www.mddus.com


ABOVE: Implant treatment carried out in upper arch without addressing periodontal disease in lower arch. (PHOTO ABHI PAL)


Coordinating care When more than one practitioner is involved in patient care, it is important to understand who has responsibilities for what aspects of care. Examples are when a patient is referred to another practice for implant treatment or when a patient self-refers solely for implant treatment – or where different practitioners carry out the surgical and prosthetic implant treatments. Without a clear understanding of where responsibilities lie (and in the case of a complaint relating to treatment planning) all practitioners involved in the patient care could become liable to some extent. In the case of different dentists carrying out the surgical and prosthodontic aspects of implant care it is essential that both practitioners agree what is possible to achieve in a particular case, and communicate this to the patient.


Consent Consent is a vital component of healthcare delivery. In the first instance, valid consent requires that the patient is competent and un-coerced. The patient must also be sufficiently informed about the procedure and alternatives, together with their material risks, benefits and costs. Alternatives might include bridges or dentures. There


might also be a number of implant-based solutions. These treatments must, in the opinion of the practitioner, be clinically justifiable before being placed on the consenting menu. Risks are those which the reasonable patient in these particular circumstances would regard as significant. Exploration of this issue necessitates bespoke, interactive dentist-patient discussions. Where a highly technical subject is being planned, particular consideration should be given to the comprehensibility of this information. Patients should be given time to reflect on this advice and should be allowed to return with any ongoing concerns. Written consent for implant treatment is not mandatory,


unless sedation or general anaesthesia is provided. However, I cannot over-emphasise the importance of providing written information, as long as it has been properly drawn up, as a way of ensuring that information has been provided. In order to ensure consent is valid there needs to be patient understanding and therefore I must also caution against solely relying upon giving written information for the purpose of obtaining consent. It is essential that the practitioner spends time in verbally checking that the patient understands the information provided, even if it has been given in writing and allow sufficient time for the patient to consider the information. Furthermore, provision of written information should be as patient-specific as possible. Part of valid consent is to ensure that the patient is aware


of the expected end result. This is particularly important where there is an aesthetic element. Time spent with models, photographs and diagnostic wax-ups at the outset will help to ensure there are no unexpected surprises at the end of treatment. The provision of a written treatment plan and an


estimate of costs is, however, mandatory. This becomes crucial where the treatment is complex with multiple phases, or the plan (and consequently the costs) change during treatment. Good clinical records are essential to evidence the care and discussions provided. Computer-driven templates are useful in making this process more efficient, but the dentist must ensure that all the information contained in pre-designed templates apply to the individual patient.


Dr Abhi Pal is a GDP who carries out implant dentistry and is currently vice-dean of FGDP(UK). He is frequently called upon by defence organisations, the GDC and clinical negligence lawyers to provide independent expert advice in complaints related to implant dentistry.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16