I wanted to share a conversation I had with a young doctor the other day because it is not at all atypical of the conversations I have ALL THE TIME. For some reason many, if not most, orthodontists think that there is a RIGHT WAY of doing things when it comes to orthodontics and that how other orthodontists feel about our mechanics is important. I want to make this very clear:
THERE ARE NO POINTS FOR STYLE!
RESULTS ARE THE ONLY THING THAT MATTER!
SPENDING LESS MONEY FOR THE SAME RESULT IS ALWAYS BETTER!
FASTER IS BETTER IF ALL OTHER THINGS ARE EQUAL!
FEWER VISITS ARE BETTER IF ALL OTHER THINGS ARE EQUAL!
LESS WIRES CHANGES IS BETTER FOR PATIENT COMFORT AND FOR YOU!
MORE OPTIONS IS BETTER IF ALL THINGS ARE EQUAL!
SIMPLE IS BETTER THAN COMPLICATED!
Below is a transcript of a conversation between a young doctor and me. I share it in hopes that others will shake off “what everyone else does” and figure out how to do what is best for them and best for their patients!
YD: Ben, Sorry to bother. Are you 018 or 022? I’m currently 022 but I am looking at making the jump to 018 for simplicity purposes.
Me: No bother. I’m 022 because I can always use a smaller wire if I want to in 022 brackets but I can’t use a bigger one in 018. I’ve bought several practices that were 018 and it’s fine but I don’t see how one can make an argument that 018 simplifies anything – unless you’re selling 018 brackets I guess. Having 018 and 022 brackets in your practice at the same time certainly doesn’t simplify. I can attest to that.
YD: Agreed but I feel like I run through too many wires currently. 018 would simplify. What wire do you typically finish in? Maybe I need to revisit my wire sequence. I know you are busy, but do you have a write-up of the mechanics/ wire sequence you use? If not…no worries…I just thought I would ask before making any rash decisions.
Me: I used to use 014 NiTi for 10 weeks, 022 Cu NiTi for ten weeks and I run elastics and chain, then 19×25 TMA. This is optimum for efficiency and speed but in some ways it gets the job done too fast and 20×20 copper NiTi cost more than all the other wires together so I switched to 014 NiTi for ten weeks, 018 NiTi for ten weeks, 20×20 NiTi for ten weeks with elastics and chain and then 19×25 TMA. This sequence is still very fast. We want minimum cost and great efficiency in the appliances we use because this allows us to extend financing and make great care affordable for everyone. I still don’t see how 018 is simpler than 022.
YD: I think it all depends on wire sequence. Do you have problems with your 19×25 TMA breaking? If you don’t use a lot of stainless steel wires, are you closing most your space on 20×20 NiTi?
Me: I don’t have any problems with TMA wires breaking and I bend a lot on TMA. I close space on 20×20 NiTi and on TMA wire unless it’s extraction space then I use SS. Again, I don’t see any difference between 018 and 022 other than I can use a bigger wire in an 022 if I want and I can’t in 018. I had this convo with David Sarver the other day and he feels the same. I’ve treated thousands of cases in each size bracket. Obviously it makes no difference to me what you use. You asked so I’m telling you my opinion. I don’t think you can get much simpler than 3 wires.
You think you need this:
When this works better:
You think there are points for style and technique and visualize yourself like this:
But there are no style points. Results are the ONLY thing that matter!
YD: You would laugh at my wire sequence. I guess “I” am making it more complicated. Have a good weekend. Thanks for your time.