Sometimes risk is not always obvious and can come from an unexpected quarter. For example, involvement in dental implant treatment is sometimes a surprising risk to dentists.

Many dentists in Ireland provide treatment involving dental implants. Some place the implants themselves, some do the subsequent restoration work, whilst others carry out both. The increasing availability and popularity of implant treatment is most likely down to the impressive results produced, which in turn creates happy patients.

As with any clinical procedure, success will depend upon:

•  careful assessment and planning

•  effective technique

•  ensuring the aim and result achieved is matched to patient expectation.

In the vast majority of cases, treatment is successfully delivered and both patient and dentist are satisfied with the result. However, in particular, the ‘disappointment gap’ can be a powerful driver of patient complaints, especially when high costs are involved. However, these factors apply to all forms of dental care and are not unique to implant treatment. 

Why does implant treatment have more dentolegal risk?

There are some specific factors found in claims arising from implant treatment not found as often in other forms of treatment. These mean that dentists who are involved in implant treatment may find themselves at greater risk of being involved in compensation claims and these often have high costs.

Remedial treatment

If implants fail there can be a need to remove and replace them, carry out bone grafting and provide replacement restorations. The costs of this treatment can quickly escalate. When the time commitment and the inevitable patient inconvenience are also included the cost is often disproportionately high.

Multiple dentists

Dividing the process of placing and restoring implants between two or more clinicians has the benefit of allowing each member of the team to play to their strengths. However, when there is an issue with the final outcome it is often not clear where the responsibility lies. For example, has the restoration been compromised by the implant or has the implant been compromised by the restoration? Who is responsible for the choice of implant location?  

Claimant solicitors will look for any issues and will exploit any apparent weaknesses in all parts of the treatment. This can result in all of the dentists involved in the patient’s care becoming parties in the legal claim.

Chronic pain

A patient left with chronic pain can generate significant expense in legal claims.

Neuropathic orofacial pain presents with persistent and severe pain with no clearly identifiable clinical cause. This is an outcome that can arise in virtually any case, even with an experienced practitioner providing treatment with no technical fault. The issue is simply that following treatment the patient develops persistent intractable pain. Literature is scarce around the prevalence of 'neuropathic pain' or altered sensation following dental implant treatment, but it does feature in legal claims.

It is inevitable that a legal claim involving chronic pain, especially including allegations of ‘psychological effects’, will involve high claims for damages. Additionally, the legal environment in Ireland means the level of awards for damages can be considerably higher than in other jurisdictions, which also encourages claims.

What can be done to avoid the dentolegal risk of implant treatment?

Obtaining valid consent is essential. In accordance with the principles set out in Geoghegan v Harris, the patient must be made aware of material risks to ensure that there are no unpleasant surprises should the treatment not achieve the ideal outcome.¹ For example, the patient should be aware that pain can develop following implant treatment, which is not necessarily due to any fault with the treatment. Although there will be no problem with the vast majority of cases, both clinicians and patients need to be of aware of the fact that problems can arise.  

The consent process should be robust for all stages of treatment and clearly documented. Clear records may not prevent implant problems arising but should a claim arise they are of great value for defending a dentist’s position, particularly to demonstrate that valid consent was obtained. 

Reference

¹ Geoghegan v. Harris [2000] IEHC 129; [2000] 3 IR 536