First two-year complications of fixed partial dentures, eight units or more. Swedish Guarantee Insurance claims.

This study is an analysis of fixed partial dentures (FPDs), 8 units or more, that failed or suffered severe complications within the first 2 years after cementation. The material consists of claims to the Swedish Guarantee Insurance for Fixed Prosthodontics. Claim reports, radiographs, etc. were available. Over a 6-month period, 36 FPDs were sampled, 34 of which were made by general practitioners. The sampling resulted in 41 complications in 26 maxillary and 10 mandibular FPDs, 29 of which were made in metal-ceramics. The mean extension was 10.9 units, with an abutment/pontic ratio of 1.4; 40.6% of the abutments were root-canal treated and supplied with root posts. The complications were: metal framework fractures 41%, loss of retention 24%, porcelain fractures 17%, tooth/root fractures 10%, and miscellaneous 7%. The high proportion of metal framework fractures is not in accordance with other studies of FPD complications. No factor that could explain this high frequency could be identified. The fact that the selection of FPD complications applied to the first 2 years only, that the FPDs had been constructed by general practitioners, and that there were many root-canal-treated abutments and distal extension cantilever pontics, might be factors of importance.

Treatment injuries in dentistry--cases from one year in the Swedish Patient Insurance Scheme.

Eight hundred and fifty-one claims submitted to the Swedish Patient Insurance Scheme were studied and analysed. The most frequent claim referred to root fractures of roots with posts, and to root perforations also related to root posts. Other relatively frequent claims referred to pulpal complications in connection with fixed prosthodontics, root perforations related to endodontic treatment, and dysaesthesia. The mean latency time (the time from the actual treatment to the diagnosis of the injury) was for root fractures 10.6 months, and the mean latency time for root perforations that were not directly observed during preparation was 15.9 months. Pulpal complications of teeth treated with crowns or fixed partial dentures had a mean latency time of 7.6 months. Injuries with a low frequency were, for example, fracture of vital abutments for crowns or fixed partial dentures, damage to tissue by electrosurgery or to the floor of the mouth by drilling, or perforations to the antrum. Two cases of particles dropped into the patient's eye were also reported.

Prosthodontic claims in the Swedish Patient Insurance Scheme.

The Swedish Patient Insurance Scheme includes a guarantee insurance for prosthetic treatment. Retreatments of failures, up to 2 years after cementation of fixed prosthodontics and 1 year after delivery of removable prosthodontics, are covered by the guarantee insurance scheme. Almost all private practitioners were included in this scheme at the time of the study in 1989. During a specific period all claims were studied at the time of reporting, when annexed radiographs and so forth could be analyzed. One hundred and thirty-six claims were recorded with regard to treatment injury, reasons for remake, latency times from cementation or delivery to diagnosis, and details about the teeth or constructions involved in the claim. The dentist's opinion of the cause of the failure was also recorded. The reports covered treatment injuries, most of them root perforations during preparation for a post. The guarantee claims for single crowns concerned porcelain fractures, loss of retention, and root fractures as the most frequent failures. For fixed partial dentures the failures were recorded as loss of retention, porcelain fractures, tooth or root fractures, and metal framework fractures in that order. The dentist gave information about his/her opinion of the reason for the failure in only 38.5% of the claims. There were, however, no clear findings about the reasons for the failures.

The Swedish patient insurance scheme and guarantee insurance for prosthodontic treatment.

During 1975-76 a no-fault compensation system for treatment injuries in dentistry and failures within prosthodontics was introduced in Sweden. The guarantee insurance scheme for prosthetic treatment has changed somewhat during the years and, in 1987, became mandatory for all dentists in Sweden. All necessary retreatment not included in the National Dental Insurance Scheme (eg allergy to dental materials, all treatment following radiotherapy-related xerostomia) is included. For fixed prosthodontics, all replacements are covered by the scheme for the first 2 years. For removable prosthodontics, this is limited to the first year. A patient may choose any dentist in Sweden to carry out the retreatment. The claim system is simple and the number of cases has steadily increased, probably because dentists are becoming more familiar with the system and are willing to use it. The costs are paid for by private practitioners, the Public Dental Service and private dental laboratories. The insurance files are available for research purposes.

Dental claims in the Swedish Patient Insurance Scheme.

The Swedish Patient Insurance Scheme covers treatment injuries and guarantees the replacement of failed removable prostheses for 1 year and fixed prostheses for 2 years after fitting. In this paper, 573 dental cases are analysed for a 3-month period in 1986, during which crowns and bridges formed the vast majority of failed treatments that were reported.