Straight Smile Solutions

How to get out of Invisalign Jail

I’ve been in Invisalign jail. I have family members currently in Invisalign Jail. I have clients in Invisalign Jail. Align technology has one of the most unfriendly financing policies and procedures. Once you get yourself in jail it can take years to get out of it.

This is one of the top three reasons doctors I work with switch to white label or other aligner companies. Now that other aligner companies are offering some of the once proprietary bells and whistles like bite ramps and precision cuts, it makes the leap a little bit softer.

If you’ve been in Invisalign jail, I would like to hear your story. Hopefully we can encourage Joe Hogan to change his policies. Please email me at [email protected]

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How to Get Started with Phase 1 and RPE in your Practice

Many doctors are interested in integrating Phase 1 Orthodontics in their practice. Early treatment with Phase 1 Orthodontics has life-long health and esthetic benefits.

We have several resources we recommend to get started:

1. Read Our Blogs:
https://www.straightsmilesolutions.com/blog/
https://www.straightsmilesolutions.com/blog/rpe-2/
https://www.straightsmilesolutions.com/blog/codes/

2. Listen to our Podcasts:
https://www.truedentalsuccess.com/the-dentalpreneur-podcast/831-straight-talk-part-1/
https://www.truedentalsuccess.com/the-dentalpreneur-podcast/832-straight-talk-part-2/

3. Watch our YouTube videos:
https://www.youtube.com/channel/UCZQDILf1sP5qR4p78673bzA?view_as=subscriber

4. Watch our archives webinars:
http://gpwebinar.com/dr-wilson31775959

5. Get a 1:1 consultation- it’s free! Go to https://www.straightsmilesolutions.com to schedule or https://theorthowhisperer.com

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Schwartz vs RPE- Which is better?

Should you pick a removable or fixed expander?

Read more about expanders here: https://www.straightsmilesolutions.com/blog/rpe-2/

Benefits of Expanders in Phase 1 EARLY MIXED DENTITION:

Develops the arches to the ideal width. Hypothetically speaking usually when the arches are developed in the early mixed dentition to the ideal width, the teeth tend to come in straight/straighter, there is less risk of impactions, there is less crowding, less risk for orthognathic surgery, less chance of premolar extractions. Of course we are just “paving the road” for the future. We can’t always predict the future. We can just make it more likely to turn out better. It also decreases the chance that they actually “need” braces. You can do this in combination of an EG appliance (eruptive guidance) for retention and you should have a super-nice outcome. Most likely you’ll only need a few express/white label aligners for Phase 2. Again, no promises! It just just more likely.

SCHWARTZ VS FIXED:

Some patients/parents come in with a strong preference for fixed or removable. You should go over the benefits and risks of each one and still make a clinical recommendation.

REMOVABLE (aka Schwartz)-
* Can be done in upper or upper/lower. Look at the arches. If there is lower crowding do upper and lower. If there is posterior crossbite, do 2 turns a week on top and 1 on the lower. If no crossbite and just v-shaped arches or crowding, do 2 turns top, 2 turns lower per week.
* Sometimes when you “untrap” the lower arch you can get some growth of the mandible and some natural expansion of the lower arch. A lower schwartz is just for arch expansion. There is no suture in the mandible so you aren’t growing jaws there.
* Schwartz is WAY better from the patient experience. Hygiene is better, discomfort is better, they can eat whatever they want, they can pick colors and bling it out. Schwartz is “fun”. Most patients are very compliant. Give them a case with a necklace or clip so they don’t lose it at school or at lunch.
* Build in a compliance contract/agreement with the price if they do lose them or the price to upgrade to fixed if they elect to.
* Schwartz expanders also can be customizable to add screws/pistons to jump anterior crossbites, distalize molars or facemask hooks to help to bring a maxilla forward.
* You can add acrylic to the front plate to open the COS (fix deep bites) or to the posterior teeth to intrude the molars (open bite)
* You can also embed a tongue/thumb crib for habits
* It is easier to turn because you can take it out of the mouth

FIXED
* Often parents like the idea of fixed initially but from a patient experience, it is pretty miserable. They are bulky, hard to talk, hard to eat and uncomfortable. They are also smelly and trap a lot of food and plaque. More often than not, parents who elect fixed tend to regret it in hindsight. It is also hard for the parents to turn because they need to do it intra-orally.
* If you have a severe thumb habit, a fixed might be better because they will take out the removable appliance.

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Easy Wire Sequence for Straightwire

Doctors often ask me about wire sequence for patients. It can be impossible to create a cookbook/cookie-cutter wire sequence but in general this is how I do it:

1. 14 niti (but sometimes you go go straight to 16 if not that crooked)
Very rarely do I need to start with 12 niti. It is only if it is crazy crooked or with very high canines.

2. 16 niti (but sometimes you can skip this if it “cooked” good in 14)

3. 18 niti ( you can do front teeth power chain only in this wire but go mesial to mesial only from lateral to lateral and put a single tie on the distal)

*** stop here*** wait until 18 niti is 100% passive and then re-eval bracket position and rebracket to ideal prn.

Once all the bracketing is perfect and both you and the patient are 100% happy with the alignment and leveling of the teeth you can move on.

4. 17×25 niti
(in this wire you work on bite and close spaces so elastics and power chain if needed)

5. 18×25 niti

Usually done after this unless there are transverse issues still and then you can go into SS wire like 18×25 Stainless

OR

If you still have deep bite or open bite issues you can go into RCS/ACS wires

https://www.youtube.com/watch?v=dGTteuhjjrI&t=98s
https://www.youtube.com/watch?v=6XxBmenWd2g&t=50s

Contact us at https://www.straightsmilesolutions.com  or https://theorthoswhisperer.com for support on any ortho case.

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Why are my Patient’s Invisalign Aligners Cracking?

There can be numerous reasons why Invisalign, ClearCorrect or clear aligners aligners crack but this blog will discuss the most common reasons. In order to diagnose the issue you need the following records:

1. The Treatment Plan
We are looking to see if the treatment plan was indeed “good” and even viable. If it is too rapid or unpredictable, this may be a cause of the breakage.

 

2. Compliance
I always recommend creating an in-house aligner tracking system but there are turn-key resources out there like www.GPorthotracking.com. You must have tracking pictures to measure the patient’s compliance.

3. New dental work or new teeth
If new molars are popping up like 12-year old molars or 3rd molars, this can act as a lever or pivot and cause flexing of the tray. Consider rescanning and be sure you capture the full distal aspect of the terminal molar.

If you have a patient who is breaking aligners, be sure to connect with us for a complimentary consultation at www.straightsmilesolutions.com or https://theorthowhisperer.com

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RPE, Expander, Schwartz

PURPOSE: The purpose of this appliance is to widen the arch(es) usually to aid in the correction of a crossbite (usually due to a functional shift), resolve crowding, and/or expand overly constricted arches, particularly in the posterior region. When designing your appliance, make sure you communicate your goal to the lab so that the design is optimal.

DELIVERY: Seat the appliance with your fingers. If teeth have been lost or new teeth have erupted since the impression, you may need to adjust with an acrylic bur. The appliance should seat evenly with no rocking and adhere securely to the teeth. The patient should be able to remove and reinsert the appliance properly.

INSTRUCTIONS
Week 1: The first week is an adjustment period for the patient. The patient should wear the appliance 24/7, except for eating and sports.

Subsequent Weeks: The patient should activate the appliance 1x-2x per week and continue to wear the appliance 24/7 except for eating and sports. The frequency will vary with the skeletal maturation of the patient. Do this on the same day consistently and chart the number of turns completed. It’s best to activate the appliance at night after brushing teeth to minimize discomfort.
Turn the appliance in the direction of the arrow. Make sure you are always turning the same direction and completing the turn fully before removing the key. You should see the next hole before you remove the key. If you can’t see the next hole, the turn isn’t fully completed. If they key doesn’t have a safety handle, tie floss on the key before sending it home with the patient. Tell the patient to bring the expander and the key to every appointment.
APPLIANCE CHECKS: It’s best to check the appliance every 4-6 weeks to ensure that the turns are being done properly. At each appointment check the jackscrew length with a periodontal probe and document. Also check the fit of the appliance to ensure it still fits properly. Adjust as needed to accommodate new teeth or loose teeth. Check the teeth that are being activated with floss to see if contacts are opening. Usually after 2-3 months, you will see the crossbite correct and/or the crowding begin to resolve. The arch form will become U-Shaped. Once you have acquired the optimal amount of space, retain for 3 months full time. This stabilizes the outcome. Palpate the roots around the buccal plate for any fenestration or pathology. You will have some relapse, so it’s best to expand a little bit more than needed.

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Invisalign and Elastics

Precision cuts with Invisalign can be a bit scary for a general or pediatric dentist.

Here’s a few of my favorite videos. My suggestion is to make your home care and demonstration videos eventually with your own patients and post them on your website.

https://www.youtube.com/watch?v=RGP1aofolXg&t=15s

(note- she’s using slot to slot which is different than is slot to button)

Contact us at StraightSmile Solutions for sample home care and tracking instructions.

You can buy the 3/16 medium elastics and buttons from the Invisalign store.

3/16 medium is for slot to button (1/4 medium if they have big teeth)
3/16 light is for slot to slot
3/16 heavy for button to button

 

Elastics need to be changed at least 4 times a day.

Check the bite as well as the tracking at every appointment or consider using a system like www.GPorthotracking.com

To schedule a complimentary ortho coaching session, please visit www.straightsmilesolutions.com or https://theorthowhisperer.com

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Picking the Right Retainer: Vivara®, Essix®, Hawley

In this blog post, we’ll be talking about removable retainer options. Your dentist can discuss the best retainer for your smile as there are pros and cons to each type. This is something that you may want to discuss with your dentist even before you start braces or aligners.

A retainer keeps your teeth from moving after they’ve been straightened with braces. Several decades ago, dentists recommended retainers for only 3-6 months, but we’ve found now that retainers should be worn for life to ensure the best long-term outcome.

Hawley Retainers

Lab Fee: $80-150

Biomaterials: plastic or acrylic with metal wire

Longevity: 1–50 years

Characteristics:

• adjustable

• can choose plastic color to personalize

• doesn’t stain easily

• easily removed for eating and oral hygiene and won’t likely need replacement unless major dental work is done.

• metal wire visible in front of teeth

• can be lost or damaged

Also called wire retainers, these are removable retainers made of thin metal wire and plastic or acrylic and are shaped to fit the roof of your mouth or along the inside of your lower teeth. The attached metal wire runs across the outside of your teeth to maintain alignment. A local lab usually makes these unless the dentist has an orthodontic technician in-house.

The retainer is adjustable if you need a better fit when you first get it or if your teeth need slight realignment later.
It’s more durable than a clear plastic retainer.
It can last for years if used and cared for properly (note: the author has had hers for 25 years and it has never needed an adjustment!)
It allows the bite to settle fully and balance because the teeth can touch, which may be better for the TMJ.
Its disadvantages:

It affects your speech more than other retainers.
It’s more noticeable than the other types of retainers.
It initially costs more than a clear retainer, but it is more economical over a lifetime.
Clear Retainers

These are removable retainers that are molded to fit perfectly within the new position of your teeth. To make this type of retainer, a mold or scan of the teeth is created, and that image is 3D printed. Then, very thin plastic or polyurethane is heated and sucked down around the mold. It is not advisable to use your last aligner as a retainer because it isn’t thick enough to hold the teeth straight long term.

Essix®, Vivera®, Zendura®- Lab Fees:

• $275 for four upper/four lower for Vivera

• Essix $30-$70 per retainer from an orthodontic lab. Or, make your own Essix or Zendura A in-house if you have a Biostar and 3D printer at $3 a retainer.

Biomaterials:

* plastic or polyurethane

Longevity:

6–12+ months

Characteristics:

• fitted so that teeth stay in place better

• thin and easy to talk

• clear/invisible

• convenient to have multiple back-up pairs made

• easily removed for eating and oral hygiene

• may need yearly replacement so this can get expensive over a lifetime

•may need new impressions and retainers if any dental work that changes shape or size (filling)

•easier to lose or damage

A clear plastic retainer has the following advantages:

It’s invisible.
It’s less bulky and may be more comfortable than a Hawley.
It’s less likely to affect your speech than a Hawley retainer.
Disadvantages of a clear retainer:

It’s not adjustable if you need realignment or if you get new fillings or dental work. It would need to be replaced every time. Often the doctor will charge not only for the new retainer but also the new scan/impression. This will get expensive over a lifetime.
If it cracks or breaks, it can’t be repaired.
It can warp if exposed to heat (e.g. left in a car.)
You may need five, ten, or more retainers PER arch in a lifetime. Each one lasts an average of 6 months.
It tends to become discolored (and more visible) over time.
Top and bottom teeth don’t touch naturally with this type of retainer.
It can trap liquids and bacteria against your teeth, which can cause cavities and periodontal disease.
The main difference in the three common brands of clear retainers is the type of plastic material they are made of. The brands are Vivera®, Essix®, and Zendura®. Vivera is sometimes incorrectly called Invisalign®. The same company makes the two products, but Invisalign is an aligner used to straighten teeth instead of metal braces. It is not a retainer.

There are pros and cons to each retainer type. Your orthodontist will recommend the best type for you based on your teeth and why you need braces. But don’t forget to consider your preferences on the look and amount of time and effort you are willing to spend on it. You will most likely be using and maintaining your retainer for a lifetime, so it’s important that you have the retainer that works best for you. Dentists: If you have questions about setting up your retainer options, please visit us at www.straightsmilesolutions.com

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Retention Scripting and Wear Protocol

I’ve written quite a few blogs on retention.

There is no one size fits all protocol.

The Orthodontic Aftercare Opportunity

Esthetic Bonded Fixed Retainers

Bonded Retainers

Choosing the Best Type of Retainer after Orthodontic Treatment

There is also a lot on our youtube page.

https://www.youtube.com/channel/UCZQDILf1sP5qR4p78673bzA?view_as=subscriber

Basically, you need to pick the right retainer to fit the case clinically.

I love positioners and hawleys the most and essix and bonded retainers the least. The pros and cons are listed above in the blogs and YouTube.

Hawleys and Essix need to be worn full time for at least 6 months and can be tapered after that but the exact tapering schedule needs to be customized for each patient or relapse occurs.

Here is my scripting, let’s say I am talking to my hypothetical patient, Sarah, who is 13.

“Sarah, you’ve been doing a great job with your retainers. Let’s talk about phasing your retainers down. I know you’ve been wearing them 24/7 but you do take them out for eating and sports. Tell me a little bit about how that is for you. What is the longest you’ve left them out? Did they feel tight or achy when you put them back in? If so, that was too long. Your teeth have already moved and if we do that too often, they won’t move back. Try to find how many hours you can leave them out without feeling any discomfort. That is your sweet spot. Each month try to add one more hour. Some patients can safely go to nights after 6 months of full time wear and some may take years to taper back. Listen to your body. It is a marathon, not a sprint.”

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How to Optimize your Invisalign Doctor Locator Profile

It blows my mind how many of my www.straightsmilesolutions.com doctors don’t take the time to idealize and optimize their Invisalign Doctor Profile. If you want help, please visit www.straightsmilesolutions.com and click on “contact-us” to schedule a free call.

This is a free, no-brainer, five-minute exercise that can get you referrals.

Here are the steps to rise the ranks and hopefully be displayed on the first page of the doctor locator in your city:

Go to this page: https://www.invisalign.com/get-started/find-a-doctor
Put in your zip code. Search and see where you are. If you aren’t on the first page, you have work to do! Be sure to look at teens and adults.
Make sure you are treating at least 5 teen patients per year to stay on the teen locator.
Now log in to you Invisalign portal. Did you accept the advantage TOS this year? If not, accept it. Go to the top, right corner under your name and click the tab to the profile section.
Take a professional picture and upload it. Also take some time to fill in all the blanks to update the hours, insurance and other important sections of the profile.
That’s it! As you rise in the ranks (bronze, silver, gold..etc) you’ll also rise within the doctor locator. If you get an iTero you’ll also rise.

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