Endodontic Complications: 9 Actions to Address
The Risks of Endodontic Complications
One inherent risk and common complication of root canal therapy (RCT) is the accidental separation of an endodontic rotary or hand file within the root canal system. Frequent rotation of stock, thorough inspection of instruments before use, thoughtful case selection, and proper technique can help minimize the risk of separation. Despite these precautions, instruments can still separate, which is not considered malpractice. Typically, the dentist’s response to the separated instrument influences whether the patient perceives this as wrongdoing on your part, leading them to file a complaint with the Board or initiate legal action.
Once a file separates, it immediately alters the complexity of the treatment and the patient’s perception of your competency. The separated instrument will often negatively impact the tooth’s cleaning, shaping, and obturation, affecting its long-term prognosis. In some cases, this foreign body may be easily retrievable; however, in others, you may not recover it. Despite the presence of the separated file, you might still be able to adequately prepare, cleanse, and obturate the canal. However, in some situations, the separated file will hinder the complete cleansing, shaping, and obturation of the affected canal, leading to recurrent infection.
Nine Steps You Can Take
Once this unfortunate complication arises, you can take specific actions to minimize potential loss and prevent worsening an already tense situation. Before beginning treatment, inform the patient of the likelihood of this complication occurring and the possible impact on the tooth’s prognosis if it does. Explain that root canal therapy is an attempt to save a tooth that would otherwise likely need extraction. In the event of a separated instrument, take the following steps:
1. Promptly inform the patient about what happened, its implications for further treatment, and the long-term outlook for their tooth.
2. Attempt to retrieve the foreign body (only if this skill set is well within your training and experience). It may always be more prudent to refer the patient to a specialist for a second opinion and further treatment rather than exacerbate the situation with an unsuccessful retrieval attempt that may further impair the tooth and its prognosis. If you successfully retrieve it, document the retrieval with a follow-up X-ray and an appropriate chart entry.
3. Given the untoward complication of the separated file, advise the patient on the tooth’s long-term prognosis.
4. Reassure the patient and remain engaged with them. Do not delegate this responsibility to an assistant.
5. Instruct the patient that this complication is not unusual and assure them that you will take all reasonable steps to reduce its impact on their tooth’s health.
6. Explain the potential complications because of this unfortunate occurrence.
• Retrieval procedure that may involve surgical intervention
• Long-term prognosis
• Restorability
• Infection
• Extraction and replacement
7. Delay permanent restoration until the tooth is stable and its prognosis can be definitively confirmed.
8. As a gesture of good faith, you may consider reducing or returning fees for the RCT procedure. Returning a fee is a personal and professional judgment issue. (Let us know if we can help.)
9. Document the incident and conversations with the patient in their chart.
Conclusion
Be transparent and honest with the patient anytime an unforeseen complication or error arises during treatment. You should promptly inform the patient or the patient’s representative precisely what occurred, demonstrate empathy, and provide an appropriate remedy or support to rectify the situation, if possible. Discuss with the patient the short-term and long-term impacts of what has transpired. Quick recognition and thoughtful judgment in addressing endodontic complications (or any complications) can reduce potential claims and lessen the repercussions of such claims. It can also significantly contribute to maintaining the credibility and trust you have worked hard to establish with your patient.
The information contained on the DentistCare Blog does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only. We encourage all blog visitors to consult with their personal attorneys for legal advice, as specific legal requirements may vary from state to state. Links or references to organizations, websites, or other information is for reference use only and do not constitute the rendering of legal, financial, or other professional advice or recommendations. All information contained on the blog is subject to change.
