This week provided an interesting series of polls on Ortho101. I’m working hard to question everything – especially the things we take for granted – and I’m proud of the other members of Ortho101 for doing the same. Let’s have a look at the results of the polls and see what we can learn about what we do and why.

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This first one seems obvious but it’s a great question that we don’t ask nearly often enough. As indicated by the results and despite the qualifications surrounding some of the “yes” answers, it becomes obvious that the majority of orthodontists still believe that steel ties are the proper way to ligate archwires. Why do I care? Well, mainly because patients hate getting them applied, they take forever to apply (patients hate that too), it takes a long time to train a new employe how to do them properly, the tips can become untucked and poke the patient, the patients like having color ties and, finally, the evidence pointed out by another member of the group shows there is no difference in steel ties and O ties!

Essentially using steel ties is the ortho version of fly fishing and catching very little while feeling superior to the spin caster who is catching fish on every cast! We need to get over ourselves. And before you start talking about how I must not know how to do steel ties or that I’m just lazy I’ll tell you that I went to a Tweeter school, bought a straight up Tweed practice when I graduated and can use a Coon plier like a champ – spinning it in either direction even! Oh, and don’t forget that even the largest arch wires have slop in the bracket and we aren’t trying to immobilize the wire anyway!

Moving on…

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A friend of mine suggested we post this question. I was impressed with the practicality of the responses. It appears that taking staff on big trips is waning in favor though it used to be considered mandatory. I think it’s important for staff to see and interact with other teams from successful offices but I think the way we do this will change over time and look more like The MKS Forum where you go to an easy to get to city (not a vacation city) where accommodations are not too expensive and you pack in a tremendous amount of learning in a couple days instead of spending a week there. I guess we will have to wait and see how this plays out.

Finally, we asked the following:


The original poll only had “yes” and “no” as options and the rest were added by Ortho101 members. The results were interesting and, as predicted, nearly 2 to 1 in favor of using a micro etcher. A lot of respondents stated that they only reused the brackets on the same patient – honestly I assumed that to be the case and it never occurred to me that we need to state it but that’s what I get for assuming.

There was a pretty heated conversation accompanying the poll and the folks who use a micro etcher were very keen to defend what they do and why it “doesn’t add any time”. To those of you who use a micro etcher I would say this:

I used a micro etcher for many years when I used to use fancy brackets. If memory holds, you guys are leaving out a few things – like the tip of the etcher getting clogged or the lid to the container that holds the abrasive getting stuck so you can’t open and refill it or the 10′ diameter gray circle that surrounds the etcher or the fact that the assistants might dawdle just a bit going to and from the machine when you are busy in the clinic or the fact that blasting the back of a bracket that just came out of someone’s mouth with air and abrasive creates aerosol nastiness that you cannot stop or clean up effectively…. And that’s just what I remember. Oh, and how much do these machines and the cabs cost? How many brackets do you have to etch to make that up? And if you say “not too many” then why are you using such expensive brackets? It’s amazing to me that so many people defend what they do with this even when it is pointed out so clearly that etching brackets is not a good idea by so many. I quit using one several years ago for all the reasons I listed and many of the ones others posted. I just wish someone had pressed me on this question earlier!

So, in my opinion, the pragmatic orthodontist will:

  1. Stop using steel ties
  2. Be extremely selective when deciding to take staff on trips
  3. Stop reusing brackets and a micro etcher (this may or may not include using less expensive brackets)

Question everything. Especially the things we take for granted!

Given the current landscape, we MUST look at what we do and understand why. We can’t afford to do things the way we always have. Let me know if you have any questions you’d like to poll our group of 1600 orthodontists and residents on or join Ortho101 on Facebook and ask for yourself. Have a great week!