Topics are incisor position and staff hiring.1. If your guide in treatment is the position of the upper or lower incisors, how do you determine that position? If not the position of the incisors, what is your guide?
Virtually all the respondents felt the lower incisor position was important in determining their treatment plan. Most said they also took other major factors into consideration--especially the patient's profile and facial esthetics--before deciding on the position of the lower incisors. Other influential factors included the amount and thickness of attached gingiva in the lower anterior region; the mandibular plane angle (higher angles could be more upright, lower angles allowed greater flaring); and the degree of upper incisor exposure and the patient's smile.
The APo line was by far the most frequently used reference for lower incisor position. A range of -2mm to +3mm seemed to be acceptable. The lower incisor to mandibular plane angle was also mentioned, as was SNB (used in both angular and linear measurements).
Comments included:
"I try to use 1-APo of 0-2mm as my guide. If pogonion is prominent I feel good going with maximum advancement of 1." "My guide in treatment is the position of the lower incisor to the APo line after taking into consideration the following: the mandible is in centric relation or we have done a CR-CO conversion, and a growth prediction and VTO have been constructed." "I use a Tweed-style IMPA of 90-95°, varying according to mandibular plane angle." "We use lower incisor to APo line with adjustments for race, age, convexity, etc., as suggested in the Ricketts analysis." "If the lower incisors are aligned with no broken contacts and they are placed posteriorly to the APo line, then I would allow these teeth to come forward up to the APo line. If the anterior teeth are crowded and there is no lip habit, then I would not move these teeth forward if possible, but extract or strip to gain room." 2. List, in order of importance, the criteria you use for hiring personnel. Give the reasons for your ranking.
A large majority of the readers regarded personality as the most important criterion used in hiring. Appearance and experience were about equal as a distant second. Age was also mentioned frequently, with many orthodontists preferring more mature staff members. Several respondents also thought education was important, usually requiring at least a high school diploma.
References and testing, although mentioned by a few respondents, were not highly regarded as indicative of future performance. The applicant's background and resume were considered least important by most practitioners.
Some of the reasons given:
"I would choose personality first, because I want the personnel to treat patients first and teeth second.""Orthodontics requires a personality with a high level of communication and caring during all phases of the treatment. The future growth of any practice will be affected by the experience a patient receives, assuming that the technical expertise in most specialist offices is excellent.""A personality with a sense of responsibility in getting a job done without being told (110% effort).""A clean, neat appearance with excellent oral health is essential. We must be examples of what we preach.""I don't get too many applicants with experience. I have found with the few experienced people I have hired that they tend to do things the 'old' way, even when you teach them a new approach.""Their previous work record will give insight into stability or if they jump from job to job.""I prefer an older person--so that young children's schedules, illnesses, etc., do not affect work attendance.""Maturity is more important than age; however, since orthodontics is no longer confined primarily to children, more mature (older) individuals may be most appropriate.""I would not hire a 50-year-old assistant if my others are in their early 20s, or vice-versa.""I lean toward the over-30 with a stable home life and a neat appearance, but not taken with high fashion.""I find most references I have checked state the applicant's strengths and overlook their weaknesses, so they sound better than they are.""Our best method of testing a prospective employee has been a three-month probation period."JCO wishes to thank the following contributors to this month's column:
Dr. Carroll P. Andres, Bound Brook, NJ
Dr. Grant R.N. Bowbeer, Ann Arbor, MI
Dr. Michael A. Colb, Pueblo, CO
Dr. Frank Dudas, Peterborough, Ontario
Dr. William J. Koenig, Kirtland, OH
Dr. Neal Murphy, Los Angeles, CA
Dr. William W. Rathke, Hamburg, NY
Dr. Joanne H. Sasse, Victor, NY
Dr. Terence E. Walsh, Metairie, LA
Dr. Baron V. Whateley, Fort Wayne, IN
Dr. Lynn L. Whimpey, Federal Way, WA
