THE READERS' CORNER
The topics include archforms and emergency procedures.
1. What archforms do you use in archwires at various stages of treatment?
The readers reported using a wide variety of archforms during treatment. More than 80% used some kind of preformed arch, with AccuArch and Tru-Arch the most popular. More than half of the clinicians said the most important factor in determining the treatment archform was the original archform of the patient, particularly in the mandible. The majority then matched a preformed arch to the existing archform. Many of the orthodontists used an ideal archform for finishing.
Under what circumstances do you believe the patient's archform can be changed?
Most of the clinicians clearly felt that the archform should only be adjusted in cases where the problem was primarily dental. Crossbite, an obviously constricted asymmetrical or deformed arch, or the need for labial tip or torque to correct lingually inclined teeth were all thought to be strong indications of the need to change the patient's archform. About two-thirds of the readers were conservative in their approach, while the rest felt that archform could be changed easily.
Under what circumstances and within what limits would you expand incisors? cuspids? bicuspids? molars?
Many subjective criteria were listed for expanding incisors. The majority believed that severely retroclined or lingually locked incisors could be moved forward to normal positions with minimal risk. A more conservative approach was taken to canine expansion, with modifiers such as "minimal", "rarely", and "only for crossbites" commonly mentioned. Correction of lingual inclination and torque were seen as the principal indicators for expanding in both the premolar and molar areas.
How much arch length would you try to make up with expansion before you would extract?
Half of the respondents felt that 3-5mm was the greatest amount of arch length they would try to make up with expansion. Another 25% said they would go as far as 7mm before extracting. The remainder were split between expanding as much as 10mm or expanding only 3mm or less.
Do you retain expanded cases longer than cases that are not expanded?
Two-thirds of the clinicians reported retaining expanded cases longer. Of the other one-third, many said they used fixed retainers in all their patients, and therefore did not treat expansion cases any differently.
Do you make any archform modifications in your archwires for asymmetrical cases?
Most of the respondents (73%) felt it was necessary to modify archforms in cases of asymmetry. The remaining 27% did not do so.
Do you coordinate upper and lower archwires?
Fully 93% of the readers reported coordinating their archwires, and many of them emphasized the response with "always".
Specific comments included:
2. Do you keep an emergency log that includes the patient, problem, repair time, operator, and date?
Only 19% of the respondents reported keeping an emergency log.
What is your average response time to an emergency?
Three-quarters of the clinicians said they saw emergency patients "immediately", "the same day", or "as soon as the patient can get to the office".
If you are not able to entirely eliminate the emergency immediately because of time constraints, how soon on average can the patient be reappointed to complete the job?
Twenty-three percent of the readers reported being able to complete emergency repairs the next day, 33% within seven days, and the remainder within two weeks.
What is your most frequent emergency?
The most commonly reported emergency (60%) was a loose bracket or band. Poking wires were the next most common causes of emergencies (30%), and items such as broken wires or chains accounted for the remaining responses.
Do you believe 10% of the patients have 90% of the emergencies?
Nearly three-fourths of the practitioners felt they did have problem patients who were responsible for many of their emergencies, while the rest were less sure.
Do you keep an operatory chair free for emergencies? Do you build time into your daily schedule to accommodate emergencies?
Only 23% of the clinicians said they routinely kept a chair free for emergency patients. However, 64% of the respondents reported building time for emergencies into their schedules.
Do you have an answering machine or answering service? If so, how would you rate the effectiveness of either in terms of responding to emergencies ?
Virtually all the offices had either an answering machine (76%) or an answering service (22%). The orthodontists almost unanimously rated the effectiveness of both as good or excellent, and a high degree of patient satisfaction was noted.
Is your home telephone number available to patients? Are you available for emergencies on your days off?
More than 85% of the doctors provided their home phone numbers to their patients. More than 90% reported being available on days off.
Is your office covered for emergencies when you are unavailable? If so, by whom?
All the respondents said they had coverage for emergencies. A little more than half reported having an arrangement with a local colleague. About 20% were covered by a senior assistant as at least a first step before contacting a colleague. A similar percentage reported arranging coverage through a partner or associate in the office, while several practitioners had arrangements with patients' family dentists.
Comments included:
JCO wishes to thank the following contributors to this month's column:
Dr. Peter J. Abell, Brattleboro, VT
Dr. Richard Alston, Tarboro, NC
Drs. Noble D. Anderson and Stephen B. Ingram, Jr., Lebanon, PA
Drs. Irwin and Leon Aronson and Tom Broderick, Savannah, GA
Dr. Wayne A. Aspito, Oak Brook, IL
Dr. Dean T. Bawden, West Jordan, UT
Dr. James D. Campbell, Panama City, FL
Dr. Phillip M. Campbell, Huntsville, TX
Dr. Douglas D. Durbin, Lexington, KY
Dr. Stephen E. Ellender, Jr., Houma, LA
Dr. Gerald Ginsberg, Phoenixville, PA
Drs. James A. Ginzler and Randall L. Shaw, Livonia, MI
Dr. Jerome Goldberg, Monroe, NY
Dr. Carl S. Hoffman, Meriden, CT
Dr. William W. Iversen, Fort Collins, CO
Dr. S. Meredith Johnson, Jr., Jeffersonville, IN
Dr. Arthur M. Kammerman, Garden City, NY
Dr. Michael Kelly, Suffern, NY
Dr. Thomas C. Lovlien, Ashland, WI
Dr. Larry L. Majznerski, Wyoming, MI
Dr. Charles M. Manning, Charlottesville, VA
Dr. Allen Marks, Glenview, IL
Dr. S. Murray Miller, Newton, MA
Dr. P.D. Mowbray, Jr., Marion, VA
Dr. Donald R. Oliver, Creve Coeur, MO
Drs. Roger J. Parlow and Richard D. Marulli, Edison, NJ
Dr. Howard V. Peskin, Charleston, SC
Dr. John R. Phillips III, Birmingham, AL
Drs. James M. Poco and Joseph K. Buchanan, Vallejo, CA
Dr. Jerrold J. Pollack, Frederick, MD
Dr. Jacob M. Posen, Armonk, NY
Dr. Robert R. Prososki, Kearney, NE
Dr. Kellie A. Sanzone, Watertown, NY
Dr. Larry E. Sims, Tulsa, OK
Drs. Jesse E. Soltis and Raymond J. McMullen, Barrington, IL
Drs. Neil I. Sushner and Nahid Sina, Washington, DC
Dr. Martin F. Van Vliet, Ramsey, NJ
Dr. John W. Vornholt, Lewiston, ID
Dr. Terrence L. Wenger, Mayfield Heights, OH
Dr. W.V. Williamson, Newport Beach, CA
Dr. John R. Winzler, Eureka, CA
Drs. Robert E. Youngquist and Christopher W. Carpenter, Denver, CO
