Legal Liability in Dental Treatment and Implant Malfunctions

What are Dental Treatment and Implant Errors?

Dental treatment and implant errors occur when a patient suffers harm due to diagnosis, treatment, surgery, implant placement, prosthesis, root canal treatment, crown placement, filling, tooth extraction, or cosmetic dentistry performed by a dentist or dental clinic in a manner contrary to medical and dental standards. In practice, such disputes dental malpractice, implant malpractice, faulty dental treatment, compensation claims due to dental treatment , or generally, malpractice lawsuits .

In dental treatments, not every undesirable outcome automatically means the dentist is at fault. Failure of an implant to take, post-treatment pain, temporary sensitivity, swelling, or the need for revision can be considered complications in some cases. However, legal liability arises if the dentist fails to perform an adequate examination, incompletely evaluates X-rays or CT scans, plans an inappropriate treatment, selects the wrong implant, performs faulty surgery, causes nerve damage, fails to manage an infection, does not adequately inform the patient, or abandons treatment prematurely.

The Patient Rights Regulation covers all public and private institutions and organizations providing healthcare services. The aim of the regulation is to ensure that individuals benefiting from healthcare services can exercise their patient rights in a manner consistent with human dignity and that they can utilize legal means of protection against rights violations. Therefore, dental treatments and implant procedures are also evaluated within the framework of patient rights, informed consent, medical records, compensation, and professional responsibility provisions.

The Most Common Mistakes in Dental Treatment

Dental errors can manifest in many different ways. The most common complications include faulty implant placement, incorrect root canal treatment, unnecessary tooth extraction, faulty prostheses, poorly done crowns, technical errors in fillings, nerve damage, jawbone damage, failed infection, inadequate sterilization, misdiagnosis, insufficient imaging, and failure to meet aesthetic expectations.

Treatment planning is extremely important, especially in implant treatments. Implant placement without evaluating the patient's jawbone structure, bone density, nerve and sinus areas, systemic diseases, smoking status, diabetes, oral hygiene, need for bone grafting, and existing tooth structure can lead to serious harm. Incorrect implant placement, proximity to nerves, damage to the sinus cavity, infection around the implant, or incompatible prosthesis with the implant can result in long-term pain, tooth loss, jawbone loss, loss of sensation, and additional treatment costs.

Errors can also occur in root canal treatments. Fractures of the root canal file, fragments remaining in the tooth or jawbone, incomplete root canal filling, perforation, failure to clean an infection, or performing the procedure on the wrong tooth instead of the one requiring treatment can all be grounds for compensation claims. In one Supreme Court decision, a compensation dispute based on the claim that a root canal file broke and became lodged in the jawbone during root canal treatment was considered; the case discussed claims of damages such as tooth loss and the need for implants.

Dentist's Responsibility in Implant Failure

Dental implant placement is often more than just a simple dental treatment; it's a comprehensive procedure involving surgical planning, imaging, bone assessment, prosthetics, and follow-up. Therefore, claims of implant failure aren't solely based on whether the implant screw was properly placed. The treatment plan, surgical procedure, materials used, prosthetic fit, infection control, follow-up appointments, and patient instructions are all evaluated together.

A dentist's liability can vary depending on the nature of the procedure. While some dental treatments are considered within the scope of a classic agency contract, the discussion of a contract for services may arise for implants, prostheses, crowns, and cosmetic dentistry applications. In a decision regarding implant treatment, the 3rd Civil Chamber of the Supreme Court of Appeals stated that dental treatment is considered within the scope of a contract for services, that the care expected from a dentist should be at the highest level in interventions on the human body, and that material and moral damages should be considered if implant placement is deemed inappropriate.

This approach increases the importance of patient expectations and dentist commitment in dental practice. For example, if a patient has paid for a specific number of implants, a particular type of prosthesis, an aesthetic smile design, or fixed teeth, it should be examined whether the resulting outcome is consistent with this treatment plan. Of course, an absolute guarantee of results is not always acceptable in interventions performed on the human body. However, if the patient has not reasonably achieved the promised treatment outcome, and this is due to the dentist's faulty planning or execution, liability for compensation may arise.

The Difference Between a Complication and Dental Error

In dental treatment and implant cases, the most important distinction is between complications and faulty procedures. A complication is an undesirable outcome that can occur despite interventions that comply with medical and dental standards. For example, temporary swelling, pain, bruising, sensitivity, or temporary discomfort during the healing process after an implant can be considered normal in some cases. However, not every negative outcome can be explained by labeling it a "complication.".

For an outcome to be considered a complication, the treatment must first have been planned and implemented according to standards. Furthermore, the patient must be informed of the risk before treatment, their consent must be obtained, and the physician must take the necessary action promptly if a complication arises. For example, if an infection develops after implantation, it should be investigated when the infection was detected, whether the patient was called for follow-up, whether antibiotic or surgical intervention was required, and whether the physician fulfilled their follow-up obligations.

Similarly, nerve damage can be cited as a risk in some implant procedures. However, if the nerve pathway has not been adequately assessed with panoramic X-rays or CT scans before treatment, if the implant is incorrectly positioned, or if the patient has not been informed of the risk of numbness and loss of sensation, the defense of "complication" may not be sufficient. The critical question here is: Did the dentist take the necessary precautions and measures expected of a diligent and expert dentist under the same circumstances?

Informed Consent and Patient Education

Informed consent is extremely important in dental treatments. The patient must know what the procedure is, why it is necessary, what consequences may arise if the procedure is not performed, alternative treatment options, the risks of the treatment, the probability of success, and what precautions should be taken after the treatment. The Patient Rights Regulation governs the patient's right to receive information about health services and medical procedures; it also explicitly recognizes the principle of consent in medical interventions.

Article 70 of Law No. 1219 on the Manner of Practice of Medicine and Related Professions stipulates that dentists must obtain the prior consent of the patient, or the guardian or trustee if the patient is a minor or incapacitated, for all types of procedures; and that this consent must be in writing for major surgical interventions. This provision shows that in dental treatment and implant procedures, consent is not merely a formal document, but a fundamental element in the legality of the intervention.

The mere existence of a consent form is not always sufficient. Simply having the patient sign a general form stating "I accept the risks of implantation" may not be enough in a specific case. The patient should be clearly informed about the possibility of implant failure, nerve damage, sinus complications, infection, the need for bone grafting, prosthesis incompatibility, the possibility of revision, the duration of treatment, the use of temporary teeth, and care responsibilities. This information is even more crucial in high-cost procedures such as aesthetic dentistry, smile design, zirconium crowns, laminate veneers, implant-supported prostheses, and full mouth restoration.

Legal Responsibility of a Private Dental Clinic

Dental treatments are often performed in private dental clinics, oral health polyclinics, private hospitals, or private practices. In this case, the responsibility may not rest solely with the dentist performing the procedure. The clinic or healthcare facility may also be responsible for the organization of the services provided, the equipment and materials used, sterilization conditions, record keeping, personnel selection, and the appointment and follow-up system.

The relationship between a private dental clinic and a patient can, in many cases, be considered a consumer transaction. Current legislation regarding the Law No. 6502 on Consumer Protection is published by the Ministry of Trade. In private healthcare services, the patient is, in most cases, the consumer receiving the service, while the clinic or hospital is the party providing the service.

Therefore, the competent court for cases involving errors in private dental clinics is often the Consumer Court. However, this outcome is not automatic in every case. The specific circumstances—such as independent dental practices, private clinics, private hospitals, services provided by companies, aesthetic procedures, or dental treatment in public institutions—must be evaluated separately. The prerequisites for mediation and monetary limits for filing a lawsuit in the Consumer Court should also be considered.

Error at State Hospital or Oral and Dental Health Center

If dental treatment was performed at a state hospital, oral and dental health center, or a public university dental faculty, the legal recourse differs from that in private clinics. Dental health services provided by public institutions are a public service. If this service is poorly performed, delayed, or not performed at all, the administration may be considered to have committed a service defect.

In this situation, in most cases, instead of directly filing a private law compensation lawsuit, the option of applying to the relevant administration and pursuing a full judicial review in the administrative court is considered. According to Article 13 of the Administrative Procedure Law No. 2577, individuals whose rights have been violated by administrative actions must apply to the relevant administration within one year from the date they learned of the action, and in any case within five years from the date of the action; if the request is rejected or no response is given within thirty days, a lawsuit can be filed within the statute of limitations.

This distinction is crucial. A faulty implant procedure performed at a private dental clinic may not be subject to the same legal process as a faulty tooth extraction performed at a state-run dental health center. Filing a lawsuit in the wrong court or missing the deadline to appeal to the administration can lead to a loss of rights. Therefore, one of the first things to do in cases of dental malpractice is to determine in which institution the procedure was performed and under what legal relationship it occurred.

What types of compensation can be claimed?

Patients who suffer harm due to dental treatment or implant failure may claim monetary and non-monetary compensation if the conditions are met. Monetary compensation aims to cover the patient's economic losses. This may include reimbursement of the cost of faulty treatment, new treatment expenses, costs of implant removal and replacement, bone grafting, sinus lifting, prosthesis replacement, medication costs, examination fees, X-ray and CT scan costs, transportation expenses, loss of earning capacity, and temporary disability.

For example, if implants had to be removed because they were placed at the wrong angle, the patient can claim not only a refund of the initial payment but also additional costs arising from the removal of the implants, repair of bone loss, new implant and prosthesis treatment, temporary teeth, and the long treatment process. If a tooth was lost due to faulty root canal treatment and the patient had to get implants, the cost of the implants can also be considered among the damages.

Compensation for moral damages is claimed due to the pain, distress, suffering, aesthetic impairment, difficulty speaking and chewing, social isolation, loss of self-confidence, prolonged edentulism, painful treatment process, permanent loss of sensation, or disfigurement of the face experienced by the patient. Dental health directly affects not only a person's physical health but also their social life, speech, nutrition, and appearance. Therefore, claims for compensation for moral damages often hold significant importance in cases of dental malpractice.

How to Prove Dental Malpractice?

Providing evidence in dental treatment and implant cases requires technical knowledge. The patient must demonstrate that they have suffered harm, that this harm is related to the dental treatment, and that the dentist or clinic acted negligently. However, since treatment documents are often held by the clinic or hospital, obtaining all medical records completely is essential in the initial stage.

Evidence that can be used includes the treatment plan, X-rays, panoramic film, periapical film, CT scans, measurements, laboratory records, implant brand and serial number information, documentation of materials used, consent form, prescriptions, invoices and payment documents, appointment records, follow-up notes, WhatsApp and email correspondence with the doctor, photographs, second dentist's opinions, and expenses related to the new treatment.

Under the Patient Rights Regulation, patients have the right to review and obtain copies of their health records. Failure to provide medical records, incomplete records, or the existence of documents that give the impression of being subsequently altered can also be raised in legal proceedings.

In dental implant cases, pre- and post-operative imaging records are particularly crucial. The implant placement angle, distance from the nerve canal, relationship with the sinus, bone levels, signs of infection, and the fit of the prosthesis to the implant are examined through these records. In root canal treatments, pre- and post-operative X-rays, the presence of broken instruments, the quality of the root canal filling, and the reason for tooth extraction are important.

The Importance of Expert Reports

In cases involving dental treatment and implant errors, courts typically request expert reports. These reports significantly influence the outcome of the case. The expert panel should ideally include dentists from the relevant specialties. Implant cases may require evaluations from oral and maxillofacial surgery, periodontology, prosthetic dentistry, and radiology specialists. Root canal treatment cases require the opinion of an endodontist; prosthetic dentistry specialists for prosthesis and crown cases; and orthodontics specialists for orthodontics cases.

A simple statement such as "the implant did not take" or "it is a complication" is not sufficient in the expert report. The report must provide clear and reasoned answers to questions such as: Was the pre-treatment planning correct? Is the patient suitable for the implant? Were the necessary imaging studies performed? Was the implant placed at the correct angle and depth? Was the prosthetic planning appropriate? Was the infection management correct? Was the patient adequately informed? And is there a causal link between the resulting damage and the treatment?.

The Supreme Court's decision regarding implant treatment also emphasized that the matter is technically complex, requires evaluation based on expert reports, and that the duty of care in dental treatment must be treated with the utmost care. Therefore, expert reports that are incomplete, superficial, outside the relevant field, or fail to review all records should be challenged. If necessary, an additional report, a new expert panel report, or a university/Forensic Medicine Institute evaluation should be requested.

Can a criminal investigation be opened?

Dental treatment or implant errors can, in some cases, lead not only to a compensation lawsuit but also to a criminal investigation. In particular, criminal complaints may be filed with the prosecutor's office in situations involving serious bodily harm, permanent nerve damage, extraction of the wrong tooth, deliberate risk-taking, falsification of documents, alteration of records, or treatment performed by unauthorized persons.

However, there are specific procedures for investigations into healthcare professionals. According to Article 18 of the Annex to Law No. 3359 on Basic Health Services, certain authorization mechanisms apply to investigations into medical procedures and practices related to examination, diagnosis, and treatment performed by physicians, dentists, and other healthcare professionals working in public or private health institutions and foundation universities; the Professional Responsibility Board process may come into play.

Criminal investigations and civil lawsuits are different. A criminal investigation examines the dentist's criminal liability, while a civil lawsuit aims to compensate the patient for the material and moral damages suffered. However, reports, statements, and documents obtained in the criminal case file can be used as important evidence in a civil lawsuit.

What should a patient do if they suspect a dental malpractice?

Patients who suspect a dental treatment or implant error should first gather all relevant documents. These include clinic consultations, payment receipts, invoices, treatment plans, X-rays and CT scans, implant information, consent forms, prescriptions, follow-up records, and correspondence with the doctor. If the patient has consulted another dentist, the second dentist's assessment and new treatment plan should also be added to the file.

In the second stage, up-to-date documentation of the current dental condition is necessary. New panoramic X-rays, CT scans, photographs, and expert evaluations are crucial in revealing the consequences of faulty treatment. However, caution should be exercised regarding the removal of implants or a complete change of treatment before obtaining the current evidence, if possible. This is because proving a previous error may become more difficult after a change in treatment.

Thirdly, it must be determined whether the procedure was performed in a private clinic, private hospital, doctor's office, state dental health center, or university hospital. The competent court, mediation process, administrative appeal period, and litigation timeline may vary depending on this.

Fourthly, the cost of damages must be calculated completely. Patients often only consider claiming reimbursement for the treatment they paid for. However, in cases of faulty dental treatments, claims may also include re-treatment costs, implant removal, bone grafting, prosthesis replacement, loss of earning capacity, transportation and medication costs during the extended treatment process, and emotional distress.

Conclusion: Effective legal processes are essential in cases of dental treatment and implant defects

Dental treatment and implant errors are serious health law disputes that directly affect a patient's health, appearance, speech, nutrition, and social life. Faulty implants, incorrect root canal treatments, unnecessary tooth extractions, ill-fitting prostheses, nerve damage, infections, incorrect crowns, or insufficient information can cause both financial and emotional harm to the patient.

In cases like these, not every adverse outcome is automatically attributed to the dentist's fault. However, not every "complication" defense absolves the dentist or clinic of responsibility. The crucial factors are whether the treatment was properly planned, whether necessary imaging and examinations were performed, whether the patient was adequately informed, whether the consent was valid, whether the treatment was carried out in accordance with dental standards, and whether the resulting harm was managed correctly.

Patients who experience dental malpractice should gather their medical records, keep imaging documents, obtain a second opinion from another physician, clearly distinguish between private and public clinics, and fully present their claims for both material and moral damages. As emphasized by the Supreme Court, the level of care expected from dentists in procedures such as implants and prosthetics is very high; therefore, legal liability may arise in cases of inadequate planning, faulty application, or insufficient follow-up.

A well-prepared case file can effectively document pre-treatment promises, lack of consent, X-ray and CT scan findings, implant placement, prosthesis fit, signs of infection and nerve damage, new treatment costs, and the patient's emotional distress. In dental and implant cases, the primary goal is not only to identify the error but also to compensate the patient for the damages suffered to the greatest extent possible.