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1. How often do you attempt to distalize maxillary molars?

More than half of the respondents (57%) reported attempting molar distalization "frequently" in their practices. The remaining 43% said they did so "sometimes". No one checked "rarely" or "never".

What are your diagnostic criteria for distalizing maxillary molars?

The criteria varied widely among the clinicians, but some of the most commonly mentioned were Class II or end-to-end molar relationship, maxillary dental protrusion, mild-to-moderate crowding, good profile, good maxillary second molar positions, low-to-moderate mandibular plane angle, and good expectations for patient cooperation.

Do you ever remove maxillary second molars to help achieve this distalization? If so, what are your criteria?

Upper second molars were extracted at least occasionally by 66% of the orthodontists responding. Their criteria included good third molar position, compromised second molars, high-angle or open-bite tendency, and the need to avoid extraction of bicuspids in a deep-bite case.

What mechanics do you prefer for distalization?

About one-third of the clinicians reported using headgear as their principal distalizing appliance, with the remainder using various combinations of intra- and interarch systems. Class II elastics were by far the most popular type of interarch mechanics (used by 71%), followed by the Jasper Jumper (20%) and the Herbst and sliding jig or yoke (14% each). Of those who employed intra-arch mechanics, 63% used compressed coils, 15% used long archwires, and about 10% each used Cetlin or Wilson mechanics.

What are the most significant problems you have encountered in distalizing maxillary molars, and how have you addressed these problems?

Almost every respondent mentioned patient cooperation as a problem. Other significant concerns included tendencies toward bite opening and molar extrusion, tipping and rotation of molars, and reciprocal anterior movement of the incisors.

Comments included:

  • "Patient cooperation is the biggest problem. I try to avoid elastics, removables, and headgear whenever possible. Second molar impaction can also occur. I avoid distalization in cases with posterior arch-length deficiency (unless I'm willing to extract second molars)."
  • "If I'm not getting cooperation with elastics and headgear, I change to the Hilgers Pendulum Appliance or extract bicuspids."
  • "If I get molar tipping, this is addressed by use of combination headgear."
  • "You usually tip them back, then you have a big problem in really holding the anchorage. You must use a headgear and/or a Nance palatal holding arch so as not to just burn up the anchorage again during space closure."
  • "The biggest problem I had was the flaring of upper incisors caused by the opposite force of the open-coil spring. I have reduced these problems by placing the patient on Class II elastics and, if need be, placing a Nance arch on the upper second bicuspids."
  • 2. How do you determine starting staff salaries?

    A variety of methods were reported, including comparison with other practices (used by 50%), comparison with non-orthodontic employers (48%), arbitrary decision (25%), and a set percentage of practice gross income (20%).

    What percentage of your 1992 gross income was devoted to staff salaries (excluding orthodontist salaries)?

    Although the reported percentages ranged from 11% to 28%, more than two-thirds of the practitioners were in the 19-21% range.

    How often do you give staff salary increases? How do you determine the amount of salary increases?

    Exactly half of the respondents said they gave annual salary increases. Eighteen percent reported semiannual raises, and the remaining 32% did not have a particular schedule. Most offices used several different criteria to determine the amount of their salary increases. The most popular was evaluation of individual employee performance (57%), followed by cost of living (38%); a set formula, often 20% of gross income, based on practice performance (32%); and arbitrary decision (27%).

    How motivational have you found salaries and salary increases to be in terms of staff performance?

    The most common response was that although salaries and raises were important, overall job satisfaction and recognition were much more important, especially in the long term.

    Specific comments included:

  • "We use a set formula that depends on the accomplishment of the written objectives for the past year and the completion of next year's written objectives form."
  • "Using 20% of gross income for staff salaries has been extremely motivational. The staff are eager to accommodate extra procedures, particularly starts, because their salary depends on it. There is little motivation to hire more or excess staff because it dilutes the salary pool. So everyone works at the limit, hiring when absolutely necessary for growth."
  • "I have found salaries and salary increases to be extremely motivational. The more the office collects, the more everyone makes. We've been on it for five and a half years, and there would be a revolt if we tried to stop. From a doctor/manager standpoint, it's very easy because salaries are always fixed (16%), and there is no fretting or regretting over hourly salary raises, etc."
  • "I don't find salary increases to be very motivational. The staff comes to expect them."
  • JCO would like to thank the following contributors to this month's column:

    Dr. David C. Adams, Oceanside, CA

    Dr. Steven P. Billings, Parkville, MO

    Dr. Mark P. Brieden, Grand Rapids, MI

    Dr. Jeffrey R. Browman, Lakewood, CO

    Dr. H.I. Bussa, Jr., Houston, TX

    Dr. David H. Crowder, Memphis, TN

    Dr. Carl Dann III, Orlando, FL

    Dr. William G. Davis, Raleigh, NC

    Dr. George D. Bankhead, Crestwood, MO

    Dr. Donald D. Dierkes, Orinda, CA

    Dr. Keith R. Erickson, Burnsville, MN

    Dr. Edward M. Goldman, Westminster, MD

    Dr. Nancy L. Gum, San Jose, CA

    Dr. Joseph Gray, Upland, CA

    Dr. Theodore L. Grier, Bristol, VA

    Dr. Michael D. Habern, Flower Mound, TX

    Drs. David G. Hall and William J. Hardin, Bartlesville, OK

    Dr. Barbara Hershey, Durham, NC

    Dr. Stephen L. Herzberg, New Rochelle, NY

    Dr. Thomas F. Kaineg, St. Petersburg, FL

    Dr. Richard Karlson, Sebring, FL

    Dr. Peter Keller, Romeo, MI

    Dr. Ronald Knight, San Angelo, TX

    Dr. Melvin Kogod, Wheaton, MD

    Drs. John F. Lawson and Wayne O. Sletten, Albert Lea, MN

    Dr. Larry W. Leddy, Saginaw, MI

    Dr. Barry A. Levin, Altamonte Springs, FL

    Drs. Ronald R. Lints and William M. Northway, Traverse City, MI

    Dr. James V. Martuccio, Warren, OH

    Dr. Richard D. Marulli, Edison, NJ

    Dr. David M. Meyer, Brookings, SD

    Dr. William A. Mehan, Manchester, NH

    Dr. Allen H. Moffitt, Murray, KY

    Dr. Donald R. Montano, Bakersfield, CA

    Dr. Norman Nakaji, Salisbury, NC

    Dr. Reggie Noble, San Angelo, TX

    Dr. Jeffrey R. Norkin, Georgetown, CT

    Dr. R.E. Offerman, Waukesha, WI

    Dr. Jan A. Olenginski, Wilkes-Barre, PA

    Dr. Andrew T. Panchura, Pittsburgh, PA

    Dr. Roger J. Parlow, Edison, NJ

    Dr. Bradford W. Porter, Altamonte Springs, FL

    Drs. David B. and Thomas K. Reen, West Springfield, MA

    Dr. Peter M. Roth, Agoura Hills, CA

    Dr. Richard Schechtman, Jefferson Valley, NY

    Dr. Clifford C. Seran, Pitman, NJ

    Dr. Walter Stewart, La Grange, GA

    Dr. Thomas A. Tiller, Corpus Christi, TX

    Dr. Gary A. Udis, Jenkintown, PA

    Dr. John B. Wahlig, Corning, NY

    Dr. Stanley R. Wehrli, Fort Collins, CO

    Dr. Robert R. Westbrook, Victoria, TX

    Dr. Ronald R. Yen, Garland, TX


    Dr. Sinclair is an Associate Editor of the Journal of Clinical Orthodontics and Professor and Chairman Department of Orthodontics University of Southern California School of Dentistry, Los Angeles, CA 90089.

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