We wish to thank Drs Hall and Frazier for expressing their concerns about our comments. We could not agree more with the message; however, when putting pen to paper, occasionally the message can be misstated. Of course, treatment and care should be interdisciplinary, and without question, the patient always benefits from enhanced communication between the surgeon and the orthodontist. The idea we were trying to convey, and which obviously fell somewhat short, was that it is inappropriate for the orthodontist to perform a surgical VTO instructing the surgeon which jaws to treat and how much to move each segment in any direction. We should not dictate the surgical procedure to be performed if we are not performing the surgery. That point is the risk management take-home message. Thus, once a treatment plan (joint orthodontic/orthognathic intervention) has been agreed upon by all parties (orthodontist, oral surgeon, and patient), the orthodontist should then be practicing prescription orthodontics to facilitate the surgical correction to the extent that the proposed orthodontics is within clinically acceptable parameters. Although it is outside the scope of this response to cite other clinical risk management scenarios dealing with such manifestations as labial gingival dehiscences and prophylactic third molar extractions, the general approach from a risk management perspective is not to dictate particular procedures to be performed but, instead, to request a consultation relating to the areas of clinical concern. Finally, we agree with the comment that following the wrong opinion voiced by one concurrent treating practitioner can often lead to suboptimal results. Therefore, it is important from a risk management perspective to always keep in mind the “soft veto power” that we, as the referring doctor, have. If we have any doubts or concerns about the consulting doctor’s recommendations, we can always refer our patient for a second opinion. That is not only our right but also our obligation.
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