coronal perforation PANIC

[randomdoc]

Recently graduated and in my first RCT in the real world, I perforated the the mesial of the crown of tooth # 30 at (the level of furcation ).

I PANICKED and have not written in my notes, but radiograph shows anyway. There were no MTA in the office so I did not know what to do. I put cotton pellets and cavit and pt will be back soon for post/core.

Other young dentist in the clinic said it will be OK and that my PFM crown margin will be subgingival and that I do not need to tell the pt anything. I AM WORRIED. I am thinking about writing an addendum to my notes and call the pt to bring him ASAP. How would you approach this mess...please advise.

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[AU07DMD]

First mistake was choosing a molar as your first RCT in the real world. But can't go back and change that now...

Are you asking for clinical advice on how to fix this or are you asking for professional/ethical advice?

Clinical - if you can't restore this tooth properly without repairing the perf (and I imagine you can't), then I would refer to an endodontist to help you repair the perf if possible. If you post an x ray of the case maybe some of our endo lurkers could give you advice.

Professional - Always document what happens and inform the patient. It sounds like you now have a discrepancy b/w what the x-ray shows, what is in your notes, and what you told (or didn't tell) the patient. Correct/ addend your notes now to reflect what is on the x-ray. Call the patient to check and see how they are doing and you can mention there was a troublesome spot during the root canal that you want to check up on before you proceed any further with the restoration of this tooth.

I have made several mistakes in my young career and probably pissed off a few patients but they almost always appreciate their doctors being up front with them if something doesn't go as anticipated (and that you have a roadmap/solution to remedy the problem!)

 

[AU07DMD]

Recently graduated and in my first RCT in the real world, I perforated the the mesial of the crown of tooth # 30 at (the level of furcation ).

I PANICKED and have not written in my notes, but radiograph shows anyway. There were no MTA in the office so I did not know what to do. I put cotton pellets and cavit and pt will be back soon for post/core.

Other young dentist in the clinic said it will be OK and that my PFM crown margin will be subgingival and that I do not need to tell the pt anything. I AM WORRIED. I am thinking about writing an addendum to my notes and call the pt to bring him ASAP. How would you approach this mess...please advise.

Also, I wouldn't take any comfort in the opinion of just one young dentist (myself included) - obviously you are worried because you know something didn't go according to plan. Your co-worker isn't responsible for this patient so that is easy for him to say. Glad that you came on here to solicit input from your colleagues in the dental profession and hopefully someone with more clinical experience with RCTs than me can help you further.

 

[dvm'08]

How is it even possible that you didn't report this complication to the patient and provide them with options on how to proceed?

In my line of work that would constitute blatant malpractice... is it different for dentists?

 

[Sublimazing]

Extract the tooth and don't tell the patient it's gone

How is it even possible that you didn't report this complication to the patient and provide them with options on how to proceed?

In my line of work that would constitute blatant malpractice... is it different for dentists?

You guys are forced to tell the animals the mistakes you make? Do the animals understand? What does the fox say?

 

[nuartywayne]

**** happens, but how you handle the situation is what's important. Obviously you have a conscience. Be upfront with the patient, don't tell him/her you made a mistake straight out, explain that its a remote possibility and it looks like by the PA taken that it would be best to refer out.

Also if that's the advise and the philosophy of your current employment get the hell out of there as soon as you find another place.

 

[bsp1013]

How did you perf the crown at the level of the furcation on the mesial? That sounds literally impossible. Does this tooth have 2 mesial roots?

 

[auths4]

You need to inform the patient and send him to endo if you're unable to handle the complication

 

[Localnative]

Maybe I missed this, but did patient sign informed consent?

2 outcomes patients conclude from "attempted" endo treatment after they sign a preoperative consent:
-successful conclusion with a salvaged tooth
-poor prognosis with likely need for removal and later single unit replacement vs FPD

if you discussed the above scenarios with patient pretreatment, you've covered at least some of your bases. but its NEVER too late to come clean with a patient. withholding the info completely - this will burn you potentially.

 

[briansle]

Recently graduated and in my first RCT in the real world, I perforated the the mesial of the crown of tooth # 30 at (the level of furcation ).

I PANICKED and have not written in my notes, but radiograph shows anyway. There were no MTA in the office so I did not know what to do. I put cotton pellets and cavit and pt will be back soon for post/core.

Other young dentist in the clinic said it will be OK and that my PFM crown margin will be subgingival and that I do not need to tell the pt anything. I AM WORRIED. I am thinking about writing an addendum to my notes and call the pt to bring him ASAP. How would you approach this mess...please advise.

This is not a big deal. It happens most commonly with molars that are mesially tilted into a missing tooth space. You start accessing the pulp chamber and forget that you need to angle the handpiece mesially to follow the long axis of the tooth. It resolves without complication. The bone in that area usually resorbs alittle that's all. Think of it as alittle crown lengthening.

Include it in your notes, I would explain to patient we ran into alittle complication that can happen, but no to be worried, its just one of those things that can happen with a RCT and "he/she" may feel some pain for the next couple days in that area. And go ahead and with PFM. You're not gonna get sued for this or anything. This is all part of the learning process.