dentistry Dominic Thorncroft

Case Study – Defective Filling

Case Study

Consent is a complex subject and although there are universally agreed principles there are also certain “grey areas” when the dental team needs to make their own balanced judgements. For consent to be valid, the patient must have received enough information to make the decision.

This is what we mean by ‘informed consent’. Giving and getting consent is a process, not a one-off event. It should be part of an ongoing discussion between the dentist and the patient. The Montgomery ruling with regards to consent has replaced the previous ruling with Bollam. The dentist must therefore share all material risks as well as those that he thinks that the individual patient would want to know.

The guidance states that the dentist needs to find out what your patients want to know, as well as telling them what you think they need to know. So examples of information which patients may want to know include:

  • Why you think the proposed treatment is necessary.
  • The risks and benefits of the proposed treatment.
  • What might happen if the treatment is not carried out?
  • And other forms of treatment, their risks and benefits.
  • And whether or not you consider the treatment is appropriate.

This case was discussed whereby a patient came in and the examination revealed a defective filling in LL5. The notes revealed that this restoration had only been done in the last 6 months at another dentist.

Furthermore, the reason had been to remove a previous overhang. The patient was informed and it was proposed to correct the filling material and the options were given to the patient including demonstrating on the patient’s own radiographs. In the end, the patient decided not to have further treatment as this was now going to be the third lot of treatment for this tooth.

In addition, the patient made it clear that should she experience any symptoms, then she would have an extraction. It was therefore decided to keep the tooth under observation.

dentistry Dominic Thorncroft

Case Study – Gingival Overgrowth

Case Study

This was a case report concerning a patient who had been booked in just before the Christmas break as an emergency. The radiograph shows a fractured pinned crown in UL5 with the fracture being subgingival and a degree of gingival tissue overgrowth. It was not possible to recement the fractured portion of the tooth so an alternative had to be considered.


An easy and conventional treatment was the construction of a partial upper denture to replace UL5 however due to the Christmas break, there was no way the dental lab could have fabricated one with such time constraints. In the consultation a discussion of other solutions included:

  • Placing pins around the remaining root and a composite restoration,
  • Preparation of the adjacent crown and construction of a temporary bridge,
  • Pin removal with a new direct post.


In the end, the gingivae were reflected back and 3 dentine pins placed with a composite crown build up. Needless to say, this patient was extremely grateful at being able to carry on her day to day activities without the embarrassment of an unsightly gap.

She was given instructions to be extremely careful with biting as this was only a very temporary measure until a full discussion could take place for a permanent solution.