Clinical Practice Earl's Pearls Treatment Time Sinks...What Extends Total Treatment Time I was fortunate enough to have " EJ " as one of my faculty during my residency. Both in lab and in clinic, Earl was a perfectionist, regimented in his process but always creative in his clinical approach. In 2010, I had the pleasure of recruiting him as the keynote speaker for the Arizona Association of Orthodontists Annual Session to deliver his version of Earl's Pearls. Ever since that lecture, I have integrated an .022 × .018 Bioforce ribbon wire in my office when I need to address torque early. This one " pearl " has avoided many " Treatment Time Sinks " for me. Thanks EJ! -Dr. Michael Feinberg Dr. Earl Johnson 1. Imperfect Bracket Placement □ Ignoring problem brackets □ Multiple Uncoordinated Resets: * Not correcting everything at one appointment * Back and forth with various wires multiple times 2. Waiting for Teeth □ Starting Tx too soon: not all teeth have erupted □ Waiting for soft tissue to recede □ Starting impaction correction too late 3. Rigid Standardized appointment intervals 4. Mañana effect: Putting required Tx off until next appointment 5. Inefficient Leveling □ Starting with a too stiff initial wire □ Illogical wire progression □ Attempting rotation correction without adequate room □ Attempting rotation correction with a too stiff wire □ Re-leveling after loose bracket without adequate alignment space □ Re-leveling with too stiff wire □ Starting Bite Opening too late...Auxiliary Bite Opener or Turbo Pads 6. Inefficient Detailing □ Detailing with a stiff barely adjustable wire □ Waiting until steel wires to start torque correction □ Utilizing stiff steel wires for detailing 7. Tx Strategy □ Trying to use treatment protocol that won't work □ No realistic monitoring of progress □ Reluctance to quit after no cooperation from patient or parent This clinical pearl is reprinted from an original article published previously by Dr. Earl Johnson in the Bulletin. Summer 2023 PCSO Bulletin 85