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BY RACHEL COOK Californian staff writer firstname.lastname@example.org
LOS ANGELES -- An administrative hearing against a dentist accused of harming patients in Bakersfield resumed Monday with a graphic video of an oral surgeon quickly prying some of that allegedly shoddy work out of a patient's mouth.
Set to classical music, the video showed Dr. Dennis Smiler easily popping out implants that were lodged in Sheila Rios' mouth, but not fully surrounded by bone. Smiler pointed out that Rios had bone loss around 180 degrees of the implants, which were placed by Dr. Robert Tupac.
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Smiler also testified that based on X-rays taken in April 2007 -- about three months before Tupac extracted all of Rios' teeth -- the woman's teeth did not need to be removed. The X-ray shows Rios' natural teeth were solidly in her bone, Smiler said.
"I look at this X-ray and I'm sad...The sadness is that as good as implants are, they are only a substitute for a tooth," Smiler said. "I don't see why these teeth had to come out."
Tupac -- who is accused of dental negligence -- was not present as the hearing continued at the Office of Administrative Hearings in downtown Los Angeles. His attorney, Jason Friedman, said Tupac was involved in a "serious auto accident" that smashed his leg.
The hearing began in February but was continued after four days packed with testimony from Rios, another past patient, former and current employees of Tupac's and a Bakersfield dentist who reported his concerns about Tupac's work to the Dental Board of California. The state Attorney General's office filed an accusation against Tupac last year on behalf of the board.
Smiler, an oral and maxillofacial surgeon, testified that Rios came to him with dental implants that were showing through her gums. Smiler ultimately performed several surgeries including a bone grafting procedure on Rios. But in cross examination, Friedman indicated that another dentist later told Smiler that some of his work on Rios also was failing about two years after Smiler treated her.
Rios was referred to Smiler, who has lectured about bone grafting procedures internationally, by a Bakersfield dentist. Smiler said he shows the video of Tupac's work as an example of "what not to do."
In his testimony, Smiler stressed the importance of properly placing implants. Cortical bone, Smiler explained, is dense and gives structure, while cancellous bone is a woven network and contains blood that allows for bone growth. If implants "encroach" on the cortical bone, the bone resorbs, or "melts away." The soft tissue attached to the bone then follows.
During the video of the surgery, Smiler said Rios had almost no cancellous bone, almost everything had resorbed.
Smiler listed off multiple problems with Rios' dental work from Tupac, including a root of a tooth that was left in her bone, facial bone loss, and open margins in the work. He testified that he wrote in a letter to a dental board investigator that Tupac was negligent in his care of Rios and deficient in his planning.
Smiler worked with another dentist to restore Rios' mouth, including giving her new implants. Smiler was paid about $90,000 for his work, according to testimony Monday.
While Smiler said Rios healed well and all her work was stable when she left his care, he also acknowledged that he learned she has since had difficulty with his bone grafting and implants.
Friedman asked Smiler if he had seen records from another previous dentist of Rios indicating that she in fact asked for all of her teeth to be removed. Smiler said he had not.
"I think any dentist who would take these teeth out would not be following good dental protocol," Smiler said.
Friedman grilled Smiler about the specifics of his conversations with Rios' subsequent dentist, but Smiler said he could not recall the details. Friedman asked Smiler if he knew why his work on Rios also failed, but Smiler said he did not.
The attorney asked Smiler if sometimes a practitioner's work can fail even if they do everything right. Smiler said yes. But, he later added that he did not think Tupac did everything right in his treatment of Rios.
The hearing drew to a close just before 3 p.m. Several other dentists will take the stand this week in the case, as well as a dental board investigator. But the hearing won't wrap up any time soon.
The attorneys agreed to postpone Friedman's presentation of Tupac's case because of the accident. On Monday, the judge hearing the case said that the next opening in her schedule is in July.
Friedman said he did not know the specifics of the accident that wounded his client. But the Victorville California Highway Patrol confirmed that on Sept. 12, a Robert Tupac crashed a Kia Optima into a semi on a two-lane road.
The crash happened at 11:30 p.m. on Highway 395 north of Victorville. Tupac was heading north toward Shadow Mountain Road when for an unknown reason he allowed the 2011 Kia Optima he was driving to cross a double yellow line directly into the path of an oncoming semi, said Public Information Officer Matthew Hunt. Tupac was the only person in his vehicle and the only person injured in the crash. He was airlifted to a hospital.
Hunt said Tupac was found to be at fault in the crash but that no charges had been filed. He said there was no indication that drugs or alcohol were involved. The Kia had major damage, while the semi's gas tank was punctured. Diesel fuel was spilled onto the road and the scene was declared a hazardous materials incident, Hunt said.