William Tyler successfully defended an orthodontist against allegations of negligence in the recently decided case of MA v CB

Negligence in Orthodontistry – A Successful Defence

William Tyler (Deans Court Chambers), instructed by Hashim Talbot (Dental Protection) successfully defended an orthodontist against allegations of negligence in the recently decided case of MA v CB.

MA had attended CB with moderate crowding in his upper arch that had caused UR3 to erupt palatally and UR2 to become proclined. CB had suggested a simple expansion approach using Damon appliances to address the crowding and bring the errant teeth into line. Treatment started about six months after the initial assessment and took place over the course of about a year, MA was provided with retainers but missed a review appointment and was lost to follow-up.

Approximately 18 months after the Damon appliances were removed MA said that he began to feel a strange sensation at UR2 with a bad taste in his mouth. Subsequent investigations revealed root resorption and MA was advised that the tooth had a limited prognosis.

MA sued CB for damages asserting that UR2 had been non-vital at the time he was first assessed, that CB should have identified this from an OPG he had exposed at that time and further that CB should have undertaken quantitative arch length analysis. Had CB done so, it was argued, he ought to have advised the Claimant to undergo, and the Claimant would have undergone, an extraction approach to the rectification of his crowding and alignment of his teeth.

Following a 3 day trial Recorder Kirtley dismissed the claim. He found that it was not necessary to find whether or not UR2 was non-vital at the time of the initial assessment, the question was whether on an analysis of the OPG no responsible body of orthodontists, acting logically, would have failed to identify a cause for concern worthy of further investigation. He found that he could not reach that conclusion on the evidence. 

On the question of quantitative arch length analysis he accepted that whilst some orthodontists may pursue such an approach, there were those who did not and that the reasons for not doing so were considered and reflected experience in practice in circumstances where the precise measurement of overcrowding was unlikely to be determinative of the treatment programme followed. Moderate overcrowding, of itself, he found, did not demand an extraction approach. 

Accordingly he found no breach of duty and dismissed the claim.