## Facts

- Inna Khiterer received dental treatment from Dr. Mina Bell, a dentist, beginning in October 2001 in Brooklyn, New York.
- The treatment included root canal therapy on two teeth, crowns for those teeth, and a replacement crown for a third tooth.
- Khiterer claimed she and Bell agreed the crowns would be porcelain fused to gold (“porcelain-on-gold”).
- The crowns were fitted in June 2002, and Khiterer last saw Bell in December 2002 after missing appointments.
- The following summer, while seeing another dentist, Khiterer learned the crowns placed by Bell were entirely porcelain rather than porcelain-on-gold.
- Khiterer brought a small-claims action alleging defective services and breach of contract.
- Before trial, the court advised that any claim “in the nature of dental malpractice” would require expert testimony; Khiterer elected to proceed only on a breach-of-contract theory.
- At trial, Bell testified that if porcelain crowns were used instead of porcelain-on-gold, it was not intentional.
- Bell also testified that porcelain crowns and porcelain-on-gold crowns cost the same to the patient and that porcelain crowns were at least functionally equivalent, and in her view therapeutically better, than porcelain-on-gold.
- Khiterer did not prove physical injury, medical complications, or that replacement of the crowns was medically required.
- Khiterer did not prove out-of-pocket replacement costs or any difference in economic value of the crowns she received as compared to porcelain-on-gold crowns.

## Issues

1. Whether a patient may maintain a breach-of-contract claim against a dentist (as distinct from malpractice) based on an alleged express promise to provide crowns of a specified material.
2. Whether using porcelain crowns instead of porcelain-on-gold crowns is a breach that is nevertheless excused from forfeiture under substantial performance because the deviation was trivial and innocent.
3. Whether a patient who proves breach of a contract for professional dental services, but proves no personal injury or economic loss, may recover more than nominal damages.

## Decision

- The court found that the parties’ agreement called for porcelain-on-gold crowns and that Bell’s use of all-porcelain crowns did not match that promise, constituting a breach of contract.
- The court concluded Bell substantially performed because the substitution was not willful, the crowns were functional for their intended purpose, and the record supported economic equivalence.
- The court declined to award the cost of replacement or a refund because, on these facts, that measure would be out of proportion to any benefit to be gained where no harm was shown.
- Because Khiterer did not prove actual damages (personal or economic), the court awarded nominal damages only.

## Legal Principles

- A contract claim arising from medical or dental services is viable only when it rests on an express, specific promise to accomplish a definite result or provide a specific feature of treatment, rather than a claim that care fell below professional standards.
- Under substantial performance, a minor, unintentional deviation from the contract does not justify a forfeiture; the remedy focuses on compensating the plaintiff for any loss caused by the deviation.
- Contract damages aim to provide a fair indemnity for the loss proved, not a windfall; when the cost to correct the deviation is grossly disproportionate to the benefit, courts may refuse that measure and look instead to difference in value.
- A patient who proves breach of a contract for professional dental services but does not prove personal injury or economic loss is limited to nominal damages.

## Conclusion

Khiterer established that Bell promised porcelain-on-gold crowns but provided all-porcelain crowns, which constituted a breach; however, because the substitution was unintentional, the crowns were functional and economically equivalent, and Khiterer proved no injury or financial loss, the court treated the work as substantially performed and limited recovery to nominal damages.


Khiterer v. Bell, 2005 WL 192354 (2005)