Creating a Transfer of Retention Plan for Orthodontists in Your Network

For orthodontists to whom you refer preferentially, if you haven’t already done so, I recommend having a discussion about their ideas and preferences regarding retention, generally, and transferring retention responsibility specifically.

Because most orthodontists recommend what amounts to lifetime retention, and most also have a defined time after active treatment that they’ll monitor retention, it makes sense that you should have a plan for transitioning that responsibility from the orthodontist to you.

Your discussion should include:

• Does the ortho treatment fee include a defined period after active treatment that retention will be monitored? If so, how long? If a patient wants to have retainers monitored after this defined period, what fees are incurred?
• What type/types of retention do they prefer?
• What instructions are given to patients who relocate shortly after active treatment, during the period in which they would be monitoring retention? For example, are these cases transferred to another orthodontist?
• What role, if any, do they want you to have during the period after active treatment when they are monitoring retention? For example, can retainers be cleaned at routine recare visits? What about minor adjustments?
• Do they have a protocol for addressing minor relapse for your mutual patients?
• How do you want to handle retention for patients who require new retainers after restorative treatment or other treatment renders previous retainers ineffective or unusable?

In short, you and your orthodontist should have a plan that will help protect your patients from avoidable relapse due to problems with retention. Of course, you can’t protect a patient who neglects their responsibilities for compliance with a prescribed retention strategy, but you also don’t want your patients to suffer relapse because no long-term plan has been made.

Consider the benefits to all parties involved

While this might seem like a lot of fuss for something most of us haven’t thought to bother with, consider the following potential benefits to all parties; patients, general dentists, and orthodontists.

• It reinforces for the patient that long-term retention is important to maintain a beautiful result.
• It reinforces the idea that the general dentist and specialist are working together for the benefit of the patient.
• It makes it easier to address the fact that monitoring retention is an actual service (and, thus, reasonable fees are justified).
• It clarifies exactly when management of retention transfers from the orthodontist to the general dentist, making it less likely that patients will “fall through the cracks.”
• It’s a manifestation of the principle — and I think this is a big one — that you, as the general dentist, are sharing your patients with the specialist. If you’re going to be directly involved with retention, you have a greater interest in the result that you’ll eventually be asked to maintain. It makes it easier to justify that you’ll need to assess the ortho treatment result before appliances are removed.
• It offers patients yet another reason to remain loyal to your practice.
• It makes it easier for you to direct patients to an orthodontist in your referral network when they know that you already have a plan in place that considers their long-term interests. (That’s not to say you can’t also monitor retention for an orthodontist outside your preferred referral network. However, there’s nothing wrong with pointing out to patients proactively — that is, when you’re making a referral — that you haven’t established the same sort of working relationship with all specialists as you’ve been able to establish with specialists to whom you refer preferentially).

If all of this has convinced you that it makes sense for you to develop a transfer of retention plan with your orthodontist, you still have to decide which retention method you will use.

Often, it’s easiest and most effective to simply take over monitoring the retention method already in use, in which case all that’s typically required is cleaning and inspecting the existing retainer. Or, in some circumstances, you may wish to employ some different form of retention.