Should I Restore Abfractions Before Starting a Clear Aligner Treatment Plan?

When creating your clear aligner treatment plans, knowing how to approach cases such as abfractions is crucial. Luckily, we’ve outlined a few key things you should know to help with this to help.
Should I Restore Abfractions Before Starting a Clear Aligner Treatment Plan?
Generally speaking, whether you should restore abfractions before starting a clear aligner treatment plan should be based on the opinion of a professional restorative dentist. However, if you do decide to go ahead with clear aligners on an abfractions patient, drawing up a custom, special informed consent document is vital; however, this may not necessarily be enough to cover you if issues arise due to treating an abfractions patient who should have undergone restoration first.
The Risk of Using Clear Aligners for Abfractions Without Restoration
It is possible to scallop around the abfractions with the trim line, this can alter the way that force is applied to the teeth, thus impacting the progression of the case (and causing more unpredictable movements accordingly). However, if you decide to take on an abfractions case with clear aligners without restoration, keep the type of plastic used for your clear aligners in mind when determining the correct brand to use. Abfraction cases may be more prone to snapping, especially with alternative clear aligners that use a more rigid plastic than Invisalign.
With that being said, overall, we recommend that you restore abfractions before completing the clear aligner treatment plan to avoid being liable for issues that may arise down the line.

How to Use Invisalign for Cases with Wisdom Teeth

Wisdom teeth can be somewhat frustrating when doing orthodontics, requiring several specific intricacies to ensure you’re tackling an Invisalign or clear aligners case properly. Following this, today’s guide has summarized some of the core things you should think about before starting to help inform your decision.
However, it’s worth considering here that every dentist will have their own opinions when it comes to doing clear aligners / Invisalign with third molars. As such, this may come down to personal preference – but some approaches may have higher risk attached.
Should Third Molars (Wisdom Teeth) Be Pulled?
When studying orthodontics, you’ll usually be told that third molars don’t matter, provided that they are fully erupted and don’t have a risk of decay or pericoronitis (etc). That’s generally true in braces cases, but for clear aligners, this may be a little trickier.
We should also point out that if you are consolidating spaces and moving the molars, make sure they are fully covered and there is full wrap around the back of the molars. Distilization and elastics also require full coverage.
Fully Impacted Molars
If a patient is under the age of 25 and has third molars that are ⅔ developed or greater (or are mesially erupting), they may need removing before treatment. While a lot of research will say this won’t matter, one-quarter of public opinion is much higher that this is an issue – and doing these cases without removing the third molars first could leave you at risk of complaints to the dental board (etc).
Partially Erupted Molars
If a patient has partially erupted molars, there are two main options to keep in mind. If the patient wants to start Invisalign shortly, removing them is the best bet to prevent complications from arising. Alternatively, you could wait until they are fully erupted, but there’s still no guarantee that they won’t need removal once they have erupted.
Fully Erupted Molars
In the case of fully erupted molars, if these are covered – at least ⅔ – by the tray (which may require a scan), Invisalign or clear aligners may be a safer approach. Make sure they are also fully covered if you are using Essex retainers (this is less important for Hawley or bondeds).

If you have an orthodontics patient with a posterior openbite tendency, you may need to take a more specific approach to retention when finishing cases. As such, we’ve looked at some of the best types of retainers for these individuals to help their orthodontic treatment plans go more successfully.

Causes of Posterior Openbite Tendency During Retention

There are numerous potential causes for posterior openbite tendency. It’s worth noting that this usually won’t happen with bonded retainers and Hawleys. However, it can potentially happen during aligner treatment, and having patients wearing retainers full-time for more than three months can potentially predispose this.

This is especially likely if the patient had issues with a posterior openbite during the treatment itself. As such, if your patient experienced this, you likely won’t want to use two Essex retainers when finishing their case.

With Essex retainers, since they are just plastic and don’t have an articulator and they aren’t equilibrated, the back teeth touch first, which leads to jaw rotation – thus causing the additional pressure that can lead to a posterior openbite tendency.

What Retainers Should I Use?

If your patient has a posterior openbite tendency, you’ll likely want to use either one Essex over a Hawley or one Essex over a bonded. If two Essex retainers are a must, wearing one at night and one in the day may be a potential compromise; this may be better suited after starting full-time with one Essex and one Hawley.

What Age Should Patients Be for an Implant?

If you have a patient who needs an implant fitted as part of their orthodontics treatment plan, knowing when to do this isn’t always straightforward. Fortunately, we’ve outlined some key things you should know about the optimal age for an implant treatment plan to help you choose when to address this for your patients.

When is the Optimal Age for Patients to Get an Implant?

Many people assume that, once a patient turns 18, they will be a good candidate for an implant. However, this isn’t always the case, as some patients may continue to grow after this stage, which can severely impact the results of the implant. This can leave the jaw and teeth growing around the implant, causing very poor results down the line (especially with anterior cases).

As such, before doing any implants, always take at least two serial Cephs (at least a year apart) to ensure there is no growth between these two stages. For girls, the safest time may be around 21 years of age; for boys, this likely increases to around 25 years, to be safe. However, you may be able to start this anywhere between 18 – 21 years for girls and 21 – 25 years for boys, provided that the patient has fully stopped growing; if there is any growth between the two Cephs, do not start the implant treatment plan until you are confident the growth has stopped.

Should You Stop Using Cookie-Cutter Invisalign Preferences?

When creating treatment plans with Invisalign, it can be tempting to set a wide range of preferences – however, this may not necessarily be an effective way to create the right approach. In line with this, we’re looking at whether you should stop using Invisalign’s “cookie cutter” approach to preferences when determining a treatment plan.

Should You Use Preferences in Invisalign Treatment Plans?

Not all bites are the same. As such, using Invisalign preferences can often overcomplicate matters significantly and lead to Clin Checks that seem abnormal or complex.

With that being said, you may be able to put a few preferences in place; for example, some potentially useful preferences can include:

• put full-size attachments on laterals if there is rotation
• put attachments if the molars have extrusions
• finish the case with three points of molar contact, two pre-molar, light canine guidance and no anterior contact assuming there is opposing

You should always check each case manually to ensure that the treatment plan is tailored to the patient’s specific case. Indeed, while some preferences may apply to one patient, they may not apply to another; for example, if the preference says never to lock the terminal molars, this may be appropriate for some older patients, but this likely won’t be appropriate for a young patient with mixed dentition.

Get Professional Support

If you are learning to use Invisalign, using preferences may seem tempting, but this can make things much more complicated. As such, we recommend learning to use Invisalign manually – and our experts here at Straight Smile Solutions can help. If you’re feeling unsure, contact us today to find out more about our consulting services and how we can help you learn to use Invisalign more effectively for your treatment plans.

Did iTero Technology Stop Selling Refurbished 2 Scanners?

Here at Straight Smile Solutions, we have had very good experiences with iTero Align Technology’s Refurbished 2 scanners – however, some people have been saying that these orthodontics solutions are no longer available.

So, what’s the current position with iTero Technology’s Refurbished 2 scanners? Well, after recommending the Refurbished 2 Scanners for a while now, having received our own, we’re curious to hear from other doctors regarding their own experiences with sourcing these products.

Reps Telling Doctors that Refurbished 2 Scanners are No Longer Available

Unfortunately, it seems that reps from iTero Align Technology have been informing doctors that Refurbished 2 scanners are no longer available for purchase. In turn, this means these doctors will have to choose another product, such as the 5.

However, we here at Straight Smile Solutions are unable to confirm whether this is the case, and so we would appreciate any feedback from other doctors regarding whether they were able to get hold of a Refurbished 2 Scanner and what prices were being asked for these products. In addition, we would be interested to know what sort of options and bundles are being created for doctors in terms of what the package contains, how many tips are included, and so on.

PARENTS! Can’t Find the Right Airway-Focused Orthodontist? Meet Dr. Julia- She’s here to help!

I. Introduction

Hello everyone! I’m thrilled to be addressing the StraightSmile Solutions Community today. Our focus is on Airway-focused early Orthodontics—an essential topic that impacts the well-being of our youngest patients and their families. I’m Dr. Julia, a holistic dentist passionate about educating and supporting parents on these crucial matters. Today, we’ll delve into why this philosophy of care is transformative. Early intervention Orthodontics can positively influence facial growth, breathing, and sleep, significantly impacting a child’s overall health. Join me in exploring these connections and understanding the profound effects of our work on the holistic well-being of our patients.

II. Personal Introduction

• Julia, a holistic dentist
• Owns a business focused on educating and supporting parents
• Facilitates connections between parents and providers

III. Importance of Holistic Dentistry

• Paradigm shift from a traditional dental education
• Emphasis on whole-body health
• Far-reaching effects of dental work

IV. Main Themes: Early Intervention Orthodontics

• Better facial growth, breathing, and sleep for young patients
• Addressing issues like bedwetting through dental interventions

V. Nasal Breathing and Nitric Oxide

• Roof of the mouth’s influence on nasal breathing
• Palatal expansion for improved nasal breathing
• Connection to nitric oxide production and blood pressure

VI. Sleep Quality and Hormone Release

• Better breathing leads to improved sleep
• Influence on hormone release, e.g., anti-diuretic hormone
• Impact on bedwetting, social connections, and emotional well-being

VII. Deep Dive Recommendation

• Suggested resource: “Breathe, Sleep, Thrive” by Dr. Shireen Lim
• Book’s relevance for parents and practitioners

VIII. Crooked Teeth and Air Flow Limitation

• The link between crooked teeth and airway obstruction
• Early recognition of growth deviations and physiologic dysfunction
• Shifting focus in Orthodontics from tooth position to airway health

IX. Jaw Development and Dietary Factors

• Historical changes in jaw development
• Influence of modern diets, habits, and environments
• Early Orthodontics’ role in influencing arch form and jaw development

X. Posture and Total Body Health

• Significance of oral posture on total body posture
• Connection to chiropractic support and overall health
• Examples include flat-faced breeds like pugs

XI. Chewing, Swallowing, and Downstream Effects

• Impact of open mouth posture on tongue position
• Influence on swallowing, chewing, and gut health
• Complex relationships with issues like gas, constipation, reflux, and ear infections

XII. Sleep and Autonomic Regulation

• Breathing’s role in autonomic regulation (fight or flight vs. rest and digest)
• Impact on mood, anxiety, and tantrums
• Importance of sleep for parasympathetic functions

XIII. Immune Function and Inflammation

• The link between stress reduction, better sleep, and immune function
• Effects on T cells, cytokines, and inflammation reduction
• pH levels, nitric oxide, and antimicrobial effects

XIV. Hormonal Production and Recovery

• Hormones influenced by sleep, including cortisol and insulin
• Memory consolidation and waste removal during sleep
• Cumulative effects of long-term imbalances

XV. Warning Signs in Childhood and Adult Health

• Potential health conditions in adulthood with childhood warning signs
• Obstructive sleep apnea and its symptoms and comorbidities
• Importance of early intervention for a healthier future

XVI. Conclusion and Call to Action

• Recap of the key points covered
• Encouragement for practitioners to get involved and break the cycle
• Emphasis on learning warning signs and collaborating with specialists
• Invitation to connect with Dr. Julia for further discussion

How to Launch an Airway Practice (I just wanted to add- never take a course sponsored by a PRODUCT)
I. Introduction
Dr. Amanda from StraightSmile Solutions, and today I want to dive into the intriguing world of being an “Airway Dentist” or establishing an airway practice. Recently, a fellow practitioner approached me, wanting to launch an airway-focused orthodontics practice. While I can guide you on the orthodontic component, delving into the broader realm of an airway practice remains a mystery to me. Various courses claim to equip practitioners, but without firsthand experience, I can’t vouch for their effectiveness. Let’s focus on the orthodontic aspect – emphasizing non-retractive mechanics, removables over fixed appliances, and the integration of orofacial myofunctional therapy (OMT).
II. Understanding Airway Dentistry
A. Definition of Airway Dentist
B. Distinction between Airway-focused Orthodontics and an Airway Practice
C. Limitations in Dr. Amanda’s expertise – unable to guide the launch of a complete airway practice
D. Mention of various courses available, but Dr. Amanda’s lack of personal experience with them
III. Airway-focused Orthodontics
A. Subcomponent of Airway Practice
B. Dr. Amanda’s expertise in launching Airway-focused Orthodontics
C. Emphasis on not using retractive mechanics and devices like High pull headgear or cervical P headgear
D. Preference for using removables over fixed appliances
E. Integration of Orofacial Myofunctional Therapy (OMT) into orthodontic Airway practice
IV. Components of an Airway Practice
A. Importance of partnering with OMT professionals
B. Collaboration with cervical Chiropractic offices
C. Essential partnership with Ear, Nose, and Throat (ENT) specialists
D. Necessity of having a CBCT for scanning and analyzing Airways
E. Potential role of companies like Beam Readers in analyzing CBCT scans
V. Challenges and Considerations
A. The complexity of determining treatment sequences (e.g., surgery, expansion, OMT)
B. Importance of addressing mouth breathing and potential diagnostic challenges
C. Exploration of additional diagnostic tools beyond home sleep tests
VI. Lack of Information on Airway Courses
A. Dr. Amanda’s inability to recommend specific courses for launching an airway practice
B. Mention the course as an interesting option
C. Expressing interest in beta-testing courses but unwillingness to pay for them
VII. Research on Airway Practice Components
A. Exploring subjective and objective paperwork
B. Identifying effective ways to diagnose mouth breathing
VIII. Challenges and Uncertainties
A. Patient cooperation and acceptance of additional treatments
B. Diagnosing mouth breathing without home sleep tests
C. The ongoing research on Airway practice components
IX. Conclusion
Dr. Amanda from StraightSmile Solutions emphasizes the complexities of launching a comprehensive airway practice, distinguishing it from the narrower focus of airway-focused orthodontics. While she can assist with the orthodontic component, the broader aspects of an airway practice remain unfamiliar. Dr. Amanda expresses skepticism about various courses claiming to cover the entire scope, highlighting her reluctance to invest without concrete knowledge. She advocates collaboration with professionals such as oral myofunctional therapists (OMTs), cervical chiropractors, and ENT specialists. Integrating CBCT technology, assessing mouth breathing, and addressing sleep concerns are also underscored. Dr. Amanda remains open to exploring courses and sharing valuable insights for those navigating the evolving landscape of airway-focused practices.

Using Braces to Expand the Lower Arch

Phase 1 patients can present a unique range of challenges and possibilities, and considering the different options to optimize your orthodontics treatment plan is crucial. As part of this, we’ve outlined some of the core things you need to know about using braces in your orthodontics treatment plans to expand the lower arch in phase 1 patients, including whether this is a quick or practical solution versus doing a Schwartz, Williams, or Flea.
Can I Use Fast Braces to Expand the Lower Arch?
While there are several ways that you can potentially expand the lower arch in Phase 1 patients, and since the lower arch does not have a suture, it is just tipping. In line with this thought, braces (and aligners) can potentially be used to expand the lower arch in mixed dentition patients, provided that the patient isn’t likely to be losing teeth soon.
However, it’s worth noting that some patients may still need Schwartz, Flea, or Williams in order to create a wide and balanced bite.
How Using Braces Compares to Schwartz, Flea, or Williams
Some of the most common alternatives to expanding the lower arch with braces is to use a Schwartz, Flea, or Williams approach. These may be important in cases where fast braces aren’t going to be suitable to expand the lower arch.
The main example of this is when the patient is missing teeth since two lower teeth must be bonded in order for uprighting to work. Furthermore, after checking the pano, it’s also crucial to check whether the patient is likely to have any teeth attempting to erupt; if there are any that may come through any time soon, don’t attempt to use braces to expand the lower arch, as bonding the teeth together with braces can potentially do a significant degree of harm to the patient.
If the patient isn’t missing any teeth, using braces can help to give comparable results as with Schwartz, Flea, or Williams cases (but without the same lab fee costs). However, regular checkups and reports are vital to ensure the normal progression of the orthodontics case. If the patient does not attend recall appointments, you may be liable for patient abandonment.