“I just want you to move this tooth. Can you do it with a retainer?” patients often ask innocently. It’s so tempting, especially as a young orthodontist, especially in a start up practice. The urge to “help the patient out” and “do them a favor” by making a retainer with springs or by resetting teeth and doing a suck down retainer calls to us like the Sirens. And just like those Ancient Greek myths, everyone has heard the legend about the one time, at band camp, when this orthodontist did a retainer for a patient who didn’t want braces but only wanted this one tooth fixed and the patient wore the retainer faithfully and the result was great and the patient was happy and grateful and told all their friends and everyone lived happily ever after… But really, how often does that happen?

Almost never in my experience.

When I was young and proud and knew everything I often tried to help patients who didn’t want braces by doing a retainer. The problem is that we are set up for failure before we even start. The patients who “only want a retainer” are generally the most demanding, highest maintenance, most cost sensitive, least willing to show for appointments, least compliant and most unrealistic patients you will encounter – though they claim otherwise. And these are the patients we decide we want to treat with the least reliable, most compliance dependent devices we have? What generally happens when you agree to do a retainer is that you charge a couple hundred dollars for “just moving a tooth” and then you spend the next two years and a great deal of money making multiple retainers and ultimately putting fixed appliances on the patient for no additional cost because they are dissatisfied with the result. This is followed by a thorough flogging by the disappointed patient in your office, to their friends and to their dentist. All because you tried to help the patient and cut them a break. No amount of up front discussion and informed consent about compliance and the limitations of the device and the fact that we are “just moving one tooth” will save you after the fact despite what you think.
Don’t do it.
It took me two or three years before I figured this out and made the practice policy, “Retainers retain and movers move”. It sounds simple and stupid but adhering to this policy will save you grief and help you keep your hair and stomach lining. When a patient asks for a retainer to move a tooth I always say the same thing. “I can make you a retainer to hold what you’ve got or we can do braces or Invisalign to move the teeth into better position. Retainers retain and movers move. Totally up to you.” They will plead, rationalize, argue and cajole but don’t fall for it. Do your patient and yourself a favor and use the right tool for the job.
When you ignore this advice and it works out well, drop me a note and let me know about it. And, if for some reason, using a retainer to “just move one tooth” should happen to go wrong, perhaps you can share those stories too!
Have a great week.

12 thoughts on “Shift Happens

  1. Really great point! This is so so tempting!! Definitely save yourself the headache and listen to this advice.

  2. This was a great reminder for all of us. Attempting to move teeth with retainers is inefficient and costly for us. Unfortunately it’s the dentist who tell the patient “Dr. ____ might be able to do it with a retainer”. So educating PCD’s is part of the challenge.

  3. Yes, I used to have a stomach lining and hair. Then I tried a few times in my early career. It is such a lovable trait in orthodontics that we truly want to help people. But I have given up and yes, I’m so much happier.

  4. weii, if you try to do a short cut, you are the loser.
    why? 1. first of all you charge less hoping it is only a retainer. then
    2. you end up marrying that patient for ever. you end up adjusting that appliance for no charge for ever.
    3. now if you tell the patient that you need to pay more for the visits or you need fixed braces, you are a bad dentist
    4. unsatisfied patients , you know what they can do in today’s online freedom of speech?

  5. It happened with me with a dentist colleague. And yes she was high maintenance and least compliant and most unrealistic. After I gave up, I told her this won’t work and you need braces. And yes again I got flogged. Never again.

  6. Wow is no one going to present an opposing view? I have had several successful experiences and made some raving fans doing this.

  7. Present away Kevin. I’m speaking to the majority of cases and the majority of orthodontists. Of course there are exceptions when it comes to both.

  8. I’ve done this a number of times on my retention patients who have strayed from the path of compliance. Both finger spring Hawleys or dimples in their Essex retainer have given me successful results. I always preface this treatment with, “We can give it a shot with the retainer but it doesn’t always work.”

  9. Again if it works for you then do it. I don’t think that playing the lottery is a good idea either but I’m sure those who have won would disagree with my assessment. Thanks so much for sharing Ravi. The discussion among peers is far more valuable than my weekly ramblings! Have a great weekend.

  10. Been there, done that. In the end it’s a patient that doesn’t want anything “fixed” but prefers something “removible”.
    That means they want to “remove” it.
    I also went through that “trying to help” stage. My success rate was…. and I’m not exagerating….0%.
    Now I say, “if you want something corrected, it must be fixed appliance, simplified maybe, but fixed.
    If they go somewhere else, that’s another orthodontist’s migrane, and he or she will be the one they complain about to their friends.

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