Duvall Discipline Panel Decision (redacted) - College of Dental ...

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The Panel reviewed a letter of complaint from R W , two letters from subsequent treating
dentists Drs. C and L, the chart, radiographs, a response letter from Dr. Duvall and heard
testimony from Dr. Penner.
(a) Endodontic Treatment to 2.4 and/or 2.6
Dr. Duvall performed root canals to teeth 2.4 and 2.6 for RW.
As to tooth 2.4, Dr. C examined it after the root canal was performed. He advised that it: "was
tender to percussion and non responsive to ice [and that} the fill appears to be 3-4mm short
of the radiographic apex with some possible apical pathology."
Dr. Penner testified that a tooth that does not respond to cold is not vital with a nerve response.
He reviewed the periapical radiograph of tooth 2.4 from May 19, 2009 and confirmed Dr.
C’s observation that the filling material was at least 4mm short of the apex. He pointed out
that there was no entry in the chart to explain this. Dr. Penner further stated that when a
dentist is filling a canal, it will be readily apparent that the fill is not where it should be and that a
final radiograph should be taken. It will indicate whether there is a problem with the fill. If
there is, the dentist ought to repair it. He said that root canal treatments should extend to within 1
mm from the tip of the canal to prevent bacteria from entering the tooth causing infection.
In this case the option for RW was to perform another root canal or remove the tooth.
In his response letter regarding the endodontic treatment to tooth 2.4, Dr. Duvall agreed that it:
"was short of the apex and after this amount of time I cannot remember the reason for that.
However, in the x-ray, it appears as if the canal was calcified. "
Dr. Penner testified that the canal did not appear to be calcified. Other than to admit that the fill
was short, Dr. Duvall did not provide any explanation to suggest that his work was performed to
an appropriate standard in respect of tooth 2.4.