Transfer orthodontic patients are a typical part of any active orthodontic practice. Families and individuals move for various reasons such as job transfers, proximity to extended family members, geographic and climate changes, and boarding school or college enrollment. In these scenarios, switching orthodontists to continue active orthodontic treatment in a new location is inevitable. However, it has come to my attention that more and more families are choosing and planning to be a ‘transfer’ orthodontic case. What I mean is that some of our foreign patients with family members abroad choose to start their orthodontic treatment abroad – while visiting family members or vacationing – knowing that they will need to continue active treatment with another orthodontist back
home, upon their return. The reasoning behind this is oftentimes financially driven or motivated. As a locally-practicing orthodontist, I would like to refute the myth that starting orthodontic treatment intentionally, with the intention to continue treatment elsewhere, is financially advantageous and/or beneficial to the patient in any other way. There are numerous inherent challenging factors in these situations:
• Most orthodontists have different philosophies pertaining to diagnosing and treatment planning cases. (Some orthodontists prefer to do a lot of early orthodontic treatment or phase I - to balance growth and dental development – while others prefer to treat only once permanent teeth have erupted and baby teeth have fallen. Some orthodontists are comfortable extracting permanent teeth while others try to avoid extractions by all means. Some orthodontists are more comfortable with compromise finishes in cases in non-growing patients with significant skeletal imbalances while others turn to surgical treatment plans.)
• The variability of orthodontic treatment philosophies is likely further exacerbated by different training residency programs, cultural preferences specific to the region and distinct ideal aesthetic frameworks.
• Different orthodontists utilize different mechanics, modalities and appliances to treat their patients. Even doctors trained around the same time period within the same geographic region find that different appliances work better in their hands to get the job done.
• Clinician's preferences vary; something as simple as positioning or placement of braces on teeth can be somewhat different based on the doctor.
To summarize, there can be a true rift between the foreign orthodontist starting the treatment and the one taking over that transfer case. Pragmatically, there can be clinical and financial implications as a result of this rift or different treatment approach. We have had transfer cases that presented with fixed appliances and extracted permanent teeth that I would have treated without any extractions. Thus, a different clinical treatment plan altogether was initiated and I had to make accommodations to adapt to the decisions and preferences of the original orthodontist. Furthermore, I have had transfer cases with braces bonded distinctively enough that I had to remove them, polish the adhesive off and re-bond new braces on the teeth from scratch. I have also done this when the braces bonded by the starting orthodontist were not the same as the braces that we use in our practice in terms of size, appearance or prescription. In these situations, not only was there extra chair time and inconvenience for the patient of initially starting the braces, removing them and rebonding them again but usually an additional expense. In these cases, when new appliances have to placed, the treatment essentially has to be started over. As a result, no savings or discounts are feasible for patient families that present with initial orthodontic appliances in place. Usually, such cases actually cost more since the initial appliance placement investment or down payment is forfeited. Also the poor patient has to go through a tedious process of getting braces on a second time. In conclusion, it is usually simpler and more efficient to have the orthodontic treatment initiated and finished by the same doctor. Clinically, this often leads to a seamless treatment progression, less total time in treatment and congruent decision-making pertaining to the need for extractions, appliances selected and intervals between adjustments. Financially, this frequently leads to a less expensive treatment case. Thus, it is critical that the families considering starting orthodontic treatment and transferring for treatment continuation consider all the pertinent factors at hand and make a prudent decision.