The scene
The member noted that the post within the UL1 crown was short and that it appeared, from the radiograph, to diverge from the path of the UL1 root canal.
The patient's porcelain jacket crown at UL1 gradually deteriorated and seven years later the member applied for Dental Practice Board approval to replace this crown utilising the existing post. The member advised the patient that, while the post was shorter than ideal and apparently diverged from the path of the root canal, it had retained the previous crown effectively over a number of years. The member advised that an alternative option would be to remove and replace the existing post and core at UL1 which, particularly in view of the apparent deviation of the post from the path of the root canal, posed a significant risk of root fracture.
The new bonded porcelain crown provided at that time suffered several de-cementations. On each occasion, the member discussed with the patient the benefits and risks of re-preparing the post space in order to provide a longer, parallel sided post which would provide better retention for the overlying crown. Four years later, the patient requested the member to proceed with removal of the UL1 post in order to provide a new post to support the crown at this tooth.
The member removed the post, but was unable to locate and access the root canal. He therefore referred the patient to a local dental hospital for further advice and/or treatment. After treatment at the dental hospital to locate and deepen the post hole, the patient re-attended the member complaining of tenderness at UL1. Investigation of the tooth revealed the root had fractured, and the tooth was subsequently extracted.
A letter of claim was later sent to the member from the claimant's solicitors alleging that the member's attempted removal of the UL1 post had created a perforation in this tooth, resulting in its subsequent fracture.
The outcome
The solicitors claimed that a radiograph taken before the member referred the patient to the dental hospital showed the member had created a non-centralised post hole at UL1. A DDU dental adviser's opinion was that comparison of all available radiographs of UL1 confirmed the divergence of the post hole at UL1 prior to the member's treatment of this tooth.
The solicitors further claimed that an area of radiolucency within the UL1 root on a radiograph taken by the dental hospital indicated excessive removal of root tissue during the member's attempt to extract the existing UL1 post. The dental adviser considered that, since this area of radiolucency did not appear on any subsequent radiographs taken at the dental hospital, on the balance of probabilities, this was a radiographic anomaly.
The dental adviser also confirmed there was no evidence in the clinical records from the dental hospital that the member had removed additional root tissue during the attempted removal of the post. These records noted that the post space preparation, while appearing to follow the long axis of UL1 root, actually deviated significantly towards the palatal aspect of this tooth. By overlaying the radiographs taken before and after the member's removal of the post from the patient's UL1, it was possible to demonstrate that the pre-existing post had been removed with no additional enlargement of the post hole.
On the basis of the radiographic evidence, the DDU's view was that, on the balance of probabilities, the patient had suffered the unfortunate root fracture of UL1 following the removal of the existing post and core by the member and thereafter the further preparation of UL1 root canal at the dental hospital. It was noted that the clinical record from the dental hospital contained a warning to the patient of the poor prognosis of UL1 before further preparation of UL1 root canal.
The DDU responded to the solicitors in the above terms, strongly denying that the member's treatment had caused the claimed loss and replacement of the patient's UL1. Shortly after the letter of response was served, the solicitors advised that they had been instructed to discontinue their claim against the member.
This page was correct at publication on 22/12/2010. 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.