I’ve tried it both ways over the past decade and ultimately found that I can finish cases 4-6 months faster bending wire to correct minor rotations and discrepancies than I can by repositioning and dropping down in wire size (to be clear if I miss my bracket position badly enough to cause more than 10 degrees of rotation or more than 2 mm of discrepancy then I’ll repo).
I never gave it much thought but recently we’ve had several docs visit the office and every single one of them has asked me why I bend wire rather than reposition.
“Why do you bend wire? Doing repos takes much less time”, they said time and again.
The statement didn’t make sense to me but given that every visiting doc said the same thing I began to question what I do. I couldn’t understand how doing a pan and repo appointment took less time than putting marks on a 19×25 TMA wire and putting a plier to it.
I finally realized that the visiting doctors were talking about DOCTOR time and I was talking about CHAIR time and total TREATMENT time. It is true that adjusting final bracket position is faster than marking and bending wire. Well, it’s faster if you don’t count the assistant/chair time it takes to take brackets off, remove the glue (in Arkansas and many states the doctor has to remove glue), place retractors, etch, prime and place new brackets (even more time if you’re using fancy brackets and have to clean and reuse them). Repositioning brackets is also faster if you don’t count the treatment time – dropping down in wire size, having to stop elastic wear, repeating the wire sequence, etc.
What’s my point?
If you want to be more efficient then there are two ways of looking at that: Doctor time and chair time. When we talk about “faster” or “easier” it seems that the overwhelming tendency is to talk about doctor time and utilizing less of it. If you are efficient and the doctor time is your limiting factor then that is a good idea. However, if you are spending a great deal of time at your desk and still trying to avoid utilizing your time then it might be time to re-examine your motives and make sure it’s not just laziness!
Repositioning still doesn’t guarantee that the tooth will be in the right place. You might have to reposition again. Much easier to bend a wire.
I base the decision on what point of treatment we are in. If it’s early and we are still in round niti wires, then I think it will save both doctor and chair time to replace the bracket. If we are in a 19×25 finish wire, then it is better to bend the wire.
Both good points!