Medicolegal Aspects of Vertical Root Fractures

Abstract

The vertical root fracture may appear in conjunction with a physical or occlusal trauma or iatrogenic complications often encompassing endodontic and prosthodontic treatments involving the placement of a post. Under certain circumstances, this complex scenario may trigger a wish from the patient for economic compensation. The determination of a fractured root is complicated and challenging as it is often not distinctly objective and more a prediction rather than a definitive diagnosis. In case a vertical root fracture is suspected, a timely decision regarding the diagnosis is required to avoid unnecessary bone loss and ensuing legal claim. In many parts of the world, the patient would have to take the practitioner into a civil court to get compensation. However, in a number of countries, there is legislation which deals with injuries in relation to medical treatment or compensation. Medicolegal considerations are in a few countries particularly detailed. Within these countries, dental complaints and insurance cases are relatively frequently occurring. A subcategorization of endodontics-related complaints shows that the inadequate root filling represents a major risk for complaints. In combination with the occurrence of vertical root fractures, it represents a challenging complication clinically as well as medicolegally, because inadequate root filling may mask the presence of a vertical root fracture. Statistics about claims may indicate where risk management and educational efforts can be most effectively directed to improve the standard of dental care. A continuous improvement of preventive treatment concepts including the development of diagnostic tools seems warranted, as an accurate diagnosis may prevent or reduce the risk of complications in particular related to vertical root fractures.