Thank you Richard and Dr. Bornfeld for your answers.

This is what my student dentist told me (I got an email back from her
after your replies; this work was done about a year ago):

"custom abutments are not required, stock abutments could have been
used, but in my experience results are better with custom abutments
especially when multiple implants are used as in your case. Some form
of abutment has to be used otherwise the PFM (crown) can not be
placed, since it is the connector between the implant screw and crown.

I'm not sure why your original treatment plan did not include the
custom abutments, it might have been that at the time of your original
treatment plan the University did not charge for abutments."
-------------------------------------------------------
By the way, if her last comment is the case, then I think the prices
on my treatment plan should be honored.

This is why I am asking the question:
I had a Treatment Plan for 4 implant crowns and it called for 6
implant crowns at $850 each. [2 had not yet been done at the time of
this bill).  This is what I agreed to and I was never told anything
different was going to be done or that any expenses were being added.

So when I got my bill, I saw that I was charged $675 for the Implant
crowns, high noble - but also 4 x $650 for "Implant Custom Abutments".

So that is $2600 more than what I was told I'd be charged, and no one
dicussed this with me! (??!!)

(Granted, the PFM's were $175 less each so that offsets some of the
difference, but still that leaves a $1900 difference added.)

So I am in the process of contesting this on the grounds that I was
never told they would be needed.

Would it not be standard practice to tell a patient if an extra $2600
was going to be added to his bill? especially if he has a signed
treatment plan that does not call for custom abutments?

I think at the very least they should compromise with me and charge me
LESS for the custom abutments.

What do you think?

And maybe you can help me out here - if I paid $650 per crown and $675
per custom abutment (remember, this is at a dental school, so I should
get it cheaper - I had to endure many more appt's than necessary for
their lack of competence and many more hours in the chair for the same
reason plus they are learning on me), how much room is there for them
to discount this any further to allow for any money back due to their
having not told me about it?

I'm willing to compromise as I understand it may have just been an
oversight, but still I don't think it's right to expect a person to
pay $1900 more than their treatment plan called for without having
told them.

And finally, what would be an average ballpark price for custom
abutments per crown at a dental office?

Comments? Opinions?