I Risk Management I Fig. 1 Fig. 2 16 AGD Impact Advertise with Caution The mother of a 13-year-old male brought him to an orthodontic practice that employed both orthodontists and general dentists. The clinic director was a specialist in orthodontics, which made it legal for the clinic to advertise under the heading of “orthodontists” in the Yellow Pages. The boy’s mother had a capitation-type dental insurance plan in which the clinic participated. It was unclear whether the referral came from the patient’s general dentist perusing the insurance list of eligible orthodon- tists or if it was a direct referral, although the general dentist’s name was listed on the “referred by” line in the chart. Photographs, diagnostic casts, and a panoramic X-ray were obtained at the initial appointment. (The panoramic X-ray is shown in Fig. 1.) The patient had a Class III bite and an ectopically positioned maxillary left canine tooth, but it was anticipated that a good orthodontic result could be obtained. Online eDitiOn Treatment progressed with the general dentists initially handling the bulk of treatment. One year into treatment, a panoramic X-ray (Fig. 2) was taken to assess the position of the impacted canine in preparation for the crown being exposed and bracketed. The patient was referred to an oral surgeon, the tooth was exposed and bracketed, and brought into position without incident. As expected, the X-ray showed resorption on the root of tooth No. 10 where the crown of the canine had ectopically pressured that area (Fig. 3). However, there was no resorption apparent on any other teeth and treatment proceeded for an additional two-and-a-half years, prolonged due to a number of missed appointments and broken brackets. When treatment was nearing completion, there were concerns expressed about the patient’s third molars. A panoramic X-ray was taken three-and-a-half years into treatment and moderate to severe resorption was noted on nearly all of the patient’s teeth (Fig. 4). This resorption was not communicated to the patient or his mother immediately because the clinic supervisor wanted to be involved in a meeting with all of the treating dentists and orthodontists and the patient and his mother. However, the panoramic X-ray was sent to the oral surgeon and he pointed out the resorption. One month later the patient and his mother met with the treating general dentists and orthodontists and the bands and brackets were removed. Two months later, a lower retainer was placed and when the mother asked about prolonged treatment and the potential for it to aggravate the resorption, the consulting dental professional Fig. 3 One in a Million www.agd.org August 2010