Should you do a RPE on a Pediatric Patient with Daily Nosebleeds
I. Introduction
Dr. Amanda from StraightSmile Solutions answers a question she received regarding whether it is safe to use an expander for orthodontic treatment in a child who experiences regular nosebleeds. She explains that daily nosebleeds are not normal and the child should first be seen by their primary care physician to rule out any underlying pathology. She notes that there are many potential causes of nosebleeds, ranging from dry climate to allergies to mouth breathing. However, before proceeding with any orthodontic treatment involving expanders and distraction osteogenesis, which breaks the jaw, the nosebleeds must be evaluated and cleared by the primary care doctor or ENT. Dr. Amanda stresses the importance of following this chain of command before orthodontic treatment so as not to put the child at risk if there is an unidentified bleeding disorder or condition present. She advises against treating these patients without clearance from the primary care physician first.
II. Medical Concerns
A. Distraction osteogenesis and its relation to breaking the jaw and forming new bone
B. Potential dangers if there is an existing pathology or regular hemorrhaging
C. Collaboration with a friend, a dentist with extensive experience in pediatric orthodontics and interaction with ENTs
III. Expert Response
A. Daily nose bleeding is not considered normal in children
B. Primary physician as the first point of contact
1. Referral process and follow-up
2. Importance of keeping the primary care physician informed
C. Dry climates and commonality of daily nose bleeds, influenced by humidity
D. Medications, constipation, diet, congestion, post nasal drip, allergies, and mouth breathing as potential causes
IV. Diagnostic Measures
A. Nasal patency test to assess airflow through the nose
B. Lateral symmetric X-ray to identify adenoids
C. Panoramic x-ray for assessing turbinates and septum issues
D. CBCT for airway analysis and sending to specialists for further examination
E. Sleep pediatric SDB questionnaire to identify potential sleep-related issues
F. Referral to an allergist if congestion or allergies are suspected
V. Professional Recommendations
A. Priority is given to physiologic concerns over orthodontic expansion
B. Advice to stick to the Primary Care First, Ortho second approach
C. Importance of obtaining proper releases from primary care or ENT before proceeding with orthodontic treatment
D. Discouraging treatment if parents fail to follow recommended procedures
VI. Conclusion
Dr. Amanda from StraightSmile Solutions provides invaluable insights into a complex query about children with nosebleeds and the use of expanders for orthodontic reasons. Emphasizing the importance of recognizing daily nosebleeds as abnormal, she wisely advises a systematic approach. Collaborating with a knowledgeable friend with extensive pediatric orthodontic experience, she underscores the significance of involving primary physicians and ENT specialists in the decision-making process. Dr. Amanda’s prudent guidance, rooted in patient safety, reinforces the necessity of addressing medical concerns before pursuing orthodontic interventions, showcasing her commitment to comprehensive and responsible healthcare.

Ghost IPR 2.0

I. Introduction

Dr. Amanda clarifies the concept of “ghost interproximal reduction” (IPR) in Invisalign treatment planning. She explains that ghost IPR refers to virtual IPR added to refine slight open contacts at the end of treatment when everything else in the case is perfectly aligned. Dr. Amanda emphasizes that ghost IPR should only be used as a “quick fix” for minor issues, not to address major tooth size discrepancies, crowding, or anterior contacts. She outlines the exact workflow for when ghost IPR is indicated, stressing the importance of addressing all other alignment and occlusal issues before considering this final detail refinement of light contacts with a few final aligners.

II. Reasons for IPR

1. Tooth science discrepancies
2. Mandibular Bolton as a common reason
3. Alternatives to IPR: Veneers or fills on small teeth
4. Importance of CBCT in treatment planning
5. Utilizing CBCT function for miraculous insights
6. Old school methods if CBCT is unavailable

III. Top Three Reasons for IPR

1. Bolton discrepancies
2. Addressing anterior contacts
3. The necessity of IPR in certain cases

IV. Ghost IPR Defined

1. Introduction to Ghost IPR
2. Differentiating Ghost IPR from conventional IPR
3. Clarifying Invisalign’s lack of recognition of the term

V. Straight Smile Solutions Debond Workflow Form

1. Emphasizing the importance of the workflow form
2. Availability through the YouTube channel
3. Membership perks and generous sharing of resources

VI. Conditions for Ghost IPR Application

99. 99.99999% completion of the treatment
100. Ensuring teeth are perfectly aligned
101. Bite settled, three points of occlusion on molars, two points on premolars
102. Ghost IPR as a final touch
103. Tightening up random open contacts
104. Ideal circumstances for Ghost IPR application

VII. Identifying Contacts for Ghost IPR

1. Charting and flossing technique
2. Marking light contacts
3. Using Leaf gauges and IPR gauges for measurement

VIII. Virtual Power Chain (VPC) Considerations

1. The role of VPC in refining treatment
2. Using VPC sparingly
3. Caution on potential crowding issues

IX. ClinCheck Verification

1. Verifying open contacts in ClinCheck
2. ClinCheck’s role in detecting open contacts
3. Decision-making based on ClinCheck results

X. Ghost IPR Request Process

1. Requesting Ghost IPR subtly
2. Seeking 0.1-millimeter IPR on specific sites
3. The discretion of Ghost IPR application

XI. Conclusion

Through her website, StraightSmile Solutions, Dr. Amanda offers valuable insights on orthodontic procedures like Ghost IPR. Her thorough explanations emphasize the importance of traditional IPR, cautioning against confusion with virtual or Ghost IPR. Watch her previous videos to ensure a comprehensive understanding. Dr. Amanda advocates for meticulous case evaluation, recommending Ghost IPR only when the bite is settled, occlusion points are optimal, and all other aspects are perfected. Her guidance, rooted in practical experience, demonstrates a commitment to achieving ideal results and maintaining long-term dental health.

A Phase 1 Case that Didn’t Need Phase 2
I. Introduction
Dr. Amanda from StraightSmile Solutions discusses a case where phase one growth modification and expansion treatment in a young patient resulted in a great outcome without needing phase two braces or aligners. She shows photos of the patient at age 13 after early treatment and notes the improvements from the original malocclusion. Although the patient did not wear retainers and had some relapse by age 18, Dr. Amanda explains how certain aspects improved further with natural settling. She then demonstrates why this is now an easy case for alignment with 32 Invisalign trays over 6 months.
II. Phase One Growth Modification
A. Brief explanation of the concept of Phase One treatment
B. Mention of growth modification and expansion techniques used
C. Emphasis on the positive outcome observed in the case study patient at age 13
III. Case Study Patient Profile
A. Patient age and initial conditions
B. Reference to the lack of early pictures but positive feedback from parents
C. Noteworthy issues such as overbite, overjet, and narrow arches
IV. Success without Traditional Orthodontic Treatment
A. Highlighting the achieved results without the need for braces or aligners
B. Discussion on the cosmetic and medical aspects of the patient’s outcome
C. Emphasizing the cost savings for parents and the satisfaction with the achieved results
V. Medically vs. Cosmetically Necessary Treatment
A. Dr. Amanda’s perspective on the necessity of Phase Two treatment
B. Assertion that, in some cases, cosmetic results may suffice without further intervention
C. Introduction of the idea that Phase Two may not always be medically necessary
VI. Importance of Retention
A. Recommendation of retainers at age 13 and their role in maintaining results
B. Addressing the issue of mesial migration and gradual changes over time
C. Encouragement for patients to wear retainers consistently
VII. Patient’s Return at Age 18
A. Observation of changes in tooth rotation, especially in tooth number seven
B. Positive aspects of midline correction and bite improvement over time
C. Acknowledgment of settling and coordination in the bite without retainers
VIII. Transition to Phase Two
A. Consideration of the patient’s desire for further improvement before college
B. Evaluation of the case as a “green case” suitable for various aligner systems
C. Mention of the treatment plan, including the surprising default of 32 aligners by Invisalign
IX. Conclusion
Dr. Amanda presented an illustrative case of a patient who underwent phase one growth modification expansion treatment at age 8. Excellent results were achieved by normalizing overbite, overjet, and arch form. The patient was given retainers at age 13 but did not wear them consistently. Some relapse in tooth positions occurred from age 13 to 18, including rotation of a few teeth. However, the overall settling of the bite over time without retention improved the midlines and side-to-side class I occlusion. While continued retention is generally recommended, this case shows that some aspects of the bite can self-improve. With a straightforward 6-month aligner treatment, an excellent final result can still be achieved in such growth modification relapse cases.
X. Closing Remarks
A. Expressing gratitude for the shared insights and informative content
B. Encouraging viewers to explore more case studies and information on Dr. Amanda’s YouTube channel
C. Endnote thanking the audience for their time and attention.

When it’s OK to do Single Arch Upper or Lower Only Ortho Treatment Braces or Invisalign
I. Introduction
Dr. Amanda from StraightSmile Solutions delves into a crucial topic that often leaves orthodontists hesitant – the request for upper or lower braces, single Arch braces, or Invisalign. Dr. Amanda emphasizes the importance of caution, highlighting her three key rules. She stresses the need for a ClinCheck or ClearPilot setup to calculate the Bolton and checks for anterior contacts. Discouraging discounts on single Arch treatments, she shares valuable insights into the complexities involved. With a focus on overjet cases as exceptions, Dr. Amanda provides a foundational understanding to empower orthodontists in making informed decisions and avoiding potential pitfalls in these specialized treatments.
II. Dr. Amanda’s Approach
● Dr. Amanda’s first rule: Always toss the case into ClinCheck or ClearPilot setup
● Importance of calculating Bolton in clear aligner cases
● Second rule: Never proceed until checking for anterior contacts
● Third rule: No discounts for single Arch treatment, explaining the added difficulty
III. Challenges of Single Arch Treatment
● Dr. Amanda discusses the difficulty of working with one Arch
● Mention of the misconception that single Arch treatment is quicker or easier
● Warning against offering discounts due to increased complexity
● Emphasis on the need for patients to acknowledge the potential switch to dual Arch treatment
IV. Examples of Cases Where Single Arch Might Be Considered
● Dr. Amanda shares instances where single Arch treatment might be considered
● Acknowledgment that exceptions exist, but caution is crucial
● Patient with very straight bottom teeth and minor rotation in a single tooth
● Cases where patients have minimal issues in one Arch, making it a potential candidate
V. Specific Considerations for Single Arch Cases
● Dr. Amanda explores the limitations of making space for single-arch treatment
● Exclusion of expansion, extraction, and sequential distalization in single Arch scenarios
● Emphasis on IPR (Interproximal Reduction) and proclination as the primary options
● Discussion on the challenges of IPR in cases with significant crowding
VI. Case-Specific Considerations
● Dr. Amanda discusses scenarios where single-arch treatment might be feasible
● Exploration of cases with a slight overjet or a gap between specific upper or lower front teeth
● Importance of evaluating contacts and the impact on the overall treatment plan
VII. Exceptions to Consider: Overjet Cases
● Dr. Amanda emphasizes comfort with overjet cases for single-arch treatment
● Detailed explanation of scenarios involving upper or lower overjet and how it influences treatment decisions
● Utilization of CBCT sagittal slices for proper assessment
VIII. Conclusion
Dr. Amanda from StraightSmile Solutions emphasizes the importance of caution when considering single Arch braces or Invisalign treatments. She highlights the complexity of such cases, urging practitioners to rely on digital tools like ClinCheck or ClearPilot setup to assess viability. Dr. Amanda discourages offering discounts for single Arch treatments due to their increased difficulty and potential for complications. She underscores the need to thoroughly examine each case, mainly checking for anterior contacts and possibly switching to dual Arch treatment. Exceptions may exist in cases of minimal overjet, but she advises against single Arch approaches to ensure optimal outcomes and practitioner protection.
IX. Closing Thanks
● Dr. Amanda expresses gratitude for watching and hopes the information provided is helpful
● Encouragement for orthodontic professionals to prioritize patient education and ethical treatment decisions

Sometimes, you might find that your patient displays a hyperdivergent profile, and knowing how to tackle these cases is often important. Fortunately, today’s guide outlines the main things you should know about developing a suitable hyperdivergent treatment plan; this should help make finishing cases in hyperdivergent patients a little easier.
What is a Hyperdivergent Profile?
Generally speaking, hyperdivergent profiles are characterized by long and backward growth, which usually arises due to airway issues (such as a blocked, small, or underdeveloped airway) or diets and habits. However, it’s worth noting that this can also have a small genetic link, too.
If you have a young patient presenting with a hyperdivergent profile, intervening ASAP is vital. Always run an OMT screening, an STB screening, and try to fix the airway issues prior to starting orthodontics work on a young patient with this presentation.
Unfortunately, if an adult patient has a hyperdivergent profile with minimal overbite, you’ll either need to refer the patient for jaw surgery or simply deal with the presentation as it is (assuming a treatment plan in this case is even possible, which it may not always be).
Take Care to Check the Smile Lines
Before starting ortho work to correct the vertical on a hyperdivergent case, make sure you have checked the smile lines closely to reduce the risk of complications arising. The ClinChecks and setups, and sometimes even in braces cases, can result in the incisors being pulled down, making them look much more gummy when finishing cases.
As such, in these cases, it will usually be more effective to do relative intrusion of molars with posterior bite turbos or rests rather than absolute extrusion of the incisors. However, if you’re not sure, don’t hesitate to get in touch with a professional orthodontics advisory team, such as our experts here at Straight Smile Solutions, for specific and tailored guidance on how best to tackle each individual case.

Should You Take a Phase 1 Interceptive Transfer Case?

When it comes to your phase 1 interceptive patients, it’s always important to ensure you’re taking the right approach – but when it comes to transfer cases in orthodontics, things can be a little more complex, and ensuring you know the patient’s history of treatment is essential. But should you even be taking a phase 1 interceptive transfer patient? Well, today’s guide has covered the key things you should consider to help you decide whether phase 1 interceptive transfer cases are right for you.
Why are Phase 1 Interceptive Transfers Complex?
Unfortunately, phase 1 interceptive transfer cases are often in a class of their own compared to regular patients. Indeed, if you are accepting a transfer case, you’ll need to be aware that you could potentially be taking on liabilities from the previous ortho provider; as such, checking each transfer case very carefully is essential to reduce the risk of getting caught out.
It’s worth noting here that Phase 1 interceptive and functional appliance transfer patients are very different from both Invisalign/clear aligner and braces transfers. As such, just because you’ve done Invisalign transfers successfully doesn’t necessarily mean this will work with Phase 1 interceptions.
Before taking on these transfer cases, always make sure you’ve manually checked the current work and get a copy of the initial treatment plan and records, as well as a summary of the treatment plan and all current progress and treatment notes. Don’t forget that you will also need to obtain a transfer form. If you can’t get the paperwork and notes from the previous provider, or if you are unsatisfied with what you’re provided with, starting a brand new case may be safer.
Remember: you are not obligated to take on a transfer case, nor did you have to use the appliances that were used before. As such, if you are not satisfied the work was done well to begin with, don’t hesitate to suggest starting again to the patient. Naturally, the patient may not be happy with this if they have already paid out to have the case started elsewhere; however, if the current treatment does not align with your treatment philosophy and approach perfectly, why take the case as it is?

Should I Take a Transfer Braces Case?

When it comes to your case selection, making sure you know whether or not to take on a transfer braces case is hugely important. However, this is something that many general dentists just starting with ortho overlook, often assuming that a transfer case will simply give faster braces results than starting from square one. However, this may not always be as straightforward as it seems, and so we’ve outlined what you should consider when braces patients move to help you decide whether or not to take these cases.
Should I Take on Braces Transfer Cases?
Before you take on a braces case that’s already started with another provider, check whether the patient has any paperwork, and check the brackets and the type of braces. Usually, patients will have the release, the transfer documents, their initial records, the treatment plan, the bracket type, and the like in a neat packet, which can help inform your decision.
If you do not have this information, tackling the braces case as a continuation may be risky. As such, we here at Straight Smile Solutions generally recommend avoiding any transfer cases that do not have this information at minimum. If you are concerned, you can potentially debond the current braces and then complete a new set of records and rebond the braces.
Before proceeding with any case, always complete a perio exam, get clearance and signed off by a general dentist, and ensure all the x-rays and initial records are taken. Then, consider the bracketing; if it’s not already 100% perfect, it can be easier to fully remove the brackets than repositioning several.
What About Invisalign?
If you have a transfer patient who has already commenced with Invisalign treatment, this usually shouldn’t be a problem, assuming it’s a US to US transfer case; in this scenario, it’s standard of care for the dentist to fill out a transfer form, which should make the case easier. Always get a copy of the original initial records and progress records, at least, to help ensure you are taking on a case that has been treated appropriately.

If you have been looking at finishing cases more quickly, considering fast braces techniques could be valuable – and simultaneously using an expander with braces can help speed up the process. However, if this is something you’ve been considering, it’s important to choose the right wires to ensure this fast braces approach won’t affect the expansion and make finishing cases harder.
What Wires Should I Use When Expanding an RPE Simultaneously with Braces
When choosing the right type of wire, you need to keep several factors in mind. Generally speaking, up to 18 ni-ti wires will be suitable for use simultaneously with expanders, as these are relatively flexible wires and don’t provide a counter force against the expander. However, try to avoid any wires heavier than an 18 ni-ti, as these may be more likely to exert a counter-force.
In addition, you could consider using sectional wires in the front when tackling fast expansion and braces cases simultaneously. However, this may somewhat depend on where you are looking to expand; for example, are you looking at the molar, premolar, or anterior areas predominantly? Indeed, this can influence the results and may cause the patient’s final arch form to look more like a triangle.
Overall, expanding an RPE and using fast braces simultaneously is possible, but you will need to use light wires (i.e., no heavy wires or Power Chain), which helps ensure that space isn’t closed and there are no significant counter forces. However, there is the risk they might pop some spaces; this can be resolved when finishing cases during the retention phase after the expansion is complete.

Fixing Generalized Mild Phase 1 Anterior Crossbites with OCS

When treating generalized mild Phase 1 anterior crossbites, there are many different options you could potentially consider – and choosing the right treatment plan can have a significant influence on the success of your orthodontics cases. As such, we’re outlined some of the key things you should know about using OCS to fix generalized mild Phase 1 anterior crossbites as follows to help.

OCS Should Only be Used in Young Patients

If you’re looking to use an OCS treatment plan, this should only be used for young Phase 1 patients. Indeed, for older patients, OCS may not be a suitable approach to treating a generalized anterior crossbite; however, just because a patient is young does not necessarily mean OCS will work for their case.

Always Diagnose the Cause Before Using OCS

OCS can be an incredibly valuable tool provided the cause of the negative overjet or anterior collisions. If the cause is due to an inclination of the incisors, and there is no skeletal malformation (e.g., the SNA, SNB, and ANB are normal), then OCS can potentially be used, provided you have contacts that can be used. It’s also possible to use OCS if the upper incisors are upright; however, if they are flared, you should not use OCS.

If you do use OCS, seeing the patient regularly is absolutely critical; otherwise, it is possible to push the teeth through the bone, which can naturally cause severe complications. Indeed, OCS is a very active mechanic and can do damage if not monitored closely.

Fixing an anterior crossbite in Phase 1 patients always depends on the diagnosis. If you’re not sure about the most appropriate treatment plan for your case, be sure to reach out to a professional orthodontist, such as our team here at Straight Smile Solutions, to help.

Understanding Black and Blue Dots in Invisalign Cases

In many cases, Invisalign’s system can offer a range of incredibly valuable tools, and understanding how to make the most of these is very important. In line with this thought, today, we’re looking at some of the key things you should know about the black and blue dot system with Invisalign to help you make the most of this tool.

What do Black and Blue Dots Mean in Invisalign?

When ordering aligners through Invisalign, you can turn on the TMA system to utilize the black and blue dot guides. These dots refer to the complexity of the case and how many aligners you might need, making it very useful information to consider when selecting cases.

What Do Black and Blue Dots Mean?

Blue dots indicate a moderate case that will likely need between 40 and 60 aligners to complete. Meanwhile, black dots may need anywhere up to 99 aligners or a hybrid aligner and braces approach to complete (or you could potentially consider a functional appliance in growing patients).

If you hover over the black or blue dot, you’ll be able to view information about the tooth, such as how much extrusion there might be or the angle of tipping. This will help you decide whether you’ll need a large attachment on these teeth; if the dots refer to intrusion, this may be less necessary, but extrusion or tipping cases will often benefit from having a very large attachment instead.

Be Careful with Black Dot Cases

If you see a black dot on any of your patients, you may need to consider carefully whether you should be taking on the case with Invisalign as a general dentist. In young, growing patients, black dots may not be such a major concern; however, in adults (or patients who are past the point of skeletal maturity), black dot cases may be much more concerning, which is important to keep in mind before starting an Invisalign treatment plan.

If you’re not sure, reach out to a professional orthodontist to see whether an Invisalign treatment plan will be suitable for black dot cases. You might find that some black dot cases would benefit from a braces or hybrid treatment plan, instead.