That's Life: Here's Hoping I Don't See You in the News
That's Life: Here's Hoping I Don't See You in the News
I attend a lot of dental meetings, and read the internet dental forums , so I get lots of opportunities to hear people’s opinions on dentistry and the changing face of dental technology. Maybe it has to do with the way I view the importance of what we do, or maybe it’s the amount of money we have invested in technology here, but I see a trend that from my vantage point is disturbing. In fairness it has a lot to do with societal change and is not limited to dentistry.
The case on my mind today has to do with a laboratory owner who e-mailed me in search of some metal guide tubes for a surgical guide they were making. Now, model-based surgical guides have been made for decades and they work for simple surgeries of one or two units, where there is abundant bone and little chance of perforating a nerve or sinus. When I looked at the pictures of these models, I knew this was not the case. I was not just being asked to sell him the tubes, I was also walking him through the process of guide fabrication. Without the benefit of a CT scan/tissue sounding, he was using the diagnostic wax up as the guide for implant positioning. Again, not unusual, but the narrow and deeply resorbed ridge worried me and I said so.
He replied, “It’s not my responsibility to know what is where. I’m just filling the prescription and showing the doctor the ideal position for the implant. It’s up to him to decide if that is possible.”
I’m afraid that was not the impression I was given. In fact, with the doctor requesting metal guide tubes, I believe he was expecting some kind of precision in his osteotomy, not just a suggestion. The prescribing doctor may not even understand how a surgical guide is made. It was obvious to me that the technician only had a fundamental understanding of the process. Maybe I’m reading between the lines, and I’m all wet on this, but without the benefit of knowing either party, I could only draw conclusions based on assumptions I made at the time.
Let’s be clear about something. There is a big difference between a surgical guide and an acrylic stayplate or nightguard, even though the process for fabrication combines the techniques of both. We live in a society today where people will usually call their attorney before they call 911 when something goes wrong. When it comes to making a decision like filling a doctor’s prescription, when we don’t have all the information we need or when we see something being done that is contraindicated, it’s our responsibility to decide to go forward or not. To simply state that the responsibility for problems lies downstream with the dentist is, I think, delusional.
Any true understanding of personal or professional responsibility requires that we make decisions based on a sound understanding of the action we are taking. To me that means remaining up to date on technology, not oblivious, not afraid to ask questions or to look dumb. Sometimes it means passing on a project that I’m not experienced enough or qualified to participate in. Some laboratory owners think that I’ve become on old curmudgeon or even paranoid, or that I’m trying to scare people away from an area of dental technology that holds a lot of opportunity.
You be the judge. A California jury awarded $1.7 million to a patient injured when a dental implant was placed without the aid of CT scanning technology and a computer guided surgery. (Read the story here: http://www.pcdl-usa.com/blog/?p=12.)
As dental laboratories grow in size and assets, the attorneys will see our increasingly deep pockets, we will certainly become targets of litigation, and saying it’s, “not our responsibility” may be a difficult stance to defend. I think it’s wise to take a look at what you are doing, review your insurance coverage and talk to your attorney about liability releases and need for additional coverage if you fabricate surgical guides. The FDA is reviewing their classification status as we speak. Now is as good a time as any.
I don’t want to read your story on the internet.
