Root Canal Irrigants and Medicaments in Endodontic Malpractice Cases: A Nationwide Longitudinal Observation.

INTRODUCTION: The aim of this study was to assess the role of root canal irrigants and medicaments in endodontic injuries verified in Finland and to estimate the rate of such events over time. METHODS: The study material comprised all endodontic injuries verified by the Patient Insurance Centre in 2002 to 2006 (n = 521) and 2011 to 2013 (n = 449). The data, based on patient documents scrutinized by 2 specialists in endodontics, included patients' and dentists' sex and age and the service sector. We recorded the use of root canal irrigants and medicaments, each as a dichotomy. Furthermore, we dichotomized the injuries as those related to root canal irrigants/medicaments and any other injuries. The injuries were also dichotomized as avoidable (could have been avoided by following good clinical practice) or unavoidable (normal treatment-related risks). Statistical evaluation used chi-square tests and t tests; logistic regression produced odds ratios (ORs). RESULTS: The verified injuries (N = 970) comprised 635 (65%) avoidable and 335 (35%) unavoidable injuries. The number of irrigant-/medicament-related injuries was 69, accounting for 7.1% of all verified injuries; all resulted from sodium hypochlorite and calcium hydroxide, and 87% were avoidable. The overall rate of sodium hypochlorite/calcium hydroxide injuries was 4.3 cases per 100,000 endodontic patients per year. Compared with other injuries, sodium hypochlorite/calcium hydroxide injuries were more likely avoidable (OR = 3.8) and more than 5-fold likely in 2011 to 2013 than in 2002 to 2006 (OR = 5.6). CONCLUSIONS: Extreme care is needed when applying sodium hypochlorite and calcium hydroxide into root canals to avoid increasing harmful consequences.

Endodontic Risk Management: A Dento-Legal Perspective.

This article provides an overview of some of the issues in the assessment and management of endodontic patients which may lead to dento-legal problems. It covers assessment, the appropriate use of radiographs, special tests and the importance of following the correct consent process. It outlines why record-keeping is particularly important, and looks at problems that occur, such as perforation, fractured instruments and hypochlorite accidents.

[Medicolegal aspects of iatrogenic root perforations].

AIM: To retrospectively analyze the medico-legal aspects of iatrogenic root perforations (IRP) that occurred during endodontic treatments. METHODOLOGY: A comprehensive search in a professional liability insurance database was conducted to retrospectively identify cases of IRP following root canal treatments (RCTs). The complaints were categorized as either financial risk bearing or financial nonrisk bearing, and related demographic and endodontic variables were analyzed. RESULTS: One hundred and twenty cases of patients with IRP were identified. Twenty six cases (22%) were elective RCTs, and 94 cases (78%) were endodontic treatments performed due to pathologic processes (p < 0.05). Sixty cases (50%) were identified in mandibular molars, significantly more than other tooth locations (P < 0.05). In 102 cases (85%) the outcome was extraction, and in 18 cases (15%) the outcome was an additional treatment (p < 0.05). For both the cases with outcome of extraction and for the cases with an additional treatment, the complaints were judged as financial risk bearing in 95% of the cases. CONCLUSIONS: latrogenic root perforation is a complication of root canal treatment and may result in tooth extraction and in legal actions against the treating practitioner. Mandibular molars are more prone to medico-legal claims related to root perforations. The patient should be informed of the risks during RCT and should get information on alternative treatments and their risks and prognosis

Trends in endodontic claims in Italy.

According to the scant data available in the literature, endodontic claims are common among dental professional liability cases and the second most common type of claim. This study aimed to describe the characteristics of endodontic claims in Italy and the most frequently disputed errors, and the discussion below includes consideration of ethical and medico-legal aspects thereof. We retrospectively analysed 120 technical reports written on cases of professional malpractice in endodontics in the last 5 years. The complainant patients were males in 22.5% of the cases, while females made up the remaining 77.5%. In the dentist sample, male operators were more often involved in litigation cases (80%) than female operators. The most frequently claimed technical errors were: lack of a complete filling of root canal/s (71.7%), the perforation of tooth structure (12.7%), extrusion of sealing materials beyond the apex of the tooth (9.6%) and the fracture of an endodontic instrument (5.9%). In 1.7% of cases it was found that the expert did not make any errors performing the endodontic therapy. In only very few cases (2.7%) no therapy was considered necessary, while the most common therapeutic solution involved in endodontic misconduct was tooth extraction (53.0%). In many cases the dentist preferred to extract the endodontically undertreated tooth and substitute it prosthetically rather than trying to re-treat it. The discrepancy between the total number of cases examined and those that eventually go to court leads us to believe that the majority of endodontic malpractice cases are resolved in out-of-court settlements.

La endodoncia en los tribunales españoles. Estudio de la jurisprudencia entre los años1990 a 2010 / Endodontics in the Spanish Courts. Study of case law from 1990 to 2010

La práctica profesional del odontólogo está actualmente ligada a las leyes que se dictany que pueden condicionar las consecuencias de sus actos clínicos. Los tribunales españoles aplican una doctrina que encuadra la actuación del odontólogo en relación al tratamiento que realiza al paciente en dos tipos de contrato: el que exige una obligación de resultados y el que supone obligación de medios. Ambos tipos han sido aplicados por los tribunales españoles para valorar la procedencia o no de condenar los actos odontológicos que se realizan. En este estudio se analizan las sentencias de los tribunales españoles de los últimos 10 años relacionadas con la endodoncia y la aplicación que la doctrina que de ellas se desprende puede tener en la práctica diaria en endodoncia del odontólogo (AU)

The practice of professional dentistry is currently governed by laws that can condition and dictate the consequences of clinical procedures. The Spanish courts apply a doctrine that treats dentistry according to the treatment carried out on the patient, using two types of contract: the first involves an obligation based on results and the second an obligation based on resources. Both types of contract have been applied in Spanish courts to assess the legitimacy of litigation againstdental procedures carried out. This study examinesthe rulings handed down by the Spanish courts over the past ten years relating to endodontics,looking at how the doctrine derived from those rulings might be applied by dentists to the everyday practice of endodontics (AU)

Risk management in clinical practice. Part 4. Endodontics.

Endodontic procedures are challenging and technically demanding. In the UK standards of treatment have been shown to have fallen short of acceptable guidelines, laying many dentists open to litigation on questions of clinical negligence by patients who understand and know what should be considered as current best practice in this area. Failure to communicate with patients about the procedure and not obtaining consent for treatment is a key area of complaint, as is inadequate record keeping. When treatment is undertaken within the framework of accepted guidelines it would be very difficult for a patient to open a claim for clinical negligence should a failure occur. This article looks at potential dento-legal problems in endodontics and how, through compliance with best practice, they may be avoided.

Risk management in endodontics.

INTRODUCTION: Endodontic claims are the most frequently filed malpractice claims in dentistry. The aim of this study was to categorize and review errors and complications related to endodontic procedures that resulted in legal actions against the treating practitioner. METHODS: All dental malpractice complaints reported to the Medical Consultants International Company (MCI) in Israel between the years 1992-2008 were retrospectively analyzed according to a structured form. All complaints were categorized as either financial risk bearing (eg, justified) or financial non-risk bearing (eg, nonjustified). The treatment errors that were found in the files were categorized according to phases of treatment: preoperative, intraoperative, and postoperative errors. RESULTS: A total of 720 complaints were analyzed including 520 complaints (72.2%) that were found to be justified and 200 complaints (27.8%) that were judged as not justified. Most of the treatment errors occurred during the intraoperative phase. In lower anterior teeth and in cases involving more than 1 tooth, significantly more errors were found during instrumentation and root canal filling (P < .05). There was a similar distribution of operator errors and of negative outcomes for teeth with elective endodontic treatment and teeth with endodontic treatment as a result of a pathologic process. CONCLUSIONS: The technical skills of the dental practitioners performing root canal treatments require improvement. All possible risks and complications should be considered and explained to the patient before treatment.

Endodontic malpractice claims in Denmark 1995-2004.

AIM: To study the reasons for and outcome of malpractice claims handled by the regional and national Danish Dental Complaint Boards (DCB) from 1995 to 2004. Specific attention was paid to endodontic claims. Three hypotheses were explored: endodontic malpractice claims are frequent, they are mostly due to technical shortcomings and male dentists are overrepresented. METHODOLOGY: The reasons for the claims were classified and assigned to at least one of 14 categories. Cases assigned to the 'endodontic treatment' category were further sub-categorized, and reasons for malpractice were examined. An age and gender analysis of dentists and complaining patients was performed only on data obtained from the endodontic cases. RESULTS: Overall, 3611 malpractice claims were registered. In 43% of the cases the dentist was judged to be guilty of malpractice. In the majority of the appealed cases the original verdict was affirmed (62.2%) by the national DCB. After crown & bridge treatment (23%) endodontic treatment was the next frequent malpractice claim (13.7%), in which 'technical complications or incorrect treatment' was the most frequent sub-categorization (28.4%). Reasons for endodontic malpractice verdicts were related to root filling quality, the use of a paraformaldehyde product and instrument fracture. Male dentists were most often involved in an endodontic claim, and the majority of complainants were females. CONCLUSIONS: Endodontic malpractice claims were relatively common in Denmark. Perceived technical shortcomings dominated the patients' complaints concerning root canal treatment. Male dentists and female patients were overrepresented indicating a gender influence on aspects of the doctor-patient communication important for liability claims.

Current practice in endodontics.

The aim of this series of six articles is to improve the quality of endodontic treatment in general dental practice by considering what is currently being taught in dental schools. This first article considers the rationale behind endodontic treatment, what we are aiming to achieve and why. It looks at the dental and medico-legal issues which dictate the standards of our practice, and sets out the programme for the series.

Endodontics--the expert opinion. What you should know before you need one.

The expert opinion is a valuable tool in the defence of a practitioner facing legal action. Even the most prudent and careful practitioner may face a situation where legal action is threatened or is a reality. In order to minimize the repercussions, the dentist would be prudent to perform treatment where indicated, do so using generally accepted techniques and biologically acceptable materials and, most importantly, maintain an accurate clinical record. This will enable practitioners to better defend their actions should difficulties arise. Then the dentist's legal advisors and experts will be in a better position to defend the dentist should legal action be initiated.