Orthodontics Expert Witness Advises on TMJ Post Procedure

Case Overview

This case takes place in Delaware and involves a teenage patient who suffers from Temporomandibular Joint Disorder following an orthodontic procedure. In February 2007, the patient began treatment with the defending orthodontist. In early 2011, the patient had a left canine tooth impaction (tooth #11 and underwent treatment to attempt to foster the eruption and descent of tooth #11. The patient was referred to the defending oral surgeon for surgical exposure of tooth #11 to attempt to promote the descent of that tooth on the left side. Orthodontic structures were then placed to apply tension on the tooth in an attempt to get the tooth to descend. On July 2, 2012, the orthodontist ordered the oral surgeon to perform another surgical procedure to attempt to descend tooth #11, to be followed by additional orthodontic pressure and tension on the left side of the patient’s mouth by the orthodontist. There has been no follow-up by the defendant following the procedure, and the patient suffered significant bone loss and severe angulations and deformity of his bite and jaw alignment. The patient had to undergo multiple dental procedures to graft bone to replace the bone lost and it is reported that the patient’s bite and jaw disfigurements cannot be repaired such that he is destined to suffer from worsening TMJ and its sequella for the rest of his life.

Questions to the Orthopedics expert and their responses

Have you ever had a patient develop the outcome described in the case?

I routinely treat patients similar to the one described but I have not had a patient develop the outcome described. The outcome, if I understand, sounds like a cant off the occlusal plane, a slant from the force of bringing the tooth into occlusion.

Is it such that orthodontic tension to cause the descent of an impacted canine tooth should be accomplished in only 6-10 months?

The length of time to erupt an un-erupted tooth varies greatly depending how high into the maxilla it was. It can some time take several years to bring it into occlusion.

Do you believe this patient may have had a better outcome if the care rendered had been different?

The patient may have had a better outcome if care was rendered differently.

About the expert

This highly qualified orthodontist received his M.S.D. in Orthodontics and D.D.S. at the Indian School of Dentistry where he graduated with distinction. This expert has been honored as a Diplomate with the International College of Dentists and Diplomate with the American Board of Orthodontics. He is a member of several professional organizations including the American Dental Association, American Association of Orthodontics, American Dental Association, American Association of Orthodontists, Angle Society of Orthodontist, Indiana Dental Association, North Central Dental Society, Mishawaka Dental Society, Indiana Association of Orthodontists, Great Lakes Society of Orthodontists, and American Board of Orthodontics. He has taught as a Clinical Instructor in the Dental Hygiene Program at the Indiana School of Dentistry focusing on Orthodontics and Temporal Mandibular Joint Dysfunction. This expert has authored 5+ publications in the field and is frequent invited guest speaker at major conferences related to Orthodontic and TM joint disorder. At his private practice, this expert is an Elite Provider of Invisalign which is a distinction reserved for the top 1% of providers of Invisalign in the country. Currently, he is an attending orthodontist at a private practice. He currently practices in three locations and has treated over 35,000 patients.