Fractured crown

The DDU was able to successfully defend a member who faced a claim alleging a failure to identify and treat caries and fit a satisfactory crown, resulting in crown fracture, infection and tooth extraction.

The scene

A DDU general dental practitioner (GDP) placed a glass-ionomer core on a patient's UL3 prior to the preparation of a crown that was fitted three weeks later.

Radiographs taken in the following years showed an area of radiolucency underneath the distal margin of the crown, the size of which was unchanged during this period. The crown fractured over four years later and the patient underwent restorative work.

The claim

The patient alleged a failure to identify and treat caries and fit a satisfactory crown, resulting in crown fracture, infection and tooth extraction. The patient claimed compensation for pain and discomfort plus the costs of prosthodontic tooth replacement, with an expert stating on the patient's behalf that they believed the UL3 fractured due to untreated caries.

The member turned to the DDU for advice and support in handling the allegation. In response, the DDU obtained its own independent expert evidence, which was supportive of our member and stated that radiographs showed a horizontal fracture caused by trauma. Faced with a difference in opinion, both parties jointly instructed a dental and maxillofacial radiologist expert to interpret the radiographs, in order to determine the cause of UL3 damage.

This expert concluded that the obvious fracture line of UL3 was consistent with some displacement of the coronal part of the tooth. They saw no evidence from the imaging to support that the fracture was due to poor marginal fit of the crown or presence of residual caries. In their opinion, it was the UL3 fracture that was the likely cause of the loss of the crown.

Given this was joint evidence, the patient had little choice but to accept the expert's opinion, and at the DDU's invitation discontinued their claim.

The outcome

As this case shows, there can be differences of opinion between independent experts, and in cases where interpretation of radiology is disputed, a dental radiologist's evidence may prove useful. This case also demonstrates how radiographs taken as part of a patient's treatment can also be useful in the defence of a claim.

Given the length of time between when the UL3 crown was fitted and when it became loose (a period of over four years), it was unreasonable to suggest that the looseness was as a result of any negligence on behalf of the member.

However, if clinically justified radiographs had not been taken during this time, the claim would have been difficult to defend.

This guidance was correct at publication 17/09/2019. 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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