Mitigating Risks Associated With Dental Implant Procedures

Dental implant procedures are an increasingly popular treatment to replace missing or damaged teeth. The American Academy of Implant Dentistry notes that 3 million people in the United States have implants, and the number grows by 500,000 annually.¹ Implants offer many benefits, but they are not without risks — and allegations related to dental implant procedures are a factor in both the frequency and financial severity of dental malpractice claims.

MedPro claims data show that cases involving implants account for 16 percent of all dental malpractice cases and 14 percent of total dollars paid (expense + indemnity). The injuries most often noted in implant cases include nerve damage, need for additional treatment, failure to heal, and infections. The most common risk factors identified in these cases are patient dissatisfaction with treatment/outcomes, failure to obtain a consult/referral, failure to select an appropriate procedure, insufficient documentation, and inadequate informed consent.²

Additionally, claims analysis has revealed that some of the common issues associated with dental implants include:

• Adequacy of the practitioner's education and training
• Suitability of the patient and the implant site
• Depth of drilling and depth of the implant
• Damage to adjacent teeth
• Issues with the all-on-four technique
• Infection following the implant procedure
• Prompt and aggressive management of complications

The following high-level strategies can help dentists and oral and maxillofacial surgeons proactively address risks associated with implant procedures:

• Devote sufficient time and attention to completing continuing dental education and training to keep current with evolving technologies and techniques in the practice of dentistry.
• Gather complete patient histories to identify medical/dental conditions and treatments that might rule out implants as a suitable option. Develop written patient selection criteria to help guide decision-making.
• Engage in thorough pretreatment planning for dental implant procedures, including appropriate imaging (e.g., cone beam computed tomography or panoramic radiographs) and clinical assessment of local and general conditions that might increase the risk of implant failure.
• Recognize that not all implant cases are the same, and they can vary in complexity. Make sure your skill level is sufficient for the complexity of the case, and make referrals as necessary to ensure patients receive specialized care.
• Conduct thorough informed consent discussions to review risks, benefits, and alternative treatment options. As part of the informed consent process, gauge whether patients have realistic expectations about implant procedures.
• Use clear, concise language when talking to patients about implant procedures and their associated benefits and risks. Avoid complex terminology and jargon, and provide information and instructions in clear, easy-to-understand language.
• If it seems like patients might be confused or struggling with health information, consider using a comprehension technique such as teach-back to:
  • Assess patients' understanding of the information provided during the informed consent process.
  • Reduce the risk of miscommunication.
  • Support patient adherence to care plans.
• Document the informed consent process, including the discussion of risks, benefits, and alternative treatment options, as well as the provision of educational materials. Make sure that any signed informed consent forms are included in patients' health records.
• Promptly and thoroughly investigate complications or patient complaints, especially when nerve damage might be involved. Do not hesitate to make a referral if complications do not resolve promptly. Failure to act quickly may increase the risk of poor outcomes.

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¹ American Academy of Implant Dentistry. (n.d.). What are dental implants? Retrieved from https://aaid-implant.org/what-are-dental-implants/

² MedPro Group dental cases closed with >/=$50K total dollars paid, closed years 2009–2022.

³ Parra, C., & Harrel, S. K. (2019, August 28). Treatment planning strategies for dental implant procedures. Decisions in Dentistry. Retrieved from https://decisionsindentistry.com/article/strategies-dental-implant-procedures/

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