Medicolegal implications of dental implant therapy

Despite the recent economic downturn, the dental implant market continues to grow year on year. Many more dentists are involved in the placement restoration of dental implants and dental implants are being placed in an extended range of clinical scenarios. Dental implant therapy remains a high risk area for the inexperienced interns of civil negligence claims and General Dental Council hearings. Risk can be mitigated by:• Ensuring appropriate indemnity • Complying with the published requirements for training • Maintaining detailed and extensive clinical records • Completing the initial phases of history, examination and investigations robustly • Recording a diagnosis • Providing a bespoke written treatment plan that includes details of the need for treatment, the treatment options (the risks and benefits), the phases of treatment, the costs of treatment,the expected normal sequelae of surgery, the risks and complications of implant therapy and the requirement for future maintenance. The provision of treatment that is different in nature or extent to that agreed can result in a breach of contract as well as a claim for negligence • Engaging sufficiently with the patient to obtain consent • Providing written postoperative instructions detailing emergency arrangements, patients who are anxious or in pain may not retain oral information • Making a frank disclosure of complication or collateral damage • Considering referral at an early stage particularly if reparative surgery is required. The stress of complications or failure may impair a dentist's normally sound judgement; there may be financial pressure, or concerns regarding reputation. In some cases, dentists avoid making a frank disclosure, feel obliged to undertake complicated reparative surgery, fail to make a timely referral, fail to respond appropriately to patient's concerns and in some cases attempt to alter the clinical records.However, in the best of hands and without negligence complications can and do occur. Complications that occur in the presence of good planning and communication and are managed appropriately do not amount to negligence, and are unlikely to lead to a successful claim.