Sometimes families need to relocate while one of their family members is in the middle of orthodontic treatment. If the move is a significant distance, they likely will have to find a new orthodontist to continue their treatment. In my experience, the majority of these “transfer” scenarios proceed smoothly. There are times though, that this transition does not go as planned for the family. My goal in writing this article is to educate and inform families about what to expect and what to look for when anticipating a move (whether coming into my practice, or moving away from Castle Rock). These tips can make this transition a much easier process.

There are two areas that I will discuss; 1) What to expect regarding treatment and finding the “right” new orthodontist, and 2) financial concerns and expectations in the transfer. I will tackle the former first. Whether your treatment has just begun, or whether you are close to having your braces removed, make sure to inform your current orthodontist of your move as far in advance as possible. At Meadows Orthodontics (and at most practices), we set up a special final appointment that includes the taking of final records. This includes taking photos, digital impressions, and radiographs as needed. I also prepare a transfer form (created by the American Association of Orthodontists -AAO) to send to your new orthodontist. This informs your new doc of your original concerns, diagnosis, types of braces and appliances used, recommendations for continued care, and an estimate of remaining time left in treatment.
I also assist in finding a new orthodontist if possible. I usually build close relationships with my patients, and I want them to find someone that they can trust, and that provides an exceptional level of care. If I do not know an orthodontist in your new area, the AAO provides a data base of orthodontists with information on their practice preferences, education, years of experience, and Board Certification status. Finally, I want to make sure that your braces are as secure and “trouble-proof” as possible for your move.

We also want the financial aspect of your move to be as stress free as possible. I like having a specific financial transfer meeting with parents, so that we can explain how we prorate or refund a percentage of your investment (if it was paid in full), or when to stop payments if the treatment was financed. Years ago the AAO provided a formula to help determine the fair amount to reimburse patients that are transferring or moving. This formula is no longer published (likely due to individual case variation and differing financial opinions of individual practitioners), but I still use it as a consistent guideline for what is “fair” for the majority of cases (It is important to be aware of this, especially at the start of treatment if you are paying in full). If there is any “grey area”, I tend to err in the patient’s favor, as maintaining great relationships is more important to my business than “nickel and diming” will ever be.

For patients that are moving to the Castle Rock area, we recommend that, as described above, you complete and resolve any financial issues with your current/former orthodontic office before you move. It is important to understand what percentage remains with your or your child’s treatment, and that you are comfortable with the agreed upon financial arrangement. Most orthodontists will gladly discuss your case details with one another (with proper HIPPA compliance) to ensure a smooth transition, but resolving and closing out your previous financial arrangement (and reimbursements if applicable) upon moving are solely between you and your previous office.

On our part, we will do our best to make your transition as easy as possible. When you arrive at our office after your move, we will perform a full examination, and will base our fees to finish your treatment on several factors. The most important factor is how long it will take to complete your case, but may also be influenced by case difficulty, appliances or braces that may need to be replaced, and how fairly we believe you were financially “sent on your way” at your previous location. With the vast majority of cases there is a very similar estimate of remaining treatment goals, and we are on our way to getting you finished! In the rare case that we believe you have considerable more time remaining than your previous orthodontist estimated, I will explain in depth why this is the case, and may recommend a second or third opinion, just so you feel at ease with the treatment that still remains.
Regarding your insurance benefits, be sure to let your original orthodontist and insurance carrier know when you are moving and when your last appointment will be with your original orthodontist. Without this information, your insurance carrier may continue to send payments to an office where you or your child is no longer at! (The above information is applicable to braces, clear braces, and Invisalign)

As always, if you have any questions, please call us at Meadows Orthodontics and we will be glad to help you!

Dan Rejman, D.D.S., M.S.
Owner, Meadows Orthodontics, Castle Rock, CO.

Dr. Dan Rejman is Board Certified by the American Board of Orthodontists, and was recently voted Best Orthodontist in Castle Rock 2014 (Castle Rock News Press), and Douglas County’s finest Orthodontist 2014 (Douglas County Living).

The last several decades have seen an increase in popularity (and marketing) of what are called self ligating braces (brackets). Not unique to one manufacturer, self ligating braces include Empower (American Orthodontics), Damon (Ormco), Smart Clip (3M Unitek), and In-Ovation (GAC Dentsply) among many others. Basically, self ligating brackets use a permanently installed, moveable component to hold the archwire in place instead of removable elastics or steel ties.

The manufacturers of these braces have made many claims regarding the advantages of using these braces, including increased comfort during treatment, increased efficiency, shorter treatment times, and improved oral hygiene. When presented with products with such heavily marketed claims (and which are inevitably more expensive for the orthodontist and our patients), I have to examine the evidence carefully when deciding if I want to offer them to my patients here at Meadows Orthodontics. For ethical reasons, I personally try to make as many decisions as possible using an evidence-based approach. This approach certainly applies to how these braces are presented.

A recent article in the American Journal of Orthodontics and Dentofacial Orthopedics addressed the major claims to these brackets. The findings by the American Association of Orthodontists’ Council on Scientific Affairs (COSA) are very useful in determining the merits to these claims. First and foremost, the article reviews the tenants for an evidence-based orthodontics practice, and states, “Adherence to the tenants of evidence-based orthodontic practice requires that, for any orthodontic intervention applied to a patient, 3 factors must be integrated: the relevant scientific evidence, the clinicians expertise, and the patient’s needs and preferences.” (Note that manufacturers claims and marketing are not among these factors!).

Let’s take a look at what COSA determined (the complete article can be found here). “ 9 of the 14 claims regarding self ligation bracket systems have some peer-reviewed data, but the evidence does not indicate clear differences at this time for reduced friction between arch wire and bracket, reduced clinical forces, reduced treatment time, faster alignment, faster space closure, different arch dimensions, better alignment and occlusal (bite) outcomes, less patient pain, and more hygienic. Three of the 14 claims- lateral expansion leading to bone growth, lateral expansion is comparable to expansion using RPE (expander) and conventional brackets, and stability of lateral expansion long term- have no supporting peer-reviewed data currently. Only two of the 14 claims- mandibular incisor inclination, and time in “untying” the braces, were found to have significant differences.

What does this mean for an orthodontic patient of mine? First, most of these self-ligating braces are great products, and I can achieve great results by choosing to use them. But I treat the vast majority of my patients without self ligating braces, due to the fact that 1) the scientific evidence to support the “marketed” advantages of these braces is lacking, 2) I have used these braces extensively, and have found no clinical advantage for my patients (although they did finish equal to traditional braces), and 3) the vast majority of my patients do not prefer these systems, even though they are presented as an option. What it comes down to is two things: 1) Kids and teens love the color ties that are the “ligation”  in traditional braces (and that self ligation braces eliminate), and 2)  these systems are significantly more expensive, and most of my patients prefer not to pay more for a product with no real or perceived  added value. For patients with esthetic concerns, ceramic braces (traditional and self ligating) with clear ties and Invisalign are the treatment of choice for adults and older teens -you don’t need to have bright colors!

I hope this helps clarify questions that you may have had regarding this issue. I will be posting a series of articles that examine a number of orthodontic topics, and how the current scientific evidence shapes my decisions at Meadows Orthodontics.

Dan Rejman, D.D.S., M.S.

Owner, Meadows Orthodontics