Who determines when orthodontic treatment is complete?

Abstract

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 tome. 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