Dental Implant Lawsuits: A PLP Perspective
As the number of professionals practising implant dentistry increases, so does the number of implant-related legal actions. The purpose of this article is to discuss some of the ways PLP members can protect themselves from allegations of malpractice in relation to dental implant treatment.
The Drivers of Implant-Related Litigation
Implant complications that may incite lawsuits include:
- post-operative infection;
- implant failure;
- bone graft failure;
- sinus involvement;
- loss of adjacent teeth;
- non-restorable implant(s); and
- poorly restored implant(s).
While some of these occur because of negligent technique, many arise from factors overlooked during the initial examination phase and deficient or non-existent treatment planning.
As noted in the RCDSO’s Implant Guideline published in 2013, “patient evaluation and treatment planning is of utmost importance in dental implant treatment.” One or more of the following steps is often missed in the evaluation/planning stage:
- Consideration of alternative prostheses in light of the presenting status of surrounding teeth, soft tissues and associated structures;
Reviewing the patient’s medical history for relevant systemic medical conditions;
Diagnosis and treatment of pre-existing dental disease;
Detailed discussion(s) about the patient’s expectations and treatment options, including the risks and benefits of and alternatives to implants;
Assessment of the patient’s ability to maintain oral hygiene;
Thorough patient work-up including necessary imaging and other diagnostic aids; and
Collaboration between surgical and restorative dentists in developing a treatment plan.
And compared with many other dental procedures, the complications arising from implant treatment can be severe, sometimes requiring major surgical and/or prosthetic remediation. The more significant the patient’s injury and costly the corrective treatment, the more likely the patient is to sue the treating dentist.
PLP Case Study
The following is a typical PLP case involving implant failure.
A patient presented to a general dentist for new patient examination. The member took a panoramic radiograph. She noted there was a failing four-unit fixed bridge extending from 21 to 24 replacing missing teeth 22 and 23. The patient had poor oral hygiene and moderate periodontal disease but declined referral to a periodontist.
The patient’s medical history revealed she was a type 2 diabetic and a heavy smoker.
The member recommended removal of the failing bridge, placement of crowns on the abutments and two implants to replace teeth 22 and 23.
The member removed the bridge and placed an allograft in the edentulous area. Three months later she placed the implants. The 22 implant failed six weeks later and was replaced that day. A month later it dislodged in an impression and was again replaced. It dislodged again in an impression taken three months later. This time it was not replaced, and the member fabricated a 3-unit bridge extending from the 23 implant to tooth 21 and placed a crown on 24.
Two years after placement the patient presented with a loose bridge. The member noted the abutment tooth was decayed and the implant was mobile.
The patient did not return and attended another dentist who advised her that the 23 implant had failed and the 21 abutment was grossly decayed. Both required removal. He also reported heavy occlusion on the anterior teeth necessitating orthodontic realignment prior to prosthodontic treatment planning.
PLP had a number of concerns regarding the member’s treatment:
This was a complex case as defined in the RCDSO guidelines. The member should have considered whether treatment was beyond her capabilities and referral to a specialist was necessary.
- The member did not take into account the patient’s diabetes, heavy smoking, occlusal discrepancies, periodontal disease and poor oral hygiene in determining whether she was a candidate for implants.
The member did not discuss the risks, benefits and alternatives to the treatment nor did she discuss the patient’s responsibility for its long-term success.
The member did not consider whether additional imaging beyond the panoramic radiograph was necessary.
- The member did not treat the patient’s pre-existing periodontal disease before initiating implant surgery.
- The treatment ultimately failed.
PLP settled the case.
Dentists can avoid complaints and demands for compensation arising from implant placement by investing time in patient assessment and education and careful planning before commencing treatment. Further, both the surgical and prosthetic phases of implant treatment require a specific knowledge base and particular clinical skills. Members are encouraged to review and follow the RCDSO’s Implant Guidelines regarding educational requirements and professional responsibilities relating to implant dentistry.