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Medical Forum / General / Dentistry / February 2008Custom Abutments?
Hi, I just was looking over my bill and it shows that I was charged $650 each (x4) for custom abutments for each of my implant crowns: 18,19,20 and 29. (18, 19 and 20 is a 3-tooth implant crown bridge). First of all, these were not included in my Treatment Plan and I was never told they were going to need to do this or that they were doing it. Secondly, someone else told me implants don't need "custom abutments", but I have no way of knowing since I don't even know exactly what they are! I'm wondering if this could be a mistake, so can you tell me what they are and if they are indeed used for implant crowns? (I am thinking MAYBE this was a clerical error and I was not even given "custom abutments", only billed for them.) And secondly, if they did truly put them in and I did truly need them, shouldn't I have been told first, about something that was going to run me $2600 above what my Treatment Plan called for? And thirdly, if the answer to that last question is "yes", should they at least give me a price adjustment on these? > Hi, > I just was looking over my bill and it shows that I was charged $650 [quoted text clipped - 20 lines] > And thirdly, if the answer to that last question is "yes", should they > at least give me a price adjustment on these? Ideally the need for custom abutments is predictable, but often since we only see x-rays of the implant fixtures in 2 dimensions it is sometimes not apparent until you start the prosthetics. $650 is a normal fee for a custom abutment. If the implants are just where you want them you can use a stock out-of-the-box abutment. They can be as much as $300 each. It's not likely that anyone but the surgeon or restorative dentist will have an inkling if you need a custom abutment. Steve >> Hi, >> I just was looking over my bill and it shows that I was charged $650 [quoted text clipped - 31 lines] > >Steve Thanks for the info. That helps. Although it seems they should have at least warned me : "You may need custom abutments, and that might add $2400 or so to your bill!" So what exactly IS a Custom Abutment? Is there a site you can recommend where I can find explanations of this kind of stuff? > Ideally the need for custom abutments is predictable, but often since >we only see x-rays of the implant fixtures in 2 dimensions it is >sometimes not apparent until you start the prosthetics. When you say "until you start the prosthetics", I'm not sure exactly what that means. They took an "impression" of my mouth with pegs sticking out of the implants before making my crowns. Wouldn't they have known when ordering the crowns to be made that custom abutments were going to be needed? Wouldn't they have known before actually ordering the crowns? At what time would they have known? Would there not have been time for them to tell me about the charge for these before the work was done? The more I think about this, the more I think this is like taking your car in for a $2500 transmission job, you signed the estimate, and then you come back later that day and get a $5000 bill, even though you were never told about the extra $2500 in repairs... > They took an "impression" of my mouth with pegs sticking out of the > implants before making my crowns. > The more I think about this, the more I think this is like taking your > car in for a $2500 transmission job, you signed the estimate, and then > you come back later that day and get a $5000 bill, even though you > were never told about the extra $2500 in repairs... Happens every day. "When we got into the transmission, your 'blank' was also bad and that damaged the 'blank', so it ended up costing twice as much to fix as we thought". I don't know what kind of office you are dealing with. There certainly is a lack of communication. Those 'pegs' are the abutments (custom or not). This could be an honest mistake, but you should be informed along the way of what's happening (good business practice, not what is legally required). There always seems to be someone willing to 'low ball' customers. IMO, that's not very professional. I try to give patents a range of fees with large cases. Sometimes I might not be 100% sure about a tooth needing a root canal, crown, extraction, or a custom abutment until into the the work a little way. It's quite common that large cases have a wrinkle somewhere along the way that changes the fee. With a little forethought, this can be allowed for in the 'fee range'. 'Course for a shopper, if I quote a fee for a case of $4800-$6800, and Dr. X quotes a fee of $4750, who gets the business? Without a signed contract, there is no way to hold the guy to that quote (and even then the contract language may allow for increases in the fees for unforseen needed treatment). Sometimes you get what you pay for, sometimes you get less, and sometimes you get screwed. D >> Ideally the need for custom abutments is predictable, but often since >> we only see x-rays of the implant fixtures in 2 dimensions it is [quoted text clipped - 4 lines] > They took an "impression" of my mouth with pegs sticking out of the > implants before making my crowns. At that point it is generally obvious. However, since I don't have hundreds of these cases under my belt, I warn the patient that custom abutments may be necessary, and discuss the situation with the lab once they have the models poured up. When they have the model and try to put in stock abutments it soon becomes obvious that because of issues of location or inclination of the fixture custom abutments may be necessary. > Wouldn't they have known when ordering the crowns to be made that > custom abutments were going to be needed? [quoted text clipped - 3 lines] > At what time would they have known? Would there not have been time for > them to tell me about the charge for these before the work was done? I would have warned you of the possibility beforehand, told you that I couldn't give a precise fee but give a range (depending not only upon the need for custom abutment, but the fee for the precious metal. I just pass along the lab fee--the rest of my work is routine crowns and bridges. > The more I think about this, the more I think this is like taking your > car in for a $2500 transmission job, you signed the estimate, and then > you come back later that day and get a $5000 bill, even though you > were never told about the extra $2500 in repairs... I don't know what you were told, but obviously all reasonable contingencies should be discussed. The purpose for stock and/or custom abutments, including a range of fees should be included in this discussion. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 I just plan for custom abutments at the beginning and if we don't need them, no one is complaining. Signature/ Amatus / >> >>> Ideally the need for custom abutments is predictable, but often since we [quoted text clipped - 36 lines] > > Steve >I just plan for custom abutments at the beginning and if we don't need them, >no one is complaining. Amen. |
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