Dental Problems - Missing Tooth/Teeth
Dental or Orthodontic Procedure

The patient is a male who presents to the office of his dental provider for evaluation and treatment of teeth #6, 7, 8, 9. Included for review are previous letters of appeal and denial, full mouth radiographic images, multiple pages of clinical notes from the dental provider's office, multiple pages of clinical notes from the hospital from the day of admission, and a narrative provided by a patient advocate.
The patient has a history of facial trauma due to direct blunt force for which he was admitted for emergency services in a hospital setting. At the time of the trauma the patient suffered fractures to the anterior teeth #7, 8, 9 as well as lacerations to the lips. Subsequent to the accident teeth #7 and 8 were deemed unrestorable and were extracted. The patient is now edentulous in sites #7 and 8 and subsequent evaluation of the healing has resulted in the finding that the patient does not have adequate bone to allow for reconstruction leaving only restorative dentistry as the option for replacement of the missing teeth.
In question is the medical necessity of the planned treatment of fixed partial denture 6, 7, 8, 9.

The health plan's determination is overturned.

Yes, the requested service of bridge on teeth #6-7-8-9 is medically necessary as the treatment for the missing teeth #7 and 8. Tooth #9 already requires a full coverage restoration due to the extent of tooth structure lost due to the trauma. As such, a fixed partial denture is the treatment of choice as a removable partial dentures delivers non axial forces to the adjacent teeth resulting in mobility and damage to the periodontium.