Topics of the day:

1. Re: Retainers after Phase I treatment
2. Re: Retainers after Phase I treatment
3. Re: Two Phase treatmemt
4. Re: Staff salaries
5. Re: Inventory systems
6. ESCO - The Electronic Study Club for Orthodontics


From: " wavel wells " < >
To: "The Electronic Study Club for Orthodontics" <ESCO@LISTSERV.UIC.EDU>
Subject: Re: Retainers after Phase I treatment
Date: Sat, 22 Jan 2005 10:43:40 -0600

Phase one has as many definitions as those who try to define it.  To some it is anyone but an orthodontist attempting to do orthodontics, to others it is care before some specific age (9yrs?) and yet others both in and out of the orthodontic community see it as a legitimate treatment approach.  I personally don't see anything to covet about  early care.  It is hard work, requires retention of the attempted correction and there are a host of folks out there who have little early experience  waiting to make a negative comment.  That said, I am drawn to early care because I believe there is a narrow path which calls for action before the usual orthodontic age. 

Space maintenance (LA and unilateral spacers) come to mind.  As one dual trained orthodontist recently said, "crowding in the anterior is genetic while crowding in the posterior is early space loss".   Who wants to argue against space maintenance as a form of early preventive care? Habit cessation  before permanent anterior eruption? - no one has mentioned the  benefit of treating a 3mm overjet compared to 10mm at age twelve.   How about early recognition of supernumaries, ectopic eruption, congenital missing teeth or  patients with airway restrictions and all of the resulting sequela..  Young skeletal class 3 patients with confirmed maxillary retrusion represents one of the most dramatic correction possibilities in orthodontics- "this one" has literature to support action before age 12 yrs.   McNamara has established that  early maxillary expansion of posterior crossbite patients can avoid facial asymmetry and negative alteration of the articular complex, restore proper function and create needed space for the erupting middle segment - this deserves mention in any early care discussion.   Bench,Burstone and Ricketts all suggested that segmental biomechanics  offered superior positioning of the upper and lower anterior segments when compared to one full archwire. Bench and Ricketts believed that placement of the upper and lower anteriors (both vertically and AP)  was best done prior to  cuspid eruption in both arches  - this was their phase 1 along with headgear and maxillary expansion. 

Early care is intuitive in nature as someone mentioned.  You look at the case after early treatment  and you make some judgements - either the case is now much easier to treat or not.  Ethical people try to eliminate as much meaningless care as possible but some situations  I mentioned are compelling.  The AAO ran an advertisement a few years ago that suggested that seven year olds be seen by the speciality  -  I have to assume that this decision was more than a marketing effort.   Based on Gianelly's research, he indicates that 70% of our patients can accommodate the permanent dentition if leeway space is held with a lower lingual arch - what an opportunity- but it all happens prior to the loss of the lower E and prior to the age of the full permanent dentition.  For those of us who swim in this pool there is much to consider before the primary teeth are lost - it is more complicated than saying you are for or opposed to early care.  Just for the record I refer most of my older patients with needs to the appropriate source - the orthodontist.

I have enclosed some photos of a unique phase 1 retainer using Biostar and acrylic palate (see attachments).  It will hold the correction through the transitional dentition.  It is subject to wear and loss but nite wear only will avoid many problems. 

Wavel Wells
Ped. Dent.
Lawton, Ok.


From: "Jim Eckhart" <>
Subject: Fw: Retainers after Phase I treatment
Date: Mon, 24 Jan 2005 10:21:07 -0600

Removable retainers rarely fit longer than a few months during the transitional dentition because of the changing teeth...hence for years I have used fixed lingual arches, either upper or lingual or both, to stabilize arch length gaining or width gained during Stage One.  Class II correction is always postponed until age 11-12, so as to avoid having to retain that correction during transitional dentition.

Jim Eckhart


From: "Barry Raphael" <>
To: "The Electronic Study Club for Orthodontics" <ESCO@LISTSERV.UIC.EDU>
Subject: Re: Two Phase treatmemt
Date: Mon, 24 Jan 2005 09:52:44 -0500

As much as I hear about the deficits of 2-phase treatment, I just can't convince myself that my results aren't better with it. It's more than prolonging treatment. From an esthetic point of view, it's satisfying to both myself AND my patients to bypass the ugly duckling stage. From a functional point of view, its great to go from moderate crowding to leeway-space-will-be-enough.

I can't deny that there are times I wish I extracted. But there are just as many late comers I look at forlorn for the want of having my hands on them earlier.

Barry Raphael


Date: Tue, 25 Jan 2005 01:40:37 EST
Subject: Re: inventory systems

Regarding inventory systems:

Foxfales ( has a bar code scanning system that is called OIO (office inventory and ordering system?)  We've implemented it recently and it really does keep track of everything and alerts you when an item is running low.  The only downside I can see is that you have to keep a little more inventory on hand initially to make it work.  So I'll have to wait until the end of '05 to report on whether it ultimately saves in supplies costs, since we just started it in '04.

Brian Povolny
Seattle, Washington.


From: "Scott Smoron" <>
To: "The Electronic Study Club for Orthodontics" <ESCO@LISTSERV.UIC.EDU>
Subject: Staff salaries
Date: Tue, 25 Jan 2005 09:16:02 -0600


Don't want to prolong the staff salary thing much, but when you include staff salaries, is everyone including unemployment, worker's comp, and federal matching, etc...

If I take what people earn, that is totally different than the additional FICA match, the federal unemployment, state unemployment, worker's comp, etc.  Just curious.

Scott Smoron



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