Straight Smile Solutions

Hand / Wrist X-ray Analysis for Orthodontic Treatment Planning

Copyright StraightSmile Solutions® 2019

StraightSmile Solutions® uses a variation from the Hand Wrist Radiograph from The Atlas of Greulich and Pyle (1959)

Why is Growth Prediction Important in Orthodontics?

*To understand the potential direction of facial development

* Too predict growth potential left

* Too stage the onset of treatment timing prior to treatment in a Class II or III Skeletal malocclusion patient

* To select the most effective treatment plan

* To clarify a major discrepancy between dental age and chronological age

* To time Orthognathic surgery

What Data Can be Used for Growth Prediction in Orthodontics?

* Growth Charts

* Secondary Characteristics

* Skeletal Development

* Chronological Age

* Dental Development

Anatomy Markers:

To keep it simple, we recommend just focusing on 3 bones:

1. The Epiphysis and Diaphysis of the Middle Phalanges in the 3rd Finger.

They are small bones forming the fingers. They are three in number in each finger, except the thumb, which has only two phalanges. They ossify in three stages. The Diaphysis is the middle section of a bone. The Epiphysis refers to the ends of a bone.

2. The Sesamoid Bone

The Sesamoid bone is a “Dot-Shaped” bone in the thumb

3. The Radius

The wrist bone.

Pre-Puberty:

The middle finger, middle phalanges has a diaphysis that is smaller than the epiphysis

3 Years Before Peak Puberty:

The epiphysis and diaphysis of the middle finger and middle phalanges are equal

Puberty is Starting:

The sesamoid bone presents in the thumb.

Puberty is Peaking:

The epiphysis of the middle phalanges of the middle finger caps the diaphysis by surrounding like a cap.

Puberty is Almost Complete

Fusion occurs between the epiphysis and diaphysis of the middle phalanges of the middle finger in absence of the fused radius bone.

Puberty is Completed

Complete union of epiphysis and diaphysis of the radius. This is the last bone to ossify.

The ossification of all the hand bones is completed and skeletal growth is finished

StraightSmile Solutions® supports doctors with all orthodontic treatments, including but not limited to functional appliances, braces, hybrid treatment, habits, lab selection, airway and of course- aligners! Our goal is to find you the right solution for your case and your treatment philosophy and budget. We support you with everything you need: case selection, treatment planning, team training, staging, compliance, operations, outcomes, and retention. We also help to train doctors and teams with hands-on courses that are both digital and destination. For more information visit www.straightsmilesolutions.com. Disclaimer: StraightSmile Solutions® is unable to support any direct-to-consumer operations or doctors at this time.

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IPR

 

Note: Please join our IPR webinar on July 11th where we will be giving away a free FitStrip® Kit, value $199! Visit https://www.straightsmilesolutions.com/media/ to register.

IPR stands for interproximal reduction. It is the process of creating very small amounts of space between teeth to improve crowding, midlines, or overjet.

This blog is intended to serve as a general guide and is in no way a comprehensive instruction manual for performing IPR. As always, doctors must rely on their own best judgement. When you create your treatment plan, be mindful of interproximal restorations, bridges, crowns, implants, and veneers that may be damaged if modified with IPR.

Before you do anything, check your treatment plan for the staging and localization of your IPR. Some doctors prefer to stage all of the IPR at the beginning of treatment, while others prefer for the teeth to align first (round-tripping).

Armamentarium:

1. Garrison IPR Fit Strip Kit with IPR gauge and 2 serrated saws

*remove the single sided if you have them

2. Unwaxed Dental Floss

3. Fluoride (optional)

IPR PROCEDURE

Isolate the tongue, lips, and cheeks. Protect the patient’s soft tissue with a mirror and cheek retractor.

· Tie one end of the floss to the Strip handle for safety and let it hang outside of the patient’s mouth.

· Check for fully broken contact using unwaxed dental floss. Keep track of IPR performed by using an IPR Chart.

Start with the serrated saw locked in the straight position to open the contact. For anterior teeth, you can use the handle, if you prefer.

Once you open the contact, gently work your way up the sequence of files in the locked and straight position, and STOP when you are at least 1 file smaller than the size you actually need. Gently move the strip backward and forward between the teeth along the contact area in a sawing motion. It takes roughly 8-12 motions, but the precise number is ultimately dependent upon each individual patient.

Verify the size with the IPR gauge. Note: not all IPR gauges are calibrated. We recommend using only the Garrison Dental Fit Strip Gauge for ideal accuracy.

Once you obtain the size of the space that is 1 size smaller than you need, curve the strip and lock it in the curved position. Then, work your way BACKWARD down the file sequence from coarse to fine around the contacts in order to round them. Measure the space again. The finishing and polishing process will remove a very small amount of enamel too, so it’s important to save at least -.1mm for finishing and polishing.

Make the gauge one size smaller than you need, and place it in between the two teeth to verify the correct amount of space. If the gauge does not fit in between those teeth, continue to file between the surfaces of the teeth until the desired result is reached.

The Fit Strip IPR kit is the only one that actually locks in the curved position to prevent hand fatigue.

FAQ

Is there a limit to the amount of IPR that can be done?

Yes, there is a limit to the amount of IPR we would do on any one interproximal space during the course of a treatment, except if a revision was submitted and the doctor asked for more IPR. As a rule, we recommend no more than 0.5mm per interproximal space.

Instructions for cleaning and sterilization:

1. The FitStrip should be brushed clean with water and soap or a cleaning solution of your choice.

2. The FitStrip is suitable for ultrasonic baths if appropriate clamping implements are used to prevent instruments from touching.

3. Avoid excessive touching of the strip, and ensure all debris is removed prior to use. Each strip must be washed and disinfected before every use.

4. Strips can be vapor-sterilized in an Autoclave with steam at 273°F (134°C) for 5 minutes.

StraightSmile Solutions® supports doctors with all orthodontic treatments, including but not limited to functional appliances, braces, hybrid treatment, habits, lab selection, airway and of course- aligners! Our goal is to find you the right solution for your case and your treatment philosophy and budget. We support you with everything you need: case selection, treatment planning, team training, staging, compliance, operations, outcomes, and retention. We also help to train doctors and teams with hands-on courses that are both digital and destination. For more information visit www.straightsmilesolutions.com. Disclaimer: StraightSmile Solutions® is unable to support any direct-to-consumer operations or doctors at this time.

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Bonded Retainers

Bonded Lingual Retention

The prevention of relapse of crowding, rotations or spacing in the maxillary and mandibular anterior segments following orthodontic treatment.

Main Types:

1. Lab Custom Cast or 3D Printed

2. In-Office Fabrication

For this review, we’ll be discussing creating your bonded retainer in-office. This saves on time and lab fees.

3 Major wires used:

Stainless steel braid wire.

Titanium Single strand.

Titanium braid wire.

SS Braid wire

Permanent retention is greatly enhanced using a flattened, dead soft 8-braided wire. Intra-arch splinting with this thin ribbon arch prevents torque control problems that can occur using a round braided wire of these procedures.

When bonded on the lingual of the upper incisors, a very thin rectangular wire can be adapted with little lower incisor interference.

The soft wire is easy to adapt and prevents inadvertent tooth movement associated with active force wires.

It’s excellent for semi-permanent orthodontic splinting of the upper or lower incisors. It can be used to hold diastemas closed, maintain difficult extraction sites and solving various other tooth-splinting dilemmas.

Excellent for splinting periodontally compromised teeth.

Titanium Single Strand

Single strand NICKEL FREE titanium flat metal ribbon with increased interproximal strength is ideal for semi-permanent splinting and maintaining difficult extraction sites.

Titanium wire offers reduced wear rates and is nickel-free, eliminating potential patient allergy issues. The wire can be easily formed, and its flat dimensions are ideal for retaining final torque positions.

Braided Titanium Wire

NICKEL FREE Braid construction enhance strength to avoid snapping and increase surface area.

Unique strand construction allows a slight degree of physiological movement yet retaining the post treatment smile arch.

StraightSmile Solutions® supports doctors with all orthodontic treatments, including but not limited to functional appliances, braces, hybrid treatment, habits, lab selection, airway and of course- aligners! Our goal is to find you the right solution for your case and your treatment philosophy and budget. We support you with everything you need: case selection, treatment planning, team training, staging, compliance, operations, outcomes, and retention. We also help to train doctors and teams with hands-on courses that are both digital and destination. For more information visit www.straightsmilesolutions.com. Disclaimer: StraightSmile Solutions® is unable to support any direct-to-consumer operations or doctors at this time

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High Margins on Clear Aligners in a General Dental Office

Implementing a clear aligner solution in a general or pediatric dental office is an excellent revenue booster. Many dentists are concerned about high lab fees and low margins.
I recommend this basic algorithm to calculate the efficiency of orthodontic services:
1. Run a report of the last five orthodontic cases you’ve completed successfully (D8050-D8090). Calculate the collections and average them. Write the number here: _________
2. Calculate the overhead on each case. The overhead includes:
· The sum of lab fees for all the appliances, aligners, refinements, revisions and retention
· The sum of all supplies used
· The sum of the overhead on the chair time throughout the lifetime of the case (from consult to retention) for both doctor and staff chair time.
· Average the overhead on the 5 cases. Write the number here:____________
3. Subtract 2 from 1. Write the number here:______________
You should be profiting at least $1500-$2000 on each case. Below are a few suggestions to decrease aligner overhead:
1. Utilize an off-label/white label aligner from a dental lab
By selecting and outsourcing to these smaller labs, you will significantly reduce your overhead and, consequently, your patients’ fees. By offering more affordable alternatives, your patient base will diversify, grow, and last, and your bottom line will skyrocket.
2. Develop an in-house lab within your own practice
Invisalign® cases take several weeks to design, print, and ship. For the pioneer-minded dentist, and even for those who aren’t, we strongly encourage investing in a small in-house lab.
Benefits of an in-house lab:
• A turnaround time of hours, rather than weeks
• Control over the manufacturing process
• Convenience for patients with minor tooth movement cases
• The potential of offering more appliances – like mouth guards and splints
• Happy patients
• Increased profits

3. Consider a hybrid option
Many labs will work with you on a hybrid option of outsourcing parts of the in-house workflow to save on cost, labor, or equipment. Which cases are appropriate for in-house aligners, and which cases are better for branded aligners? The answer comes down to both volume and biomechanics. You’re fooling yourself if you think that Invisalign® technology is required for an ideal outcome in all cases. It’s not. The vast majority of cases can be treated either without attachments or with more simplistic attachments that are available in the in-house/non-branded aligners. You don’t need G5 or G6 technology for the average case.
The key to success is case selection. I would recommend treating only mild to moderate, adult dentition, Class I malocclusion cases with the in-house aligner option. If you need guidance on case selection, I always recommend that general and pediatric dentists have an orthodontic coach to help guide them through case selection and assist with some of the obstacles they may encounter through the duration of the treatment.
Setting your price point is also important. With the new Invisalign “brick and mortar” stores nationally selling the average case between $2500 and $3500, the sweet spot is $2999 and below.

StraightSmile Solutions® supports doctors with all orthodontic treatments, including but not limited to functional appliances, braces, hybrid treatment, habits, lab selection, airway and of course- aligners! Our goal is to find you the right solution for your case and your treatment philosophy and budget. We support you with everything you need: case selection, treatment planning, team training, staging, compliance, operations, outcomes, and retention. We also help to train doctors and teams with hands-on courses that are both digital and destination. For more information visit www.straightsmilesolutions.com. Disclaimer: StraightSmile Solutions® is unable to support any direct-to-consumer operations or doctors at this tim

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Invisalign Assist® vs Invisalign GO!®

Click here to watch our video.

With the publication of my blog about Invisalign GO! launch in the United States, there have been many questions about the difference between Invisalign Assist and Go.

The Invisalign Assist Package is an aesthetically-oriented treatment (aka anterior movements, not bite correction) option designed for GP’s to treat simple malocclusion of anterior teeth without the need for A-P correction.

Invisalign Assist, like GO! offers built-in tools/resources/support to help general dentists provide aligner treatment. Some key attributes of the treatment include:

Batch Shipping: Aligners are shipped in batches of 10, so doctors can proactively track treatment progress during the case. (This means you don’t get all the aligners at one time. They ship them in small amounts and when you give the thumbs-up that everything is going ok, they will send more. ClearCorrect® does this already as standard. I think it’s good because it’s more eco-friendly.)

Progress Tracking Tool: Doctors are prompted to take a scan/impression and submit for an online assessment between each batch. (This service is also offered by DM, Dental Monitoring for an additional fee but they do this with photos. Sometimes people think it’s a pain to have to take a new scan/impression every 10 aligners).
Automatic ClinCheck Modification: If the treatment is not tracking to plan, Align will adjust the ClinCheck before manufacturing the next batch of aligners. (They will modify your ClinCheck for you based on #2).

Detailed Appointment Plans: Customized instructions for every individual patient including details attachment placement and IPR staging. (They will simplify it for you. Note- straightsmilesolutions already does this standard for our clients but for all cases and all systems.)

Compliance Indicators: To gauge the wear time of aligners (Note, these are available on the Comprehensive Invisalign system as well but for an additional fee).
Assist does not include some aligner features, like: Precision Cuts, Eruption Compensation or Molar tabs.

With Invisalign Assist, there is no limit to the number of aligners on each case and the Additional Aligner policy is 5 years. This is the same as Comprehensive.If an Invisalign Assist case requires 13 or fewer aligner, then the case is manufactured as a complete case and all aligners are shipped. In this situation, the doctor receives a discount on invoice for the shorter treatment case.

StraightSmile Solutions® supports doctors with all orthodontic treatments, including but not limited to functional appliances, braces, hybrid treatment, habits, lab selection, airway and of course- aligners! Our goal is to find you the right solution for your case and your treatment philosophy and budget. We support you with everything you need: case selection, treatment planning, team training, staging, compliance, operations, outcomes, and retention. We also help to train doctors and teams with hands-on courses that are both digital and destination. For more information visit www.straightsmilesolutions.com. Disclaimer: StraightSmile Solutions® is unable to support any direct-to-consumer operations or doctors at this time.

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My Journey as a Linkedin Influencer

We didn’t learn any business skills in dental school. I do remember a professor putting on some Tony Robbins tapes, but that was the extent of our training. Like other new grads, I was woefully unprepared for the real world. I see new grads reaching out on Facebook forums and I also see a lot of predators out there. I try to offer advice and my contact information, but I am often kicked off forums for reaching out and offering to help.

One of my tips for new grads is to start creating content and building their Linkedin network. Even if you are happily employed or stable in your practice, the network really an an amazing resource.

I started building my network a few years ago when Linkedin was new and novel. Now I have almost 16000 followers, mostly all in the dental industry. At first I would try to reach out to at least 30-50 people a day in companies I found interesting. I offered everyone a complimentary consultation. Often you find incredible synergy when least expected. I never turn down a phone call. I book my schedule just like I did in my practice with a “production” column (for paid clients) and a non-production column. Sometimes I double book my non-production column in case phone calls flake out.

I read a lot: books, journal articles, other posts. I focus mostly on Linkedin but also on YouTube. I ask a lot of questions.

Aim high, never be afraid to reach for the stars. You would be surprised who is listening. Thanks to Linkedin, I had a great conversation with the Invisalign CEO, Joe Hogan.

Your expertise will slowly lead to paid opportunities: speaking engagements, travel, paid influencer compensation and explorative phone calls.

I don’t do paid advertising on Linkedin. I tried, but I found the process to confusing.

StraightSmile Solutions® supports doctors with all orthodontic treatments, including but not limited to functional appliances, braces, hybrid treatment, habits, lab selection, airway and of course- aligners! Our goal is to find you the right solution for your case and your treatment philosophy and budget. We support you with everything you need: case selection, treatment planning, team training, staging, compliance, operations, outcomes, and retention. We also help to train doctors and teams with hands-on courses that are both digital and destination. For more information visit www.straightsmilesolutions.com. Disclaimer: StraightSmile Solutions® is unable to support any direct-to-consumer operations or doctors at this time.

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Masseter Botox for Dentists

 

Click here to watch the video.

Intra-oral or masseter Botox is an simple but valuable addition to your menu of services. Although not all states allow dentists to administer therapeutic intra-oral Botox, I believe they should. If you can give an IA injection, you can surely give therapeutic Botox.

The benefits are both cosmetic and functional:

Facial slimming
A reduction in bruxism (including clenching and grinding)
A reduction in TMD disorders
Although I’ve never been formally trained, I have been a recipient of this therapeutic treatment for many years and I consider it a very important medical procedure. There are many courses for dentists but I haven’t seen any yet that focus only on the oral cavity.

StraightSmile Solutions® supports doctors with all orthodontic treatments, including but not limited to functional appliances, braces, hybrid treatment, habits, lab selection, airway and of course- aligners! Our goal is to find you the right solution for your case and your treatment philosophy and budget. We support you with everything you need: case selection, treatment planning, team training, staging, compliance, operations, outcomes, and retention. We also help to train doctors and teams with hands-on courses that are both digital and destination. For more information visit www.straightsmilesolutions.com. Disclaimer: StraightSmile Solutions® is unable to support any direct-to-consumer operations or doctors at this time.

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Hot off the Press! Invisalign Go!

click here to watch the video.

Today I had the honor of meeting with Mr. Raphael Pascaud, SVP of Business Development at Align Technology. ® His team has granted me permission to blog to my followers about the new Invisalign GO® product which, after some initial beta testing in Europe, is now being launched globally to general dentists.

I would like to thank Mr. Hogan and Mr. Pascaud for taking the time to listen to my feedback and to tell me more about their new program. Ultimately, their goal is to support the general dentists in their network and to encourage collaboration between orthodontists and general dentists. Since this goal is also one of the core values of StraightSmile Solutions®, it’s great to be in some synergy with their team finally.

In a nutshell, doctors can elect to be a part of the Invisalign GO® program. It’s a separate program than the traditional Invisalign Fundamentals™ course. There are a few key benefits to this program that are not available to traditional Invisalign providers:

1. You’ll be able to receive immediate feedback on cases through the Invisalign® Photo Uploader App. (Note- StraightSmile Solutions® already offers this feedback service to our clients through our own proprietary platform.)

2. If your case is accepted to Invisalign GO®, you’ll receive a customized treatment plan that only involves “green” (predictable) movements.

3. If a case is not accepted to Invisalign GO®, you’ll have the option to refer the case to an orthodontist in your network automatically.

4. Immediately, you’ll be able to toggle the set-up without sending the Clincheck® in for a modification to see the Clincheck® with/without attachments or with/without IPR. That’s four Clinchecks® at the beginning. This saves you at least a week of modifications and quite a lot of time.

If you are interested in opting into Invisalign GO®, please visit check with your TM or call Invisalign to sign-up. The pricepoint is similar to a Lite® pricepoint and is hundreds less than Invisalign Assist.®

StraightSmile Solutions® supports doctors with all orthodontic treatments, including but not limited to functional appliances, braces, hybrid treatment, habits, lab selection, airway and of course- aligners! Our goal is to find you the right solution for your case and your treatment philosophy and budget. We support you with everything you need: case selection, treatment planning, team training, staging, compliance, operations, outcomes, and retention. We also help to train doctors and teams with hands-on courses that are both digital and destination. For more information visit www.straightsmilesolutions.com. Disclaimer: StraightSmile Solutions® is unable to support any direct-to-consumer operations or doctors at this time.

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Digital Orthodontic Courses On Demand- Alternative to Fast Braces and Six Month Smiles

Click here to watch a video from our digital education series.

DIGITAL COURSES- TURNKEY, CUSTOMIZABLE ORTHODONTIC EDUCATION IN-A-BAG™!

As StraightSmile Solutions® celebrates its third anniversary, we are proud to announce our first hands-on course! This is a low-cost, customizable alternative to Six Month Smiles® and Fast Braces®. 

Click here to register DigitalCourseTOS or email us at [email protected] and we’ll send you an electronic version via Docusign® Please complete and return the signed document with your preferences and registration for the course. Following the completion, we will send you an invoice through Stripe® which can be paid by Debit or Credit. Once the payment is processed, we’ll assemble your custom course bag and ship it. Since the bags are totally customized, we appreciate your patience. This can take up to 14 business day for the US and 21 business days for international. We will notify you with the tracking once it’s shipped. Please email us at [email protected] with questions.

The world’s first customizable, digital, orthodontic education. Just pay for what you need!

* Basic Straightwire Mechanics

* IPR

* IntraOral Elastics

* Orthodontic Photography

* Case Selection and Treatment Planning

Customized, learn as you go, on your own time with a built-in feedback and accountability loop for team members. Please email us for details and for a customized proposal. Discounts for group practices.

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Are Aligners Hurting our Oceans?- Aligner Recycling

Click here to watch the video.

I had a disturbing conversation today with Dr.Sherif Kandil (K-Line Europe GmbH) about aligners, aligner fabrication and the environment. I was not aware that neither aligners, nor the models that are utilized to create the aligners are recyclable. I didn’t know that this wasn’t a sustainable manufacturing process and is potentially leaching plastics into the soil and oceans. I encourage those of us the the aligner and orthodontic community to work together as “one team” to develop more efficient and more eco-friendly products for the orthodontic industry and reduce our global thumbprint. Sharif gave me permission to share this this article with my Linkedin followers. If you are interested in joining our mission, please e-mail me for next steps.

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