How many types and styles of archwires do you use?
This can be an inventory/stocking/overhead nightmare! So my strategy is to both reduce supply overhead and increase treatment and office efficiency by reducing the types and styles of archwires I use.
Again, here's my 2 cents:
Upper/Lower Nitinol arch forms:
Don't order both. Just order and use either upper or lower. I've always used just one type here. I just don't think it makes a difference with something as flexible as nitinol. Some may say that if you don't use both upper and lower that the teeth won't interdigitate or perhaps you can end up with a wider mandibular arch causing anterior/posterior crossbites, but I just haven't seen it clinically. Ever.
Ovoid/narrow/euro, etc.,:
Again only one shape used here. The alternative can be a real headache if you are trying to match each patient's natural arch form with your current stock. I always use a rounded, ovoid arch form. For everyone. Once we're into steel wires, if needed they can be reshaped to customize the arch better. But in nitinol for me, its ony one shape.
Sizes:
Of course this depends on your prescription so I'll just list my typical sequence (.018 Roth):
.012 Nitinol (Love this wire!)
.016 Nitinol
16x22 Thermal Nitinol or 17x25 Thermal Nitinol
16x22 SS (if needed)
Often nonextraction cases are debonded with U/L 17x25 Thermal Nitinols.
The goal is to use a prescription and treatment mechanics that utilize only a few wires. Some times I venture from this (I use .018 nitinol that I put my own reverse curve in, etc.), but again for the 70% of patients this is the norm.
Consider the effect on overhead: the bulk of my wire orders are 4 wires. Contrast this with someone who typically uses 6 wires x U/L x 2 or 3 arch forms and all of a sudden you are stocking 24 different wire types and sizes rather than 4. That alone is an overhead burner and labor/charting/inventory intensive.
Bonding vs. Bending
I typically don't bend wires. I have several rebounds during treatment, so once the brackets are exactly where I want them the wires usually don't need any bends. Now, if I have a patient scheduled for a debonding the next appointment and #8 is tipped slightly lingual then I will put a quick bend if for something like that.
This strategy can be a tricky one in an effort to control overhead. I will definitely go through more brackets and thus more overhead with bonding instead of bending. However, I feel that my clinical efficiency is improved and treatment time reduced such that it makes up for it. Also, since the brackets are now so inexpensive (blatant commercial see www.cxorthosupply.com), I feel the impact on overhead isn't as great.
Well, that's it for archwires!
As always, comments are welcome!
Dr C
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