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CC BY-NC-ND 4.0 · Eur J Dent 2019; 13(03): 450-458
DOI: 10.1055/s-0039-1700767
Review Article
Dental Investigation Society

Aspects of Clinical Malpractice in Endodontics

Mothanna Alrahabi
1   Department of Restorative Dentistry, College of Dentistry, Taibah University, Madinah Munnawara, Saudi Arabia
,
Muhammad Sohail Zafar
1   Department of Restorative Dentistry, College of Dentistry, Taibah University, Madinah Munnawara, Saudi Arabia
2   Department of Dental Materials, Islamic International Dental College, Riphah International University, Islamabad, Pakistan
,
Necdet Adanir
3   Department of Restorative Dentistry, College of Dentistry, King Faisal University, Al Ahsa, Saudi Arabia
› Author Affiliations
Further Information

Publication History

Publication Date:
03 December 2019 (online)

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Abstract

The clinical dentistry and endodontic procedures involve very technique-sensitive procedures, therefore exposing the operator to risks of causes not only damage to patients but also leads to malpractice. Among various disciplines of dentistry, endodontics-related cases witness the most frequently filed malpractice claims. This is due to the fact that the endodontic treatment procedures involve operative and surgical procedures, using a variety of medicaments and techniques. The endodontic procedural errors can be preoperative errors (such as incorrect diagnosis and misinterpretation), intraoperative errors including root canal and pulp chamber perforations, ledge formation leading to apical transportation or zipping, hypochlorite accidents, and fracture of instruments. More critically, failure to use rubber dam may result in inhalation or ingestion of endodontic instruments. Under such circumstances, the endodontist may have to face legal consequences. Due to the increased healthcare load and patients’ awareness, it is important to know the legal ramifications of adverse effects, failed restorations, or other complications, to avoid any legal ramifications of endodontic procedures and associated techniques. Therefore, precautions must be taken to prevent any postsurgical complications, patient complaints, and/or failures. For this purpose, the operator must consider ethical principles and adhere strictly to the standards of healthcare while performing the diagnosis and treatment. A referral toward a specialist or consultant endodontist is always an appreciable option and should be considered in the best interest of the patient. The aim of the article is to highlight various aspects of malpractice in clinical endodontics, and associated materials and challenges. In addition, commonly occurring operating errors during endodontic treatment, possible consequences, precautions, and management have been discussed.

Keywords

complications - dentistry - ethics - medicolegal aspects - root canal treatment
 

  • References

  • 1 Bal BS. An introduction to medical malpractice in the United States. Clin Orthop Relat Res 2009; 467 (02) 339-347
    CrossrefPubMedGoogle Scholar
  • 2 Manca R, Bruti V, Napoletano S, Marinelli E. A 15 years survey for dental malpractice claims in Rome, Italy. J Forensic Leg Med 2018; 58: 74-77
    CrossrefPubMedGoogle Scholar
  • 3 Conrad DA, Whitney C, Milgrom P. et al. Malpractice premiums in 1992: results of a national survey of dentists. J Am Dent Assoc 1995; 126 (07) 1045-1056
    CrossrefPubMedGoogle Scholar
  • 4 Ventä I, Lindqvist C, Ylipaavalniemi P. Malpractice claims for permanent nerve injuries related to third molar removals. Acta Odontol Scand 1998; 56 (04) 193-196
    CrossrefPubMedGoogle Scholar
  • 5 Ozdemir MH, Saracoglu A, Ozdemir AU, Ergonen AT. Dental malpractice cases in Turkey during 1991-2000. J Clin Forensic Med 2005; 12 (03) 137-142
    CrossrefPubMedGoogle Scholar
  • 6 Özdemir MH, Salaçin S, Ergönen A. The patients’ rights statutes and the physicians’ sensitivities. Turk Klin Tip Etigi Hukuku Tarihi 2000; 8 (01) 3237
    Google Scholar
  • 7 Webber J. Risk management in clinical practice. part 4. endodontics. Br Dent J 2010; 209 (04) 161-170
    CrossrefPubMedGoogle Scholar
  • 8 Selbst AG. Understanding informed consent and its relationship to the incidence of adverse treatment events in conventional endodontic therapy. J Endod 1990; 16 (08) 387-390
    CrossrefPubMedGoogle Scholar
  • 9 René N, Owall B. Dental malpractice in Sweden. J Law Ethics Dent 1991; 4: 16-31
    PubMedGoogle Scholar
  • 10 Hapcook Sr CP. Dental malpractice claims: percentages and procedures. J Am Dent Assoc 2006; 137 (10) 1444-1445
    CrossrefPubMedGoogle Scholar
  • 11 Pinchi V, Pradella F, Gasparetto L, Norelli GA. Trends in endodontic claims in Italy. Int Dent J 2013; 63 (01) 43-48
    CrossrefPubMedGoogle Scholar
  • 12 Brown E. Dental Services: Use, Expenses, And Sources Of Payment, 1996–2000. Rockville, MD: Agency for Healthcare Research and Quality, Public Health Service, US Department of Health and Human Services 2004
  • 13 Swanljung O, Vehkalahti MM. Root canal irrigants and medicaments in endodontic malpractice cases: a nationwide longitudinal observation. J Endod 2018; 44 (04) 559-564
    CrossrefPubMedGoogle Scholar
  • 14 Cohen S, Schwartz S. Endodontic complications and the law. J Endod 1987; 13 (04) 191-197
    CrossrefPubMedGoogle Scholar
  • 15 Givol N, Rosen E, Taicher S, Tsesis I. Risk management in endodontics. J Endod 2010; 36 (06) 982-984
    CrossrefPubMedGoogle Scholar
  • 16 Bjørndal L, Reit C. Endodontic malpractice claims in Denmark 1995-2004. Int Endod J 2008; 41 (12) 1059-1065
    CrossrefPubMedGoogle Scholar
  • 17 Seidberg BH. Ethics, morals, the law and en dodont ics.. In: Ingle JI, Bakland LK, Baumgartner JC. eds. Ingle’s Endodontics. USA: PMPH; 2008: 86-114
    Google Scholar
  • 18 Zanin AA, Herrera LM, Melani RF. Civil liability: characterization of the demand for lawsuits against dentists. Braz Oral Res 2016; 30 (01) 1-8
    Google Scholar
  • 19 American Association of Endodontists. The standard of practice in contemporary endodontics. Endodontics: Colleagues for Excellence. Fall 2014; :: 2-11
    Google Scholar
  • 20 Kersten DD, Mines P, Sweet M. Use of the microscope in endodontics: results of a questionnaire. J Endod 2008; 34 (07) 804-807
    CrossrefPubMedGoogle Scholar
  • 21 Creasy JE, Mines P, Sweet M. Surgical trends among endodontists: the results of a web-based survey. J Endod 2009; 35 (01) 30-34
    CrossrefPubMedGoogle Scholar
  • 22 Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review–Part I: chemical, physical, and antibacterial properties. J Endod 2010; 36 (01) 16-27
    CrossrefPubMedGoogle Scholar
  • 23 Arkes HR, Schipani CA. Medical Malpractice v. the Business Judgement Rule: Differences in Hindsight Bias. OregonLaw Rev 1994; 73: 587-638
    Google Scholar
  • 24 Vehkalahti MM, Swanljung O. Operator-related aspects in endodontic malpractice claims in Finland. Acta Odontol Scand 2017; 75 (03) 155-160
    CrossrefPubMedGoogle Scholar
  • 25 Daokar S, Kalekar A. Endodontic failures-a review. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) 2013; 4 (05) 5-10
    CrossrefGoogle Scholar
  • 26 Barnes JJ, Patel S. Contemporary endodontics - part 1. Br Dent J 2011; 211 (10) 463-468
    CrossrefPubMedGoogle Scholar
  • 27 Ahmad IA. Rubber dam usage for endodontic treatment: a review. Int Endod J 2009; 42 (11) 963-972
    CrossrefPubMedGoogle Scholar
  • 28 Huggins DR. The rubber dam–an insurance policy against litigation. J Indiana Dent Assoc 1986; 65 (03) 23-24
    PubMedGoogle Scholar
  • 29 Taintor JF, Biesterfeld RC. A swallowed endodontic file: case report. J Endod 1978; 4 (08) 254-255
    CrossrefPubMedGoogle Scholar
  • 30 Forrest WR, Perez RS. AIDS and hepatitis prevention: the role of the rubber dam. Oper Dent 1986; 11 (04) 159159
    Google Scholar
  • 31 Wong RC. The rubber dam as a means of infection control in an era of AIDS and hepatitis. J Indiana Dent Assoc 1988; 67 (01) 41-43
    PubMedGoogle Scholar
  • 32 Miller RL, Micik RE. Air pollution and its control in the dental office. Dent Clin North Am 1978; 22 (03) 453-476
    PubMedGoogle Scholar
  • 33 Madarati A, Abid S, Tamimi F. et al. Dental-dam for infection control and patient safety during clinical endodontic treatment: preferences of dental patients. Int J Environ Res Public Health 2018; 15 (09) 2012
    CrossrefPubMedGoogle Scholar
  • 34 Anabtawi MF, Gilbert GH, Bauer MR. et al. National Dental Practice-Based Research Network Collaborative Group. Rubber dam use during root canal treatment: findings from The Dental Practice-Based Research Network. J Am Dent Assoc 2013; 144 (02) 179-186
    CrossrefPubMedGoogle Scholar
  • 35 Kvinnsland I, Oswald RJ, Halse A, Grønningsaeter AG. A clinical and roentgenological study of 55 cases of root perforation. Int Endod J 1989; 22 (02) 75-84
    CrossrefPubMedGoogle Scholar
  • 36 Nicholls E. Treatment of traumatic perforations of the pulp cavity. Oral Surg Oral Med Oral Pathol 1962; 15 (05) 603-612
    CrossrefPubMedGoogle Scholar
  • 37 Syed A, Fahad S, Abu Bakar S. et al. Frequency of Procedural Errors during Root Canal Treatment Performed by Interns. Br Biotechnol J 2016; 12 (01) 1-8
    Google Scholar
  • 38 Abou-Rass M, Frank AL, Glick DH. The anticurvature filing method to prepare the curved root canal. J Am Dent Assoc 1980; 101 (05) 792-794
    CrossrefPubMedGoogle Scholar
  • 39 Eleftheriadis GI, Lambrianidis TP. Technical quality of root canal treatment and detection of iatrogenic errors in an undergraduate dental clinic. Int Endod J 2005; 38 (10) 725-734
    CrossrefPubMedGoogle Scholar
  • 40 Ingle JI. A standardized endodontic technique utilizing newly designed instruments and filling materials. Oral Surg Oral Med Oral Pathol 1961; 14 (01) 83-91
    CrossrefPubMedGoogle Scholar
  • 41 Deutsch AS, Musikant BL. Morphological measurements of anatomic landmarks in human maxillary and mandibular molar pulp chambers. J Endod 2004; 30 (06) 388-390
    CrossrefPubMedGoogle Scholar
  • 42 Alrahabi M, Sohail Zafar M. Evaluation of root canal morphology of maxillary molars using cone beam computed tomography. Pak J Med Sci 2015; 31 (02) 426-430
    PubMedGoogle Scholar
  • 43 Zafar MS, Alrahabi M. Cone beam computed tomography for exploring morphology of Mandibular first molar. Br J Med Med Res 2015; 6 (05) 514-521
    Google Scholar
  • 44 Moreinis SA. Avoiding perforation during endodontic access. J Am Dent Assoc 1979; 98 (05) 707-712
    CrossrefPubMedGoogle Scholar
  • 45 Jafarzadeh H, Abbott PV. Ledge formation: review of a great challenge in endodontics. J Endod 2007; 33 (10) 1155-1162
    CrossrefPubMedGoogle Scholar
  • 46 Nagy CD, Bartha K, Bernáth M, Verdes E, Szabó J. The effect of root canal morphology on canal shape following instrumentation using different techniques. Int Endod J 1997; 30 (02) 133-140
    CrossrefPubMedGoogle Scholar
  • 47 Kapalas A, Lambrianidis T. Factors associated with root canal ledging during instrumentation. Endod Dent Traumatol 2000; 16 (05) 229-231
    CrossrefPubMedGoogle Scholar
  • 48 Harty FJ, Parkins BJ, Wengraf AM. Success rate in root canal therapy. A retrospective study of conventional cases. Br Dent J 1970; 128 (02) 65-70
    CrossrefPubMedGoogle Scholar
  • 49 Alrahabi M, Zafar MS. Assessment of apical transportation caused by nickel-titanium rotary systems with full rotation and reciprocating movements using extracted teeth and resin blocks with simulated root canals: A comparative study. Niger J Clin Pract 2018; 21 (06) 772-777
    CrossrefPubMedGoogle Scholar
  • 50 Junaid A, Freire LG, da Silveira Bueno CE, Mello I, Cunha RS. Influence of single-file endodontics on apical transportation in curved root canals: an ex vivo micro-computed tomographic study. J Endod 2014; 40 (05) 717-720
    CrossrefPubMedGoogle Scholar
  • 51 López FU, Travessas JAC, Fachin E, Fontanella V, Grecca F. Apical transportation: two assessment methods. Aust Endod J 2009; 35 (02) 85-88
    CrossrefPubMedGoogle Scholar
  • 52 Stewart JT, Lafkowitz S, Appelbaum K, Hartwell G. Distortion and breakage of Liberator, EndoSequence, and ProFile systems in severely curved roots of molars. J Endod 2010; 36 (04) 729-731
    CrossrefPubMedGoogle Scholar
  • 53 Crane AB. A Practicable Root-Canal Technic. Philadelphia and New York: Lea & Febiger 1920
  • 54 Rizvi A, Zafar MS, Farid WM, Gazal G. Assessment of antimicrobial efficacy of MTAD, sodium hypochlorite, EDTA and chlorhexidine for endodontic applications: an in vitro study. Middle East J Sci Res 2014; 21 (02) 353-357
    Google Scholar
  • 55 Khurshid Z, Zafar M, Qasim S, Shahab S, Naseem M, AbuReqaiba A. Advances in Nanotechnology for Restorative Dentistry. Materials (Basel) 2015; 8 (02) 717-731
    CrossrefPubMedGoogle Scholar
  • 56 Johal S, Baumgartner JC, Marshall JG. Comparison of the antimicrobial efficacy of 1.3% NaOCl/BioPure MTAD to 5.25% NaOCl/15% EDTA for root canal irrigation. J Endod 2007; 33 (01) 48-51
    CrossrefPubMedGoogle Scholar
  • 57 Goldman LB, Goldman M, Kronman JH, Lin PS. The efficacy of several irrigating solutions for endodontics: a scanning electron microscopic study. Oral Surg Oral Med Oral Pathol 1981; 52 (02) 197-204
    CrossrefPubMedGoogle Scholar
  • 58 Madarati AA, Zafar MS, Sammani AMN, Mandorah AO, Bani-Younes HA. Preference and usage of intracanal medications during endodontic treatment. Saudi Med J 2017; 38 (07) 755-763
    CrossrefPubMedGoogle Scholar
  • 59 Spencer HR, Ike V, Brennan PA. Review: the use of sodium hypochlorite in endodontics–potential complications and their management. Br Dent J 2007; 202 (09) 555-559
    CrossrefPubMedGoogle Scholar
  • 60 Hülsmann M, Rödig T, Nordmeyer S. Complications during root canal irrigation. Endod Topics 2007; 16 (01) 27-63
    CrossrefGoogle Scholar
  • 61 Sharma S, Hackett R, Webb R, Macpherson D, Wilson A. Severe tissue necrosis following intra-arterial injection of endodontic calcium hydroxide: a case series. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105 (05) 666-669
    CrossrefPubMedGoogle Scholar
  • 62 Kishor N. Oral tissue complications during endodontic irrigation: literature review. N Y State Dent J 2013; 79 (03) 37-42
    PubMedGoogle Scholar
  • 63 Zhu WC, Gyamfi J, Niu LN. et al. Anatomy of sodium hypochlorite accidents involving facial ecchymosis - a review. J Dent 2013; 41 (11) 935-948
    CrossrefPubMedGoogle Scholar
  • 64 Hatton J, Walsh S, Wilson A. Management of the sodium hypochlorite accident: a rare but significant complication of root canal treatment. BMJ Case Rep 2015; 2015: bcr2014207480
    CrossrefPubMedGoogle Scholar
  • 65 Başer Can ED, Karapınar Kazandağ M, Kaptan RF. Inadvertent apical extrusion of sodium hypochlorite with evaluation by dental volumetric tomography. Case Rep Dent 2015; 2015 (247547) 247547
    PubMedGoogle Scholar
  • 66 Becker GL, Cohen S, Borer R. The sequelae of accidentally injecting sodium hypochlorite beyond the root apex. Report of a case. Oral Surg Oral Med Oral Pathol 1974; 38 (04) 633-638
    CrossrefPubMedGoogle Scholar
  • 67 Bowden JR, Ethunandan M, Brennan PA. Life-threatening airway obstruction secondary to hypochlorite extrusion during root canal treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101 (03) 402-404
    CrossrefPubMedGoogle Scholar
  • 68 Kavanagh CP, Taylor J. Inadvertent injection of sodium hypochlorite into the maxillary sinus. Br Dent J 1998; 185 (07) 336-337
    CrossrefPubMedGoogle Scholar
  • 69 Bradford CE, Eleazer PD, Downs KE, Scheetz JP. Apical pressures developed by needles for canal irrigation. J Endod 2002; 28 (04) 333-335
    CrossrefPubMedGoogle Scholar
  • 70 Kahn FH, Rosenberg PA, Gliksberg J. An in vitro evaluation of the irrigating characteristics of ultrasonic and subsonic handpieces and irrigating needles and probes. J Endod 1995; 21 (05) 277-280
    CrossrefPubMedGoogle Scholar
  • 71 Strindberg LZ. The Dependence Of The Results Of Pulp Therapy On Certain Factors: An Analytic Study Based On Radiographic And Clinical Follow-Up Examinations. Mau rit zon 1956
  • 72 Iqbal MK, Kohli MR, Kim JS. A retrospective clinical study of incidence of root canal instrument separation in an endodontics graduate program: a PennEndo database study. J Endod 2006; 32 (11) 1048-1052
    CrossrefPubMedGoogle Scholar
  • 73 Spili P, Parashos P, Messer HH. The impact of instrument fracture on outcome of endodontic treatment. J Endod 2005; 31 (12) 845-850
    CrossrefPubMedGoogle Scholar
  • 74 Parashos P, Messer HH. Rotary NiTi instrument fracture and its consequences. J Endod 2006; 32 (11) 1031-1043
    CrossrefPubMedGoogle Scholar
  • 75 Arens FC, Hoen MM, Steiman HR, Dietz Jr GC. Evaluation of single-use rotary nickel-titanium instruments. J Endod 2003; 29 (10) 664-666
    CrossrefPubMedGoogle Scholar
  • 76 Eikenberg SL. Comparison of the cutting efficiencies of electric motor and air turbine dental handpieces. Gen Dent 2001; 49 (02) 199-204
    PubMedGoogle Scholar
  • 77 Feil PH. A theory of motor performance and its applications to preclinical dental skill acquisition. J Dent Educ 1989; 53 (04) 226-232
    CrossrefPubMedGoogle Scholar
  • 78 Alrahabi M, Zafar MS, Ahmed N. Effects of handpiece speed on the performance of undergraduate dental students in preclinical training. Journal of Taibah University Medical Sciences 2015; 10 (01) 50-55
    CrossrefGoogle Scholar
  • 79 Abusamaan M, Giannobile WV, Jhawar P, Gunaratnam NT. Swallowed and aspirated dental prostheses and instruments in clinical dental practice: a report of five cases and a proposed management algorithm. J Am Dent Assoc 2014; 145 (05) 459-463
    CrossrefPubMedGoogle Scholar
  • 80 Grossman LI. Prevention in endodontic practice. J Am Dent Assoc 1971; 82 (02) 395-396
    CrossrefPubMedGoogle Scholar
  • 81 Susini G, Pommel L, Camps J. Accidental ingestion and aspiration of root canal instruments and other dental foreign bodies in a French population. Int Endod J 2007; 40 (08) 585-589
    CrossrefPubMedGoogle Scholar
  • 82 Mahesh R, Prasad V, Menon PA. A case of accidental aspiration of an endodontic instrument by a child treated under conscious sedation. Eur J Dent 2013; 7 (02) 225-228
    Article in Thieme ConnectPubMedGoogle Scholar
  • 83 Nixdorf DR, Moana-Filho EJ, Law AS, McGuire LA, Hodges JS, John MT. Frequency of persistent tooth pain after root canal therapy: a systematic review and meta-analysis. J Endod 2010; 36 (02) 224-230
    CrossrefPubMedGoogle Scholar
  • 84 Nixdorf DR, Law AS, Lindquist K. et al. National Dental PBRN Collaborative Group. Frequency, impact, and predictors of persistent pain after root canal treatment: a national dental PBRN study. Pain 2016; 157 (01) 159-165
    CrossrefPubMedGoogle Scholar
  • 85 Wolcott J, Rossman L, Hasselgren G. Management of endodontic emergencies. In: Berman LH, Hargreaves KM, Cohen SR. eds. Cohen's Pathways of the Pulp Expert Consult-E-Book: Elsevier Health Sciences. 2011. 40–48
    Google Scholar
  • 86 Mattscheck D, Law A, Nixdorf D. Diagnosis of non-odonogentic toothache. In: Hargreaves KM, Cohen S, Berman L. eds. Cohen’s Pathways of the Pulp. St Louis: Mosby; 2011: 49-70
    Google Scholar
  • 87 Khan AA, Maixner W, Lim PF. Persistent pain after endodontic therapy. J Am Dent Assoc 2014; 145 (03) 270-272
    CrossrefPubMedGoogle Scholar
  • 88 Nixdorf DR, Moana-Filho EJ, Law AS, McGuire LA, Hodges JS, John MT. Frequency of nonodontogenic pain after endodontic therapy: a systematic review and meta-analysis. J Endod 2010; 36 (09) 1494-1498
    CrossrefPubMedGoogle Scholar
  • 89 Haug SR, Solfjeld AF, Ranheim LE, Bårdsen A. Impact of case difficulty on endodontic mishaps in an undergraduate student clinic. J Endod 2018; 44 (07) 1088-1095
    CrossrefPubMedGoogle Scholar
  • 90 Estrela C, Pécora JD, Estrela CRA. et al. Common operative procedural errors and clinical factors associated with root canal treatment. Braz Dent J 2017; 28 (02) 179-190
    PubMedGoogle Scholar
  • 91 Ciobanu IE, Rusu D, Stratul SI, Didilescu AC, Cristache CM. Root canal stripping: malpractice or common procedural accident-an ethical dilemma in endodontics. Case Rep Dent 2016; 2016: 4841090
    PubMedGoogle Scholar
  • 92 Choctaw W. Avoiding Medical Malpractice: A Physician's Guide to the Law: Springer Science & Business Media 2008
  • 93 Goldberg R. Medical malpractice and compensation in the UK. Chi-Kent L Rev 2012; 87: 131161
    Google Scholar
  • 94 Stauch MS. Medical malpractice and compensation in Germany. Chi-Kent L Rev 2011; 86: 11391168
    Google Scholar
  • 95 Blau I, Levin L. Medical malpractice: an introduction for the dental practitioner. Quintessence Int 2017; 48 (10) 835-840
    PubMedGoogle Scholar