Iatrogenic damage
Prof. Kukletová, M.
Iatrogenic damage in dentistry
Iatrogenic damage is an accidental
damage to patient caused during
treatment procedures, most frequently as
a result of non lege artis approach
Iatrogenic damage has to be differentiated
from complications which can occure after
treatment
Inaccurate surgical intervention, access or
inapproprite behavior (e.g. non sterile
instruments, procedures)
false medicament prescription or
application
hurry, stress
incorrect diagnosis
burn-out syndrom
Causes of iatrogenic damage
 The most frequent types of iatrogenic damage:
- damage of neighbourning tooth during
preparation
- extraction of a non indicated tooth
- injury of cheeks,tongue by the bur
- swelling of soft tissues after penetration of
NaOCl into the periodontal space, sinus
maxillaris on endodontic treatment
- emphysema after root canal irrigation using
hydrogen peroxid
- etching with chemicals during endodontic
treatment
- cutting of neighbouring tooth root on surgical
extraction
How to prevent the iatrogenic damage of
patients
to avoid rush work under stress
perfect and careful medical history
to respect rules of work safety
indicated therapy
checking of all medicaments before their
application ( syringe, needle, medicament,
solution, anesthetics)
protection of neighbouring teeth
Damage of the neighbouring tooth
Common mistakes
Amalgam filling
Class I
Extension for prevention
Entire fissure complex not involved
Marginal ridge not weakened
Cusps – fissure – extension of cavosurface
margin
Sharp edges
Retention
Box- like cavity
Parallel walls with undercuts
Convergent occlusally
Mistakes
Dish-like preparation
Bevel for amalgam
No undercuts
Resistance
A. Tooth
has to remain strong enough
cusp - inlay
plastic filling
B. Filling
2mm
Too shallow
Floor of the cavity
Must not be of the same depthprotection
of the dental pulp
Base
Composite filling
Class I
1. To remove carious dentine
2. Retention
A, Extension for prevention
B,Resistance-2mm depth
3. Retention
Micromechanical – etching
Dentinal adhesives - hybride layer
Class II cavity
Mistakes
1. Extension for prevention
Tangent
American rule
Small extension
Small resistance of the tooth
Sulcus x ep.attachment
Predilection for caries
Injury of the epithelial
attachment
Retention
Too wide isthmus
Too narrow isthmus
Too short dove tail preparation
axial extension
Sharp edges
gingival wall – 90°
Resistance-filling
Resistance-tooth
No undermined enamel
No over extension
Cusp protection x replacement
Class II cavity
Marginal ridge
A. Mistakes during cavity preparation
1. Wrong indication for instruments
 air turbine machine
 micro motor
 burs, discs
2. Insufficient pulp protection (heat during preparation)
3. Unfinished preparation
 Micro motor
 Hand instruments
B. Insufficient dry field (rubber dam, rolls)
C. Wrong choice, application of matrices
Wedging, point of contact
D. Wrong mixing (preparation) of filling materials
Mistakes during cavity filling
E. Occlusion, articulation
F. Finishing, polishing