Molar tooth anatomy sometimes includes auxiliary root canals, loops, curved roots and fins which are difficult to detect, clean and obturate (fill). Many times, general dentists try to perform root canals on multi-rooted molars with these conditions and it could be below the standard of care for dentists under like or similar circumstances for them to do so. Other situations that may require referral by a general dentist to an endodontist to perform the root canal are narrow canals, abnormally large canals, internal resorption, broken files in a canal, canals requiring a post, and canals that are in the inferior alveolar nerve canal or in the sinus for maxillary molars and pre-molars.
Improper technique by a general dentist performing a complex root canal can lead to apical and coronal leakage of the root canal, root canal failure and, in the worst case scenario, injury to the nerves and other anatomic structures around the tooth. Improper technique can be in the form of over instrumentation of the root, not getting accurate working lengths, using excessive force while condensing with instruments to compact the gutta-percha, not properly sealing the core prior to obturation, not creating an apical stop, or over filling the canal by applying too much gutta-percha too quickly or placing too much volume in the canal to the fill with canal without exuding out of the end of the canal.
In addition to improper technique, a general dentist can commit dental malpractice while performing a complex root canal therapy treatment by: failing to perform an adequate and sufficient implant placement work-up and evaluation, including measurements to determine the depth of the available bone into which the implant can be safely placed without injury to the nerve; failing to sufficiently determine the location within the bone of the nerve bundle (the bundle that carries the nerve, the artery and the related anatomy through the jaw) to allow for the safe placement of the implant without injury to the nerve; placing the implant into the nerve canal and injuring the inferior alveolar nerve; failing to timely treat and/or remove the implant after becoming aware of complaints of numbness or pain or pain and numbness together; failing to adequately monitor and mitigate the consequences of paresthesia after negligent placement of the implants into the nerve canal; failing to timely refer the injured patient to a nerve specialist after the implant was placed in the nerve canal and the patient sustained a nerve injury, as indicated by the signs and symptoms of number, pain and/or pain accompanied by numbness relayed by the injured patient; and failing to gain informed consent for the implant procedure. All of these are actions or inactions on the part of the general dentist that can result in a dental malpractice claim, if the malpractice has resulted in injury sufficient in nature to warrant the filing of a malpractice claim.