THE READERS' CORNER

PETER M. SINCLAIR, DDS, MSD

Topics include slot sizes, full vs. segmented arches, and use of loops; and inventory methods.

1. What slot size do you typically use?

Fifty-seven percent of the clinicians reported using an .018"X.025" slot, 36% used an .022"X.028" slot, and the remaining 7% used a bidimensional slot.

What size archwire do you typically use for closing arch mechanics?

With the .018" slot, the most common closing archwires were .016"X.022" (43%) and 017"X.025" (37%). A few respondents used .016"X.016" (13%) or .016" round (7%). There was no particular favorite among clinicians who reported using an .022" slot; .018" round, .016"X.022", .017"X.025", .018"X.025", and .019"X.025" were each used by 15-20% of the readers.

Do you prefer to use a segmented arch or a full archwire, and under what circumstances would you use each?

An overwhelming majority preferred to use a full archwire, citing "better control" as the principal reason. However, these particular situations were often cited as indications for segmented mechanics:

1. Open bites, particularly those with steps in the occlusal plane.

2. Maximum anchorage cases where canine retraction is indicated.

3. Cases requiring incisor intrusion.

4. Mixed dentition cases.

5. Cases requiring unilateral space closure or retraction.

6. Patients with malpositioned canines that are impacted or severely tipped to the mesial.

What mechanics do you usually use for closing?

Loop mechanics were preferred by 40% of the respondents and sliding mechanics by 32%. The remaining 28% said they used both types.

If loop mechanics, what type of loop do you use?

The keyhole loop was cited by 34% of the orthodontists who used loops, the Bull loop by 27%, the closed helical loop by 27%, and the T-loop by 11%.

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If sliding mechanics, what is the closing force?

More than 85% of the respondents reported using elastomeric modules or power chain as their principal means of space closure with sliding mechanics. Titanium coils were used by 25% of the readers, Class I elastics by 20%, and stainless steel coils and Class II elastics by about 10% each.

Do you typically put a tieback in the closing arch?

Of the clinicians who used mainly sliding mechanics, only 18% placed tiebacks in their closing archwires. Of those who used loops, however, 53% said they placed tiebacks.

What is your best advice to other orthodontists on problems to avoid or clinical tips to use in closing arch mechanics?

General themes of the advice included:

1. Set up and control anchorage carefully.

2. Level and open the bite before starting to close.

3. Don't overactivate the archwires.

4. Close spaces slowly.

5. Maintain careful torque control of the upper incisors.

Some specific comments:

"When activating loops by turning the archwire down distally, be careful to have the archwire bend exactly at the distal of the molar tube. Otherwise, the wire may return, partially closing the loop without closing the space."

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"Always attain Class I canines and molars before closing any residual spaces."

"Place sufficient lingual root torque in the maxillary anterior segments when closing, to prevent uprighting of the maxillary incisors."

"Properly fill your slots with the appropriate archwire."

"You must open the bite before starting closing mechanics and maintain bite opening during closing loop mechanics."

2. Do you maintain an in-house inventory of supplies ?

Nearly all of the respondents (94%) reported keeping an in-house inventory.

How do you organize and store your supplies?

Many of the orthodontists kept bulk items in a storage area away from the operatory (such as a basement) and kept immediate needs in the clinical area. Closets and cabinets adjacent to the operatory or in central islands were often used for immediate storage. Many respondents said they labeled the storage areas for each item, especially in bulk storage, so they could see at a glance if items on a shelf were getting low. Others placed tags on particular units in the bulk storage area that would let the staff know it was time to reorder when those units were taken out. Ordering information was often kept on 3"X5" index cards; only 8% of the respondents kept their inventory on computer.

Specific responses included:

"Front-office supplies are stored in one set of cabinets, and the front-office personnel are responsible for their ordering. Similarly for the clinical area."

"I always keep a supply reserve put aside so that if the staff forgets to tell me we are out of something, I can reorder before we are completely out."

"Our supply room uses the 'last in, last used' system. A daily supplies-needed log is kept and the supply room checked weekly. Our computerized allocation for supplies is 7% of gross."

"We keep 3"X 5" cards with the company's name and toll-free number, along with the ideal quantity to order. They are filed by the supply item's name."

"Our supplies have an order point marked with a red tag so we can't get too low."

Who is responsible for keeping the inventory?

In 67% of the offices, one staff member was responsible for keeping inventory. More than one staff member was responsible in 27% of the offices, and the orthodontist carried out this function in 6%.

Who decides what will be ordered and from which companies?

Thirty-five percent of the clinicians said they made the decisions themselves, and another 35% did so in cooperation with a staff member. In 20% of the offices, one staff member alone made ordering decisions, while more than one staff member was responsible in 10% of the offices.

Have you been able to obtain quantity discounts? If so, what advantages and disadvantages have you found?

About 90% of the practices said they could get quantity discounts. Advantages included lower costs, less frequent ordering, better inventory control, and better service. Disadvantages included tying up capital, storage space requirements, the possibility of overstocking on items no longer needed, and the limited shelf life of some products.

Comments included:

"When ordering in bulk, large items (such as 100-pound barrels of plaster) can be a problem. Smaller packages ordered in bulk are better."

"Sometimes with bulk ordering you use the stuff faster, as the staff does not appreciate the value when they see larger amounts. This can cause waste."

"We are a one-stop shopper as much as possible. This gives us more clout with the companies in all areas."

"We joined a service called Profit Finder. You get a catalogue of products and the companies that offer the lowest prices. The turnover time is longer, but we are definitely saving money."

Have you used the "just-in-time" inventory method? If so, what advantages and disadvantages have you found?

Only 28% of the clinicians had tried this method. Specific points included:

"We use it in a pinch, but it's not our preferred method of inventory control."

"An advantage is that there is less money tied up in inventory and in out-of-date products. The disadvantage is that sometimes things are not in time."

"We are sometimes 'just-too-late'. The advantage is that we can take advantage of a sale or decide to change products based on new information."

"It is not an advantage, because sometimes you wonder, 'Has it come in yet?' The office does not appear to be organized, and you have to do inventory almost daily."

Additional advice on inventory management included:

"Draw up a budget for supplies at the beginning of each year."

"Try to obtain samples before purchasing large quantities."

"Cross-train several staff members in ordering, and emphasize conservation of supplies among all staff members."

"I personally approve all bills before payment. The bills are paid from statements only, so it's clear what has been ordered, received, and paid."

"Separate staff members should match the purchase order with the bill, as a method of checks and balances."

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

Dr. H. Joseph Andrews, Dana Point, CA

Dr. George M. Ash, Saline, MI

Drs. Robert A. Azarik and Donald C. Bedrosian, Perkasie, PA

Dr. Eric M. Barnes, Chicago, IL

Dr. Neil L. Blitz, Warwick, RI

Dr. Charles F. Bohl, Brookfield, WI

Drs. Gary A. Bolmgren and Jerry E. Johnson, Edina, MN

Dr. F.A. Booth, Fayetteville, NC

Dr. Robert J. Brown, Hilliard, OH

Dr. Steven W. Campbell, Salem, OR

Dr. John M. Capogna, New Hyde Park, NY

Dr. Anthony F. DeBerardinis, Easton, PA

Dr. Marshall R. Deeney, Perry, NY

Dr. Marshall B. Fleer, East Brunswick, NJ

Dr. Kenneth F. Freer, Vallejo, CA

Dr. R.S. Friedman, Morris Plains, NJ

Dr. Roger A. Grace, Fort Walton Beach, FL

Drs. Douglas S. and Lawrence S. Harte, Livingston, NJ

Dr. Tucker Haltom, Albuquerque, NM

Dr. Candyse Jeffries, Florence, KY

Dr. Wendy J. Katz, Marietta, GA

Dr. Alan P. Kawakami, Sierra Vista, AZ

Dr. Gary R. Keszler, Ukiah, CA

Dr. J. Nicholas Leyko, Perry Hall, MD

Drs. Steven J. Luccarelli and Stephen E. Weiss, East Williston, NY

Dr. James D. Martin, Pleasant Hill, CA

Drs. Mark S. and Steven G. Misencik, Strongsville, OH

Dr. Donald R. Oliver, Creve Coeur, MO

Drs. Stanley Pastor and Patrick D. Shannon, Tulsa, OK

Dr. William C. Patterson, San Ramon, CA

Dr. E. Tyler Pearson, Bristol, TN

Dr. Robert C. Penny, Weatherford, TX

Dr. Donald Peppercorn, Willoughby, OH

Dr. William A. Raineri, Liverpool, NY

Dr. Justin L. Roth, Lakewood, CO

Dr. Kenneth Rowan, Jefferson City, MO

Dr. Bruce W. Scarola, Brandon, FL

Dr. James Schweiger, Duluth, MN

Dr. Michael W. Sheets, Corvallis, OR

Dr. James B. Smith, Freedom, CA

Dr. George A. Sullivan, Phoenix, AZ

Dr. James N. Thacker, Cincinnati, OH

Dr. Leo Wasserberger, Bloomfield Hills

Dr. Stanley P. Williamson, Edina, MN

Dr. Gene H. Wilskie, Lynnwood, WA

Dr. Morton Wintner, Coraopolis, PA

Dr. Stanley J. Wolfe, North Haven, CT

Dr. Jeff S. Zapalac, Austin, TX

Journal of Clinical Orthodonics

THE READERS' CORNER

1. What slot size do you typically use?

2. Do you maintain an in-house inventory of supplies ?

PETER M. SINCLAIR, DDS, MSD

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