The case

A general dental practitioner was consulted by a young adult patient for extraction of tooth 16. The tooth was symptomatic, and radiographs showed that the lesion was close to the pulp. Consent was obtained for extraction, and the procedure was carried out under local anaesthetic. 

During the procedure, the mesiobuccal root became dislodged and was displaced into the maxillary sinus. The member suspected an oroantral communication (OAC) and informed the patient immediately. A periapical radiograph and panoramic scan confirmed the root displacement. 

The patient was referred on the same day to a maxillofacial and oral surgeon (MFOS), who scheduled surgical removal. The procedure was successfully carried out a few weeks later. 

The patient subsequently wrote to the member expressing concern about the complication and the distress it caused, as well as the unexpected financial burden. The patient also noted difficulty obtaining medical documentation to support the time that needed to be taken off work and requested full reimbursement of the costs they had incurred.

How Dental Protection helped

The member contacted Dental Protection shortly after receiving the patient’s complaint. The dentist was reassured that displacement of a root into the sinus is a recognised complication of upper molar extractions and does not, on its own, indicate substandard care. 

However, because the patient had experienced distress, financial loss, and had not been expressly warned of the risk of an oroantral communication (OAC), Dental Protection advised that a goodwill reimbursement could be a fair and proportionate way to resolve the matter. 

The member was supported in drafting a measured and empathetic response to the patient. Suggested wording acknowledged the patient’s experience without making any admission of liability and offered reimbursement of both the initial consultation and surgical costs. 

As a discretionary indemnity organisation, Dental Protection was able to assist the member proactively, without waiting for a formal claim or HPCSA complaint. Support was approved for the member to reimburse the patient and then recover the amount from Dental Protection. This meant the patient was not left out of pocket, and the member’s own finances and reputation were also protected. 

The patient accepted the offer, and no further action was taken. The member later confirmed that the matter had been resolved to everyone’s satisfaction.

The member’s prompt recognition of the complication, immediate referral, and willingness to engage constructively with the patient and Dental Protection were instrumental in achieving a swift and amicable resolution. No legal claim or HPCSA complaint followed.

Learning points

• Known complications must still be discussed. Even when a complication such as sinus perforation is widely accepted as a risk of the procedure, it is important to explain it clearly as part of the consent process and to document the discussion. 

• Proactive communication preserves trust. The member’s timely, transparent communication and professional tone helped de-escalate the situation and maintain the therapeutic relationship. 

• Goodwill gestures do not equal liability. Offering reimbursement in carefully selected cases is not an admission of fault, but can be a powerful way to demonstrate professionalism, empathy, and fairness – and may prevent more serious escalation. 

• Discretionary indemnity allows for early support. Unlike insurers that may only act after a formal claim has been submitted, Dental Protection can assist members at an early stage, helping them resolve issues before they become formal legal or regulatory disputes. This flexible and reputationally sensitive approach ensures both the patient and member feel supported and treated fairly.