I just had a patient call the office yesterday.  This is a patient who we
had been treating for many years.  This past year, they opted for an HMO
plan and left the practice.  Patient has a composite on the incisal edge of
a maxillary incisor.  Because of the parafunctional habits of this person,
they only get 2-3 years before the composite chips and has to be repaired.
As soon as they got on the HMO plan, it chipped again.  They waited a bit to
get in and have it fixed.  The HMO clinic repaired it, but it felt funny to
the patient on the way home.  That night, it fell off (the repair that is).
They call the office and are told they cannot be seen for 3-4 months and
that there is no guarantee since those composites never last any time.  They
insist the patient get a porcelain jacket on the tooth (not covered by the
plan, of course).  For a 2mm Disto-Incisal chip.  Funny how our bonding
always lasted 2-3 years for this person. And, each failure was within the
material, so that more enamel never had to be cut.  Since 1992, the
restoration has not gotten any bigger, and the patient is fine with the 2-3
year maintenance protocol.

I guess I get to do a small composite this week.