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1. What is the most efficient method you have used to distalize upper molars?

There was a considerable variety of responses from the clinicians: 36% used headgear as their principal distalization mechanism, 25% used the Jones Jig, and 15% used either a Pendulum appliance or a Nance appliance in combination with nickel titanium closed-coil springs.

What is the most efficient method you have used to distalize lower molars?

About one-third of the respondents used lip bumpers with various types of elastics or coil springs. Another third said they did not try to move lower molars distally because they felt such mechanics were unsuccessful. The remaining third used a variety of other techniques.

What is the most efficient method you have used to distalize cuspids in extraction cases?

Elastomeric chains were the most common mechanism, employed by 55% of the respondents. Nickel titanium springs were used by 16%, followed by a Nance appliance in combination with Class I elastics.

What is the most efficient method you have used to close extraction spaces?

Again, the most popular device was elastomeric chain (43%). Another 30% of the orthodontists preferred closing arches with various loops, and fewer than 10% each used Class II elastics or TMA closing loops for space closure.

What is the most efficient method you have used to rapidly expand the palate?

The Hyrax rapid palatal expander was used by 64% of the clinicians. Fewer orthodontists used a Haas (16%) or bonded (15%) rapid palatal expander.

What is the most efficient method you have used to bring impacted cuspids into the arch?

The most common technique, favored by 48% of the respondents, was to attach a power thread from the impacted canine to a stiff archwire or lingual arch. Twenty-one percent used a power chain in a similar manner, and 20% used an auxiliary archwire from the maxillary first molar tube.

What is the most efficient method you have used to upright mesially inclined molars?

A number of techniques were mentioned, the most popular (27%) being uprighting coil springs attached to the archwires. Slightly smaller numbers of clinicians preferred uprighting loops built into the archwires or sectional TMA loops. About 10% used utility-type arches to provide the uprighting force.

What is the most efficient method you have used to control rotations?

This was another problem with a wide range of solutions. About 30% of the respondents used twin brackets, tying the archwire tightly with steel ligatures. Another 20% favored rubber rotation wedges. Several clinicians preferred power chain to gain an overcorrection of rotations, and nickel titanium archwires were also mentioned. Many of the readers recommended combining their technique with a lingual attachment to provide force on both sides of the rotated tooth.

2. Please rate the importance of the following in choosing your present main office location.

Very--Somewhat--Not Important

92%..........5%...........3%..........Desirable place to live and bring up children

47%..........47%.........6%..........High child population projection

30%..........46%.........24%........Encouragement from referrers

29%..........38%.........33%........Availability of suitable office

26%..........52%.........22%........High per-capita income

22%..........35%.........43%........Home or college town

14%..........45%.........32%........Low competition

For this group of orthodontists, finding a desirable place to live and raise children was clearly the most important criterion in locating their offices. The second most important factor was the child population projection. Next in importance were prospects for referrals and the availability of suitable office space.

What market research did you use in choosing your present location?

About 30% of the respondents said they had used no market research. Those who had done research cited the local school district and the Chamber of Commerce as the most useful sources of information. Orthodontic and dental colleagues were also mentioned as sources. Many clinicians who had moved from previous office locations recommended mapping the homes of their patients and trying to relocate as close as possible to the center.

If you were to draw a circle on a map that included all your patients, what would the radius of that circle be? What radius would a circle including 75% of your patients be?

Responses to the first question ranged from 5 to 1,500 miles, but the maximum distance of patients from the office was usually between 30 and 50 miles. For about 60% of the practices, primarily those in urban areas, 75% of their patients came from within 3 to 5 miles of the office. For the remainder, principally in more rural areas, 75% of the patients came from within 10 to 15 miles.

What effect has your current location had on your ability to attract patients?

A little more than half of the clinicians suggested that their locations were significant in attracting patients. One-quarter felt their locations had little effect, and another one-quarter thought they were in poor locations that made it difficult to attract patients.

How have the demographics of your area changed since you moved into your office? Have these changes caused you to re-evaluate your location?

About 45% of the respondents said the demographics in their areas had not changed and that they were not re-evaluating their locations. Twenty-one percent believed their demographics had improved, mainly because of growth in their surrounding areas. An equal number felt the demographics of their locations had worsened, causing them to re-evaluate their situations.

If you were to change your main office location today, what would be your main criteria in choosing a new location?

The vast majority of respondents identified easy access to the office as their principal criterion for a new location. This included street access, sufficient parking, and proximity to schools and major referral sources. Several orthodontists mentioned the need for high dental awareness and high disposable income in areas to which they would relocate.

Specific comments included:

  • "When I started, I was near the outer edge of the city, and now I feel I am more inner city. I have considered a satellite in a suburban town."
  • "My location in a large metropolitan area has enabled me to maintain a diffuse patient distribution."
  • "Don't set up in a one-company town (e.g., IBM); look for a fairly steady employment base. There's less risk of downsizing or loss of the major employer in town."
  • "The limitation of new development in my area is reducing the number of new families moving into the neighborhood. I am currently seeking a more accessible office location with better parking."
  • "I'm choosing a new office location. I would like to own my own building, be close to my original office, and have plenty of parking."
  • JCO would like to thank the following contributors to this month's column:

    Dr. Robert M. Andresen, Davis, CA

    Dr. Maurice J. Belden, Presque Isle, ME

    Dr. George E. Black, Moses Lake, WA

    Dr. Charles F. Bohl, Brookfield, WI

    Dr. Thomas A. Brown, Shelby, NC

    Dr. Leonard Chumak, Nepean, Ontario

    Dr. Mark L. Dake, West Plains, MO

    Dr. Walter A. Doyle, Lexington, KY

    Dr. Gary Engelking, San Jose, CA

    Dr. Joe H. Farrar, Hendersonville, NC

    Dr. Harry H. Fung, Willowdale, Ontario

    Dr. Howard D. Iba, Tulsa, OK

    Dr. Brent R. Lang, Louisville, CO

    Dr. Michael L. Lanzetta, Taylor, MI

    Dr. Marc S. Lemchen, New York, NY

    Dr. Rodney D. Littlejohn, Waterloo, NY

    Dr. Joseph D. Martinez, La Grande, OR

    Dr. Malcolm L. McInnis, Riverside, RI

    Dr. Matthew I. Milestone, West Orange, NJ

    Dr. Stephen Miller, Pointe Claire, Quebec

    Dr. Michael G. Mills, Edmonton, Alberta

    Dr. Willis H. Murphey, Jr., Fort Worth, TX

    Dr. William C. Piarulle, Rochester, NY

    Dr. A. Wright Pond, Colonial Heights, VA

    Dr. Rajendra Rana, Poughkeepsie, NY

    Dr. W. Ronald Redmond, Laguna Niguel, CA

    Dr. Carter C. Reese, New Hope, MN

    Drs. Suellen H. Rodeffer and David Tod Garner, Jacksonville, FL

    Dr. Jack J. Rosenberg, Burke, VA

    Dr. Robert T. Scott, Westminster, MD

    Dr. Gary F. Stauffer, Lethbridge, Alberta

    Dr. O.B. Vaughan, Corpus Christi, TX

    Dr. Richard B. Williams, Billings, MT

    Dr. H. Warren Youngquist, Colorado Springs, CO


    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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