Could MEWING Be the Solution for 3rd Molar Extractions?

A Tribute to Dr. John Mew and His Legacy

Panoramic X-rays: The First Clue

• Dr. Amanda emphasizes the importance of reading panos (panoramic X-rays) before seeing the patient whenever possible.
• Start by counting the teeth—many clinicians overlook missing lower incisors or impactions.
• Evaluate for pathology, impacted third molars (wisdom teeth), or anomalies such as odontomas or supernumeraries.
• If something appears unusual, don’t ignore it—take additional PAs or CBCT scans for accurate diagnosis.

Risks with Impacted Third Molars

• In adults with fully formed third molars and no space (ramus/tuberosity limitations), extraction is usually recommended.
• Leaving them in can create vertical occlusion issues, risk damage to second molars, and cause root blunting.
• Attempting ortho without addressing these risks could result in clinical liability, even with informed consent.

The Role of Early Growth in Preventing Extractions

• Jaw growth, breathing patterns, sleep posture, and diet from as early as age 1–2 impact future space for third molars.
• Encouraging proper nasal breathing and facial development early may reduce the need for extractions later.
• However, it’s not guaranteed—even with ideal growth and habits.

Tribute to Dr. John Mew and “Open Wide”

• Dr. Amanda honors Dr. John Mew, creator of the “Mewing” philosophy promoting forward facial growth through tongue posture and nasal breathing.
• Recommends watching Open Wide (formerly on Netflix) for a visual understanding of Mew’s ideas.
• Advocates for questioning orthodontic norms like unnecessary premolar extractions.
• Dr. Simon Wong’s airway-focused orthodontic courses are also recommended to align with Mew’s vision.

10. Early Treatment Philosophy for Class III Cases
    • Dr. Amanda emphasizes early intervention for Class III malocclusions, especially those with a retrusive maxilla (bimaxillary retronathia).
    • Ideal treatment begins once the first molars erupt—typically before age 10.
    • The goal is to expand the arches, loosen craniofacial sutures, and protract the maxilla to improve airway and facial balance.
11. Rationale for Protraction Facemask Use
    • The protraction facemask is Dr. Amanda’s preferred appliance for addressing skeletal Class III growth patterns.
    • Works especially well when combined with expansion to stimulate sutural flexibility and bone remodeling.
    • Can help grow the maxilla forward in cases with airway concerns, assuming ENT clearance is given.

III. Key Cautions and Success Factors
• If there’s a deep bite or lower incisors blocking forward movement, protraction won’t be effective.
• A proper anterior open bite must be created first—either through bite blocks, anterior bite plates, or occlusal acrylics.
• Customization depends on the patient’s cephalometric x-ray findings, which should guide appliance design.

1. Airway & Growth Considerations
   • Successful treatment assumes no major myofunctional or breathing issues—nasal breathing must be patent.
   • This method can redirect unfavorable growth patterns to achieve better aesthetics and airway function.
   • Combining early maxillary advancement with lower mandibular advancement later (e.g., using MA appliances) can produce excellent outcomes in growing patients.
2. Resources & Learning Support
   • Additional training on facemask design, timing, and protocols is available through Straight Smile Solutions’ YouTube playlists and Phase I education courses.
   • One-on-one support is also available via their consulting platform.

Defining Guided Orthodontics

• Dr. Amanda opens by admitting she had to ask ChatGPT what “guided orthodontics” even means—highlighting it as a buzzword.
• Defined as a personalized treatment approach using digital tools where final aesthetic and functional outcomes are simulated before treatment.
• Examples include:
  • Working backward from a final restorative or aesthetic goal (like implant space or veneer placement).
  • Using ClinCheck or working with a consultant for case planning.
  • Prosthetically Guided Orthodontics (PGO), where ortho is coordinated around prosthodontic needs.

The Big Mistake: Lack of Collaboration

• Many dentists and orthodontists “wing it” without setting clear restorative, aesthetic, or functional goals first.
• Especially problematic in multi-disciplinary cases (e.g., making space for implants or bridges).
• Guided orthodontics requires coordinated planning with all involved providers—restorative dentists, implant specialists, orthodontists, etc.
• Solo planning without collaboration = not guided ortho, “guess ortho.”

Strategic Planning = Reduced Risk + Predictable Results

• General dentists can do more if they’re educated and work with ortho mentors.
• Starting with a clear goal allows you to reduce risks, avoid treatment failures, and achieve more predictable outcomes.
• Essential to document informed consent thoroughly: risks, benefits, and alternatives to each proposed plan.

Business Tips: Funnel, Labs, and Avoiding Bankrupt Systems

• General dentists have more income potential if they handle both ortho and restorative “double-dipping.”
• Some guided ortho companies have gone bankrupt. Amanda advises not to rely too heavily on one system or lab.
• Recommendation: work with flexible ortho mentors and have multiple lab options to reduce vulnerability.

Final Words: Don’t Wing It

• Straight Smile Solutions offers a unique service: synchronous case planning + multiple treatment pathways explained.
• If clients ignore offered Zooms or choose to “wing it,” the failure isn’t on Amanda.
• Guided ortho means strategic, documented, collaborative planning, not mindlessly following AI or outsourcing without understanding.

5 Sports Where Invisalign or Clear Aligners Are Always Better Than Braces
Why Braces Can Be Dangerous in High-Impact Sports
• Dr. Amanda strongly advises against braces for athletes in certain sports due to safety concerns.
• Fixed metal appliances (brackets, bands, wires) can cause serious mouth injuries if there’s facial impact.
• Braces also create unpredictable movements and frequent breakages in these contexts.
• No mouthguard fully protects the mouth from braces-related trauma in high-contact sports.
Top 5 Sports Where the Only Safe Option Is Invisalign
1. Skateboarding (with tricks) – The Risk of falls or facial impact makes metal braces too dangerous.
2. Rugby – High-contact sport where facial injuries are common.
3. Martial Arts (beyond white/green belt) – Especially Muay Thai, MMA, and boxing—any hits to the mouth could cause major damage with braces.
4. Ice Hockey – Puck or stick injuries to the face are a serious risk.
5. Football – While common, brace wearers face complications with mouthguard fit and potential wire damage during collisions.
Why Invisalign Is Safer and More Functional
• Aligners sit flat against teeth with no protruding parts, making custom mouthguards easier to fit and refit.
• Clear aligners don’t interfere with normal oral movements or protective gear.
• Aligners can be temporarily removed if needed and replaced afterward, giving flexibility that braces don’t.
Don’t Forget Music & Lifestyle Factors
• Dr. Amanda also references past videos on how musical instruments can be impacted by braces.
• For example, brass or woodwind instrument players may struggle with lip pressure over brackets.
• Key message: Get to know the patient’s lifestyle—not just their dental concerns, but how their daily activities could affect (or be affected by) orthodontic appliances.
Final Thought: It’s Not About Preference—It’s About Safety
• Parents and kids often come in with a preference for braces or aligners.
• However, in these high-risk sports, aligners are not optional; they are necessary.
• Choosing incorrectly leads to broken brackets, damaged teeth, bone trauma, and longer treatment times.

How to Avoid Posterior Open Bites (POB) with Posterior Crossbite Correction

1. Understanding the Risk of POB During Crossbite Correction

• Dr. Amanda from Straight Smile Solutions addresses the complications of correcting posterior crossbites, particularly the risk of developing posterior open bites (POBs).
• ClinCheck or other aligner planning setups like Clear Pilot may suggest that a crossbite is fixable, but their recommendations are based on AI estimations, not biological certainty.
• Just because software shows possible movement doesn’t mean it’s achievable, especially in adults, where bone doesn’t remodel easily.
• The bone must be present and responsive for safe expansion; adult bone often does not adapt the way children’s bone might grow.

1. Biological Limits of Expansion in Non-Growing Patients

• In non-growing (adult) patients, the risk of POB increases because the maxillary bone is often rigid and may not accommodate expansion.
• Courses or systems that promote “expanding away from crowding” oversimplify real biological constraints—Dr. Amanda labels this as “a load of BS.”
• Even orthodontists can’t always predict how bone will react; case progression should be monitored incrementally (expand → evaluate → repeat).
• Relying on software projections without imaging is risky—true bone response is unpredictable.

III. Importance of CBCT in Treatment Planning

• Incorporating CBCT imaging into aligner setups (e.g., Invisalign, Spark) gives clearer insight into whether there’s adequate bone support for expansion.
• CBCT doesn’t guarantee bone will move, but it confirms whether expansion is even anatomically possible from the outset.
• Without CBCT and cautious planning, the risk of creating an iatrogenic posterior open bite increases significantly.

1. Legal and Clinical Responsibility

• If aligners or wires are delivered without proper follow-up protocols, the clinician remains legally responsible, even if the patient ghosts or disappears.
• Emails, letters, and texts are not always enough to shift liability if a patient fails to return and complications arise.
• Clinicians must adopt a conservative, monitor approach when they treat complex crossbites, especially in non-growing adults.

1. Final Recommendations

• Do not rely solely on AI-generated plans for crossbite correction.
• Always evaluate the patient’s skeletal anatomy through CBCT when available.
• Proceed incrementally, reassessing throughout treatment to avoid POBs.
• Understand your liability in treatment outcomes—always document and follow up carefully.

1. Understanding Minor Tracking Issues
   • Minor tracking issues are common and not necessarily alarming if there’s no pathology and the bite remains stable.
   • When issues arise, reboot the case to the original plan—no need for major changes unless problems worsen.
   • Clinicians are advised against trying to “push through” misaligned cases with more aligners; this may cause complex setbacks.
   • Do not appease patients by giving too many trays—limit to five until tracking improves.
   • Virtual or in-person monitoring every few weeks is critical to catch and manage issues early.
2. Efficient Refinement Submission Tips
   • Use existing attachments if they’re intact and well-placed—avoid unnecessary removal and re-bonding.
   • Select “continue towards achieving the same final treatment plan” during submission to avoid resetting the whole case.
   • Avoid the “make finishing adjustments” option, as it often derails previously optimized setups.
   • Always review revised plans closely—even with proper selections, Invisalign may introduce unintended IPR or attachment changes.

III. Custom Treatment Instructions for Refinement
• Sample instructions include:

• “Use existing attachments unless replacement is necessary.”
• “Add additional attachments as needed for extrusions, torque, or rotations.”
• “Refer to movements in the previous plan.”
• “Finish with 3-point molar, 2-point premolar, and light canine guidance.”
  • Inform the lab if IPR has already been completed to avoid repetition or under correction.
  • Always count trays and estimate based on prior usage to avoid short refinements.

1. Clinical Strategy for Success
   • A strong initial ClinCheck, tight tracking oversight, and saved aligners allow for smooth reboots.
   • Refrain from giving all trays at once unless systems are in place for accountability.
   • Establishing refined workflows reduces the need for ongoing consultation and saves long-term time.

TOP RETENTION MISTAKES DOCTORS MAKE BEFORE DELIVERING ESSIX OR VIVARA RETAINERS

1. Introduction: Addressing Retention Concerns

• Dr. Amanda responds to a viewer’s question regarding discomfort with a Vivara retainer, highlighting the importance of post-orthodontic care.
• The issue raised—pressure on a specific tooth from the retainer—illustrates common retention challenges.
• Retention is described as the third, often neglected, phase of orthodontic treatment.
• Dr. Amanda emphasizes that successful orthodontics doesn’t end with braces or aligners; it includes lifetime retention planning.

1. The Importance of a Retention Protocol

• Many dental professionals overlook or inadequately address long-term retention.
• Dr. Amanda asserts that retention is both a patient satisfaction opportunity and a revenue stream.
• Poor retention planning leads to frustration, negative reviews, and missed referrals.
• A well-maintained outcome turns patients into “walking, talking billboards” for your practice.

III. Retainer Awareness Among Families

• Parents and teens frequently discuss retainer types and protocols in everyday settings (sports events, parks, etc.).
• Being transparent and informative about aftercare distinguishes dental providers and builds trust.
• Orthodontists are more likely than general dentists to have robust aftercare plans in place.

1. Creating a Comprehensive Retention Plan

• Dr. Amanda recommends that all practices implement a clear, signed retention agreement before treatment begins.
  • You should detail: type and number of retainers, replacement process, breakage protocols, and cost expectations.
  • Should address relapse scenarios and future retainer needs.
• Outsourcing retainers to third parties may reduce long-term practice value; in-house management is preferred.

1. Practice Growth and Support

• Dr. Amanda offers dentists a complimentary consulting session (not for case review) to explore retention strategies and services.
• Encourages participation in courses or à la carte support for deeper retention protocol implementation.
• Emphasizes hands-on learning and consistent access to professional guidance for retention success.

1. Conclusion

• Retention is a critical but often neglected component of orthodontic success.
• Establishing a solid, transparent retention plan improves outcomes, reduces risk, and strengthens a practice’s reputation and longevity.

HOW TO ADD A PANO AT REFINEMENT WHEN ROOT UPRIGHTING IS A PROBLEM IN INVISALIGN
I. The Role of Panoramic X-rays in Refinements
• Panoramic X-rays (PANO) are crucial for monitoring root positions, resorption, and pathology during Invisalign refinements, especially in cases requiring root uprighting.
• ClinCheck currently lacks a direct option to upload a PANO during a refinement, only allowing CBCT uploads if CBCT was included in the initial submission.
• Dr. Amanda highlights this as a limitation and advocates for PANO inclusion as a standard of care.
II. How to Add a PANO at Refinement
• Use a creative workaround by uploading the PANO in one of the available photo slots—e.g., replacing the profile photo or another image if necessary.
• Include clear treatment notes: “Refer to PANO in the photo section. Please upright tooth #__ as shown.”
• Email the PANO directly to Align Technology ([email protected]) with the case number and timing, noting in ClinCheck: “PANO sent at [time]; please refer to PANO to upright [tooth number].”
• Without clear notes, Align won’t act on the PANO—AI doesn’t diagnose or plan, it follows clinician instructions.
III. Misuse of AI in Treatment Planning
• Many clinicians overly rely on engines or AI-based Flex Rx setups without reviewing or adjusting plans.
• Dr. Amanda stresses that AI is a tool, not a replacement for clinical diagnosis and planning.
• In legal cases or complaints, clinicians are held accountable for poor planning.
• Always review AI-generated plans critically; override errors like unnecessary IPR or expansion.
IV. Clinical Recommendations
• Take PANO updates every 6–12 months or more frequently if clinical signs suggest root issues.
• Guide Align Technology with explicit directions—AI should assist, not replace, your judgment.
• The extra step of including a PANO helps ensure accurate root positioning and minimizes long-term complications.

1. Introduction to Posterior Open Bites (POBs) and Crossbites
   • Dr. Amanda from Straight Smile Solutions revisits the topic of posterior open bites (POBs) and posterior crossbites—common challenges in aligner orthodontics.
   • POB = Posterior Open Bite; can be caused by vertical issues or arch expansion interferences.
   • Emphasis on identifying the true cause—whether it’s vertical (bite opening due to intrusion/eruption) or transverse (due to arch shape or bone limitations).
   • Aligners often fail to address these issues unless the underlying skeletal/bone anatomy is carefully considered.
   • Planning errors (e.g., over-expanding or misdiagnosing the curve of Wilson) lead to complications that aligners alone cannot fix.
2. Diagnostic Tools: CBCT & Curve of Wilson Evaluation
   • CBCT imaging is invaluable for planning, especially in adults, where bone stability is more predictable.
   • CBCT-integration features (available in Invisalign and Spark) offer high-value insight, but not all platforms (e.g., Clear Correct) support it.
   • Even if CBCT isn’t integrated, clinicians should examine transverse slices to evaluate bone presence and the Curve of Wilson shape.
   • The Curve of Wilson (buccal-lingual inclination of molars) must be upright for proper occlusion—distortion leads to POBs.
   • AI in aligner portals isn’t yet reliable for predicting bone response—manual assessment is essential.

III. Expansion Pitfalls and Treatment Planning
• Over-expansion is a common recommendation in ortho courses, but it’s not always safe.
• If the bone isn’t there, expanding the arch can push teeth out of the bony housing, creating instability and bite issues.
• Dr. Amanda warns that elastics or trimming trays cannot fix POBs caused by transverse interferences like an exaggerated curve of Wilson.
• Determining if the problem is skeletal vs. mechanical is the first step to effective planning.
• Clinicians must ask: “Can I expand?” “Is there bone?” “What’s happening with the Curve of Wilson?”

1. Assessing Incisor Position & Bone Housing
   • Flared incisors may already be outside the bony housing—further movement worsens the situation.
   • Instead of flaring more, retraction might offer better stability and esthetics.
   • CBCT or cephalometric images help confirm tooth position in relation to the alveolar bone.
   • Important for making decisions about IPR, extractions, or avoiding over-expansion.
   • Dr. Amanda emphasizes time-saving diagnosis: seasoned orthodontists can visually assess flared incisors without waiting for metrics.

1. Conclusion and Clinical Takeaways
   • Crossbites and POBs must be diagnosed correctly—vertical vs. transverse root causes.
   • Use CBCT and assess the Curve of Wilson to avoid treatment failures.
   • Aligners alone cannot fix biomechanical problems caused by poor planning or bone limitations.
   • Utilize available tools and imaging to customize treatment, especially for complex cases.
   • With accurate diagnostics and conservative biomechanics, clinicians can treat tougher cases safely and successfully.

Non-Extraction Options for Shark-Retained Teeth

1. Introduction

• Dr. Amanda from Straight Smile Solutions discusses “shark teeth,” a common condition where kids have two rows of teeth due to retained baby teeth.
• This occurs when the roots of baby teeth don’t resorb fully, often during the eruption of permanent incisors or molars.
• It’s a developmental variation—not always a cause for alarm.
• The key is understanding the child’s behavior (wiggler vs. non-wiggler) and family dynamics for appropriate treatment planning.
• Rushing into extractions isn’t always the best first step.

1. Conservative Strategies for Shark Teeth

• Wiggling Encouragement: Children should be encouraged to manually loosen their baby teeth if they’re comfortable.
• Candy Orthodontics:
  • Supervised biting of hard, sticky candies like Sugar Daddies helps dislodge retained teeth.
  • Effective in children who can’t or won’t wiggle their teeth themselves.
  • Must be paired with proper oral hygiene to prevent decay.
• These methods use natural muscle forces—what Dr. Amanda calls “free orthodontics.”
• Avoids trauma or complications of premature extractions.

 III. Appliance-Based Support

• Bio-Trainers & U Concept Devices:
  • Functional appliances that improve tongue posture, lip seal, and nasal breathing.
  • Simultaneously help realign teeth and correct oral habits.
  • Especially useful in sensory-sensitive children or when natural methods don’t work.
• These devices offer dual benefits: orthodontic support and improved orofacial function.

1. Role of Parents & Hygiene

• Successful treatment depends on active involvement from both parents.
• Involving dads is essential—conflicts arise if only one parent consents.
• Hygiene is critical during the “shark teeth” phase.
  • Tools like WaterPiks and Sonicare brushes help clean hard-to-reach areas.
  • Especially important when candy, orthodontics, or appliances are used.

1. Conclusion

• Most cases of shark teeth resolve without invasive procedures.
• Dentists should delay extraction unless infection, pain, or hygiene problems arise.
• Encourage natural loosening, involve both parents, and use tools like appliances or candy-based methods when needed.
• With proper supervision, children can benefit from their body’s natural mechanics to achieve healthy, aligned smiles.