Dental Implant Lawsuits: What is the Best Way to Protect Myself?

Your first premis is wrong.There is no such thing as a simple implant case. Even less complicated cases have the potential of becomming difficult. Knowledge is power. The more you know the better off you and your patients are. What you have been told is basically true. Generalists are often held to the standard of care of specialists when performing the same procedure, that is why there are specialists. Therefore,it is wise to demonstate as high a level of training as possible, A weekend course does not allow this level of competence.The implant companies would like to down play this need for training since they want as broad a market as possible. It would be wise to have more then a survey education before you begin.Even if you only do "simple" cases.This is wise from both a legal and moral stand. We all want our patients to have the best care.

I just came from a course in California. Dr. Nowzari where he said that there are law firms in california that are dedicate to extreme make over cases and implant and implant related surgery. Lawyers are getting wise as are patients. How long do you think it will be before people realize they can get a boat load of money from people doing surgery that they arent trained to do. The ADA can say all it wants about limiting credentials the fact of the matter is when your sued a lawyer is going to look at the training you have an compare it to whats out there.

here's the way i see it: anyone can drill a hole and screw in a fixture- technically it's not hard, especially with today's materials. however--- even the simplest cases can have complications, both local and systemic. the local complications can usually be dealt with on relatively favorable ground. it's the systemic complications that are scary: example: i was recently asked to consult on a near death septic patient in the hospital. the patient had dental implant surgery by a local dentist in good standing. The patient rapidly developed infection and sepsis - (actaully an endocardidits) and required two weeks of hospitalization. the patient's family is enraged that something like this could happen. you can bet that the dentist who did the original surgery will be highly scrutinized - even though he may have been within standard of care. they will certainly go after his training credentials, office sterility, etc... his training and treatment will be compared to that of a specialist. another case - a pan-sinusitis after a simple indirect sinus bump- again, serious systemic complication from routine, standard of care implant dentistry. The ENT was highly critical of the dentist's treatment (surpirse-surprise)and found him at fault for not recognizing pre-existing sinus disease. last one- floor of mouth hematoma requiring intubation and surgical treatment from routine implant placement. these are certainly rare cases, but if you drill enough holes into people they could potentially happen. unless you are trained to recognize and treat all of the potential complications of a procedure that you do, should you be doing it??? again, no disrespect to any general dentists, but the legal world is evil. be carefull.

Dr. SB Oral Surgeon is absolutely correct. Knowledge is power. Look to the American Academy of Implant Dentistry for a lot of the formal training you need to be competent in placing and restoring implants. The AAID has a good mentorship program as well as maxi courses in your area to more familiarize you with the many implant products and surgical approaches that are available. One screw up can cost you years of misery.

I agree with the other postings--in a court of law you will be held to the standard of care as the specialist who routinely does the procedure. It is for this reason that although I am trained to, I choose not to perform facial cosmetic surgery or reconstruction, and even refer out my TMJ cases. Subsequently, I have a stress-free practice (well, sort of!).

Specialists "Presumed to have a higher level of competence"..... WOW! That attitude will definitely get you sued. "I only do simple implant cases"..... WOW! You haven't done enough cases if you think you can always tell a simple case from a complex case. I do 300 implants a year and would never be so bold as to assume "simple". Remember, you are surgeon because you can handle the 1 in a 100 that goes BAD, not because you can do the 99 that are uncomplicated. I have found I don't need to cover my butt when I am doing what most would agree is best thing for my patients. If you are worried about defending your qualifications from a lawsuit or the boards.... then I think that question has answered itself...

I would be sure and have an excellent relationship with specialists. Especially an oral surgeon as general dentists,periodontists, pediatric dentists, and endodontists can all have an infection that becomes serious and require the expertise of an oral surgeon.

It seems as if the lecturer has sensible advice, either from experience or for some other reasons. However, the only way to get your question answered with certainty is by consulting an attorney who is competent in malpractice defense in the state in which you practice or by consulting with your malpractice carrier. Asking a group of dentist's this question is akin to an attorney asking his peers how to do a root canal (well...not exactly, but you get my drift). That being said, regardless if you are a general dentist or specialist performing "simple" or "complex" procedures, risk control is imperative in a society whose basis is in law. Protecting yourself from a lawsuit should be as important as it was in getting the training to perform implant surgery. That means having in place the means to defend yourself in the case of a lawsuit. In a court of law, we are all held to the same standard of treatment, regardless of training.

Agree with all of the above. It is not a matter of inferiority when you are a GP only doing certain restorative procedures that you are comfortable with. In fact some of the most successful and productive GP's limit their practice to procedures they are 100% comfortable with. Also as a GP you are able, capable and intelligent enough to place dental implants. The point is WHY IN THE WORLD would you want to put your reputation, emotional comfort and financial stability on the line for your ego of financial gain? As others above pointed out, even as experienced implant surgeons we deal with complications and we treat every implant case with velvet gloves because we KNOW WE ARE GUARANTEED to have complications in a small number of complications. We have to deal with it and even for us it can be a source of significant stress! There is so much necessary restorative dentistry to be done that is left undone that I can't imagine why someone would want to get into surgical implant placement for financial gain.It always appears the grass is greener on the other side.

1) Continuing education – seek out the best and learn from them 2) Be cautious with the types of cases you treat – if you do not perform a procedure routinely (weekly/monthly) refer it to someone else that does 3) Treat your patients like you would treat your family 4) Complications – refer to competent specialists EARLY (especially nerve injury, infections) 5) Thoroughly document your exam, diagnosis and treatment – I have been asked to defend cases where all that is written was “implant # 19” to describe the surgery. 6) Be honest with your patient – if there is a problem let them know. Keep the lines of communication open. 7) A “fellowship” from some implant organizations can simply mean you paid a fee or took a course. The AAID has a more rigorous testing of candidates. 8) The patient’s attorney does not care about your training. They are trying to prove you deviated from the standard of care. Your credentials do not protect you. 9) Chose your patient’s wisely – high expectations can lead to big disappointments 10) I agree with the previous comment - if you drill enough holes in peoples jaws your likely to have a serious complication. The cowboys out there will get burned - The dentist that puts the patient first will have the peace of mind that they tried to do their best and help their patient.

Agree with all of the above statements. The BEST way you can avoid an implant lawsuit--REFER to a periodontist or OMFS to place it.

I have a certificate in Pros, ICOI Fellow, Misch Grad, taken umpteen zillion CE courses, served as expert witness in suits. I would get as much going for me as far as credentials, training, and as Dr Kimsey said get some referral specialists who are discreet! But..... Let's face it... Implantology is becoming horribly turfish!!! We as Dentists are no longer able to rely on decay related business so Implants Cosmetics, and Orthodontics are fields that are being learned by GP's to make a living. The Lawyers are seeing these fields as new "RAW MEAT"!! Unfortunately too many specialists (Periodontists seem to be the worst) are all too eager to defend their turf and idea of exclusive rights to implants! This is usually done by bashing and discrediting GP's and even each other. The lawyers LOVE IT! It's EASY even to find "Hired Whores" The preponderence of expert opinion in these cases usually prevails irregardless of training which is the same for GP,OS and perio in some instances. Unfortunately in some instances the expert is the guy with the biggest mouth!! Sure misteaks are made and negligence is done, but Dentists turning cannibalistic sure aggrivates it!! Ever notice how MD's defend their own kind even if they Rx rat poison. There is a level of education and competency that should be reached and maintained. If all of us as Dentists could help each other instead of being predatory( not to condone incompetence) I think our lives could become a little better, and the lawyers a little worse!!! P.S. I am presently involved as expert witness, in a malpractice case against an OS. One could argue either way, for or against him, but I'm not cutting that plaintiff any slack and will go out of my way to help this OS, because: 1) he did an excellent job, complications arose and they were handled wnl. 2) To me it's just the right thing to do!!!!!! Now I'm gonna get slammed and bashed for my opinion so bring it on!

Regarding the fact that most implant complications happen during the surgical phase, I wonder why the GPs don't try to refer their patients to a specialist surgeon for handling the surgical placement of the fixtures and receive them after their cases are ready for loading.This may be a wise strategy to skip the danger of numbness, infection, fracture, hematoma, and so on.Doing so, they will have their patients ready to restore prosthetically when everything is nice and easy.

Manofsteel I think you comment "Unfortunately too many specialists (Periodontists seem to be the worst) are all too eager to defend their turf and idea of exclusive rights to implants!" I think that statement is a little harsh against periodontist's and is insulting. As a periodontist I help many of my GP's in my area, via mentoring and serving as a conduit to help them get out of cases that were over their head. I also do alot of instruction on how to properly place implants and help them avoid pitfalls. I encourage my GP to do implant cases and refer when needed. I have done augmentation for many GP's and sent them back to them to place the implants. I have many periodontal colleagues which do the same that mentor and help the GP. To say that periodontists are to eager to defend there tuff is a little to much of a blanket statement. Are you an Oral surgeon? NVM I can quess. As with the rest of the above comments I agree however the problem I see is when dentist's in general is they forgo team dentistry in order to make a buck. I even see specialist not refering to other specialists for fear of losing the implant case....ridiculous I think the implant companys are to blame here as they are out there instructing clinicians that this is easy and anyone can do it, because all they want to do is sell product. I see mini implants placed in areas where tradition implants should be placed. We need to get back to the team concept of working togethor for the betterment of our patients.

I think there is definitely a turf war going on and ultimately dentists (specialists are dentists, too) will do what they feel is best for the patient and themselves. Nothing wrong with anyone doing implants as long as they are trained and competent. Just like extractions and perio surgery, if they know when to refer and utilize some sort of mentorship, I think it's perfectly acceptable. The problem I find is that the training is not standardized and the ADA is not setting standards for the courses. A weekend course is good for building knowledge but maybe a minimum number of implants (like 10) under supervision would go a long way to improving the overall quality of implantology.

Like any other procedure there are specialists that provide more complicated treatments. However a general dentist should be able to place "slam dunk" implants with proper training. And, yes he or she should be able to deal with the complications as well. Think dry sockets, post-op infections, bleeding, etc. Not every implant requires the skilled hand of a specialist. Just as, not every molar root canal needs to be done by an endodontist.

Scott K. Kareth D.M.D. Gentlemen, it is suffice to say that the comments on this question are all disappointingly boorish. All of them. Please, let us move on.

js, Great outlook . This field was started by GPs. , in some dental school post grad programs the GPR are placing more implants than the perios and oms. That said, one should obtain the most training and mentoring as possable GP and specialist alike. there is plenty of implant action to go around. Do not make the mistake of thinking that you are cock of the walk after some weekend courses. I am always learning!

The best way to avoid law suits in implant dentistry is to get out of dentistry and either sell cars, mortgages or hide under the bed. All kidding aside, learn, learn, learn and learn some more. This goes for all sepecialist and gps. I have seen FUBAR cases done by both and we all probably will have skeletons in our closet by the time we retire. So don't give up but learn!

Gosh JS you think my comments are harsh and insulting to Periodontist's...poor baby...they wern't meant to be but I call them as I see them. Apparently I'm not the only one who feels this way by the looks of some of these comments. I think Rich Hughes has the best idea, just hide under the bed. Then again thats like the best way to avoid AIDS or VD...ABSTINENCE, but then who's gonna do that! Sooo GP's don't give up Learn more! No one has a monopoly on learning!!

It is the same answer for implants, root canals, or crowns know more than you need for whatever you are doing. Don't be shy to obtain help from whatever other dentist who might know more about your particular need in a case. Sometimes the difficulty is bone or tissue other times in might be cosmetic or mental.

Something else that would help you out in that kind of situation is to keep a portfolio of all your successful works and statements from happy patients.

Implant dentistry has always been about dealing with problems as the patients are more often than not dentally compromised. The more implants you do on the more complex cases ,things will at times not work as well and it is the dealing with patient expectation and how to correct things when issues occur. According to dental insurers the majority of cases are against the most specialised and sometimes qualified , why , well thay are doing more cases and more complex cases often charging more which leads to higher patient expectation. It is often managing our patients which can be the bigger issue. Regards Peter

HOW TO AVOID A LAWSUIT IN IMPLANT DENTISTRY? First know you patient (if possable), 2) financials have to be clear 3) stay within your comfort zone (training, experience, skill etc) 4) document patients behavior, attitude and hygeine 5) do not treat people that you do not want to treat (so far in the USA it's still a free country)6) documentation 7)learn with great advanced training and mentoring

You will never satisfy all- but even the big ones get challenged- look at their work. They allways find an explenation for the cases they did not that way they teach. ((smoker,lack of compliance, habits, ill advised (by whom?/collegoides!) etc.pp) I´ve seen to narrow placed implants even by those charging others of suboptimal work. We are just to do what we think is best. Retospective viewing is just as inappropiate as promises regarding the result- even at court, no matter were it were to be. You are not god- therefore you can`t predict what the reult will be. Don´t overcharge the patient and it will be on your behalf- no matter what the result will be.

Do we still practice for lawyers or for our friends, the patients? I refuse to alter my life or decisions to the warped, unethical, scum who call themselves lawyers. Dagny Taggert is my hero. If you don't know what that means, buy a copy of "Atlas Shrugged" by Ayn Rand and see what happens when the bad guys take over.

lawyers go after some really bad dentists/doctors and some unfortunate ones. Get on youtube and type " dental implant horror story". There is a video made by a lawyer stating how an implant case gone wroing has destroyed his client. Dental problems are fixable a lot of times. However, the lawyers who can present cases in very convingcingly exaggerated manner with determination coming from clients can riun our lives. Explanation and explanation about everything to patients and if, IF, some do go wrong, then be honest and get ready to fix it at no cost. Yet, there will be some lawyers who can make case out of minute mistake. You figure, they are perfect human and never make ANY mistakes...

Dr Clifford: RIGHT ON!

Septicemia,endocarditis, haematoma, sinusitis,hemorrhage (VERY SCARY????????????),even death are possible complications- how rare may be,of any oral surgical procedures including simple extraction or even local anesthesia.That dose not mean every dentist should be afraid and stop doing dentistry. Do any dental procedure you are capable of.JUST MAKE SURE YOU HAVE PROPER TRAINING(not only for your protection but also for better treatment to your patients). Complications will arise sooner or later ,minor or major,know how to tackle them or refer in time to proper facility. Let lawyers do their work,you do yours.

I happen to agree with most of the opinions. Doing a surgical procedure does not make you a surgeon. As already mentioned complications do occur and you should be able to handle most of them. Just because, by law, you can do a procedure doesn't mean you should. We have an obligation to the public to provide them with the BEST possible care and treatment. I am a trained oral surgeon, but I also refer out cases (TMJ)to surgeons who are better trained to do this procedures. Let us do our job and you do yours.

I agree that adequate training is a must. But, I'm not convinced that just because you're a periodontist or OMS, you're trained to place implants. And, I don't think the team concept is always in the patient's best interests. Implants are primarily a restorative driven procedure. I think the best trained clinicians are surgeons who take additional ce in restorative or restorative dentists who take additional ce in surgery.

I feel very priviledged to be able to access this site and to find so much honesty in submissions. I have learned a lot and shall approach my quest for competence in Europe with new found confidence. One query, if possible; how is accuracy obtained in drilling into the upper jaw for implantation? A daughter, today, said that the pin in a root canal op was found to be 30deg off the vertial. What hope has one of work in the upper jaw of being precise. As an engineer I have to be precise. Thanks Happy New Year to all! K. Roberts

Being a General dentist and lecturer in Greece for 26 years ,restoring implants for 18 years and placing for 7 years and performing clinical implant research - i have to say that surgical implantology is extremely difficult ,better suited for surgical specialists and for very few GP's that are willing to pay a GREAT price of learning and sacrificing their peace of mind. I advice anyone who will undertake implant surgery to do it with full dedication and seriousnes.

Dr. Nikos: I pretty much agree with you. One that enters this area has to seek higher education and training. Not all dentist graduating from all schools have the necessary skills and training to manage implant surgery. Nor do they have the understanding of occlusion and prosthetics. These statements apply to generalist and specalist alike. One should learn in an organised implant program such as an AAID Maxi course which pulls together the required fields.

How long are we going to discuss this issue? as with anything you shouldnt do it unless you are trained to deal with the complications that may arise.

Funny how no one mentions the practice of Oral Medicine here. Know your patient, their health status, the drugs they take, talk to their physician when an consult is in order which in my practice is about 30% of the time. Know your patient's desires, their motivations, their expectations. Training is critical, but too often we are focused on "a mouth" not the overall person, let alone their physical, emotional and spiritual health. What is happening in a patient's life can adversely effect an outcome as well, i.e., divorce, grief. I am a periodontist and I have elected not to take on certain implant cases at this point in my career because I have practiced long enough and done enough implants to know what I do comfortably and want to do and what I feel is better accomplished by my colleagues, the oral surgeons and other sometimes other periodontists. I think we all need to know our patients a bit better and provide care from a human perspective more like our physician colleagues and patients are much less likely to sue even when things do not turn out ideally. Knowledge (wisdom) is sometimes knowing when NOT to do something. Once you have accomplished these things then you truly have done your best and need to let the rest of the worry go.

I had 3 dental implants. One succeeded, two became loose and failed. When the two were removed I was left with numbness in 1/4 of my mouth. It has been over one year and the numbness continues. I see no change. Should I sue? b

A SIMPLE SURGICAL PROCEDURE IS ANY OPERATION SOMEONE ELSE IS HAVING. OR DOING!!!

Placing implants is simple. How do you avoid a lawsuit? There is NO WAY YOU CAN AVOID being sued ever 100%, it will happen one day. You can focus on being careful and train yourself. I have placed hundreds of implants and I have managed complications a few times 1. small sinus exposure 2. torn membrane during a sinus lift 3. failed implant after the patient never came back for his P.O. checks and the implant was exposed and failed 4. exposed block graft (patient claimed he never looked at his #28 area for 5 months). Things can go wrong and it is not the end of the world, nobody is infallible. A residency will not save you, a course will not save you, "allah" will not save you, "god" will not save you, etc. Inform and educate the patient, get his consent, BE SURE that you can perform the procedure. Do not screw things into the IAn or the into the sinus. Don't place implants in a brand-new socket after an extraction unless the patient has great hygiene and is a non-smoker, get good at case selection, empathize with the patient and be nice. Nice dentists get sued less. Trust me, I have fired two dentists that did crappy work. One of them, a specialist diplomate of the AAP, screwed implants into other teeth, buried them in bone 8-10mm apical of the crest (welcome long abutments) and placed implants in non-functional areas (I called one of his implants "#16.5"). I agree 6.022 x 10^23 times with Richard Hughes: "The best way to avoid law suits in implant dentistry is to get out of dentistry and either sell cars, mortgages or hide under the bed. All kidding aside, learn, learn, learn and learn some more. This goes for all sepecialist and gps. I have seen FUBAR cases done by both and we all probably will have skeletons in our closet by the time we retire. So don’t give up but learn! " READ, LIVE AND LEARN

My only question, based on, granted a few cases, of osteomyelitis post implant placement, implant failure. If periodontists are the experts in implant placement then they should be able to to perform the resection of the mandible to treat the osteomyelitis and initiate the IV antibiotic regimen...correct. False they refer to OMFS. Now if the non-tooth bearing alveolus was considered a periodontal structure, then shouldn't the specialist periodontist be responsible for the resection or are they not qualified and grasping at straws to save a dying specialty. Endodontists are placing implants now. I thought perio and endo had enough science behind them to actually save teeth. Silly me...thought wrong.