STATE OF FLORIDA Z BOARD OF DENTISTRY DEPARTMENT OF HEALTH, PETITIONER, v. CASENO: 2014-12981 ANATOLY RIPA, D.D.S., RESPONDENT. ADMINISTRATIVE COMPLAINT COMES NOW Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Dentistry against Respondent, Anatoly Ripa, D.D.S., and in support thereof alleges: 1. Petitioner is the state department charged with regulating the practice of dentistry pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 466, Florida Statutes. 2. At all times material to this Complaint, Respondent was a licensed dentist within the State of Florida, having been issued license number DN 16596. 3. Respondent's address of record is 11880 SW 40th Street, Suite 215, Miami, Florida 33175. 4. On or about November 26, 2012, Patient I.D.P. presented to Respondent's practice for an examination due to pain in the lower right quadrant. | 5. According to the clinical record for that date, Respondent noted that Patient I.D.P. had generalized gingivitis with gums inflamed and an issue associated with her temporomandibular joint. 6. Respondent also noted in the clinical record that Patient 1.D.P. presented for the surgical extraction of tooth number 31, and he proceeded to perform the extraction on that date. 7. Respondent did not record a diagnosis or justification for the surgical extraction of tooth number 31. 8. The minimum standard of performance in diagnosis and treatment in the practice of dentistry requires a dentist to obtain a recent radiograph before proceeding with the extraction of a molar. 9, Respondent proceeded with performing the extraction of Patient LD.P’s tooth number 31 without having obtained a pre-operative radiograph. 10. In preparing a tooth for a crown, a dentist will trim a tooth to ensure it has the proper thickness and shape in order to accommodate and retain the permanent crown. A dentist may perform a “core build-up” by using filling material to supplement the tooth structure if It -has been compromised by breakage or decay. 11. On or about December 10, 2012, Patient I.D.R. presented to Respondent's practice for crown preparation including core build-ups on teeth numbers 3-14. 12. Respondent did not record a diagnosis or justification for the provision of crowns on teeth numbers 3-14. — 13. On or about December 17, 2012, Patient I.D.P. presented to Respondent's practice for root canal treatment on tooth number 14. 14. Respondent did not record a diagnosis or justification for the _ root canal treatment performed on tooth number 14. . 15. The minimum standard of performance in diagnosis and treatment in the practice of dentistry requires a dentist to take a pre- operative radiograph before performing an endodontic procedure such as a root canal. 16. Respondent did- not take a pre-operative radiograph before performing root canal treatment on or about December 17, 2012. 17. On or about January 21, 2013, Patient I.D.P. presented to Respondent’s practice for crown preparation Including core build-ups on teeth numbers 18, 19, 21, and 30. 18. Respondent did not record a diagnosis or justification. for the provision of crowns on teeth numbers 18, 19, 21, and 30. | 19. On or about January 28, 2013, Patient I.D.P. presented to Respondent's practice with a complaint of discomfort in the area of the recently prepared tooth number 18. Respondent. recommended root canal treatment for the tooth and proceeded to perform the procedure on that date. 20. Respondent did not. take a pre-operative radiograph: before performing root canal treatment on or about January 28, 2013. 21. After taking an impression of the prepared tooth for fabrication of the permanent restoration such as a crown or a bridge, the dentist will seat a temporary restoration using temporary dental cement. Once the final restoration has been fabricated, the dentist will remove the temporary and will check the fit and esthetics before cementing the permanent restoration in place..A dentist may decide to seat the permanent restoration with temporary cement rather than permanent cement to assist, for example, with future adjustments or possible endodontic procedures. 22. On or about February 25, 2013, Respondent used temporary cement to seat the permanent bridge spanning teeth numbers 19-21 and the crown on tooth number 18. 23, On or about March 25, 2013, Respondent used permanent cement to seat the crown on tooth number 30. 24. On or about June 17, 2013, Respondent used permanent cement to seat the upper arch bridge spanning teeth numbers 3-14. 25. On or about September 9, 2013, Respondent examined Patlent I.D.P. in response to a complaint concerning swollen gum tissue. Patlent I.D.P. had recently undergone a consultation with a periodontist, Dr. C., who provided a possible diagnosis of “generalized invasion of biologic width” of Patient I.D.P’s existing restorations. 26. In restorative dentistry, it is critical for a dentist to avoid placing a restoration that impinges on the connective tissue attaching the gingival sulcus to the root surface of the tooth. A restoration placed sub-gingivally . may result in localized crestal bone loss, gingival recession, and/or localized gingival hyperplasia. A patient with such a restoration will experience tenderness, bleeding, and inflammation. 27. Respondent examined Patient I.D.P. and agreed to redo the upper arch bridge spanning teeth numbers 3-14, 28. According to the clinical record, on or about September 16, 2013, Respondent redid the upper arch bridge “per recommendation of Periodontist” (Dr. C.), and he decided to change the design of the bridge to individual crowns rather than having the crowns splinted together as in the initial design. 29. According to the clinical record, on that date Respondent refined the crown preparations, retook impressions, sent the impressions to _ the dental lab for fabrication of the new permanent crowns, and placed temporary crowns on Patient I.D.P. 30. On or about October 14, 2013, Patient I.D.P. presented to Respondent's practice for the placement of the upper permanent crowns. 31. According to the clinical record for that date, Respondent removed the temporary crowns, tried in the permanent crowns, took a periapical radiograph of each crown to verify marginal seal and proper seating, adjusted the occlusion and verified bite with articulating paper, and checked the contacts between the crowns with floss. 32. Although the clinical record indicates that the new crowns were placed on this date with permanent cement, it appeared from later clinical notes that Respondent may have placed the permanent crowns with temporary cement. 33. On or about November 18, 2013, Patient I.D.P. presented to Respondent's practice for the seating of the upper permanent crowns with - permanent cement. | 34. According to the clinical record for that date, Respondent performed the same tasks outlined above for verifying the fit and occlusion of the permanent crowns and he obtained Patient I.D.P’s approval of the esthetics of the crowns before seating them with permanent cement. 35. According to the clinical record for that date, Respondent also seated the permanent bridge from teeth numbers 19-21 with permanent cement, ; . 36. The minimum standard of performance in diagnosis and treatment in the practice of dentistry requires a dentist to adequately seat and verify the fit of a restoration such as a crown so as to avoid open margins, 37. Leaving an open margin allows for bacteria and debris to access the tooth underneath, and increases the risk for developing pathologies in the periodontia and gingiva, as well as the development of dental decay. 38. The minimum standard of performance in diagnosis and treatment in the practice of dentistry ‘requires a dentist to place restorations so as to avoid violating the biologic width. 39. The permanent crowns Respondent provided to Patient I.D.P. had one or more of the following clinically observable deficiencies: (1) open margins and/or (2) violation of the biologic width. COUNT I 40. Petitioner re-alleges and incorporates paragraphs one (1) through seven (7), ten (10) through fourteen (14), seventeen (17) through nineteen (19), twenty-two (22) through twenty-five (25), and twenty-seven (27) through thirty-five (35), as if fully set forth herein. 41. Section 466.028(1)(m), Florida Statutes (2012-2013), states that “[flailing to keep written dental records and medical history records justifying the course of treatment of the patient [...],” shall constitute grounds for disciplinary action by the Board of Dentistry. 42. Respondent violated Section 466.028(1)(m), Florida Statutes, in one or more of the following ways: A. By failing to keep a written dental record justifying his performance of an extraction of tooth number 31 on or about November 26, 2012; B. By failing to keep a written dental record justifying the provision of crowns occurring on or about December 10, 2012, and/or January 21, 2013; and/or C. By failing to keep _a written dental record justifying his performance of root canal treatment on tooth number 14 on or about December 17, 2012. COUNT II 43. Petitioner re-alleges and incorporates paragraphs one (1) through six (6), eight (8) through eleven (11), thirteen (13), fifteen (15) through seventeen (17), and nineteen (19) through thirty-nine (39), as if fully set forth herein. | 44. Section 466.028(1)(x), Florida Statutes (2012-2013), states that “[bJeing guilty of incompetence or negligence by failing to meet the minimum standards of performance in diagnosis and treatment when measured against generally prevailing peer performance[,]” shall constitute grounds for disciplinary action by the Board of Dentistry. 45. Respondent violated Section 466.028(1)(x), Florida Statutes, in - one or more of the following ways: A. By failing to acquire, at a minimum, a recent panoramic radiograph or a full mouth series of radiographs before proceeding with the extraction of tooth number 31; B. By failing to take a pre-operative radiograph before performing endodontic procedures on_or about December 17, 2012, and/or January 28, 2013; C. By failing to adequately seat and verify the fit of permanent crowns so as to avoid open margins; and/or | D. By failing to place permanent crowns so as to avoid violating the biologic width. WHEREFORE, Petitioner respectfully requests that the Board of Dentistry enter an order imposing one or more of the following penalties: restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief. that the Board deems appropriate. 7 SIGNED this }( day of Hols icur 4 2016. John H. Armstrong, MD, FACS Surgeon General and Secretary Baclaet AMC Bridget &. McDonnell Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 PCP: February 5, 2016 PCP Members: L.B.; J.T.; N.F Tallahassee, Florida 32399-3265 Florida Bar #99874 TEL: 850.245.4444, FAX: 850.245.4684 Express Mail Address: 2585 Merchants Row, Suite 105 Email: Bridget.McDonnell@fihealth.gov - DOH v. Anatoly Ripa, D.D.S,, Case # 2014-12981 11 NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120.57, Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. A request or petition for an administrative hearing must be in writing and must be received by the Department within 21 days from the day Respondent received the Administrative Complaint, --———— pursuant to Rule-28-106:111(2), Florida Administrative-Code-—_If—. Respondent fails to request a hearing within 21 days of receipt of this Administrative Complaint, Respondent waives the right to request a hearing on the facts alleged in this Administrative Complaint pursuant to Rule 28-106.111(4), Florida Administrative Code. Any request for an administrative proceeding to challenge or contest the material facts or charges contained in the Administrative Complaint must conform to Rule 28-106. 2015(5), Florida Administrative Code. Mediation under Section 120.573, Florida Statutes, is not available to resolve this Administrative Complaint. NOTICE REGARDING ASSESSMENT OF COSTS Respondent is placed on notice that Petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section 456.072(4), Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other discipline imposed. DOH v. Anatoly Ripa, D.D.S., Case # 2014-12981 12

Docket for Case No: 18-006759PL