Dental implant malpractice is a fast-growing area of dental malpractice and medical malpractice litigation. According to the American Dental Association, more than 5 million dental implants are placed every year, and that number is steadily climbing by thousands of implants per year. A properly placed dental implant results in a fantastic tooth-like structure in a patient’s mouth. As with any prosthetic, a dental implant is not as good as your natural tooth, and it requires extra upkeep and maintenance. However, it’s the state-of-the-art solution for a missing tooth.
When the dental implant procedure goes wrong, it can cost the patient thousands of dollars, and it can take years to repair the damage done. Sometimes, the damage done to a patient’s mouth cannot be repaired. If you suffered injuries as a result of a dental implant procedure, contact one of our dental implant malpractice lawyers to make sure your rights are protected.
What is a Dental Implant?
A dental implant is a titanium device that is placed into the bone. The most commonly used type of dental implant is a root form implant, which is a titanium screw. Once placed in the bone, that titanium screw integrates into the bone and provides an anchor for a crown or a denture. However, the titanium screw implant is not the only type of implant out there. There are some other types of dental implants that you might hear about. For example, there are endosteal implants, subperiosteal implants, mini dental implants, and blade implants. Although there are other types of implants, we will talk about the more commonly encountered types of dental implants below in more detail. Keep in mind, this list does not mention all types of dental implants.
Endosteal Dental Implant
An endosteal dental implant is an implant that is placed within the bone.
Subperiosteal Dental Implant
A subperiosteal implant is placed under the covering of the bone, or the “periosteum.” The implant is placed on the outside of the bone, but in close enough contact with the bone that a fibrous attachment to the implant is formed. In some cases, with titanium implants, actual integration with the bone occurs.
The term “mini-implant” is a misnomer. The actual term is “transitional implant” because they are not intended for long term use. They are designed to support a temporary prosthesis while the conventional implants integrate or heal into the bone. Mini implants are defined by their diameter. An implant with a diameter of 3mm or less is designated a “transitional” implant. Transitional means they can be removed easily when it is time for the conventional implants to be restored. This characteristic is due to insufficient bony integration associated with a 3mm or less diameter. In other words, 3mm is not big enough for adequate predictable bony integration.
The blade implant was one of the first solutions in the history of dental implants. A blade implant is a thin slice of titanium that has abutments on top for a crown. This implant could be placed into the jaw, and it could hold several crowns in a line along the blade. Today, blade implants are rarely used.
Dental Implant Surgery
Dental implant procedures are surgical. They are invasive procedures. Dental implant surgery typically involves drilling a hole into the bone and then placing a foreign substance into the bone. Usually, this is a titanium post or screw. Essentially, the dental implant replaces the root of the natural tooth. There are two broad categories of implant surgery: One-stage surgery and Two-stage surgery.
Two-Stage Dental Implant Surgery
This is the most common type of implant surgery because it is the most predictable. As the name implies, a two-stage dental implant requires two surgical procedures. In the first stage, the implant is placed into the bone. Then, the dental implant is allowed to heal for several months. In the second stage, the dentist will go back in, open or remove the gum directly over the implant, and attach the healing abutment that forms the soft tissue contours. Once the soft tissue matures, the patient is ready for the crown, which is the part of the structure that resembles to tooth.
One-Stage Dental Implant Surgery
A one-stage implant surgery carries a little more risk because the top of the implant is exposed to the fluids of the mouth. As the name implies, a one-stage surgery requires only one surgical procedure. The implant is placed into the bone, and a healing abutment is placed at the same visit. This allows for the potential of leakage into the surgical site as the implant integrates. There are implants that are specifically designed to be placed at the level of the gum and are done in a single surgical visit.
Note that anytime a procedure extends into the bone, there is risk of infection, and proper aseptic protocols must be followed to avoid infection. Therefore, whether we are talking about a one-stage or a two-stage dental implant surgery, the same risks are involved.
Dental Implant Process
The dental implant process can take several months to over a year. So, that begs the question: Why does the dental implant process take so long?
Bone heals slowly. One cycle or a “sigma” of healing in human bone is 17 weeks. The first week is the reaction to the injury (surgery) and is known as the Activation Stage. The next two weeks are the beginning of remodeling, known as the Resorption Stage. The next week and a half after that is known as the Quiescent Stage or Reversal Stage. These 3 stages comprise the preparation for the next thirteen weeks of bone formation known as the Formation Stage.
Typically, the first step of the dental implant procedure is to remove the tooth where the implant will be placed. That is, if the tooth is still there. The next step is to ensure there is sufficient bone for the implant. Sometimes, a bone graft is needed to add more bone for a better foundation for the implant. If the implant is to be placed in the upper jaw, sometimes called the “maxilla,” the patient may need a sinus lift and a bone graft to create a good foundation for the implant.
The next step in the dental implant procedure is to place the implant. If the patient needed a bone graft, the dentist may not place the implant for 3-4 months after the bone graft procedure. Once the implant is placed, the dentist may wait to put a temporary on the post until the implant fully integrates into the bone. Other times, a dentist may immediately put a temporary on the post. To avoid putting too much pressure on the newly placed implant, the dentist may affix the temporary to adjacent teeth so that the implant does not bear the pressure of the bite. That way, the patient has a tooth-like structure above the implant post instead of a gap.
After several months and if the dentist places the implant properly, the implant will integrate into the bone at the proper angle to provide support for a crown or prosthesis. At that point, the implant will be ready to accept bite pressure. This is when the dentist will bring the patient in to place the crown on the implant. If everything goes well, the patient has a beautiful tooth with a sturdy foundation.
Reasons for Dental Implant Malpractice Litigation
The reason for dental implant malpractice litigation is error. The error may be intentional or unintentional. The term for such an error is a breach of the standard of care. The standard of care may be defined as what a prudent doctor would do under the same or similar circumstances. There may be one or several errors at issue in any given dental implant malpractice lawsuit. These breaches form the basis of the injured patient’s claim for damages. The most common errors are a result of insufficient training, improper imaging, and preoperatory planning, and insufficient review of patient medical history. Let’s touch upon each of these issues in detail.
An Epidemic of Unqualified Implant Dentists
Insufficient dental implant training and credentialing is a big reason dental implant malpractice lawyers get phone calls. Often times, an inexperienced dentist with none of the proper credentials or training will attempt to place implants when that dentist should have referred the procedure to a more qualified professional. What is the result? Bad things can happen, including some of the following:
- Infection can be introduced during surgery;
- Vital structures can be damaged;
- The implant will fail or fall out; or
- The implant is improperly placed off center or at a bad angle and cannot be restored.
All these errors can cause the patient serious pain, lost time and money, and missed work. Not to mention, the patient is often in a worse condition than before the surgery and will have to pay to correct or revise all the damage the offending dentist caused.
Dental implant malpractice lawyers have a front seat to the changes taking place in implant dentistry. At the current time, dentists do not need specialized training to place an implant. In other words, anyone with a degree in dental medicine and a license to practice in the relevant state may perform implant surgery. I have heard this likened to the days when any doctor could perform brain surgery, or really any other extremely specialized procedure, without specialized training and credentialing after medical school. Thus, we are in a unique, wild-west phase of implant dentistry.
This will not be the case forever. Currently, dental schools are working to create residency programs for young aspiring dentists to become specialized in dental implantology. Additionally, organizations like the American Academy of Implant Dentistry and the American Board of Oral Implantology have programs to credential the best-of-the-best in dental implantology. Therefore, it’s likely that, in time, only truly qualified professionals will be placing dental implants.
At the present time, however, the placement of implants by unqualified dentists is a serious problem. People are getting hurt, and many aren’t aware that the harm they’ve suffered is actionable dental malpractice. The success rate of dental implants is somewhere around 97-98%. However, when an implant fails or falls out, the dentist will often tell the patient that the implant falling out is a normal occurrence and nothing went wrong. Let’s be very clear: It is NOT normal for a dental implant to fall out.
Unfortunately, doctors often tell their patients that it is normal for a dental implant to fall out, and patients trust their dentists. As a result, patients don’t assert their rights, and the statute of limitations for a dental implant malpractice lawsuit may run before they realized they have been wronged. The reality is that the success rate of dental implants was 97-98% in 2008, over a decade ago. With better technology and typical advancements in the field of dentistry, the success rates of dental implants should increase.
The problem is that many patients don’t even know they’ve been harmed when their dental implant fails, as we talked about above. When an implant fails, a dentist will often shift the blame to something else, even to the patient. Then, a dentist might cover the issue up and send the patient home. The patient may never know the truth: The dentist messed up, and that’s why the implant failed.
Failure to Take Proper Images and Plan for Surgery
During the planning phase and before attempting a dental implant procedure, the clinician must conduct a presurgical diagnosis of the patient to determine the overall complexity of the case. Some of the main considerations regarding complexity should include the following:
- The number of dental implants to be placed;
- The location of the implants;
- The type of implants;
- The angulation of the implants;
- The abutments to be placed.
This process is known as the diagnosis and treatment planning phase of treatment. It is arguably the most important, and sadly, the most overlooked phase of treatment.
As of 2010, the use of computerized tomography (CT) was considered a mainstream part of the preoperative planning phase. A CT helps the dentist to diagnose the volume and quality of bone at the proposed implant site, as well as the location of other structures, like the sinus and the inferior alveolar nerve.
In recent years, the use of cone beams, or “Cone Beam Computed Tomography (CBCT) scans, have become increasingly popular because the cone beam exposes the patient to less radiation than the CT, and it provides a high-quality, three-dimensional image that is sufficient for proper preoperative planning. For this reason, cone beams are quickly becoming the standard of care in implant dentistry.
The issues that often arise in the field of dental implant malpractice occur when a dentist attempts to place implants based on old school, two-dimensional images. Implants must be placed at a specific angle and in a specific location to properly support the pressure of a bite, and a two-dimensional image simply does not provide a comprehensive view of bone, teeth, and other surrounding tissues and structures. As a result, clinicians who do not take proper images can cause serious complications, like nerve damage or sinus tears.
Failure to Study Patient Medical History
Some of the most horrific cases dental implant malpractice lawyers see are cases where a doctor negligently fails to properly study a patient’s medical history. Patients with compromised immune systems, like diabetics, can develop horrific and life-threatening infections. Similarly, patients who have been administered bisphosphonate drugs may experience increased incidents of dental implant failure, as well as more serious conditions like bisphosphonate related osteonecrosis of the jaw (ONJ).
Risks of Dental Implants
Dental implant procedures pose number of risks. As with any type of surgery, things can go wrong, and sometimes things can go terribly wrong. Some of the more common risks associated with dental implant procedures are the following:
- Infection at the implant site;
- Nerve damage;
- Damage to adjacent teeth;
- Damage to surrounding soft tissues;
- Damage to the surrounding bone;
- Damage to the sinus;
- Jaw fractures;
- Speech impediments;
- Loss of taste;
- Loss of sensation in the mouth;
- Loss of sensation outside the mouth and in the lips and face;
- Openings into the sinus that allow food and drink to enter the nose; or
- Sinus infections.
Dental Implants Cost
The cost of placing a single implant is usually somewhere between $1,500 and $3,000, depending on the surgeon involved. This price typically includes only the placement of the implant into the patient’s bone, not the restoration. Additionally, if the patient requires a bone graft or sinus lift procedure, those would be added expenses. Therefore, it’s not uncommon for the finished product to be more than $5,000 per implant. Again, this all depends on the surgeon doing the procedure. A better and more credentialed implantologist will command a higher price.
Dental Implant Malpractice Settlements
As with any personal injury case, the value of a dental implant malpractice case is dependent on the damages involved. In other words, dental implant malpractice settlements can range greatly, depending on the damage done to the patient. Cases where patients have extensive medical damages or permanent nerve damage have a much higher value than cases where the medical damages or injuries are minimal.
According to the Doctors Company, which is a large insurance company that provides coverage for dentists, the average pay out in dental malpractice cases is $79,000. According to an article in the Winter 2017 edition of AAID News, published by the American Academy of Implant Dentistry, the average dental malpractice lawsuit is estimated to be around $68,000, not including legal fees. Keep in mind, these are average numbers, and these numbers include all dental malpractice claims, not just dental implant cases.
 See Gerard Duminil et al., Success Rate of the EVL Evolution Implants (SERF): A Five-Year Longitudinal Multicenter Study, 34 J. Oral Implantology 282 (Oct. 2008).
 See 2010 Guidelines of the Academy of Osseointegration for the Provision of Dental Implants and Associated Patient Care, 25 The Int’l J. of Oral & Maxillofacial Implants 3, 620-627.