Abstract
Readers are encouraged to submit clinical experiences, good and bad, in a culture of open reporting, so that other clinicians will learn from these experiences. Unlike articles in
Article
UR6 MB Root Displaced into the Sinus
Our profession is constantly under scrutiny from patients and colleagues. Human nature means that we can be fast to pass judgement. We are always told ‘you shouldn't criticize another colleague's work as you don't know the working conditions at the time’, yet perhaps, due to rising litigation rates, we are fearful of sharing our learning points due to fear of judgement and being deemed a failure.
As a two year post-graduation dentist on a DCT training programme, I still have support in a learning environment. I therefore see mistakes more as important learning points: indeed, if everything goes right all the time, that can set up unrealistic expectations.
I was treating a 26-year-old man under supervision of a specialist oral surgeon for extraction of his UR6 under local anaesthetic, the roots of which were bulbous and close to the sinus floor. The tooth had gross caries and the patient was warned about all possible complications prior to treatment.
The crown was removed and the roots were sectioned prior to extraction. The palatal and distobuccal roots were removed after luxation and application of root forceps. However, the roots were attached to the sinus floor and that therefore created a communication. The main learning point from this extraction was that, when I applied a Cryers elevator to the MB root in order to remove it, it disappeared into the sinus and was trapped inside the lining. The patient was given an early appointment for the removal of the root and the closure of the OAC with a buccal advancement flap.
I saw this as a huge learning point about careful assessment of the radiograph prior to the procedure and that root displacement into the sinus is something that can happen if pressure is applied in the wrong direction. I also learnt that instrument selection is critical and that good communication with the patient generally means that he/she will be understanding.
There has been fear relating to reflections on our mistakes since the medical case where Dr Hadiza Bawa Garba's reflections were used against her; however, our profession is based on reflective practice in order to recognize how we can become better aorder to learn from them. An open culture for sharing our shortfalls is therefore to be encouraged.