*NO RELIGIOUS OFFENSE INTENDED*

Well, this is the first blog entry for a subject near and dear to my heart. Especially in the recent economic climate and with increased numbers of orthodontic competitors, it's becoming more and more important to maintain a manageable overhead in your Orthodontic Business. I'll try to update this blog each week or so on tips and tricks I've learned over 18 yrs to keep my overhead low, mechanics efficient, and the number one cost-saver, minimizing treatment time.

COMMENTS ARE ENCOURAGED

So here we go...

.012 Nitinol

I don't know about any of you, but in our Orthodontic Residency we used modern techniques, straight wire appliances, and all kinds of nitinol wires, but before I started my private practice I had never used .012 nitinol. Starting wire was .014 (for an .018 slot) or.016 (for a .022 slot). These wires worked well. But I have to give credit to my brother (thanks to Larry!) for introducing me to the .012. Nothing has sped up my initial aligning phase like .012 nitinol. It has truly shaved months off of my average treatment time! In fact, the main reason I don't use expensive self-ligation brackets is that I just don't need them for quick alignment. I have the .012!

With the .012 you can get immediate engagement in 95% of the brackets, and you get a super light, gentle force that often results in limited or no pain for the patient after the full bonding appointment. I rarely ligature tie rotated teeth at the first appointment, but that's an option for me at the next visit with some of the stubborn rotations. Usually, after the 2nd visit alignment is complete.

Now, if you are using the .012 you need to be careful of certain things. No gum! I tell patients that possibly later in the treatment they can chew sugarless gum but not in the initial phases. Also, if I don't need the molars right away I still bond them but I only place the wire U/L 5-5. That way if the patient does bite something hard I don't have to worry about an emergency appointment where the wire has come out of the 6's. Also if they happen to break off the tube on the 6's (I rarely use bands- future blog subject) there isn't a long wire poking them.

So if you haven't already tried it, use .012 nitinol!

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Future blog subjects: bonding vs. banding, BT's, efficient use of chair time.

05/02/2022 UPDATE
 
Crazy this was over 10 yrs ago...
So I'm going back over these blog posts and commenting about anything I may have changed my mind on since posting. 
In this particular Blog even though it's been 10 years I really haven't changed much, but I've added a few things:
* Still use .012 NITI in 99% of cases as starting wire
* Still only initially engage wire U/L 5-5 to reduce emergencies
Things I've added
* Sometimes I even use .012 THERMAL NITI to get initial full engagement with severely crowded teeth.. Now this is a very flexible, super light force wire that does not fully rebound so don't expect severe rotations to fully correct. 
* I've added small and large eyelets as KEY in my starting regimen. They work excellent for engaging lingually displaced teeth without the need for coil springs in many cases!
Here's a typical case where initial eyelets were used:
Day of Initial Placement


                                        2nd Adjustment
Let me know your thoughts! I'll update a couple of these blogs each month to show what things have stood the test of time in my office!