few mill short of the tissue. Now he changes his mind on the second job too so no more bar. He paid 3500 owes me 3500 for the second case. I called for payment but have not heard back from him. Now do I send him the bill for the rest of the components? Oh also the first patient told me he dropped the denture that's why it fractured and a tooth broke as well, and he superglued an attachment back in when it came out of place not recommended by me, this cause the denture to not seat well and rock and flex. Am I to blame. I don't think so. This has me angry I don't want to touch these dentures again and want to cut my loss.

Sounds like a client you need the fire asafp. Seriously, you're paying this guy to send you work....are you enjoying the abuse?

 

[PCDL]

Yep. Agreed. Cut this yahoo loose. From what you have stated, he is trying to shoot from the hip with these designs. And personally, I find the haders he chose to be a bit dated. I'd cut your losses, get paid for what you can, and politely tell him you can't give him the caliber of work he deserves.

 

[drrichard]

I'll say, you have learned a lesson from this case. Before starting any case you (in my opinion as I do myself) should educate your client about the process and the costing of the complete treatment. If they agree to bear the entire expenses on treatment, ask them to pay at least half the estimated or exact cost then start the treatment.

I'll suggest forget what happened and make a healthy relation with your clients.