StraightSmile Solutions®

I. Introduction

• Dr Amanda from StraightSmile Solutions addresses a common clinical dilemma: rotated molars in mixed dentition when planning an expander or banded appliance.
• If you band a rotated molar, the expander may sit strangely and produce unpredictable forces.

II. The Problem

• A rotated molar makes band placement awkward.
• The expander (RPE or other banded appliance) may not fit properly or may deliver off- axis forces.
• This can compromise expansion and lead to unwanted tooth movement.

III. The Solution: De- Rotate First

• Yes, de-rotate the molar before delivering the expander.
• A simple 2×4 (two brackets on incisors + two on molars) or even just a 2×2 can straighten the molar.
• You may not bond the front teeth if the arch is too constricted; focus on the rotated tooth.

IV. Invisalign as an Easier Alternative

• Invisalign First is much simpler for de-rotating molars before expansion.
• Aligners can gradually upright the tooth without complex mechanics.

V. When Mechanics Get Complex

• Sometimes you need to engage the tooth behind the rotated molar or use lingual buttons.
• Not every case is simple. If you are unsure, consult an orthodontist.

VI. The Bottom Line

• De- rotate the molar BEFORE banding for RPE or other appliances.
• A few weeks of light mechanics now saves you from a poorly fitting expander and unpredictable results.
• When in doubt, phone a friend (orthodontist) for guidance.

When Can You Debond and Finish That Phase 1 Interceptive Case? (Braces, Invisalign, or RPE)

I. Introduction

• The Phase 1 debond checklist is completely different from the comprehensive/Phase 2.
• Many clinicians either under-bake (raw) or overdo (burnt) Phase 1.
• Poorly done Phase 1 can lead to board complaints or refund requests, especially if another provider catches the mistakes.

II. The Goal of Phase 1

• Fix the bite, habits, and myofunctional issues.
• Set up the foundation so that permanent teeth (3s, 4s, 5s, 7s) have space to erupt.
• No guarantees that every tooth will come in perfectly, but you must create the space.

III. The Debond Checklist

• Upper and lower 2-2 (7-10) should be erupted, aligned, and in proper occlusion.
• There should be a small overjet – no anterior tooth-to-tooth contact.
• If Cs (canine primary teeth) are still present, there must be space around them for the permanent canines.
• No vaulted palate – palate should be remodelled (RPE or IPE done).
• No crossbites (anterior or posterior). The upper arch should be about half a tooth wider than the lower.
• No crowding. Over-expand rather than under-expand extra space is fine.
• No anterior open bite (AOB) or posterior open bite (POB). Back teeth should touch.
• Vertical overlap: see 10-60% of lower incisors – no deep bite.
• Nasal patency and oral habits must be addressed (myo/ENT clearance obtained before starting).

IV. The Retention and Recall Period

• Retention after Phase 1 is often unnecessary – children outgrow retainers quickly.
• Have upfront conversations about what is included (retainers, recalls).
• Keep patients on tight recall every 3 – 6 months between Phase 1 and Phase 2 – these visits are included in the fee, so charge appropriately.
• Good recall keeps patients from going elsewhere for Phase 2.

V. The Bottom Line

• Phase 1 is done when the bite is corrected, space is created, and airway/myo issues are managed.
• Document everything. Get specialist clearances in writing.
• Don’t rush. A proper Phase 1 prevents liability and makes Phase 2 easy.

Should You Solder Distal Extensions on Your RPE or Appliances for 6’s and 7’s?

I. Introduction
Dr Amanda from StraightSmile Solutions answers a common lab question: Should you add soldered distal extensions to an RPE or expander to engage the first or second molars?
The answer: it depends on your finishing plan, the patient’s age, and the appliance type.

II. The Case for Distal Extensions
Extensions can help keep molars travelling with the expansion, preventing them from lagging.
If you plan to finish the case in braces, getting a band on a wonky second molar is a nightmare. Extensions may reduce that headache.
Some labs automatically add them; others require a request. Cost is minimal (~$5-10 per case).

III. The Case Against Distal Extensions
Extensions add bulk, making the appliance more annoying for the patient (more wax, more irritation).
If you are finishing with Invisalign, you can easily pick up any mildly rotated molars later – extensions are unnecessary.
In pre-pubertal patients doing true skeletal expansion, the molars should travel with the expander anyway. If they don’t, that’s a different problem.

IV. Age and Arch Considerations
Upper arch: In a growing child, proper expansion separates the midpalatal suture; molars should move with the appliance.
Lower arch: Expanders only upright the curve of Spee molars, may not track perfectly, so that extensions might help.
For very young children (expand on E’s), be cautious about stressing primary teeth.

V. The Bottom Line
Distal extensions are optional, not required.
Use them if you are finishing with braces and want to minimise wonky molars.
Skip them if you are finishing with Invisalign aligners, which can fix minor rotations easily.
Discuss with your lab and weigh patient comfort vs mechanical benefit.

How to Avoid a Lawsuit or Board Complaint for DUMB REASONS in Braces or Invisalign

I. Introduction

• Dr Amanda from StraightSmile Solutions wraps up her liability series with the “dumb dumb” reasons for lawsuits.
• These are inexcusable, often laughable mistakes, but they happen.
• Good news: They’re entirely avoidable with basic attention to detail.

II. Pathology – Unforgivable

• Take a pano or CBCT. If you see anything suspicious (cyst, ameloblastoma, etc.), do NOT start ortho.
• Refer for radiology or take additional X-rays (PA with shift, occlusal).
• You are responsible for reading your own X-rays. Don’t start a case with any chance of pathology.

III. IPR Done Wrong

• Using a bur too aggressively can remove too much enamel or cut gums/lips.
• Stick with fine strips (slow and safe) instead of rushing with discs or burs.
• Most orthodontists avoid burs for a reason. Take your time.

IV. Allergies – Latex and Nickel

• Latex allergy: non-latex elastics are junk. Avoid elastic-based mechanics altogether.
• Nickel allergy: girls usually know from jewellery; boys may not. If suspected, send for testing and get a written release.
• Alternative: ceramic brackets with nickel-free wires (still trace nickel) or switch to Invisalign.

V. Chemical Burns (Etch) and Swallowed Objects

• Etch burns that scar can lead to payouts. Be careful.
• Swallowing foreign objects (e.g., from “mousetrap” mechanics) is a known lawsuit trigger.
• Dr Amanda avoids complicated auxiliary mechanics entirely.

VI. General Sloppiness

• Failing to document chief complaint, diagnosis, treatment plan, informed consent, and P.A.R.? (Procedures, Alternatives, Risks, Questions).
• Rushing the treatment conference without giving patients a chance to ask questions.
• Not signing and dating the consent form yourself.

VII. The Bottom Line

• Ortho is fun and not hard if you are detail-oriented and not sloppy.
• Phase One interceptive remains the safest path.
• Don’t rush. Document everything. And never start a case you’re not sure about.

I. Introduction

• Dr Amanda from StraightSmile Solutions continues her liability series, now addressing TMJ/TMD complaints.
• This category is lower in frequency but nebulous and harder to defend.
• Her core advice: If you suspect a TMJ issue, do NOT start ortho without specialist clearance in writing.

II. The Specialist Problem

• TMJ/TMD is not an ADA-recognized specialty, but oral pain specialists, prosthodontists, or OMFS/MD are the appropriate referrals.
• If you hear clicking, popping, or feel asymmetry, stop. Do not start ortho.
• Get a written release from a specialist before proceeding.

III. Red Flags on Exam

• Unilateral posterior open bites (POBs) are a major red flag.
• Asymmetries, condylar degeneration, or any POB = do not start the case.
• If you see a POB, you can try deprogramming or settling, but never start active ortho without further investigation.

IV. Imaging Requirements

• CBCT with a large enough FOV to visualize both condyles is essential.
• Use a reading service (e.g., Beam Readers, 3DX) to evaluate hard tissue asymmetry or degeneration.
• CBCT will not show disc or ligament issues, but it catches hard tissue problems.
• If you lack the right FOV technology, pass the case to someone who does.

V. Standard of Care

• A large percentage of US dentists have CBCT. If you start a case without ruling out TMJ pathology and something goes wrong, it’s on you.
• Don’t let production pressure push you into risky cases.
• You don’t have to treat every patient. Passing on a TMJ case is smart, not weak.

VI. The Bottom Line

• TMJ/TMD complaints are tough to win, but they are avoidable.
• Screen thoroughly. Never start a case with unilateral POB or joint symptoms without a specialist’s written blessing.
• Document everything. Get clearance. Sleep well at night.

I. Introduction

• Dr Amanda from StraightSmile Solutions adds a final topic to her liability series: Phase 1 airway and expansion cases.
• This area is becoming a subtle but growing source of complaints.
• The rules are still nebulous, but you need to know them.

II. The ADA/AAPD Joint Statement (2017)

• Dentists must screen pediatric patients for signs of deficient growth, development, or airway risk factors during routine exams.
• Every 6-12 months. Every child.
• Failure to screen or refer is a potential lawsuit.

III. Failure to Refer: The Big Risk

• If you suspect a breathing disorder, you must refer to a physician (ENT or sleep specialist) for a definitive diagnosis.
• You cannot simply “do an expander” and assume it will fix the airway.
• Even if the expander helps symptoms, you have no medical diagnosis on paper. That’s a liability.

IV. You Can Treat Ortho Problems, Not Sleep Problems

• Sleep disordered breathing is a medical diagnosis. Only a physician can diagnose and treat it.
• You are allowed to treat orthodontic problems (narrow palate, crossbite, tongue space) that may also improve the airway.
• But you cannot treat “sleep problems” alone without a medical referral and diagnosis.

V. Timing of Expansion

• The correct time to expand is when the first molars erupt. That is standard of care.
• “Pre-expansion” before that is not standard of care and could be a risk.
• While lawsuits are unlikely now, if records are audited later, you could be found non-compliant.

VI. The Bottom Line

• Screen every child for airway risk. Document it.
• If you see red flags, refer to ENT or a sleep specialist. Get a diagnosis in writing.
• Do expansion only for orthodontic indications—not as a standalone airway treatment.
• Follow the standard of care on timing. Protect yourself now before the rules tighten further.

2026 Update – DIBS AI: CBCT 3D Placement for Straight Wire Braces and Indirect Bonding (IDB)

I. Introduction
Dr Amanda from StraightSmile Solutions announces a new collaboration with DIBS AI (formerly Ortho Select).
DIBS AI now offers CBCT functionality for braces treatment planning and indirect bonding.
She has known the team for over 10 years and considers this a “game changer.”

II. What DIBS AI Provides
CBCT-guided 3D placement for straight wire braces.
Integrated treatment planning that shows when IPR or other adjustments are needed.
Similar to Invisalign’s CBCT feature, but for braces.

III. The Business Model: Case Packs Up Front
You must purchase a pack of cases upfront (training is included).
The pack covers setup and treatment planning only—brackets are separate.
Total cost (setup fee + brackets) is less than 25% of an Invisalign comprehensive case in the US (without volume discounts).

IV. Brackets: Your Choice
Basic mini twin brackets are affordable ($130$250 per case in bulk).
Self-ligating brackets cost more but can still work within the system.
The setup fee is low, similar to what white-label aligner services used to charge.

V. Why This Matters
Before DIBS AI, there was no easy way to get CBCT-guided indirect bonding for braces.
This brings precision, reduces chair time, and improves outcomes.
Dr Amanda is not currently working with third-party resellers—she sends doctors directly to DIBS AI.

VI. The Bottom Line
For doctors who want to do high-quality braces at a fraction of the cost of aligners, DIBS AI is a compelling option.
You need to commit to a case pack upfront, but the per-case price is remarkably low.
Contact Dr Amanda for an introduction to the DIBS AI team.

I. Introduction
Dr Amanda from StraightSmile Solutions addresses a common question: midline elastics and canting.
She has extensive content on midlines already; this video focuses specifically on why midline elastics are problematic.
Her bottom line: She does not recommend midline elastics in most circumstances.

II. The Problem with Midline Elastics
They are unpredictable.
They frequently cause canting (tilting of the occlusal plane).
Once canting occurs, it often creates more problems than you started with—and those problems may not be fixable.
The risks outweigh the benefits.

III. When Midline Elastics Might Be Considered (Rarely)
Only in the very last phase, after levelling and alignment are complete.
Heavy, stable wires must be in place.
Existing spaces between teeth increase the chance of success.
Even then, Dr Amanda still avoids relying solely on midline elastics.

IV. Better Alternatives
Use differential anchorage to shift the midline.
Sequential distalization works much better (especially in Invisalign).
In braces, you have fewer tricks, but midline positioning should be built into the initial plan.

V. Invisalign-Specific Advice
Use the Invisalign smile visualizer to set midline positioning into the plan from the beginning.
Don’t try to fix midlines at the end with elastics.

VI. The Bottom Line
Midline elastics are unpredictable and cause canting.
If you have spaces, alternative mechanics work better.
If you don’t have spaces, midline elastics probably won’t work anyway.
Dr Amanda’s strong advice: avoid midline elastics altogether.

How to Avoid a Lawsuit or Board Complaint for Impactions in Braces and Invisalign

I. Introduction
● Dr Amanda from StraightSmile Solutions continues her liability series, now focusing on impactions.
● These are the top reasons for board complaints and lawsuits, right up there with perio.
● The goal is not to avoid all problems (they will happen), but to be 100% prepared when they do.

II. The Golden Rule: Warn Before You Start
● If you see blunted, tapered, or damaged roots on the initial pano, document it.
● Ask about prior trauma, endo, or ortho. If uncertain, send to endo.
● Endo must clear the patient in writing before you start ortho. No exceptions.
● If the patient refuses, you don’t take the case. Losing a start is better than losing a lawsuit.

III. XRays: NonNegotiable
● You must take a pano before starting ortho. An FMX is not enough; you will miss things.
● Progress Xrays (pano or PA with shift) are required at least once a year. You cannot charge extra for them.
● If there is a known risk, take progress Xrays every 3-4 months. Standard of care.
● CBCT is powerful, but you are responsible for everything in the field. Pay a reader if needed.

IV. Documentation and Informed Consent
● Standard informed consents are insufficient. Create a supplemental consent for any patient with impaction or root resorption risk.
● Warn patients in writing. Have them sign. Document the warning at every progress visit.
● Keep copies of endo reports and clearances.
● If another dentist catches a problem you missed, you are toast.

V. When to Stop Treatment
● If you detect an impaction during treatment, stop.
● Remove braces or pause Invisalign. Send to endo. Get clearance before restarting.
● Be prepared to give a partial refund if needed. Build these scenarios into your treatment plan.
● You can always restart after specialist clearance.

VI. The Phase One Advantage
● Impactions and root resorption are extremely rare in Phase One interceptive patients (ages 6-8).
● Little kids have compliant bone, no perio, and minimal root risks.
● Once again, Phase One is the ultimate lawsuit prevention strategy.

VII. The Bottom Line
● Impactions will happen if you treat enough patients.
● Protect yourself with panos, progress Xrays, endo referrals, and signed supplemental consents.
● Never rely on verbal warnings. Document everything.
● And if you want to sleep at night, stick with Phase One interceptive ortho.

How to Avoid a Board Complaint or Lawsuit on an Ortho Patient with Periodontal Disease

I. Introduction
● Dr. Amanda from StraightSmile Solutions continues her liability series, focusing on orthoperio cases.
● Periodontal disease is the #1 reason for orthodontic lawsuits and board complaints.
● There is zero excuse for a primary care dentist to get sued over perio—especially if you stick with Phase One interceptive (where perio is virtually nonexistent).

II. The Golden Rule: Get Perio Clearance in Writing
● For adult patients, obtain a signed perio clearance from their periodontist BEFORE starting ortho.
● If you are the patient’s periodontist (doing inhouse perio treatment), document all probing, bone levels, and treatment plans.
● The clearance must state that orthodontic treatment is safe. If the periodontist says no, you do not start. Period.

III. Maintenance During Ortho Treatment
● Patients with perio history require periodontal maintenance (PMT) every 34 months throughout ortho.
● If they refuse PMT or fail to keep appointments, you may dismiss them—without a refund if outlined in your contract.
● Progress Xrays (or CBCT) should be taken regularly, more often than the standard yearly interval.

IV. Documentation Is Everything
● Every perio patient needs a complete record: medical/dental history, chief complaint, Xrays, diagnosis, treatment plan, informed consent (general + supplemental perio consent), and documented discussion of risks, benefits, alternatives, and questions (P.A.R.?).
● Use HIPAAcompliant software; never put patient data into public AI tools like ChatGPT.
● If you refer to a specialist, keep written proof. You are the “paperwork collector.”

V. Map Out Potential Problems Ahead of Time
● Before starting, anticipate every way a perio case could go south (bone loss, recession, grafting needs before/after).
● Put all expectations in writing, including consequences for noncompliance.
● If you don’t know how a specific tooth movement will affect the perio status, phone a friend (periodontist) and get documented advice.

VI. The Bottom Line
● Perio risk is almost entirely avoidable by doing Phase One interceptive ortho on children.
● For adults, be ruthless about clearance, maintenance, and documentation.
● A patient who is scared off by these requirements is not a patient you want.
● Don’t let a perio case become a lawsuit. Protect yourself upfront.