Orthodontics Expert Evaluates Inadequate Imaging Before Implant Surgery

This case involves a 30 year old male patient in Kentucky with a past medical history of a congenital deformation of his jaw that caused it to develop abnormally. The patient began seeing an orthodontist, who fitted him with braces. The patient later required extraction of several teeth by an oral surgeon due to severe decay. The patient’s braces were removed prior to the extraction, and the extracted teeth were to be replaced with implants. However, no medical imaging was performed prior to the removal of the patient’s teeth. The oral surgeon removed the teeth and attempted to place implants, but was unable due to the lack of usable bone in the patient’s jaw.

Question(s) For Expert Witness

1. Do you perform the procedures mentioned in this case?

2. What is the standard imaging that takes place prior to the extraction of several teeth?

3. Should the oral surgeon have confirmed that there was sufficient usable bone in the patient's jaw?

Expert Witness Response E-008007

I perform this procedure often. The type of imaging undertaken before the procedure usually involves either periapical or panoramic images of the teeth. The images do not need to be taken immediately prior to the procedure, however, and can be from the past 1-2 years or longer if clinically correlated. Furthermore, they don't necessarily need to be taken by the person performing the surgery - I commonly receive images from other orthodontists, dentists, and physicians. The required imaging can also vary depending on the type of teeth being removed, and there are instances where only clinical evaluation is performed. Regardless, a total lack of imaging in this case is troubling.