Restoration story

The scene

A periapical radiograph of this tooth showed it to have been previously rootfilled with an insufficient root filling, although the tooth was symptomless. The intended crown at UR6 was provided.

The patient returned four months later having lost the crown at UR6. The dentist noted the tooth was decayed and prepared it for a new crown. Following two missed appointments, the patient returned after five months when the replacement crown at UR6 was fitted.

Over the course of the following 12 months, the patient attended complaining of pain in the upper left quadrant and received a prescription for antibiotics. He later attended an examination when it was recorded UL67 and LL6 were sensitive. One month later the patient returned as UL7 had fractured. This tooth was root-treated and a post crown provided.

A year later the patient returned in some pain. LL5 was confirmed to be the source and the tooth was root-treated. Following this treatment, the patient reported left-sided facial swelling and bruising, together with episodes of tingling and numbness. He sought a second opinion at a different dental practice and was advised that repeat root canal treatment and crown replacement were required at LL56 and UL7.

The patient later instructed solicitors and a letter of claim was served, including allegations in respect of the member's provision of a crown at UR6 without consideration of the need for repeat root canal treatment (RCT), failure to use reasonable skill and care in the provision of RCT at UL7, and failure to exercise reasonable skill and care in the provision of RCT at LL5, including the extrusion of sodium hypochlorite into periapical tissues. A claim of several thousand pounds was brought against the first dentist, for avoidable pain and suffering and the requirement for further remedial treatment as identified by the second dentist.

The outcome

The DDU claims handler obtained a copy of the clinical records for the treatment the patient had received. An expert in oral and maxillofacial surgery examined the patient and, based on the evidence provided by the patient during the examination, the expert was firmly of the opinion that the patient's temporary symptoms of nerve injury had been caused by needle trauma during the administration of local anaesthesia for the root canal treatment at LL5, and not as a result of instrumentation of the root canal, or extrusion of sodium hypochlorite root canal irrigant through the apex during this treatment.

The clinical records and member's report were also considered by an expert in general dental practice. With regard to the member's RCT at LL5, the expert identified no breaches of duty, and was of the opinion that this treatment was of an acceptable standard, given the marked distal curvature of the apical third of the root, which had precluded obturation of the root canal beyond 3mm of the radiographic apex.

With regard to the member's RCT at UL7, the expert confirmed that, while the dentist stated in his report that obturation of the mesial root canal of UL7 could not be completed due to the canal being sclerosed, there was no note of this in the clinical records or that the patient was advised accordingly.

With regard to UR6, the expert stated that while the patient never complained of pain at UR6, the radiograph taken at the first examination showed evidence of chronic apical periodontitis.

With consent from the member, the DDU sent a letter of response denying liability and stating that there was no evidence the root canal treatment at LL5 was below an acceptable standard. A detailed account of the findings of the expert's examination of the patient was provided and the allegation of nerve injury denied. A small offer of £1,500 compensation was made, and subsequently accepted, for a contribution towards the cost of repeat RCT UL7 in the future, and new crowns at UL7 and UR6.

This page was correct at publication on 21/12/2010. Any guidance 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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