StraightSmile Solutions®
When Should Ankylosed Baby Teeth Be Extracted?
Extracting Ankylosed Teeth in Mixed Dentition Cases
Mixed dentition cases can pose a range of unique challenges, and keeping this in mind can help you make sure that you’re following the right treatment plan for your patient’s needs. One such example of a potentially tricky case is ankylosed baby teeth – but when should you extract these for mixed dentition patients?
Before you make any decisions on a mixed dentition patient’s treatment plan, always confirm that the tooth is genuinely ankylosed. To do this, you’ll usually want to take a CBCT and get this read by a radiologist, OMFS, or an online tool. You should also always check whether there is a succedaneous tooth present; if there is, you’ll likely want to put the patient on a Watch treatment plan and take regular panoramic X-rays every three or four months.
If the ankylosed tooth does not also have a succedaneous tooth below, you may want to consider whether you could get away with simply leaving the tooth in for as long as possible. However, if you leave it in, you may notice a Bolton discrepancy over time, which may require you to remove part of the sides of the tooth.
Don’t forget: if you’re not yet in orthodontics and you remove an ankylosed tooth, your patient may experience supereruption in the primary or permanent upper teeth if there is a step. As such, if you do decide to extract an ankylosed tooth, you may want to add an appliance or retainer to prevent supereruption.
Overall, each mixed dentition orthodontics case must be addressed on an individual basis. If you’re not sure whether or not to extract the ankylosed tooth, don’t hesitate to contact a professional local orthodontist, or contact our Straight Smile Solutions experts for your own consultation on each case’s treatment plan.
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Feb 14th, 2024
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When Should You Take Out Baby Canine Teeth for Orthodontic Cases?
Extracting Baby Canines: When to Do It
Extractions are sometimes necessary when it comes to orthodontic cases, and understanding when you might need to extract baby canines is hugely important. Indeed, extracting baby canine teeth is potentially an exception to typical baby tooth extraction rules, and provided that you take both out simultaneously, the midlines shouldn’t shift in your patients.
When Should You Take Out Baby Canine Teeth for Orthodontic Cases?
Whether you will need to remove baby canine teeth will often depend on the angle of the canines. If there is a slight tilt, you may need to do expansion first prior to extracting the baby Cs; however, if there is a significant tilt, you may need to approach these orthodontic cases differently and remove the canines first.
In high risk applications, studies have shown that creating space and removing the baby canines can help with reducing the likelihood of impactions occurring.
Taking Out Baby Teeth Can Cause Complications
While baby teeth are usually risky to remove, baby canines may be a safer extraction option when removed in tandem – however, removing baby canines when it is not needed could cause more impactions, and it’s crucial to make the space first (usually through expansion).
If you’re not sure about impactions in a patient, be sure to visit our document store at Straight Smile Solutions to download a copy of our My Phase 1 Smile file, which provides a whole section on evaluating impactions for canines based on overlap and angulation. Alternatively, for our members, feel free to reach out to us if you have any questions about one of your orthodontic cases to see whether extracting baby canines might help.
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Feb 14th, 2024
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Long Comprehensive vs. Phase 1 Treatment
Long Comprehensive vs. Phase 1 Treatment
I. Introduction
Dr. Amanda provides an informative overview of “long comprehensive” orthodontic treatment. She explains that long comprehensive treatment involves starting comprehensive treatment when a patient is in late mixed dentition, often spanning 2.5-3 years with breaks. Dr. Amanda outlines critical considerations when evaluating if long comprehensive treatment is appropriate for a patient, including compliance, dental age, ability to finish the case properly, and risks of surprises. She notes the pros and cons of this marathon treatment versus the shorter phase one treatment. Dr. Amanda provides orthodontists and dentists critical guidance on managing expectations and decisions around extended comprehensive orthodontic treatment.
II. Factors to Consider
A. Cost considerations
1. Two-phase vs. long comprehensive treatment cost implications.
2. Front-loading costs with initial records, treatment, and retainers.
3. Potential cost differences for providers in different networks.
B. Duration of Treatment
1. Two and a half to three-year commitment.
2. Evaluation periods and breaks during treatment.
3. Monthly or periodic visits and potential scheduling conflicts.
C. Patient Commitment
1. Importance of patient and parent commitment.
2. Risks of moving during treatment.
3. Non-refundable nature of long comprehensive treatment.
D. Compliance Issues
1. Importance of patient compliance.
2. Challenges of dealing with non-compliant patients over an extended period.
3. Considerations for both patient and parent compliance.
III. Case Selection
A. Existing Relationship with General or Pediatric Dentist
1. Advantages of having a pre-existing relationship with the family.
2. Increased comfort level for orthodontists in taking on long comprehensive cases.
B. Hygiene Considerations
1. The necessity of impeccable hygiene for a three-year commitment.
2. Avoiding long comprehensive treatment for patients with hygiene issues.
C. Dental Age vs. Chronological Age
1. Understanding that dental age and chronological age may not align.
2. Considering eruption patterns and development in treatment planning.
IV. Treatment Planning
A. Finish Considerations
1. Ensuring comfort with the anticipated finish of the case.
2. Addressing potential challenges with unerupted or impacted teeth.
3. Communicating the potential need for impaction surgery and additional fees.
B. Unknowns and Surprises
1. Acknowledging the possibility of unexpected challenges.
2. The importance of transparency in treatment planning.
3. Managing parental expectations regarding potential surprises.
C. Finishing with Braces or Invisalign
1. Considering the implications of finishing with braces.
2. Challenges with offering phase two treatment after phase one.
3. Communicating effectively with parents about treatment choices.
V. Conclusion
Ultimately, the decision to pursue long comprehensive orthodontic treatment is complex, involving considerations of cost, compliance, unknown factors, and long-term commitment. While it can provide continuity of care in one treatment plan, risks include patients moving or losing motivation. Thorough informed consent regarding potential complications and fees is essential. Assess dental age, eruption status, hygiene compliance, and family plans first. Weigh the pros and cons of phased treatment as well. With careful case selection and setting appropriate patient expectations, long comprehensive treatment can benefit certain patients when factors align favorably. Still, unpredictability remains, demanding flexibility from doctors and patients alike.
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Feb 13th, 2024
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Is the Invisalign CBCT AI Feature Accurate on Kids and Teens
I. Introduction
Dr. Amanda from StraightSmile Solutions provides valuable insights into using Invisalign’s CBCT feature for orthodontic treatment planning. She explains how this technology has been a “game changer” for adult cases, giving great accuracy and confidence to fix more complex issues. However, Dr. Amanda cautions against over-reliance on CBCT for teenage and child patients. Through her 20 years of clinical expertise, she has found regular aligners and braces can safely achieve expansion in growing patients without risk of harm. She advises using judgment based on skeletal maturity rather than just applying CBCT routinely. Dr. Amanda offers constructive feedback to Invisalign on improving their AI to account for growth potential. Overall, her goal is to educate doctors on the appropriate and safe use of advanced tools like CBCT for orthodontic treatment.
II. Positive Experience with CBCT in Adults
A. Dr. Amanda’s clinical opinion
B. Confidence in treating cases over 30
C. Addressing conservative approaches
D. Increased confidence with posterior crossbites
III. Accuracy and Reliability of CBCT Feature in Adults
A. Dr. Amanda’s claim of accuracy
B. Pushing the treatment envelope
C. Dependence on AI and CBCT feature
D. Enhanced ability to tackle challenging cases
IV. Concerns Regarding CBCT in Kids and Teens
A. Lack of confidence in AI for younger patients
B. Dr. Amanda’s extensive experience with children and teens
C. Skepticism about the need for CBCT in younger cases
D. Preference for more traditional expansion methods
V. Skepticism about Safety and Necessity in Kids and Teens
A. Dr. Amanda’s concern about overusing CBCT
B. Lack of differentiation for growing kids
C. Fear of unnecessary treatment restrictions
D. Emphasizing the need for caution in utilizing CBCT in younger cases
VI. Addressing Usage Patterns
A. Observation of widespread use in every case
B. Dr. Amanda’s disagreement with the necessity
C. Caution against defaulting to CBCT for kids and teens
D. Preference for selective and justified application
VII. Call for Improvement in AI for Kids and Teens
A. Dr. Amanda’s suggestion for AI enhancement
B. Incorporating skeletal maturity in AI
C. Acknowledging the need for educating dentists
D. Highlighting the challenges in programming skeletal age
VIII. Advice for Orthodontic Professionals
A. Caution in using CBCT for growing patients
B. Stressing the importance of orthodontic expertise
C. Encouraging continual education on skeletal maturity
D. Dr. Amanda’s recommendation to learn more from free resources on the StraightSmile Solutions YouTube channel
IX. Conclusion
Dr. Amanda of Straight Smile Solutions passionately emphasizes the transformative impact of Invisalign’s CBCT feature, particularly for adult cases, especially those aged 30 and over. With confidence born from successful cases, she lauds the CBCT’s accuracy in addressing challenges like posterior crossbites and complex scenarios that previously seemed risky. However, she urges caution with its application in kids and teens, citing a perceived over-reliance on CBCT for every case and highlighting the need for further AI development to incorporate skeletal maturity. Dr. Amanda concludes with a reminder of the ongoing education resources available for dental professionals seeking to enhance their orthodontic expertise.
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Feb 13th, 2024
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Top 10 Tips to Avoid Braces in Kids age 0-10
Top 10 Tips to Avoid Braces in Kids age 0-10
I. Introduction
Dr. Amanda from StraightSmile Solutions. Today, she shares her top 10 tips for new parents or those expecting, focusing on guiding them to make informed decisions and potentially reducing the need for orthodontic treatment. Dr. Amanda emphasizes that while it might not be feasible to implement all 10 tips, having them in mind can positively impact dental health. Her channel, tailored for dentists, serves as an educational resource supported by research and personal experience. Viewers can explore a more extensive Phase One course on straightsmilesolutions.com for in-depth knowledge. Dr. Amanda’s clinical opinions are backed by research and complemented by recommendations for further reading and viewing. Without further ado, she delves into her top 10 tips, acknowledging that some might stir controversy but stressing their potential benefits.
II. Disclaimer
A. Acknowledgment of feasibility challenges
B. Emphasis on having tips ready for patients
C. Clarification: Tips may not eliminate the need for orthodontic treatment
III. Educational Resources
A. Mention of Dr. Amanda’s channel for dentist education
B. Reference to the phase one course at StraightSmile Solutions
C. Recommendation of two books and a movie for additional information
IV. Top 10 Tips
A. Exclusive breastfeeding for one year
1. Emphasis on pediatrician advice
2. Strict avoidance of bottles
B. No pacifiers past three, four, or five months
1. Discouragement of extended pacifier use
2. Advocacy for healthy alternatives
C. No baby food
1. Historical perspective on baby food
2. Advocacy for breastfeeding and whole foods
D. Avoiding thumbs, fingers, or foreign objects in the mouth
1. Strict prohibition of non-food items
2. Emphasis on oral hygiene
E. Lips closed when eating
1. Historical context and personal experience
2. Importance for jaw and muscle development
F. Lips closed when sleeping
1. Recommendation to check on children
2. Indication of potential nasal obstruction or allergies
G. Evaluation for arch expansion around age 6-7
1. Importance of early intervention
2. Emphasis on orthodontic assessment
H. Sugar-free gum with Xylitol
1. Approval of gum for muscle development
2. Benefits of oral hygiene
I. Chewing sugar-free gum with braces
1. Personal experience and recommendation
2. Caution against hard gum
J. Avoid pulling out baby teeth
1. General recommendation against extraction
2. Exceptions for damage, infection, or cavities
V. Conclusion
Dr. Amanda from StraightSmile Solutions has shared valuable insights and tips for parents, particularly those with newborns or pregnant patients. Though her top 10 tips may be challenging to implement entirely, they provide a comprehensive guide to support proper jaw development and oral health in children. While these tips are based on Amanda’s clinical opinion and experience, she emphasizes the importance of individual circumstances and encourages parents to be mindful of their choices. Incorporating research-backed information and references to additional resources such as books and a movie enhances the credibility of her recommendations. Dr. Amanda’s dedication to dental education shines through, emphasizing the significance of early interventions for long-term oral health benefits.
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Feb 7th, 2024
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Invisalign vs. Alternative Aligners vs. White Label Aligners
Invisalign vs. Alternative Aligners vs. White Label Aligners
I. Introduction
Dr. Amanda from StraightSmile Solutions. Today, we delve into the fascinating world of orthodontic aligners, breaking down three key terminologies that might be familiar to some but are crucial for everyone involved. At the forefront is the OG of aligner systems – Invisalign, a pioneer since 1998. We explore alternative aligner systems, a diverse landscape with countless brands emerging post-Invisalign patents. Learn the importance of case selection, predictability, and accountability loops for successful outcomes. Lastly, discover the cost-effective realm of white label aligners, offering flexibility and cash flow advantages. Join us on this journey as we unravel the intricacies of modern orthodontics.
II. Invisalign – The OG Aligner System
A. Originated in 1998
B. First exposure in 1998 at UCSF
C. Leading aligner system with advanced features
D. Higher lab fee due to R&D, marketing, and brand awareness
E. Capabilities: Lower jaw growth, expander attachment
F. Continuous innovation but expensive and requires an upfront payment
III. Alternative Aligners
A. Hundreds of brands globally
B. Proliferation post-expiration of Invisalign patents
C. Caution: Quality varies, some good, some not
D. Case selection crucial for success
E. Recommendation: Watch case selection videos for guidance
F. Predictability depends on a reliable ClinCheck and accountability loop
G. Accountability Loop: Virtual or in-person check-ins for each aligner
H. Low revision and refinement rates achievable with proper planning
IV. White Label Aligners
A. Term: Unbranded aligners from the manufacturing system
B. Cost: Setup price ranges from $90 to $200
C. Process: Third-party setup, local lab manufacturing
D. Appearance: Generic, unbranded aligners
E. Branding legality: Check FDA approvals for custom branding
F. Cost-effectiveness: Lower lab fees, around $18-$25 per aligner
G. Batch printing option for cost control
H. Accountability Loop crucial for success
V. Choosing Between Options
A. Invisalign
1. Benefits: Advanced features, continuous innovation
2. Drawbacks: Expensive, upfront payment, higher lab fees
B. Alternative Aligners
1. Benefits: Variety, case-specific suitability
2. Drawbacks: Quality varies, and thorough case selection is crucial
C. White Label Aligners
1. Benefits: Cost-effective, batch printing option
2. Drawbacks: Generic appearance, accountability, Loop essential
VI. Conclusion
Navigating the world of aligner systems requires a thoughtful consideration of various options. Invisalign is the pioneer, boasting advanced features at a higher cost. Alternative aligners, numerous in variety, offer viable choices if the right case is selected and a predictable setup is ensured. White label aligners provide a cost-effective alternative, allowing flexibility in batch printing and minimizing upfront expenses. However, success hinges on maintaining an accountability loop, whether virtual or in-person. Choosing the most suitable system depends on individual preferences, desired outcomes, and financial considerations. With the right knowledge and strategic approach, practitioners can effectively incorporate aligner systems into their orthodontic practice.
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Feb 4th, 2024
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Fixing a Mental Labial Fold
Fixing a Mental Labial Fold
Some patients may demonstrate a mental labial fold (otherwise known as a mentalis fold or mental labial angle, among others). It’s potentially possible to measure the angle of the mental labial fold as part of your orthodontics service,
What Angle Suggests a Mental Labial Fold?
It’s not always clear where a case is actually indicative of a mental labial fold. However, measuring the angle in this region can allow you to determine whether there is this type of fold present in a patient more accurately.
Generally speaking, the most attractive angle is generally considered to be between 107 and 118 degrees, although ranges up to 140 may be considered still within that normal category. Anything significantly outside of that range, such as below 98 degrees or above 160.
Can An Excessive Mental Labial Fold be Fixed with an Orthodontics Treatment Plan?
In many cases, an orthodontics treatment plan can be a successful option to help resolve an excessive mental labial fold, which is worth keeping in mind. However, in order to fix these cases with orthodontics, you will usually need to start very young (often in Phase 1). It will often also be combined with oral myofunctional therapy.
The cause of these cases can vary significantly. Sometimes, it’s simply a complication of Class 2 and a big chin bud. However, it can also be the result of habits (often lip habits) and certain types of strains.
In an adult, to resolve excessive mental labial folds, jaw surgery and plastic surgery will likely be needed, potentially including fillers and recontouring. Contact an orthognathic surgeon and an OMT if you have an older patient experiencing this sort of challenge to ensure it is properly addressed.
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Feb 3rd, 2024
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What is Hybrid Orthodontics?
What is Hybrid Orthodontics?
If you have been looking to start offering orthodontics for general dentists, there’s a lot you’ll potentially need to keep in mind – and hybrid orthodontics is just one such example here. In line with this thought, today, we’re looking at some of the main things you should know about hybrid orthodontics, including what this service is and how it might work for your needs.
What is Hybrid Orthodontics?
Hybrid orthodontics is a slightly different approach to regular orthodontics services, where you use two different systems to get a better outcome. Usually, a hybrid orthodontics treatment plan will begin with braces to address harder movements before progressing to aligners for finishing cases. However, this could be done in reverse, or you may want to use a functional appliance such as a palatal expander or twin block.
Why Hybrid Treatments Can be Useful
Not all movements are necessarily easy to complete, and some may be easier to address with either braces or aligners. As such, a hybrid orthodontics treatment plan can potentially offer the best of both worlds for general dentists doing certain movements. In particular, braces are particularly effective for tricky moves, such as high canines, a very rotated premolar tooth, or uprighting a molar. Meanwhile, aligners can be more effective for some other types of movements, usually more delicate ones.
This approach can help to save a significant number of aligners, which saves a great deal of money and makes the treatment plan a lot easier too. This is also a great way to save on lab fees, potentially even allowing you to use a white label or alternative aligner brand.
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Feb 3rd, 2024
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RED LIGHT CASE SELECTION- DO NOT TAKE THESE CASES!
RED LIGHT CASE SELECTION- DO NOT TAKE THESE CASES!
I. Introduction
Hey, it’s Dr. Amanda, the face behind StraightSmile Solutions. If you’ve been following my journey, you might have caught some of my earlier videos, particularly those color-coded green, yellow, and red. Today, I bring you an updated version as I gear up for an exciting webinar on May 7th – it’s free, and you’ll snag two CE units! Check out my website to register. Now, let’s dive into the nitty-gritty. Red light cases are the ones I strongly advise against for general dentists. Trust me; these are best left to the orthodontists. From canine impactions to tricky class two cases and challenging open bites, these are potential headaches and liabilities you don’t want on your plate. Stay tuned for more insights, and don’t forget to hit the like button and subscribe – it helps fuel my coffee addiction and covers those overhead expenses. Now, let’s navigate the world of orthodontics together!
II. Webinar Announcement
● Date: “May 7th.”
● Free: “It’s free.”
● CE Units: “Get two CE units.”
● Registration: “Sign up at my website, StraightSmile Solutions.”
III. Channel Promotion
● Request: “Please like and subscribe.”
● Appreciation: “I appreciate it; it pays for my coffee and overhead expenses.”
IV. Red Light Cases
● Definition: “Red light cases are cases I don’t want you to take as a general dentist.”
● Orthodontist Recommendation: “Pass them off to orthodontists.”
● Headaches and Liability: “Taking these cases can lead to trouble and potential liability.”
V. Highlighted Red Light Cases
● Canine Impaction: “Avoid canine impaction cases with exposures.”
● Full Step Class II Cases: “Don’t take full step Class II cases, especially in non-growing patients.”
● Negative Overjack Cases: “Exercise caution with major Class III cases, especially in non-growing patients.”
● Open Bite Adults: “Avoid open bite cases in adults exceeding 4 mm without OMT treatment.”
● Open Bite Kids/Adults: “No open bite cases without OMT treatment, and ensure a proper report.”
VI. OMT Treatment Requirement
● Clarification: “OMT treatment means oral M functional therapist.”
● Verification: “Require a report from OMT stating completion and recommendations.”
VII. Crown to Root Ratio
● Definition: “Paral cases with an unfavorable crown-to-root ratio less than 1:1.”
● Stability Concern: “More crown above the bone than root inside can lead to instability.”
● Periodontist Involvement: “Mandatory involvement of a licensed periodontist at every step.”
VIII. Conclusion
Dr. Amanda from StraightSmile Solutions emphasizes the importance of avoiding red light cases for general dentists. These challenging cases, including canine impactions with exposures, full-step class two cases in non-growing patients, negative overjet cases, and open bite cases, especially without oral functional therapy, pose significant challenges and potential liabilities. Dr. Amanda advises against taking these cases unless there’s orthodontic collaboration and warns about the necessity of a licensed periodontist’s involvement in cases with an unfavorable crown-to-root ratio. The insights shared in her videos serve as a valuable guide for dentists navigating the complexities of orthodontic cases, underlining the significance of specialized expertise and careful consideration in treatment planning.
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Feb 2nd, 2024
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What are Yellow Light Cases?
What are Yellow Light Cases?
Knowing the correct approach to pick easy orthodontics cases isn’t always the simplest, and if you are a new general dentist just getting started in offer ortho services with clear aligners, knowing the difficulty of each different treatment is vital. Luckily, we’ve outlined some of the main things you need to know about “yellow light” cases as follows – situations that may need a slightly more cautious approach.
What are Yellow Light Cases?
When it comes to orthodontics, not all cases are necessarily easy, nor can they be tackled with just any clear aligner brand. Here at Straight Smile Solutions, we refer to many of these cases as yellow light cases, or “warning” cases – situations in which you should only consider progressing if you have the support of a professional, qualified orthodontist on your side. This is especially true for your first fifty cases or so, and you should continue to get support until you are extremely advanced with orthodontics, including braces, clear aligners, and Phase 1.
Examples of Yellow Light Cases
If you see any of the following in your clinic, there’s a good chance they’re yellow light cases and will need support from a professional orthodontist to tackle them safely.
- Mixed dentition cases
- Slight Class 2 cases (molars and canines up to 4mm)
- Edge to edge anterior crossbite
- Deep bite and overbite cases (where more than 50% of the lower incisors are covered)
- Open bite cases in children, provided that the etiology is diagnosed and treated first (always get an OMT to do a functional evaluation and sign off the case in writing and ensure habits are controlled before starting)
- Mild periodontal disease with past attachment loss, provided that a 1-month evaluation is completed and charted first and that pockets are 3mm or less
- Posterior crossbite cases in children under 15 years old (don’t tackle this in adults!)
Keeping these tips in mind should help you decide whether or not to take on a case. If you’re unsure, don’t panic; our orthodontics experts here at Straight Smile Solutions can help you choose the right approach for your yellow light cases.
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Feb 1st, 2024
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