twodentistsFor orthodontists to whom you refer preferentially, I recommend having a discussion about their ideas and preferences regarding retention in general if you have not already done so, and transferring retention responsibility specifically.

Since most orthodontists recommend what amounts to life-time retention and most also have a defined time after active treatment that they will 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 wishes 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 wish you to have during the period after active treatment that they are monitoring retention? For example, can retainers be cleaned at routine re-care 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 cannot 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 that most of us have not 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 is 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 are going to be directly involved with retention, you have a greater interest in the result that you will eventually be asked to maintain. It makes it easier to justify that you will 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 is not to say that you cannot also monitor retention for an orthodontist outside your preferred referral network; that is addressed later. However, there is nothing wrong with pointing out to patients proactively; that is, when you are making a referral, that you have not established the same sort of working relationship with all specialists as you have 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 what 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 is typically required is cleaning and inspecting the existing retainer. Or, in some circumstances, you may wish to employ some different form of retention. The pros and cons of different forms of retention will be covered later. All this assumes that orthodontic treatment has gone well and everyone is satisfied with the result. Retention pros and cons for results that are less than ideal will also be discussed later.

In my next article, I will go over management of retention for patients who were treated by orthodontists outside your referral network.

Cheryl DeWood is a Spear Contributing Author. [ ]


Commenter's Profile Image Mark Yanosky
June 13th, 2014
Very nice post! As an orthodontist, you've inspired me to do a better job communicating this to my referral sources. Like you mentioned, I, like most, recommend some form of lifetime retention and we can't possibly follow patients for life! Having the dental team on board is critical for long-term success! Mark