Who determines when orthodontic treatment is complete?

After I had been in orthodontic practice for 3 or 4 years, I received a referral from one of the finest restorative dentists in our community. I had not worked with this person before but had certainly heard of his reputation. He was not only a skilled clinician, but also a very demanding person. At that time, there were 10 orthodontists in town, and this dentist had worked with all of them except me. But no orthodontist to whom I had spoken had reported that it was a pleasant experience. This dentist wanted to play a major role in directing the orthodontic care for his patients, and, if the orthodontist would not agree, this dentist would stop referring to that orthodontist.

Let’s get back to the referral. I received background information about the patient and a letter that stated that this dentist wanted to meet with me after I had examined the patient. The patient was an adult with several missing teeth and moderate to severe periodontal disease. It was a difficult case, but I had some ideas about what orthodontics could do to assist in the overall restorative treatment.

So the dentist and I met for breakfast to discuss the treatment of this patient. I will never forget that meeting. The discussion about the patient went fairly well, and I suggested some treatment options to achieve the dentist’s restorative goals. This must have impressed him, because he then stated that he wanted to begin referring all of his orthodontic patients to me. I smiled and said, “That would be great!” And then came the caveat. He looked directly at me, pointed a finger in my direction and emphatically stated, “Here is the rule when you treat my patients: I tell you when to remove the brackets.” Now, I understood why the other orthodontists in town stopped working with this guy. Who would want the general dentist dictating when orthodontic appliances should be removed?

Although I wanted to tell this dentist “thanks, but no thanks” for his referrals, I simply stated, “Sure, that’s fine with me.” So our relationship began, and he started referring patients to me. And they were good patients. They were usually ready to start treatment immediately after the examination appointment. Life was good.

Then, about 18 months later, it was time to remove the appliances on some of this dentist’s patients. When I thought that I had achieved an excellent result, I sent the first patient back to this dentist to obtain his approval for bracket removal. Unfortunately, that is not what I received. Instead, he sent me a list of 8 or 10 adjustments in tooth positioning that he wanted completed before bracket removal. I could not believe this. When the patient came in, I compared every item on the dentist’s list with the situation in the patient’s mouth. Guess what? The dentist was correct on all items. Although the deviations were minor, the changes were certainly needed and easily achievable. These alterations would definitely improve the eventual restorative result.

Why didn’t I see these discrepancies? As an orthodontist, I was taught to evaluate tooth relationships from a different perspective than that of a restorative dentist. I learned a lot from that first experience. But more importantly, in the subsequent patients that I referred back to this dentist before bracket removal, I gradually learned what I had been overlooking. With time, I began to understand the value of having 4 eyes rather than 2 evaluating tooth positions in my adult restorative patients. Even today, my best-looking patients are consistently those whom I treated with this dentist.

With time, my appreciation for appropriate tooth positioning in adults has been enhanced substantially by this dentist. In fact, he has never referred a patient to another orthodontist in our town. He was finally satisfied that he had found an orthodontist with whom he could work. The lesson to be learned is that the restorative dentist should help to determine when orthodontic treatment is complete.

Apr 11, 2017 | Posted by in Orthodontics | Comments Off on Who determines when orthodontic treatment is complete?
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