Topics of the day:

1. Re: Coverage during vacations
2. Re: Emergency coverage
3. Implants and molar space closure
4. Re: Osteointegrated implants
5. Question on a specific occlusal relationship
6. TOPS management software
7. ESCO - The Electronic Study Club for Orthodontics


Date: Fri, 7 May 2004 06:31:31 EDT
Subject: Re: Coverage during vacations

Hi Rob,

1. you may want to rethink the idea of no staff for future vacations.  Having at least one staffmember in the office even if only AM or PM gives you the ability to schedule new patients who call during the vacation week.  If they call and don't receive a call back until a week later, most (I think) will go elsewhere or it will at least make them think about your services.  Having a staff member available and carrying a pager, will allow that staff member to triage the problem: wait till next week, see today, refer to a colleague who has agreed to see your patients in emergencies.

2. I always carry a pager on a day to day basis.  A staff member is tasked to carry it for those weekends in which I will not be in Maine or for vacation weeks.  I tell them that I really don't expect them to go into the office but to just calm the parent and we will deal with it on Monday.  Sometimes they realize that the only answer is to see the patient and naturally I am pleased when they take that initiative although thankfully it is rare.  They are paid a minimum of one hour's salary in these instances.

3. in your case, you should have an arrangement with a colleague to see your patients in an emergency.  Not be available at all sends the wrong message to the patient and may be a medical legal issue.

4. that brings up the idea of a practice coverage group in case of disability or death.  you might start working on developing a group of LI orthodontists who will cover each other's practices in the even of d or d, and also in emergencies during vacation periods.  It is important that these orthos be in a noncompetitive situation.

Best Wishes
Charlie Ruff


Date: Fri, 7 May 2004 07:15:48 EDT
Subject: Re: Emergency Coverage

Dear Rob,

Emergency coverage for our patients is an important part of our responsibility as orthodontists.  Fortunately, as orthodontists, we do not experience too many of these emergency situations on a monthly basis.  Nonetheless, I agree with you about vacation schedules and your concern that your patients are provided emergency services while you and/or your staff are absent.  In practices without partners or associates, this can be a real challenge. 

Developing good professional and personal relationships with other orthodontic colleagues (or other nonorthodontic dental colleagues if no orthodontic colleague is in your immediate area) is essential because these colleagues can be very helpful during vacation times or in the event of temporary disability.  A basic protocol should be discussed with these collegial neighbors to avoid misunderstandings and potential problems when your patients indeed require such emergency service during your absence.  How potential emergency patients are scheduled?, Is the schedule of the covering orthodontist compatible and extensive enough with providing comprehensive and timely emergency service or will more than one colleague be needed? What level of emergency service will be provided (are debonded attachments rebonded or simply removed)?, What constitutes an emergency that even requires an office visit or merely a supportive telephone call? What fees, if any, will be charged by the orthodontist or dental colleague rendering such emergency services?  What communications between the covering orthodontist and returning vacationing orthodontist are appropriate? These are all good questions that should be answered prior to the orthodontist leaving for vacation.  In great measure, common sense and basic ethical behavior should provide intuitive guidance to the emergency covering orthodontic office.  The rule that I use  when rendering orthodontic emergency services for any of my orthodontic colleagues is "how would I expect my patients to be treated under similar circumstances?"

Rob, you have raised an interesting question that all of us should reflect upon.  Providing reliable emergency coverage for our patients in our absence should remain an essential part of our orthodontic practice and our ethical responsibility to the public and our orthodontic colleagues.

Elliott Moskowitz,
New York City   

From: "adrian becker" <>
To: "The Electronic Study Club for Orthodontics" <ESCO@LISTSERV.UIC.EDU>,
Subject: Implants and molar space closure
Date: Sat, 8 May 2004 21:35:48 +0200

Dear Sandra Kahn and ESCO members,

Sandra Kahn wrote: " .....I am still searching for a practical way to utilize osteointegrated implants as anchorage to close lower first molar spaces".

I question why it must be an osseointegrated implant. It would seem to me that the use of one of the Korean temporary (non-integrated) mini-implants in the canine/premolar area would be eminently suited to this situation.

Adrian Becker

To: "Electronic Study Club Orthodontics" <ESCO@LISTSERV.UIC.EDU>
Subject: Re: Osteointegrated implants
Date: Sat, 8 May 2004 08:55:49 -0400

Dear ESCO,

I would recommended to Sandra to give up on osseos integrated implant in the retromolar area and use a titanium screw placed between the roots of either the lower 3,4,or5. To Rob Bruno, I would befriend your closest orthodontic competitor or one nearby but far enough away, and set up an agreement to cover for each other when your whole staff is away.  In orthodontics, we can be competitors and still be friends.

Roy King


Date: Thu, 13 May 2004 03:17:49 -0400
To: Question on a specific occlusal relationship
Subject: Researching a forgotten Name of a described phenomena?

I learned about a specific occlusal relationship described by, I believe, a periodontist and forgot the name and source of the information (the article). I would like to describe what I remember about this particular occlusion and see if anyone knows more information about this entity or phenomena. This particular relationship is when there is a central incisor that exhibits extrusion while the contralateral posterior occlusion has a crossbite.

Anyone? Anyone? ... Bueller?

Philip S. Junghans
Aviano, Italy


Date: Sun, 16 May 2004 20:33:55 -0700
From: "Jeff Stewart" <>
Subject: TOPS management software

Hello all,    

Does anyone out there use TOPS (or TOPS extreme) as their management software (which for others is a Mac based program)? What are the pluses and minuses? How is the support? What, if any, are the problems interfacing with Windows programs, for example with a digital Pan/ceph unit? Can you easily link 2 offices and home? I have previously only used windows based programs both professionally and personally and have very limited knowledge with Mac based programs but at the AAO in Florida, TOPS seemed to me to have the best management program. Thanks!

Jeff Stewart



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