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ePaper created 2015-11-12, 17:51:56 | version 1.38.0
I feature _ interview 08 I CAD/CAM 4_2015 Many may think that it is not relevant to them, but every smart physician knows that things occasionally go wrong and no one is immune. Bydocumentingdentalmalpracticeincidentsand by talking and writing about these, I aim to raise awareness and therefore help prevent future incidents. _Inyourexperience,whattypesofmalpractice are most common? There are definitely many cases in the neuro- logical field. As a medical expert, I am confronted with many instances of damaged nerves caused while placing an implant, during tooth extrac- tions or through an injection. It is common and it happens quickly. Typically, it is an inadvertent mistake, because the clinician was either in hurry or impatient. However, the consequences for the patient are mostly very dramatic and often beyond repair. _Aside from nerve damage, is there an area where mistakes are more likely? IfIhadtochooseone,Iwouldsayitisimplants. I recently had a very disconcerting case where an oral surgeon did all the preliminary examination work meticulously, the CT scan, the radiographs, everything. For that reason, he knew for certain that he was working with a bone structure of 11 mm, yet he used an implant that was 13 mm long in the treatment. Maybe he was just mis- taken or the assistant handed him the wrong im- plant and he did not recheck it, but the result was that he hit a nerve. In this particular case, the dentist was a spe- cialist, an experienced surgeon. Without raising the question of guilt—although the surgeon was without a doubt responsible for the damage— cases like this show that mistakes really can happen to anybody. _So expertise does not preclude mistakes, but there are undoubtedly also cases that result from negligence and hubris. I certainly see many cases in which dentists have carried out a treatment for which they were not qualified. I remember an incident in which a general practitioner injured nerves on both sides of the mouth during an implant treatment. That is truly unbelievable. I have seen many cases over the years, but nothing quite like that. In another case, a dentist extracted a third molar without the requisite training. He should have referred the patient to a specialist, but he chose to do it himself—possibly because it earned him another US$200 to 300 (£130 to 190)—with the result that the patient now has to live with chronic pain for the rest of her life. _Can injured nerves regain normal function eventually? Mostly, damage is irreversible. There are ex- ceptions, of course, either if the damage was not too severe or if the nerve was inside a canal. Potentially, an injured nerve can regain function over time. However, if it is an exposed nerve, such as the lingual nerve, the damage is generally irreversible, although there are some microsur- gery procedures that may improve the situation. Interventions like this, however, carry extremely high risks themselves and might even aggravate the situation. _With the consequence that patients partially lose sensation in the mouth or face? Displacement of dental implant into the maxillary sinus of a 70-year-old male patient. (© Dr Andy Wolff) CAD0415_06-11_Wolff 06.11.15 11:56 Seite 2 CAD0415_06-11_Wolff 06.11.1511:56 Seite 2