A 50-year old male patient attended his dentist for extraction of his UL6 retained root, and replacement with an implant retained crown. Unfortunately, during the course of the treatment, the implant penetrated the sinus lining, causing blood loss from the nose. It was alleged that to retrieve the implant, further drilling was required to the bone in the upper jaw. A second implant was then placed.
Three months later, the dentist fitted an abutment to the implant and a crown was also cemented. The crown subsequently fractured, and the patient returned to the practice when attempts were made to remove the implant by a different dentist, who found that the implant had integrated and could not be removed. Following a CT scan it was possible to ascertain that the implant was not completely surrounded by bone, and there was insufficient space to restore it. The implant was subsequently removed.
The patient instructed solicitors to pursue a claim against the first dentist for incorrect placement of the implant at UL6 towards the UL7, and for piercing the sinus floor during either the implant placement, or during removal of the misplaced implant.
The independent expert instructed by the DDU was of the opinion that based on the available radiography, there had been a high risk of perforating the maxillary antrum at the time of implant placement, as the pre-extraction radiographs indicated the roots of UL6 were in close proximity or through the floor of the antrum.
Whilst the loss of the first implant fixture into the antrum appears to have been an unfortunate incident, the dentist may have been vulnerable to criticism in that more care should have been taken thereafter.
The expert also found the outcome would have been more predictable if, at the time of the loss of the first implant, the socket had been packed with a substance to promote healing and bone growth, such as a demineralised bone matrix, and the second implant then placed after the appropriate healing period.
Finally, due to the proximity of the implant fixture to the UL7, it would have been very difficult to place an all-ceramic crown on a standard abutment, because the crown would have been too thin at its distal aspect. An alternative solution might have been a screw retained porcelain fused to metal crown fitted directly to the implant.
On receipt of evidence from an independent expert instructed by the DDU a letter of response was served, with the DDU member's consent, offering £3,500 compensation to cover the cost of an implant retained crown and its removal plus £1,000 for any discomfort and inconvenience caused.
This offer was rejected. The claimant's solicitors counter-offered with a detailed schedule of loss totalling over £30,000, which included sums for lost earnings and future treatment costs. On further negotiation, however, the claim was finally settled for £7,000 plus £19,000 legal costs.
Samuel Hedges BSc (Hons)
Lead claims handler
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