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.