Straight Smile Solutions

Does StraightSmile Solutions Have a Phase 1 or Interceptive Orthodontics Course?

Do You Offer In-Person Courses? Find out here

We used to do in-person courses for interceptive but they are very expensive to produce and put on and in order to do so, you have to get sponsors so it’s more affordable for dentists to attend.

The problem with sponsors is that they try to control the content that you present to lean towards their product or system, so you should never trust that kind of course.

For that reason, we stopped doing them and started putting out free courses instead on YouTube and our webinar page. It’s the same content we used to do in my actual course, except it’s free!

You can look up any system or just search Phase 1 or Interceptive and the content will come up.

Also, we have a Phase 1 webinar archived.

Beyond that, we train doctors on interceptive just like you are in ortho residency by teaching you how to treat your patients, not just “theory”. You can get that in our Concierge program here! Take a look at the video above on that page and also at our FAQ page.

Check out our book here!

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Why Doesn’t StraightSmile Solutions Do Lecture Courses on Aligners?

I do sometimes offer courses. I post them on my website here: https://www.straightsmilesolutions.com/classes/events/
The reason I don’t do actual “courses” is because these are always sponsored (because they are expensive to put on) and  in doing so you give your heart and sole away legally and you can’t speak freely.  I’ve had that happen to me in the past and I don’t wish to do that again.
If you want a destination course, I recommend my friend, Dr. Rishi Popat- here’s his courses:  https://www.straightsmilesolutions.com/classes/advanced-hands-on-classes-and-academic-ortho-courses-with-dr-rishi-popat/
Mostly, we do 1:1 coaching with doctors because that’s the best way to learn.
Also- we have over 3000 videos which are FREE and everything you need to know is there!
Check out our YouTube channel and just search by any keyword. I am sure you’ll find what you are looking for.
Here’s the link: https://www.youtube.com/channel/UCZQDILf1sP5qR4p78673bzA
Of course, please do subscribe because we add new videos almost every day and we take requests!!
Also, check out www.GPwebinar.com
That’s where we post our archived webinars.

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How Do StraightSmile Solutions Invisalign Protocols Differ from Molis and GLR?

I often get asked this question and I really don’t have an answer for it, outside of “we do things differently”:

1. We don’t have some blurb that you cut and paste in your comments section of your Invisalign Clinical Preferences.

* This never works! All it does it slow down your treatment-planning and confuse the technicians.

2. We don’t move only anterior teeth:

* How can you expect predictable outcomes if you are only moving “some teeth”?

3. We correct habits BEFORE Invisalign Starts

* This is self-explanatory. All oral habits (mouth breathing, tongue-thrusting, thumb-sucking) MUST be corrected fully before treatment starts.

4. We don’t do compromised/ orthognathic cases.

* These need jaw surgery and we don’t try heroics. Refer them to ortho.

5. We stage our treatment 2-3x longer

* Why over-promise and under-deliver?! Our way just works better and patients LOVE it!!

6. We LOVE bite turbos!

* Love, Love, Love! BUT- take them off a few aligners before the end or you’ll have overjet.

7. We believe in weekly changes but also weekly virtual tracking for an accountability loop.

* Why do refinements, when they aren’t often necessary? Do things right the FIRST time!

8. We Believe in Phase 1 Tx and Growth Modification and Expansion should be done Early in Phase 1 Treatment

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Class 3 Space Closure Mechanics



It is so important to manage space well with anchorage for Class III cases. Below are my “Class III Spacing Beads on a String Mechanics”.

At the heart of this is ANCHORAGE! The LLHA is my anchorage of choice for class 3 cases with lower spacing. If the class III case has only upper spacing, the LLHA isn’t helpful. As long as the LLHA is in you can just chain 6-6 on the lower (molar to molar)

The best way to manage this maxillary space is to close the space in units. Start with upper 3-3 (canine to canine). Once that is closed, you’ll
long-tie/undertie max 3-3. If not, please do that for anchorage. So undertie max 3-3 and chain 4-4 or 3-4 on both sides. Either way. Have the patient come back every 3 weeks for chain change.

Once the 4’s have fully protracted and uprighted, remove the lace/undertie and redo it to 4-4 and repeat, but this time to the 5’s (and so on, to the 6’s, to the 7’s, all the time wearing class 3 elastics.

If the patient is an elastic-wearing champ, this will all work out just perfect. Let him know that. If he’s not, he’ll be getting a lower incisor extracted. This is up to him. You will do everything you can to avoid this but he must wear 3/16 heavy class 3 elastics BILATERAL until the spaces are closed.

IF you get to edge to edge occlusion at ANY TIME and there’s still space left, the deal is off and a lower incisor comes out.
If you get to edge to edge and all the spaces are fully closed (including molar spaces), just add lower IPR.

This will realistically take 6-9 months. The more he wears elastics, the faster it goes. Also make sure you power chain is NEW!

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Can Periodontal Patients get Invisalign or Braces?

Yes, some periodontal patients can indeed get orthodontic treatment but it isn’t without risks.

My preference for these patients is always Invisalign over fixed braces for hygiene and also because the forces are slower and lower. This leads to less tissue breakdown over time during treatment.

Also, you need to differentiate between ACTIVE periodontal disease and past periodontal disease.

Patients with ACTIVE disease shouldn’t be treated until it’s resolved and you’ve finished the 1 month evaluation documentation and all pockets are <4mm without BOP. You also don’t want to treat patients who have more than half of their attachment gone. They should have at least 50% of crown to root ratio. Of course you need excellent, recent xrays as well.

I am also NOT a periodontist and neither are general dentists.
I punt every severe patient to perio and have them sign off in writing that they support and advise ortho Tx.
Without that signature, you’ll potentially be liable if something happens, even if you put that disclaimer in writing.

I also let them “baby sit” my patient during ortho Tx ( for PMTs) and let them put on the perio splint at the end for retention ( and I’ll do essix over)

It might be an additional out of pocket fee for the patient, but it’s standard-of-care and any patient who refuses and asks you to cut corners, shouldn’t be a patient you want in your practice.

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Why I Prefer Invisalign for Senior Patients

I know some people think I am contradicting myself, but I am indeed a fan of Invisalign. For a young, healthy, class 1 patient, there are many alternative aligner options for treatment that are just as good as Invisalign and can save you or the patient a lot of money.

That being said, orthodontics isn’t only for kids anymore and for our senior patients, in my professional opinion, Invisalign is the only way to go. Here’s why:


1. The abfractions. Invisalign has the most gentle plastic and the most forgiving trimline- I’ve seen other systems crack teeth with abfractions and extensive fillings..

2. Their pontics are nicest

3. Lowest/slowest forces for perio

If you’d like more information on clear aligner options besides Invisalign or if you’d like help with any aligner or orthodontic case, please contact us at www.straightsmilesolutions.com

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Premolar Extraction Patterns- upper bi’s vs 4bi’s

First of all, I want to preface this blog that I’ve avoided writing this blog because I am emphatically against premolar extractions for a zillion reasons. Most of the time it’s overkill and not necessary, especially with early intervention. That being said, I want to give my “rules” for extractions:

1. Always, always get a ceph and ceph numbers before even considering any extractions. Watch our content on cephs to learn why and how to interpret or schedule a session with us at www.straightsmilesolutions.com/services for hands-on help with a case.

2. Consider alternatives like IPR, expansion, proclination and distalization (which is SO easy with invisalign and elastics for anchorage as long as the 8’s are extracted!)

3. Always, always screen for OSA and never initiate extractions on any patient who might be at risk for OSA. That means, asking questions, doing an exam and referring as needed if you don’t know. Document, too! If you don’t do OSA and refer and collaborate with a sleep MD in your practice, you aren’t qualified to make this decision. This is a liability. Don’t skip this step!

4. There is ABSOLUTELY NO reason to extract on a growing kid. This isn’t standard of care IMPO. That’s my opinion and the opinion of many orthodontists and likely also a dental board, if questioned. Why risk your license because a parent is pushing you? Extractions are always last resort and growing kids shouldn’t be guinea pigs for sloppy ortho. Refer to someone who can treat properly.

If you’ve done all of the above and you still think the patient is a candidate for extractions, here’s my cookie-cutter approach:


1. You only take out upper bi’s when you are full step class II and only if and only if you’ve exhausted other options above. Use a TPA or nance for anchorage.

2. You only take out 4 bicuspids when the patient is class 1 with severe crowding. If you are worried about profiles, do 5’s but to me those are bigger teeth so extract closer to the crowding.

3. If the patient is slight class 2 with severe crowding, do upper 4’s, lower 5’s but consider a TPA or nance or anchorage.

4. If the patient is slight class 3 (less than 2mm) with severe crowding do upper 5’s, lower 4’s but consider additional, lower anchorage like a LLHA.

5. If there’ is asymmetry, you’ll need to get creative and/or if one premolar is has a less favorable prognosis (eg- perio/endo/caries..etc). It makes the mechanics a bit tricky but it’s doable and the patient will appreciate it.

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Oral Habits and Kids

Oral habits like thumb-sucking and using a pacifier use can be normal, soothing reflexes from birth to one year of age. The majority of children naturally outgrow their habit easily on their own. However, habits that persist after the age of three or four risk oral complications:

  • Crooked teeth
  • Narrow arches
  • Proclined teeth (AKA buck teeth)
  • Longer and more complicated orthodontic treatment, possibly including surgery or extractions
  • Posterior crossbites (the upper arch fits inside the lower arch)
  • Anterior open bite
  • Smaller airways
  • Impacted teeth
  • Long facial height by changing the growth pattern

Eliminating Habits

The first step to eliminating habits is to examine the patient and take limited, orthodontic records. Panos, cephs, and uncomfortable intraoral photos aren’t needed at age 3-5 but may be needed in older children. For children ages 3 and 4, I recommend making the exam fun by having the child use his own fingers to retract his teeth and make a “funny” face while biting his teeth together like an alligator. I used to save a few of these photos to show the child how other kids did it and offer a copy of the photo home as a souvenir.

I also recommend getting a baseline SDB/Habit Questionnaire for documentation. Many pediatric oral trainer companies have their own version of this form, or you can purchase one from our store.

For kids under age 5, often all you need to do to correct the malocclusion is to eliminate the habit. Positive reinforcement is the best step to start:

  • Children may suck their thumbs when they feel insecure. Work on correcting the cause of anxiety, instead of the thumb-sucking habit. Stress in the home often needs to be corrected before you can address the habit.
  • Reward children when they refrain from sucking. Use a Sticker Chart on a calendar.
  • Give verbal praise to the child. Encouragement from siblings also helps. Success with habit cessation is a win for the whole family, and the siblings should also get a reward or a family celebration, like a trip to the ice cream parlor!
  • If these methods fail, remind the children of their habit by bandaging the thumb or putting a sock on the hand at night. One of my favorite tricks is to take a large, men’s, long-sleeve T-Shirt and tie knots in the ends of the arms. You can let the child decorate it with fabric pens or tie-die it so that it’s less like a punishment and more like a fun adventure!

If that method isn’t successful, I recommend a soft, removable habit correction appliance which I call a “Tooth Pillow”. These are stock (not custom), so taking an impression isn’t necessary. Fees start at $50 and go up depending on what company you use. Some companies do require you to take a certification course to order these appliances.

For more information, check out our top-selling eBook or watch our YouTube video where I discuss U Concept® U Kiddy, Pacifiers, and Binky help for ages 2-4 years old.

For kids, older than age 5, often more aggressive treatment might be necessary beyond the removable appliances, including fixed or removable palatal cribs and/or palatal expanders. These will require full orthodontic records and an impression or scan.

These custom appliances usually stop thumb sucking immediately. They are used for 6-12 months, at least.

How to Write a Schwartz Script

“please fabricate u/l schwartz with no occlusal acrylic, lab please pick best clasps”

This is pretty standard for fixed if you want to archive the script for future patients.

Only variation would be one of the following:

1. Please add anterior bite plate
2. Please add sagittal to distalize tooth _____

3. Please add sagittal screw to advance tooth ____

4. Please add tongue/thumb crib

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How to Write a RPE Script

Ultimately this is pretty easy. Not too many variations.

“please fabricate u/l fixed expander with buccal tubes”

or 

“please fabricate u/l fixed expander”


This is pretty standard for fixed if you want to archive the script for future patients.

Only variation would be one of the following:

1. Please solder anterior bite plate
2. Please solder facemask hooks

3. Please solder tongue/thumb crib

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