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      Dealing with Evidence in Dental Professional Liability Lawsuits—General Recommendations for Dental Expert Witness Work Using the Example of Germany: A Narrative Review

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          Abstract

          Dental treatment can lead to disputes between patients and dentists, which are then brought before the civil courts as medical malpractice cases. The court regularly commissions a dental expert to answer questions of evidence in court. In the majority of cases, the expert is able to answer these questions based on his professional expertise and practical experience. In order to make the assessment comprehensible and credible for the judge and the parties, it can be helpful and reasonable to cite relevant literature references from dental textbooks and specialist journals. In individual cases, it may be necessary to carry out a systematic literature search on specific topics. Based on the situation in Germany, this narrative review makes recommendations of how to perform a literature search and make citations specifically for expert opinions that are generally applicable independent of national jurisdiction.

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          Most cited references35

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          Aspects of Clinical Malpractice in Endodontics

          The clinical dentistry and endodontic procedures involve very technique-sensitive procedures, therefore exposing the operator to risks of causes not only damage to patients but also leads to malpractice. Among various disciplines of dentistry, endodontics-related cases witness the most frequently filed malpractice claims. This is due to the fact that the endodontic treatment procedures involve operative and surgical procedures, using a variety of medicaments and techniques. The endodontic procedural errors can be preoperative errors (such as incorrect diagnosis and misinterpretation), intraoperative errors including root canal and pulp chamber perforations, ledge formation leading to apical transportation or zipping, hypochlorite accidents, and fracture of instruments. More critically, failure to use rubber dam may result in inhalation or ingestion of endodontic instruments. Under such circumstances, the endodontist may have to face legal consequences. Due to the increased healthcare load and patients’ awareness, it is important to know the legal ramifications of adverse effects, failed restorations, or other complications, to avoid any legal ramifications of endodontic procedures and associated techniques. Therefore, precautions must be taken to prevent any postsurgical complications, patient complaints, and/or failures. For this purpose, the operator must consider ethical principles and adhere strictly to the standards of healthcare while performing the diagnosis and treatment. A referral toward a specialist or consultant endodontist is always an appreciable option and should be considered in the best interest of the patient. The aim of the article is to highlight various aspects of malpractice in clinical endodontics, and associated materials and challenges. In addition, commonly occurring operating errors during endodontic treatment, possible consequences, precautions, and management have been discussed.
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            Analysis of professional malpractice claims in implant dentistry in Italy from insurance company technical reports, 2006 to 2010.

            The aim of the study was to analyze the characteristics of implant dentistry claims in Italy based on insurance company technical reports for malpractice claims.
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              Reasons for patients' discontent and litigation.

              Discontent and litigation among patients is a problem which increasingly preoccupies the medical profession. We aim to analyse the origin of discontent and litigation and to help avoiding these claims. One hundred and seventy-eight medical expert opinions were evaluated, all made following examination of the complainant. Depending on the results of the clinical examination and the study of the files it was determined whether there was either a case of malpractice or insufficient informed consent, or no fault at all in a legal sense. In addition the patient and the surgeon were questioned as to their point of view regarding the procedure and their communication and relationship before and after treatment. Frequent complaints were pain (either during treatment or afterwards), major swelling or bleeding, disturbances of trigeminal or facial nerve function, poor scar formation, loss of teeth or fixtures, faulty occlusion and discrepancies between the expected and the actual result of treatment. In 26 cases actual faults made during medical treatment were discovered. In 49 further cases, poor explanation of the proposed procedure was the reason for complaint. In the majority of remaining cases, neither faulty treatment nor insufficient information given to the patient lead to the complaint but the patient's expectations were unrealistically high. A considerable proportion of lawsuits originate from misunderstandings, and not treatment errors: The surgeons often concentrate on the legal requirements of informed consent and neglect to explain the practical consequences of the operation; the patients in turn tend not to ask about possible complications.
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                Author and article information

                Journal
                Eur J Dent
                Eur J Dent
                10.1055/s-00042133
                European Journal of Dentistry
                Thieme Medical and Scientific Publishers Pvt. Ltd. (A-12, 2nd Floor, Sector 2, Noida-201301 UP, India )
                1305-7456
                1305-7464
                16 July 2024
                February 2025
                1 July 2024
                : 19
                : 1
                : 1-6
                Affiliations
                [1 ]Dental Academy for Continuing Professional Development, Karlsruhe, Germany
                [2 ]Clinic for Conservative Dentistry and Periodontology, Christian-Albrechts-University Kiel, Kiel, Germany
                Author notes
                Address for correspondence Hans Ulrich Brauer, Dr. med. dent., Dr. phil., M.A., M.Sc., Chief Senior Physician, Oral Surgeon Lorenzstr. 7, 76135 KarlsruheGermany hansulrich_brauer@ 123456za-karlsruhe.de
                Author information
                http://orcid.org/0000-0002-8257-0976
                http://orcid.org/0000-0002-7789-6330
                Article
                EJD-24-4-3514
                10.1055/s-0044-1788320
                11750329
                39013450
                903f9b3d-9e22-474f-9c0f-2da426385931
                The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ )

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Review Article

                Dentistry
                medical liability,standard of care,evidence,research,peer-reviewed dental,guidelines,expert opinion

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