THE READERS' CORNER

1. How do you define mild, moderate, and severe anchorage problems?

Most of the clinicians based their definition on a combination of factors, including crowding, overjet, molar relationship, and incisor position. Many defined a mild anchorage problem as one where the extraction space could be closed reciprocally and where only one-fourth to one-third of the space was needed for incisor retraction. Moderate anchorage was often regarded as needing one-half to one-third of the extraction space to be closed from the anterior. A severe anchorage problem was defined as requiring at least two thirds of the space to be closed from the anterior.

What is your treatment approach to each of these problems? What appliances do you prefer?

In mild anchorage cases, the most common approach was reciprocal space closure with either elastic chain or closing loops, combined with reinforcement of molar anchorage. In moderate anchorage cases, archwires were often stopped and anchor bands were added, as was headgear (usually at night). The use of headgear was emphasized in severe anchorage cases, and segmented cuspid retraction was accomplished with either segmented archwires or anterior J-hook headgear.

In the moderate-to-severe cases, more than 50% of the orthodontists reported using headgear as their principal anchorage reinforcement appliance. Class II elastics were mentioned, but not emphasized, for all three degrees of anchorage problems. Nance and transpalatal arches became more common as the severity increased. Several readers said they would use alternative extraction combinations (for example, upper first and lower second premolars) in more severe cases.

Do you use tipback bends? Do you use any compensatory bends or other means of controlling side effects?

Sixty percent of the respondents reported using tipback bends, principally in moderate-to-severe cases. Compensatory bends--usually molar toe-in bends and added labial crown torque in the maxillary anterior region--were used by 65%.

Does the direction of growth affect the prognosis and mode of treatment?

All the clinicians felt the more vertical the direction of growth, the poorer the prognosis. In such cases, they would use high-pull headgear and were more likely to extract teeth and place Nance or transpalatal arches.

Specific comments included:

"I define mild anchorage as the ability to close space reciprocally, moderate anchorage as a case where I need to close space more from one direction, and severe anchorage as a case where I need to close space completely from one direction (or even beyond that point)."

"In mild anchorage cases, we use elastics or closing loops with no anchorage reinforcement; we add stopped archwires and anchor bends for moderate anchorage cases, and jigs with interarch elastics, headgear, and lingual arches for severe anchorage cases."

"In vertical growers, I tend to use lingual arches, transpalatal bars, and straight- or highpull headgears for anchorage. I try to avoid cervical-pull facebows and heavy or long-term Class II elastics."

2. What type of pension plan do you have?

The most popular type of plan was profit-sharing, used by 55% of the respondents. Defined-benefit plans and 401(k) plans were each employed by 15%, and the remaining 15% had no plan or one of several other options.

Did you employ an actuary to set up and monitor the plan?

Exactly one-half of the practices reported using an actuary.

About how much is contributed annually to the plan?

The doctors contributed an average of $27,500 annually. Contributions ranged from $4,000 to $50,000, with $30,000 the most frequently reported amount.

Does the necessity of including employees in the plan affect your decision about having a plan or what type of plan to have?

Nearly 40% of the clinicians felt that including employees affected their decision.

What is your age? How many years have you been in orthodontic practice? At what age do you plan to retire?

The mean age was 46. The average respondent had been in practice for 14.6 years and planned to retire in another 13 years at age 59. Hence, the average respondent started in orthodontics at age 31 and would have been practicing for more than 27 years at retirement.

What size retirement fund do you plan to have at that time?

The average fund expected at retirement age was $1.8 million. The most commonly reported value was $2 million, and the range was from $250,000 to $4 million.

Do you plan to retire completely? If not, what do you plan to do part-time? What other plans do you have for your retirement years?

A majority (58%) of the respondents did not expect to retire completely. Many planned to continue working part-time in their practices, and several mentioned being part-time teachers of orthodontics. The plans of those who said they were going to retire completely often included travel, managing investments, and playing tennis or golf.

Some specific comments:

"I currently have a profit-sharing plan. I used to have a defined-benefit plan in addition, but administrative costs to keep up with the changes mandated by the federal bureaucracy became prohibitive, and I merged the plans into one."

"I have retained a pension plan service to administer my plan. They fill out all the necessary forms, keep the plan current with all governmental changes, and provide all the worksheets required to make the appropriate contributions."

"The necessity of including employees has meant that once the ratio of employer/employee funding exceeds 70%:30%, consideration to terminate the plan will be necessary."

"Including employees means that my plan must be able to integrate with the FICA contribution."

"Including employees is one of the reasons I have a plan that allows for discretionary contributions. One must now weigh the effect of higher tax rates against the requirements of contributing a higher percentage for employees."

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

Dr. Neil L. Blitz, Warwick, RI
Drs. Paul L. Boatright and Scott B. Edmonds, Topeka, KS

Dr. Richard E. Boyd, Columbia, SC

Dr. D. Gregory Brooks, Dunn, NC

Dr. Richard M. Demko, Chesterfield, MO

Dr. Thomas A. Ferlito, Bradford, MA

Dr. Robert B. Goldman, Stamford, CT

Dr. Paul C. Hermanson, Marshalltown, IA

Dr. Robert A. Krueger, Jacksonville, IL

Dr. Peter Lagios, Naperville, IL

Dr. Robert R. Lokar, Dearborn, MI

Dr. Robert B. Lowthorp, Bishop, CA

Dr. Jack L. Markowitz, Woodcliff Lake, NJ

Dr. Clarice K. Pick, Santa Fe, NM

Dr. David M. Sarver, Birmingham, AL

Dr. Elliot R. Storm, White Plains, NY

Dr. Goodwin G. Thomas, Jr., Rock Hill, SC

Dr. John C. White, Aurora, OH