When You Inherit an Ortho Landmine

When You Inherit an Ortho Landmine

Handling long-term cases without legal fallout


Buying a practice can bring plenty of surprises: new systems, new patients, and sometimes, a treatment case that’s been dragging on for years. One orthodontist recently shared a situation many can relate to: He inherited a long-running case with unresolved issues, a frustrated parent, and potential legal implications lurking in the background.

The case involved a young patient who had been in treatment for years with a persistent midline discrepancy that never fully corrected, despite multiple treatment approaches. When the new practice owner raised concerns about possible root resorption and suggested pausing to take new records before proceeding, the parent quickly began throwing around terms like “negligence” and questioning whether the new doctor was refusing care.

It’s the kind of moment that makes every orthodontist’s stomach drop, but it’s also one that can be handled successfully with the right strategy.

1. Start with documentation and a clean slate.
Before making any decisions, take full diagnostic records, photos, scans, and radiographs to establish a fresh baseline. It’s essential both for clinical clarity and legal protection. From that point forward, keep detailed notes on every conversation, finding, and recommendation.

2. Keep the focus where it belongs: on the patient.
When things get tense, it helps to center every discussion on the patient’s health and best interests. Reassess the case objectively and determine what outcomes are still realistic. If continued treatment poses a significant risk, stopping may be the most responsible course of action.

3. Avoid criticizing prior care.
Even if past decisions seem questionable, resist the urge to place blame. Focus instead on what’s best moving forward. Phrases like “from this point forward” help redirect the conversation toward solutions instead of accusations.

4. Communicate calmly and clearly.
Parents who start using legal terminology are often anxious or confused. Staying composed and transparent builds trust. Explain that your intent isn’t to refuse care but to ensure that any next steps are safe, strategic, and well-documented.

5. Bring everyone together.
Once you’ve reviewed the records, hold a formal consultation with the family to discuss findings and treatment options. If possible, loop in the original orthodontist for clarity and continuity. Present both ideal and limited outcomes and obtain updated informed consent for any path forward.

6. Audit other inherited cases.
If one case reveals deeper problems, it’s smart to check others that came with the practice. Review records, track progress, and flag anything that feels off. A proactive audit now can prevent future trouble.

7. Know your limits.
Sometimes the safest move is to conclude treatment or refer out. Persistent compliance issues, biological risks, or unrealistic expectations can make further care unsafe or unwise. Protecting your license, your reputation, and your sanity is part of patient care, too.

The lesson? Practice purchases come with people, and sometimes, with problems. But with clear documentation, patient-centered reasoning, and calm communication, even a volatile situation can be managed safely.

Have you ever taken over a case that made you pause before touching another bracket or aligner? How did you handle it? 
What’s your take?

Share your thoughts in the comments below.


Hot Topic articles draw inspiration from active online discussions among orthodontists. Written by the editorial team with the assistance of AI, each piece is thoughtfully developed and refined under full editorial oversight.
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