Today I write this blog standing in the face of a complication for one of my patients who has undertaken extensive treatment at the practice.
Please don’t misunderstand me; this is not by any stretch of the imagination, the first time I have stood before a complication such as this or (if I continue to work) the last. I merely tried to write this blog today while the pain and hurt for both of us is still as acute as it is to get the message across to others to try and inform their practice.
The patient in question had an immediate full arch restoration approximately twelve weeks ago in the practice. In attendance on that day were three implant clinicians who between them have placed almost 8000 dental implants, a Clinical Dental technician, a very experienced Dental technician assisting on the full arch preparation of the restoration and very experienced nursing staff; a very caring team of individuals.
The case had been well planned to a developed protocol and seemed to pass quite uneventfully. The patient’s recovery was quite uneventful.
The patient returned yesterday with three of six dental implants explanted as the bridge was removed for fixture head impressions to be undertaken. This is not the largest implant complication that I have encountered, it’s not even the largest one this year!
Each time something like this happens it both kills and develops me as an individual. It is an extremely difficult sensation to deal with. It’s made all the harder when you look at our profession and feel that we are really bad at discussing these problems together. We seem to have developed into a culture where it is easier to conceal complications such as this instead of discussing them and trying to figure what happened for the better of our practice and our patients going forwards. Many years ago, in the late 1990’s I read a paper entitled ‘To err is human’ written by a cardiac surgeon who buries his mistakes. Recently I started reading ‘Do nor harm’ by Henry Marsh which is an incredible book about a neurosurgeon and is the most brutally honest clinical book I have ever read.
The book opens with the following quote from the French surgeon Rene Lariche (1879 – 1956) “Every surgeon carries within himself a small cemetery, where from time to time he goes to pray, a cemetery of bitterness and regret, of which he seeks the reason for certain of his failures”
Tonight I travel to the cemetery once again; almost twenty years in implant dentistry and my cemetery continues to fill.
As we get older and more experienced we need the support of people around us because the burden of our cemetery gets heavier and heavier. I don’t think we did anything wrong in this case but I still feel the weight of responsibility for the treatment I have advised and undertaken with this patient.
We will sort the patient, always in our practice people of this nature go to the top of the list for correction and never pay a penny for the correction they receive but it’s still a bitter pill to swallow for both the patient and for us. Perhaps I am able to take some solace in a quote by the US surgeon Chris Lillehei “Good judgment comes from experience; experience comes from bad judgment”
That said, and probably the most difficult part of this case overall, is that confronted by the same patient with the same circumstances again, I would do the same thing.
It’s long past the time where we should talk more about the complications we encounter.
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