Are you willing to make adjustments to an occlusal appliance that you did not make? Over the years I have met dentists who “never” adjust an appliance that was made by another dentist, and others who are willing to. In my experience either way it is a challenging situation and a challenging discussion with the patient. One of the key pieces I have learned over the years is whether I made the occlusal appliance or not, the instant I adjust it I am fully responsible for it. That means if it works I win, but if the patient continues to have problems, or no resolution of symptoms I am responsible. Challenge number two, is that without a complete joint, ,muscle and occlusal exam I am not fully versed in the patient’s condition and the goals of appliance therapy. therefore I do not know how the appliance should be adjusted to gain maximum benefit. The last piece of the puzzle is figuring out a fair fee for adjusting an appliance.
These three issues have helped me develop an approach for patients that have existing occlusal appliances that they believe are not working or need to be “checked”. I do not have a hard and fast rule that I will not work on an appliance made by another dentist. I do have a hard and fast rule that the patient and I complete a joint, muscle and occlusal exam before I can make any adjustments. During the exam appointment I have the ability to learn the type of appliance design I would prescribe and how this matches or is different from what the patient is currently wearing. Lastly I use this appointment to build understanding for the patient about what the goals of appliance therapy are. With this in mind the patient and I can determine where the current appliance is meeting those goals, and where it isn’t and why we think that is. The last piece of the puzzle is to build understanding around the limitations of making adjustments and the possible risks and benefits. The risks include not being able to adequately make the adjustments due to limited thickness of acrylic, possible perforation and limited to no improvement in fit. The benefits are we may be able to adjust or alter the design and effect positive changes in symptoms or comfort. A possibility is always the decision to make a new appliance.
As for fees, my appliance fee includes all of the needed adjustments and follow up appointments for a predetermined period of time. When working on an appliance I did not fabricate I charge an hourly fee to cover my time.