Case Study: Porcelain v. PFM Crowns

This case involved a female patient who presented for evaluation of a chipped tooth. The defendant recommended veneers on teeth #8 and #9. She prepared the patient’s teeth by grinding down and performing root canals on #8 and #9, but after completion of the root canals, the defendant opted to crown the teeth rather than place veneers.The patient returned to the defendant practice about five years later because tooth #9 had broken off. She was evaluated by another defendant doctor who referred the patient to an oral surgeon for extraction of tooth #9. The oral surgeon extracted tooth #9 shortly after. The patient subsequently underwent a series of bone grafts for dental implants.

The plaintiff alleged that the first defendant doctor was negligent in her preparation of the patient’s teeth for veneers and/or crowns and over-ground teeth #8 and #9. They further allege that the defendant was negligent in placing full porcelain crowns. The defense contended that the dental procedures were done within the standard of care and that the defendant placed porcelain-fused-to-metal (PFM) crowns, not full porcelain ones.

First, the defense sought to educate the jury on the anatomy of normal dentition. By showing the normal number and type of teeth, where they are located in the mouth, and the anatomy of an actual tooth, the defense set the stage for the jury to understand the plaintiff’s problems and the issues of this case.

 

Normal Dentition

The next exhibit was designed to help the jury understand what is done during a root canal. A base image showed a normal tooth, with overlays showing the removal of the center pulp of the tooth, as well as the final root canal filling it in.

 

Root Canal

Root Canal overlay

Root Canal overlay 2

The next part of the visual defense strategy utilized illustrations designed to match the first exhibit, explaining normal dentition, in order to explain the patient’s dentition when she first presented with a chipped tooth. Overlays showed the defendant’s root canal and filling preparation, as well as the crowns that the defendant placed.

 

Dentition

Dentition overlay

Dentition overlay 2

In order to help the jury understand a key issue of the case, porcelain-fused-to-metal (PFM) crowns, the next exhibit sought to educate the jury on what makes up a PFM crown, what preparation they require, and how they look in the mouth.

 

PFM Crowns

PFM Crowns overlay

Similarly, the next part of the visual defense strategy involved an exhibit explaining the same concepts with full porcelain crowns. This allowed the jury to see that the preparation for a PFM and a full porcelain crown is the same, with the same amount of tooth removed for PFM crowns and full porcelain ones.

 

Full Porcelain Crowns

Full Porcelain Crowns overlay

Lastly, the defense sought to show the jury how a porcelain crown with a line of margin can appear to look like a fracture in an xray.

 

Fracture vs. Line of Margin

This case utilized visual exhibits to walk the jury through complex and confusing dental anatomy in order to help them understand the subtle nuances of the case.

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