Damage to adjacent tooth

The scene

A patient was referred to a DDU member for extraction of UR8. The patient's UR7 had previously been root treated and had a crown in place, and during a difficult extraction of UR8 the crown on UR7 was dislodged, together with the core that retained it. As a result, the patient sought compensation for remedial treatment at UR7.

The claim

The dentist called the DDU helpline and sought our assistance. We instructed an independent expert to review the records. The expert's opinion was that our member should have been aware that the extraction of UR8 might prove to be difficult, as a radiograph taken at the time showed the tooth to have long, curved roots.

This radiograph also confirmed that UR7 had previously undergone root canal treatment and restoration with a crown. The radiograph indicated restorative core material apical to the crown margins, and that the tooth was quite narrow at its circumference at gum level.

Although the crown on UR7 appeared to create an adequate ferrule effect around the neck of the prepared tooth, the expert stated that the DDU member should have been aware of the fragile nature of the tooth, and of the risk of fracturing that tooth if leverage was applied to it.

...the expert stated that the DDU member should have been aware of the fragile nature of the tooth, and of the risk of fracturing that tooth if leverage was applied to it.

Our member confirmed she had used a Cryer's elevator to complete the extraction of UR8. This instrument is used to apply leverage to the tooth being extracted but also requires counter leverage at the same time. The independent expert confirmed that it is common practice for the adjacent tooth to be used to provide that counter leverage.

The expert commented that if UR8 did not show signs of movement very soon after reasonable pressure was exerted on it by the elevator being used, our member should have re-considered the approach to the extraction using different instruments, or, if required, considered a surgical approach.

The outcome

In view of the fragile nature of UR7, and our member's account of the extraction technique employed, the independent expert was of the opinion that our member was in breach of her duty of care by putting too much leverage on that tooth during the extraction of UR8.

The patient sought over £5,000 in damages, around half of which was for pain and suffering and future loss of UR7. Some £3,000 was claimed for root canal treatment, crown-lengthening and a post-retained crown at UR7, as well as travel expenses.

With our member's consent, the DDU settled the claim for £3,000 in full, having successfully argued that the costs claimed for remedial treatment were over-inflated. The patient's legal costs were claimed at nearly £13,000 but thanks to the DDU's persistent negotiations these were finally settled for just over £9,000.

This guidance was correct at publication 16/07/2018. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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