Orthodontics Treatment Case – $85,000.00

Orthodontic Treatment Causes TMJ Syndrome in case against Florida orthodontist

The plaintiff was a twenty-five year old legal secretary when in June, 1981, she visited the offices of a general dentist for a routine examination. The dentist suggested that she consult with the defendant who was an orthodontist and who worked in that general dentist’s office one day per month. The defendant orthodontist owned family dentistry clinics throughout south Florida where he would see patients one day a week in each location. After examination of the plaintiff, the defendant made an entry in his office record describing his patient as an “extraordinary case”. Notwithstanding this, he made no study casts, took no photographs and failed to conduct a cephalometric analysis to determine whether the patient had any skeletal defects and to determine the relationship between the jaws or the teeth to the jaws. The defendant decided that his patient needed space for the repositioning of her teeth so he ordered the extraction of four premolar teeth. After the teeth were removed he applied orthodontic brackets and elastic traction. A couple of months later, his patient complained of headaches and muscle pain in her neck and shoulders. He saw her monthly and made adjustments and she repeated her complaints each time stressing their increasing severity. The defendant apparently made no connection between her complaints and his treatment. At some point during treatment, the patient started complaining of pain in her temporomandibular joints, yet the defendant did nothing. The patient began seeing ENT surgeons, internists, neurologists and chiropractors. One of the many chiropractors she had seen suggested that she had TMJ Dysfunction Syndrome and referred her to a dentist who limited his practice to treatment of that disorder. He told her that the orthodontic treatment was causing the TMJ symptoms and referred her to another orthodontist for a second opinion. The consulting orthodontist concurred and suggested she have her braces removed. She returned to the defendant and he referred her to one of his orthodontic employees who worked in one of his other clinics. That orthodontist told her that the braces were moving her teeth in the wrong direction and removed the appliances. The patient started orthodontic treatment again, this time in the right direction and shortly thereafter had jaw repositioning surgery which she apparently needed from the outset. The defendant never realized the need for surgery since he never took the necessary cephalometric x-rays. Claim was not made for the surgery inasmuch as the patient had the skeletal defect upon presentation to the defendant who merely delayed that aspect of treatment. The case was settled after jury selection for $85,000, representing intangible damages only, inasmuch as the patient had full health insurance. Kenneth P. Liroff, D.D.S., J.D., of THE DENTALAW GROUP Ft. Lauderdale, FL represented the plaintiff. Carl M. Jenkins, Esq., Ft. Lauderdale, FL represented the defendant.

Orhodontics Surgery-$ 70,000.00

Orthodontic retrieval of impacted maxillary cuspid fails and four teeth are extracted. Spaces left by extractions require years of orthodontic treatment and surgery — $70,000 settlement in Florida.

The plaintiff, a thirty-one year old homemaker and executive recruiter for local and national firms, was referred to her general dentist, by the defendant orthodontist, to attempt the retrieval of a palatally-impacted maxillary cuspid (upper eye-tooth embedded in the roof of the mouth). The defendant, without the benefit of cephalometric x-rays, diagnosed her as having a Class II maloccusion with a nearly “ideal facial profile”. There was a relative retrusion of the mandible of six millimeters, a deficient chin and obvious vertical maxillary excess. Notwithstanding the six millimeter maxillo-mandibular discrepancy, he ordered the bilateral first bicuspids extracted. His plan was to use elastic traction to bring the lower posterior teeth forward on the lower arch wire and, with the same elastic attached to the surgically-exposed palatal cuspid, to bring the palatal cuspid down. Optimistically, he ordered the extraction of the deciduous, or baby, cuspid which was rock-solid in the site into which he hoped to move the palatal cuspid. Retrieval of the palatal cuspid failed. According to the defendant, this was because of poor patient cooperation. He then ordered the removal of the palatal cuspid and the contralateral cuspid “so that it would be symmetrical”. After one and one-half years of appliance therapy, the plaintiff started over with four large spaces in her mouth caused by the extractions on top and bottom. After another year or so the plaintiff sought another opinion and was told that she wasn’t being treated properly and that the spaces might never close without surgery. After a year of orthodontically trying to close the spaces by the second orthodontist, he referred her to an oral and maxillofacial surgeon. Following a thorough work-up, the plaintiff was proposed either fixed bridgework to close the extraction spaces or orthodontic surgery which would not only close the spaces but also correct for the retruded lower jaw and minimize the vertical maxillary excess. She elected the surgical approach and underwent a segmentalized maxillary Le Forte I osteotomy and mandibular sagittal split osteotomy. The plaintiff contended that she lost approximately six months of employment as a professional executive recruiter although admitting that she had been laid off before the surgery and that her employer denied that the lay-off was related to her impending surgery. Out of pocket medical expense was less than $5,000. There was no permanent disability or injury.

The case settled on the morning trial was to begin for $70,000. Kenneth P. Liroff, D.D.S., J.D., of THE DENTALAW GROUP Ft. Lauderdale, FL represented the plaintiff. Clark Cochran, Esq., Ft. Lauderdale, FL represented the defendant.

Failed Orthognathic Surgery – $230,000.00

$230,000.00 settlement for young woman following failed orthognathic surgery in case against Florida oral surgeon.

Plaintiff was a banker in her mid-twenties when she underwent a bilateral mandibular sagittal osteotomy and LeFort I maxillary osteotomy because of a facial skeletal deformity. An acrylic interocclusal stent was inserted during surgery and the patient’s jaws closed into the stent. During the immediate post-surgical period, the patient’s lower teeth came out of the stent and the defendant oral surgeon used Class III elastic traction to pull the lower jaw forward so that the teeth would seat in the stent.

Because the osteotomy fragments were rigidly fixed to each other the elastic traction served only to force the mandibular condyles forward in the glenoid fossae and cause dislocation of the TMJ discs. The patient required TMJ arthroscopic surgery and refracturing of the osteotomy.

An incidental finding by the subsequent treating oral surgeon was that the patient’s nasal septum was buckled and deviated which could only have resulted from the defendant’s failure to remove sufficient septum at the time of the original LeFort surgery. This finding necessitated an additional procedure to remove the excess septum.

The case settled during a mediation conference for $230,000.00 (the defendant’s policy limit of $250,000.00 minus defense costs.). Dade County (FL) Circuit Court, Case No. 93-09467-CA24. Kenneth P. Liroff, D.D.S., J.D., of , Ft. Lauderdale, FL represented the plaintiff. Jay Chimpoulis, Esq., of O’Connor & Meyers, Coral Gables, FL, for the defendant.

Child’s Orthodontic Treatment – $7,500.00

Child’s orthodontic treatment handled Improperly — four permanent teeth improperly extracted; therapy totaled six years and required head gear — $7,500 settlement in Florida.

The plaintiff, age ten and one-half, visited the defendant dental clinic for orthodontic treatment. The first orthodontist started treatment and extracted six deciduous teeth and four permanent teeth. The second orthodontist continued treatment and estimated two years of therapy and one year in retainers. Nearly four years after therapy began the plaintiff was still in treatment and saw the third clinic orthodontist who told the family that the plaintiff needed an additional two years of treatment. The plaintiff discontinued therapy and saw a private orthodontist who found fault with the excision of the four permanent teeth. The plaintiff underwent two additional years of orthodontic therapy and required head-gear to correct the extraction of the four permanent teeth. The defendants’ position was that the extraction of the teeth was a “Judgment Call”.

The case settled for $7,500 before trial. Kenneth P. Liroff, D.D.S., J.D., of THE DENTALAW GROUP Ft. Lauderdale, FL represented the plaintiff. Rob Barouth, Esq., Miami, FL and Carl E. Jenkins, Esq., Ft. Lauderdale, FL for defendants.