THE READERS' CORNER

Topics are enamel reproximation and continuing education.

1. What instruments do you use for enamel reproximation (stripping)?

All the respondents reported doing some reproximation, although the instruments used varied widely. Half used one technique only, with nearly half of these using metal strips, nearly half using a metal disc-handpiece combination, and two using the Dome instrument. Overall, metal strips were used by two-thirds of the clinicians, a disc and handpiece by half, the Dome instrument by 40%, and a high-speed handpiece and burs by 22%.

What are your indications for reproximation?

The most frequently used indication was a Bolton's tooth-size discrepancy (50%). Many respondents also used reproximation for crowding, particularly in the anterior segments (33%), for treating borderline nonextraction cases (27%), and for dealing with abnormal tooth shapes (15%).

Do you reproximate anterior teeth, posterior teeth, or both? Do you reproximate before, during, or after tooth movement?

All the clinicians reproximated anterior teeth and 70% posterior teeth, although many said stripping of posterior teeth was far less common. Fifty-five percent reported doing some reproximation prior to treatment, 83% reproximated during treatment, and 78% reproximated after treatment. Many practitioners said they often used the procedure at more than one stage on a patient.

Has reproximation been effective in preventing relapse of irregularity?

About half the respondents thought reproximation had been effective, but in many cases the answer was a qualified "yes". Of the remaining readers, many had not yet formed an opinion or found it difficult to judge.

Specific comments included:

"My indications for reproximation depend on: (a) the amount of crowding, (b) the degree of curve of Spee, (c) the amount of expansion possible, (d) the amount the anterior teeth can go labially, and (e) the tolerance of the patient."

"The most significant time for reproximation is after tooth alignment with overcorrections. In this way the teeth can be 'keyed in' or 'locked in' their overcorrected or overrotated positions, thus helping to prevent relapse of irregularity."

"Reproximation is a better option than extraction in older adults because of the shortened treatment time."

"Lower anterior teeth with round contact points when reproximated tend to relapse less and are more stable. Some teeth rotate no matter what steps are taken! "

"Even when the interproximal contacts are flattened off, sometimes the teeth will crowd up and relapse. Reproximation has been effective for treating slight relapse, particularly in the mandibular incisor region."

"I avoid reproximation of the maxillary anteriors due to the possible compromise in esthetics. I prefer to do it on the lower incisors after they are aligned, as it is easier to disc at that time and produce better esthetics."

2. How many continuing education courses did you attend in 1987? How many working days did you take out of the office?

Virtually all the respondents reported attending some continuing education courses during the previous year. The mean number of courses was 2.9, with a range from 0 to 8. These courses resulted in the average clinician losing 5.1 working days per year, or 1.7 working days per course.

How many professional meetings did you attend in 1987? How many working days did you take out of the office?

Similarly, most of the readers attended at least one professional meeting during the previous year. The mean of 4.5 meetings resulted in 6.5 lost work days, or 1.4 days per meeting. Thus, the average clinician spent nearly 12 working days per year attending courses and meetings. The vast majority of respondents reported two or three courses and a similar number of meetings, but a small group (about 15%) attended a much larger number of events.

Local events (within the orthodontist's city or state) accounted for 52% of the meetings, regional events for 20%, and national events such as AAO annual meetings for 20%. The remaining 8% were international.

JCO wishes to thank the following contributors to this month's column:

Dr. James Bednar, Flossmoor, IL

Dr. D. Briar Diggs, Missoula, MT

Dr. James K. Economides, Albuquerque, NM

Dr. Donald R. Ford, East Point, GA

Dr. Michael W. Gleysteen, Wayzata, MN

Drs. John F. Kalbfleisch and Paul C. Levin, Mississauga, Ontario

Dr. R.W. Knierim, Knoxville, TN

Dr. Mark Kurchak, Houston, TX

Dr. Richard E. McClung, Lewisburg, WV

Dr. Herbert R. Nachtrab III, South Weymouth, MA

Dr. W.G. Pringle, Clarksburg, WV

Dr. Bruce Rosenzweig, Selden, NY

Dr. Timothy Shields, Everett, WA

Dr. Neal A. Stubbs, Brandon, FL

Dr. W.V. Williamson, Newport Beach, CA

Dr. Robert G. Yahr, Janesville, WI