加拿大华人论坛 加拿大百科呼叫悬壶：在蒙城求教补牙后3个月就掉了，如何处理妥当？

在加拿大

如题：去年12月底补的牙，一位拉丁牙医，第一次找他，今天发现又掉了，洞洞依旧。不想当冤大头，也不想太影响牙医声誉，如何处理比较妥当？请多指点。

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多谢您信任，我一般不来这个版块，回复晚了。只要是人在干活，100%成功率是不现实不客观的。我就权当这个牙医是我了，因为每个牙医都会遇到这个情况，除非是上帝改行做牙医。遇到这样的病人，能再找回我来，说明对我还是信任的。一年内的case我会不收一分钱，再补一次。当然，补牙材料脱落的原因我会从专业角度认真分析，是偶然因素还是受力过大，是我没有交待清楚还是对方吃东西咬到硬东西（例如：骨头碎片、米里的沙子、辣椒籽等）.补牙充填物脱落，是医患双方都不愿看到的事情。调查显示，充填物年脱落率约4.2％。以我在过去一年补牙约1500个算，有60个脱落的补牙，理论上是说得过去的。所幸，我发现没有那么多返修cese(尽管我承诺一年的warrantee). 尽管在当年的NDEB牙医考试中，出我之右的华人牙医凤毛麟角，但我没有考到100分，临床工作中也没有达到百分百成功。但从病人角度看，这个失败就是100%失败了。还好，补牙方面我们可以做些善后工作－－再补。一个可怕的问题出现了，假如这是心脏手术，会不会也有个成功率；那些不成功的手术会有后遗症，会不会涉及到生命？谁来负责？医生的名誉会不会受到影响？法律会不会制裁这个医生？有过就医或者手术经验的，都知道术前有个informed consent要病人签字。所以，理论或者法律上说，只要没有证据证明医生蓄意、严重的不规范操作，这个医生是不该承担法律责任的。正如你补牙脱落，牙医不会因此丢掉牌照，在我们同行看来，其声誉也未必因一个补牙脱落而受损，这是大家都会遇到的事情。您的情况，我同样建议您和前牙医再沟通一下，多数牙医这种情况会给您重新补的，毕竟才三个月。以下附录的文章，是我们协会的一些资料，是讲补牙脱落率的问题的。0237 Clinical Performance of Class I,II and V Composite RestorationsU. LENDENMANN, and P. OEHRI, Ivoclar Vivadent, Schaan, Liechtenstein　　2008 ODA meeting at Metro Toronto Convention Centre Room 801B.For more than 20 years Ivoclar Vivadent routinely tested newly developed composites and adhesives in clinical trials. This has resulted in an extensive data collection, including results from pioneering materials such as Heliomolar to the state-of-the-art composite Tetric EvoCeram.Objectives: to estimate the failure rate of Class I&II and Class V composite restorations by a meta-analysis of a large number of clinical trials with composites from Ivoclar Vivadent.Methods: Data of class I&II trials with an observation time of 2 and more years (37 trials) and of class V trials with an observation time 18 months or more (9 trials) were included in the analysis. For each trial, the annual failure rate in % was estimated with the following formula: annual failure rate = (cumulative failures at final recall)/(previous failures + restorations evaluated at final recall)/(years of duration)*100.Results: Clinical trials with class I&II restorations showed an average annual failure rate of 1.8±1.5%; the min-max range was 0–5.8%. The 25% quartile was 0.9%, the median 1.7% and the 75% quartile 2.6%. Class V trials showed an average annual failure rate of 4.2±3.5% with a min-max range of 0–10.7%. The 25% quartile was 1.9%, the median 2.7% and the 75% quartile 6.9%. Hence, a two-fold higher failure rate of class V composite restorations was observed in comparison to class I&II restorations.Conclusions: Compared to class I&II restorations cervical restorations showed a higher failure rate due loss of adhesion in cavities lacking mechanical retention. Nevertheless, the resin-composites employed in these trials exhibit very well accepted clinical performance in both cervical and posterior restorations.Seq #54 - Clinical Performance of Resin Composite RestorationsIn Toronto, if a dentist fill teeth (5-8 X 200day=)1000-1600 per yearAnnual failure rate of 4.2±3.5%Annual failure number 42-65

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