Straight Smile Solutions

A Guide to Submitting Invisalign Refinements / Additional Aligners

I help doctors submit for refinements/ additional aligners every day. Here’s what I need to know first:

1. What aligner is the patient currently holding on?
2. Did you take new scan/impression?
3. Did you remove the old attachments before the impression?


Here’s a guide to doing it yourself:


If you need help with a case, please go to and we’d be glad to help you.


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This article will bring to you relevant questions and answers that will reveal the pearls required for achieving efficient and profitable orthodontic practice in a GP Practice.

Q. 1 What are the steps to take when incorporating orthodontics into a GP practice?

There is no “one size fits all approach” to launching or scaling orthodontics in a GP Practice. Our team takes time to get to know our GP Clients and helps them select the best systems that will fit the needs of their practice. An initial phone call is totally free to learn more. You can schedule it at


2. What are the Major Classifications of GP Orthodontics?

  • Branded and Unbranded Aligners
  • IDB/ Straight-wire Braces
  • Functional appliances / Phase 1 Interceptive/ Pedo Airway and Habits

Q. 3. Which of the GP Orthodontics should be undertaken first?

It all depends on the demographics of the patients. Our pediatric dentists consider the functional appliances for Phase 1 as the first category. General dentists treat older patients. Aligners are the initial category of our GP. On the other hand, the IDB straight wire is the initial category of dentists specialized in handling teenagers and young adults. You should also consider your competition and your location. More affluent demographics tend to prefer Invisalign over braces. In some populations, metal braces are considered fashionable and a sign of wealth. Know trends and your demographics before you make this decision.

Q 4. What are the armamentarium to have before starting Orthodontics?

Before commencing Orthodontics, all categories of doctors must make provisions for panoramic x-ray and intra-oral scanners. Although an IOS isn’t required, it will be very difficult to profit and scale without one. iTero is probably the best choice if you are considering Invisalign. There’s no reason you must get the most current iTero and break the bank. I recommend the iTero 2 which works just as well and still has access to the IOS (Invisalign Outcome Simulator Software) but is about half the price of the iTero 5. The bulky wand can be switched out for a newer one for a small, additional fee. It is a tiny bit slower than the 5, but you’re talking about 20-30 seconds.  $20000 is about the going price for a refurbished iTero 2 which isn’t much more than a Medit and is a lot more functional for ortho. Talk to your rep for more information.


Q. 5. Is it profitable to launch Orthodontics?

Of course, it is very profitable! You are expected to make an initial provision for supplies worth about $2000 before you can undertake the straight-wire category. Don’t be too concerned about this because it is possible to earn six figures in a year without investing in any additional supplies, equipment, marketing, or staff.

Our team can assist you with a long list of all the pertinent supplies you must have before starting Orthodontics. Follow the link below to have access to our courses and tutorials. Reach out to us if you’re interested in having a copy.

Q. 6. What are the categories of GP Orthodontics case selection?

All general dentists are expected to select cases that fall under the following categories: Green, yellow, and red categories. New dentists to orthodontics should stick with green cases. For more information, see this blog:


  1. 7. What is the future of orthodontics in the US?

Currently it is estimated that about 52% of Orthodontic cases in the US are handled by the GPs. On the other hand, an estimated 82% of GPS and Pediatric Dentists are delivering Orthodontic services. Why be part of the minority and allow DTC aligner companies to take your patients? Take back control of your patients’ oral health care by offering in-house orthodontics.

Q 9. Why is it important for general Dentists to offer both aligners and IDB and/or Phase 1 Functional Appliances?

More so, the preferences of the patient should be put into consideration. Availability of options gives room for the patients to practice the use of the appliances. Patient compliance is another major reason. For instance, not all the patients will comply with a removable appliance. It is not possible to optimize all bio-medical dynamics with a single solution. With diversification, you’re sure of achieving better outcomes and supporting patient preference. Regardless, you should have compliance contracts and paperwork in place. We have many of these documents in our store:

Q 10. Which oral habits negatively affect successful Orthodontic outcomes?

This is very dicey because of the numerous habits that can deter the success of Orthodontic procedures. Some of these habits are: Digit-sucking, thumb-sucking, lip-sucking, mouth-breathing, abnormal-tongue resting position, tongue-thrust, reverse tongue-thrust, and backward-swallow, to name a few. The importance of incorporating habit solutions into Orthodontic cases cannot be overemphasized. Of course, they bring about excellent results. It becomes more complicated when you’re dealing with kids, but you should always keep it in mind in adults too.



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TMD, TMJ, and Orthodontics

What do TMD and TMJ mean?

These are both acronyms that refer to the same condition, though one is more specific than the other. The first one, temporomandibular joint disorder (TMD) is the correct term that is used in the industry of orthodontics. It means that you have a disorder in this joint, which connects the temporal bone to your jaw.
The other term, temporary mandibular joint (TMJ) is referring to the same thing but is incorrect since it’s just referring to the join itself and not the condition impacting it! While some experts will use TMJ, most use TMD because it’s more professional.

What does it mean to have a TMD?

It basically means that you are having a problem moving your jaw up and down and it should be treated. This could be caused from arthritis in the joint itself over time. It could also be caused by stress which causes many to grind their teeth together.
TMD can also be caused by something more traumatic, such as a direct injury to your jaw, or even something like whiplash.

How is a TMD diagnosed?

Firstly, it’s ruled out from other conditions that can be causing a problem. To do this, experts may do an MRI or CT to see if the TMJ disc is in its proper position while your jaw is moving. This will help either note it as the problem or rule it out! This usually involves a referral to an oral surgeon for diagnostics. Usually, I start with my patients by having them keep a diet journal and eliminating all chewy or crunchy foods and chewing gum from their diets for a few weeks first. If the discomfort is still severe, we may refer them to a specialist. Otherwise, masseter Botox can also be helpful.

What are symptoms of a TMD?
The cause of the TMD often can note how weak or severe the symptoms are. Common symptoms include:

● Pain in the jaw, neck, shoulders, or ear (when moving your jaw)
● Your jaw gets locked open or shut sometimes
● Clicking or popping when moving jaw
● Earaches, dizziness, ringing in the ears

What treatment is available for living with a TMD?

Most of treatment is going to be about adapting your habits to help you prevent further damage to this joint. However, many will blend this with orthodontic treatment as well. The most popular options include:

● A splint: This is a clear guard that fits over your teeth. It will help align your bite properly and can reduce the pressure that is put on when you grind your teeth. This is worn all the time except for brushing your teeth and eating.

● A nightguard: This has extra thickness in it that will give your jaw more comfort when worn and can help ease pain and other symptoms. This is worn only at night, or during particularly bad flare-ups.

● Repositioning treatment: Through either dental work, or more advanced orthodontic work, you may need to receive help and treatment for a bite problem that is causing or exacerbating the problem.

In a nutshell, I don’t recommend treating patients with TMD orthodontically unless the pain has been eliminated first.

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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:
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:
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:
Of course, please do subscribe because we add new videos almost every day and we take requests!!
Also, check out
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!


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.


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

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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 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.