Extrusion of Endodontic Filling Materials: Medico-Legal Aspects. Two Cases

Valeria Santoro1, *, Piercarlo Lozito2, Antonio De Donno3, Felice Roberto Grassi4, Francesco Introna5
1 Section of Legal Medicine, University of Bari, Italy
2 Section of Legal Medicine, University of Bari, Italy
3 Section of Legal Medicine, University of Bari, Italy
4 Department of Odontostomatology and Surgery, University of Bari, Italy
5 Section of Legal Medicine, University of Bari, Italy

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© Santoro et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address corrispondence to this author at the Section of Legal Medicine, University of Bari, Policlinico, Piazza Giulio Cesare 11. 70124, Bari, Italy; Tel/Fax: +390805478249/+390805478301; E-mail:


The Authors describe two cases of alleged malpractice due to overfilling. The aim of this article is to underline some medico-legal aspects regarding the quantity of extruded material which may be considered acceptable and the consequent damage to the patient.

Two cases are presented here: In the first case, the dentist’s liability is clear due to excessive extrusion of endodontic material beyond the apical region combined with incomplete obturation of the canals. In the second case however, because two different dentists were involved, establishing the connection of causality between their work and the damage reported by the patient was not easy. This situation makes it difficult to establish the limits of potential responsibility, coupled with the complete absence of radiographic signs of periapical rarefaction and the small quantities of material beyond the apex. From a medico-legal point of view, a dentist may be held responsible for compensation and financial expenses of a patient for restoration of damage resulting from a dental procedure.

Italian guidelines offer no indications as to when overfilling should be considered the result of a procedural error, or if it fits within the range labelled as “acceptable” and this gap offers extremely subjective interpretations of legal consultants. So, it would therefore be useful to adopt more precise qualitative/dimensional parameters, keeping in mind that the guidelines offer therapeutic recommendations and are not rigid protocols.

Key Words: Overfilling, professional liability, endodontic procedurals errors, forensic dentistry.