StraightSmile Solutions®

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.

How to Avoid a Lawsuit or Board Complaint from Decalcifications or Caries in Braces or Invisalign

I. Introduction
● Dr Amanda from StraightSmile Solutions continues her liability series, now focusing on decalcifications and caries.
● Invisalign once claimed no white spot cases; she calls BS. Energy drinks + aligners = disaster.
● This is a major lawsuit risk. Protect yourself upfront.

II. The Aligner Problem: Worse Than Braces
● Energy drinks (acid + sugar) bathe teeth when trapped under aligners.
● Braces at least allow saliva to wash the teeth. Aligners trap the acid 24/7.
● Giving patients the entire box of aligners and checking virtually is dangerous. If they never come back and destroy their teeth, it’s on you.

III. Patient Abandonment: A Hidden Trap
● If something is glued on teeth (braces, bonded retainers) or the patient is wearing active aligners, you are legally responsible.
● You cannot “forget” about a patient. Follow your dental practice act: calls, emails, certified letters, then formal discontinuation.
● Once treatment is discontinued and a patient over 18 signs, you are released. Retainer checks are not required.

IV. Never Start a Case with Poor Hygiene
● Before gluing a single bracket or delivering any aligner, the patient must demonstrate good oral hygiene.
● If it’s iffy, don’t start. Don’t let an office manager or KPI pressure you into violating the standard of care.
● Get a cavity and hygiene clearance from the general dentist in writing. If you are the GP, you are legally responsible for hygiene throughout ortho treatment.

V. Monitoring and Consequences During Treatment
● Grade hygiene at every visit. Use incentive programs (wooden nickels, rewards) and clear consequences.
● If you see decals or white spots starting: supplemental fluoride, braces vacation (remove appliances), or stop aligners.
● Warn patients in writing ahead of time. Document every discussion. Parents should know that braces may be removed at any time without permission if hygiene fails.

VI. The Braces Vacation
● Sometimes you must stop treatment early to save the teeth.
● Parents may be angry, but you are beholden to your state dental practice act and your license.
● You may need to give a partial refund depending on your contract. If parents refuse to sign discontinuation, proceed anyway it’s early termination. They won’t win a complaint.

VII. The Financial Reality
● Severe decalcification leading to veneers or crowns on multiple teeth can cost $10,000 every 510 years × 40 years = $500,000 to $1 million lawsuit.
● This is entirely avoidable with proper hygiene monitoring and early intervention.

VIII. The Bottom Line
● Decalcifications and caries are preventable. Do not start a case with poor hygiene.
● Monitor constantly. Stop treatment when needed.
● Document everything. Use incentives and consequences.
● A little effort on hygiene saves you from a milliondollar lawsuit.

I. Introduction
● Dr Amanda from StraightSmile Solutions continues her liability series, now focusing on root resorption.
● 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 root resorption 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
● 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
● Root resorption 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.

What Are the TOP 6 Reasons for Orthodontic Lawsuits or Regulatory Complaints?
I. Introduction
● Dr. Amanda from StraightSmile Solutions begins a series on liability in orthodontics for general dentists and pediatric dentists.
● She is not a lawyer, but has spent years auditing CE courses and collecting data on common claims.
● Her advice: stick with Phase One interceptive cases when possible risk drops exponentially compared to adult treatment.
II. Reason #1: Failure to Diagnose or Manage Periodontal Disease
● The number one reason for orthodontic complaints almost always in adults.
● Even if you’re managing perio inhouse, there are specific protocols to follow.
● A full video will be dedicated to this topic.
III. Reason #2: Root Resorption
● Whether you caused it or not, the key is how you manage it.
● Past, present, or future root resorption must be documented and monitored.
● Another full video is planned.
IV. Reason #3: Impacted or Ankylosed Teeth
● Includes canines, premolars, second molars even if you didn’t cause the impaction.
● Failure to notice, diagnose, or manage an impacted tooth properly is a common trigger for complaints.
V. Reason #4: TMJ/TMD and Myofunctional Complaints
● Jaw joint issues and myo problems are a growing source of litigation.
● Dr. Amanda’s strong advice: don’t take these cases unless the patient has clearance from a specialist.
● If the case is a mess before you start, refer it out.
VI. Reason #5: Decalcification and Caries
● Unacceptable. Period.
● If a patient develops white spots or cavities during orthodontic treatment, it’s on you.
● You should not have started treatment on a highrisk patient, or you must remove braces if they can’t maintain hygiene.
● Managing this is standard of care.
VII. Reason #6: Miscellaneous Crap
● A catchall category for random oopsies, bad karma, and poor practice management.
● Includes appointment scheduling, staff errors, discontinuing treatment improperly, and patient communication failures.
● Much of this is basic dental school stuff unacceptable in any specialty.
VIII. The Bottom Line
● Adult orthodontics carries the highest risk. Phase One kids are much safer.
● If a patient needs ENT, myo, or perio clearance, get it before starting.
● Dr. Amanda is strict because she wants to sleep at night and she’ll drop clients who ignore red flags.
● Protect yourself: document, screen, and don’t take cases you shouldn’t.

2026 IPE Invisalign Palatal Expander: New Curve of Wilson Lower Arch Coordination Widget!

I. Introduction
Dr. Amanda from StraightSmile Solutions shares her updated 2026 approach to submitting Invisalign Palatal Expander (IPE) cases.
A new “widget” now appears in the ClinCheck submission process to help coordinate lower arch expansion and curve of Wilson up-righting.
While the widget is a smart addition, its accuracy is still unproven, so clinical judgment remains key.

II. The Old Way vs. The New Widget
Previously, the IPE submission required manual measurement and planning for lower arch coordination.
The new widget visually shows how upper expansion affects lower arch position and whether lower up-righting is needed.
If the lower arch is rolled in (curve of Wilson issue), it’s almost always accompanied by crowding, meaning the lower needs treatment, too.

III. Dr. Amanda’s Simple Rule: Slide It to 12
She advises maximizing expansion: “I wouldn’t pay $700 for an IP if I weren’t needing a lot of expansion.”
Sliding the widget to 12mm gives the greatest skeletal and airway benefit.
Cutting expansion short and finishing with aligners alone reduces airway and skeletal advantages, even if it creates some space.

IV. Lower Arch Coordination: Don’t Ignore It
Very rarely does a case require only upper expansion without lower intervention.
A constricted upper arch often causes the lower arch to roll in.
If the widget shows lower up-righting is needed, plan for lower treatment—whether with a removable expander, braces, or Invisalign First.

V. Why Invisalign for Phase 1 and Teens?
Dr. Amanda has swung back to favoring Invisalign for young patients because of its integrated tools (like IPE) and predictable outcomes.
She acknowledges the cost and closed ecosystem but maintains that for phase 1 interceptive and teen ortho, no other aligner brand matches the functionality.
Her goal is to educate doctors to use the product effectively, not to promote it unquestioningly.

VI. A Note on Her Independence
Dr. Amanda has never taken money from Align Technology and has walked away when they tried to control her content.
She invests her own time and money to learn, and her evolving opinions are based on clinical experience and what works best for her clients.

VII. The Bottom Line
The new widget is a helpful visual aid, but don’t rely on it unthinkingly.
Use it to identify whether lower arch up-righting is needed.
For maximum skeletal and airway benefit, expand fully and slide it to 12.
And always plan for the lower arch; isolated upper expansion is rarely enough.