StraightSmile Solutions®

I. Introduction
The CBCT feature on Invisalign ClinCheck allows you to overlay the patient’s teeth from their CBCT scan onto their digital treatment plan. This provides a more accurate prediction of tooth movement by incorporating root anatomy and bone structure from the scan. Use this feature for complex cases involving extractions, interdisciplinary treatment, or when precise root positioning is critical.

Dr. Amanda with Straightsmile Solutions discussing when to use the Invisalign ClinCheck CBCT feature
II. Overview of ClinCheck CBCT
A. Relatively new feature, available in the US, Canada, and Australia
B. Integrates CBCT scan into Invisalign treatment planning
C. Can show risk of fenestrations from tooth movements
D. Helps create more accurate treatment plans
E. Does not replace the need for lateral cephalometric x-rays for soft tissue
III. Recommendations for Using ClinCheck CBCT
A. Call Invisalign support to help integrate CBCT scans into ClinCheck
B. Must be done at the start of a case; can’t add later in treatment
C. Useful for complex adult cases, not needed for most teen/child cases
D. Can show risk of bone loss, root proximity
E. Improves accuracy of ClinCheck and reduces risks
F. Still, clinical judgment is needed to interpret predicted fenestrations
IV. Benefits of More Accurate ClinCheck
A. Reduces risks and complications during treatment
B. Ensures proper tracking and fewer refinements needed
C. Allows slower movement velocities if needed
D. Creates accountability loop for provider
E. Leads to better final results
V. Conclusion
A. ClinCheck CBCT is a valuable tool for complex adult Invisalign cases
B. Provides additional diagnostic information to aid clinical judgment
C. Helps create more precise treatment plans and improves outcomes
D. Recommends providers learn how to integrate CBCTs into Invisalign workflow

I. Introduction
A. Dr. Amanda from Straightsmile Solutions

B. Explaining “pre-phase 1 Ortho treatment”
II. Phase 1 Ortho Treatment
A. Usually starts around age 7-9

B. Criteria for phase 1 treatment
1. First permanent molars erupted
2. Eruption of lower anterior teeth (5, 6, 7, 8)
3. Ideal: Eruption of upper anterior teeth (7-10)

C. Goal of phase 1 treatment
1. Correct overjets
2. Address negative overbites
3. Manage crossbites (anterior and posterior)
4. Develop arches to prevent impactions and crowding

D. Phase 2 treatment should be simplified if Phase 1 is done correctly

E. Rare cases may not need phase 2 treatment
III. Pre-Phase 1 Ortho Treatment
A. For younger kids with baby teeth or limited permanent teeth

B. Considerations for pre-phase 1 treatment
1. Emotional maturity of the child
2. Parent’s awareness and concerns
3. Potential habits or issues (e.g., open bites, constricted palate)

C. Custom treatment is not recommended for very young kids

D. Simple, off-the-shelf options
1. UT trainer or U concept appliances from Great Lakes Orthodontics
2. Healthy Start appliances (requires certification)
3. Myobrace appliances (another option)

E. Emotional maturity is crucial in pre-phase 1
1. Crying, fidgeting, inability to follow instructions
2. Patience and readiness are essential

F. Reevaluate the child’s readiness over time
IV. Billing and Insurance
A. Insurance may not always cover pre-phase 1 treatment

B. Pre-authorization is recommended

C. Consider the impact on the patient’s lifetime insurance benefits

D. Charging a cash payment or providing credit for future phase 1 treatment
1. Offer a credit if pre-phase 1 goes well and they proceed to phase 1
2. Ensure compliance and motivation

E. Be aware of your state’s laws and regulations regarding billing and insurance
V. Conclusion
Pre-Phase 1 interceptive treatment benefits young patients, but its success relies on a child’s emotional maturity. Emotional maturity is crucial for a comfortable and productive orthodontic experience. Orthodontists must assess emotional readiness and consider alternative approaches when children show unease or uncooperativeness. This ensures a smoother and more successful orthodontic journey for young patients, ensuring a comfortable and productive experience for both the child and the orthodontic team.

White Label vs Alternative Aligner Companies

Have you ever wondered about what white label and alternative aligner companies are and how they differ? The differences between white label and alternative aligner companies in orthodontics aren’t always easy to identify, but luckily, we’ve outlined some of the main things you need to know to help with this. Hopefully, this will help you decide where to go for your custom aligners.
What’s the Difference Between White Label and Alternative Aligner Companies in Orthodontics?
When choosing an aligner company, it’s important to consider between investing in in-house aligners or custom aligners. And, of course, if you choose custom aligners, choosing between white label and alternative aligner companies is vital.
Sometimes, both white label and alternative custom aligners are grouped together. However, there are technically subtle differences between custom and white label aligners you should also know.
Alternative Aligners
An alternative custom aligner company is a brand (other than the “big two” brands: Invisalign and ClearCorrect, which patented the custom aligner designs first). Alternative custom aligner companies have branding and will often do marketing and the like to encourage people to try them. These alternative aligners will usually be around 20% more affordable than other options.
White Label Aligners
Another option is white label aligners. White label custom aligners are generally unbranded and can even be made in-house using 3D printers and the like. Alternatively, they may have the branding of the printing company, but they typically won’t have specific aligner branding.
White label aligners are often very affordable compared to branded solutions, and they can be either outsourced or made by your team. However, you will need to pay per aligner or retainer, rather than paying for an unlimited plan. This also means you’ll be paying for every single refinement or revision aligner.
Can All Cases Use Alternative or White Label Aligners?
Green cases are often able to be done with any choice of aligner company; however, if you have a yellow or red case, using Invisalign or getting orthodontics support is generally advisable.

Quitting Your Job with Active Invisalign Cases

Sometimes, things happen outside of our control that can leave us having to leave our jobs behind. Whether it’s a change in circumstances, a family emergency, or the like, knowing how to prepare for these situations is important. However, one topic that’s not necessarily easy to work out is how to address your active Invisalign cases – and we’ve outlined some key things you need to know in today’s orthodontics guide to help.
Do I Need to Finish Active Invisalign Cases Before Leaving?
One of the first questions you may have asked is, do you need to finish your active Invisalign cases before leaving? Well, if you’re an associate, this will likely depend on your contract. If your contract requires you to finish cases, you’ll likely need to adhere to this. The requirements may also depend on whether you’re a business employee or a 1099 contractor.
It’s also worth considering whose Invisalign account the patient falls under (e.g., in your personal account, the owner-doctor’s account, or the company’s account). If the patient is in the owner-doctor’s account, this may mean you have fewer requirements to finish the case. However, if the patient is in your account, you’ll likely need to take responsibility for finishing the case (or arranging for someone else who can). You may be able to transfer the patient to the owner-doctor’s or company’s account.
Will I Get Paid for Unfinished Cases?
There’s no saying whether you’ll get paid for unfinished cases. Check the terms of your contract to see whether you will be paid (and how much) for an active unfinished Invisalign case. Often, however, you won’t be paid all or part of the fee.
What Will Happen If I Don’t Finish Active Invisalign Orthodontics Cases?
If you don’t finish active Invisalign orthodontics cases (or arrange for someone suitably experienced to do so), there’s a significant risk of getting poor reviews on your account. This could lead to patient abandonment and make it harder to get future work in your new area after leaving the previous employer.
Fortunately, here at Straight Smile Solutions, we can help with this! We can help audit your cases, informing you as to the progress of your cases; this makes it easier to transfer cases to the owner-doctor or another associate while giving you peace of mind.

How to Close Open Contacts Posterior Spaces at the End of Invisalign / Orthodontic Treatment
Dr. Amanda – Straight Smile Solutions

I. Introduction
A. Issue: Finished orthodontic treatment, but open contacts persist.
B. Options for resolution.

II. Causes of Open Contacts
A. Insufficient IPR (Interproximal Reduction).
B. Challenge of accurate IPR.

III. Learning Accurate IPR
A. Check Dr. Amanda’s IPR videos on gpwebinar.com.
B. Upcoming free live IPR video in May 2021 (CME units).
C. Sponsored by Garrison Dental; visit their website to sign up.

IV. Options for Resolving Open Contacts
A. Unlimited/Comprehensive Invisalign or Clear Correct Cases
1. Refinement
2. New scan or impression.

B. Invisalign Cases
1. Virtual Power Chain (VPC)
a. Watch Dr. Amanda’s VPC videos for detailed instructions.
b. Risk: Overcrowding; proceed cautiously.
2. Add VPC to any Invisalign case at the end.

C. Other Brands
1. Likely need to do a refinement due to limited options.

D. Circumferential Wraparound Retainer
1. No occlusal plane wires.
2. No stabilizing wires.
3. Risk of space closure interference; no guarantees.

E. Custom Mini Positioner
1. From TP Orthodontics (US patents).
2. Precise placement like a denture wax-up.
3. Customize to close spaces.

F. Considerations for Bands Instead of Brackets
1. Open contacts are also relevant in bands.
Summary
Addressing open contacts and posterior spaces at the end of Invisalign or orthodontic treatment is crucial for achieving a beautiful and functional smile. Through the careful planning and execution of orthodontic techniques, patients can enjoy the benefits of a harmonious bite, enhanced aesthetics, and improved oral health. The journey toward closing these spaces may involve using various appliances and strategies, ultimately leading to a successful treatment outcome. The key takeaway is that post-treatment care and retention are just as vital as the initial phase of orthodontic treatment. With the right approach and commitment, patients can confidently embrace their new smiles, knowing that open contacts and posterior spaces are no longer a concern.

If you have an RPE case, it’s important to consider whether you should be banding Es or 6s. 6s are the first molars that come in when patients are around six years old. Meanwhile, Es are the second baby molars that come in at around the age of two years. However, it’s not clear which you should be banding in RPE, which is where we can help.
Should I Band Es or 6s in an RPE Case?
If you have an RPE case in orthodontics, you’ll need to consider your treatment plan carefully. Ideally, take an x-ray of the patient before going any further, as this can help influence your decision.
The main benefit of banding the Es is that they tend to be a little more comfortable for the patient, and the teeth will fall out later regardless. However, if the Es have begun to fall out and the 6s are through, these can be banded as well.
Critically, if you think that the patient’s baby teeth are likely to fall out during or shortly after the treatment plan, it’s worth not banding those teeth. Check the x-ray and try to make sure that you’ll have at least two to three months to complete the RPE case before any banded Es fall out.
And, of course, a more gradual orthodontics approach may give better results, especially in a general dentistry clinic, so ensuring you have plenty of time to complete the case can help reduce the risk of complications.

Bonding Buttons and Attachments to Crowns: What You Should Know

If you’ve been taking on Invisalign or clear aligner cases, knowing how to tackle cases with crowns is hugely important. In line with this, today’s brief guide outlines the core things you need to know to help with this.
Should You Bond Buttons and Attachments to Crowns?
If you’ve got a patient with crowns, it’s first important to clarify whether you should even consider bonding buttons and attachments to the crown. Well, for simple cases (e.g., mild to moderate crowding or Class I), you may just be able to bypass the tooth by blocking off buttons or attachments. This is because attachments may be less needed in easier cases. However, for more severe cases (e.g., extreme crowding), you may need a button or attachment.
If you’re not sure, you’ll likely want to run this by an experienced orthodontist first. Luckily, our experts here at Straight Smile Solutions can help with this, so if you need a one-to-one consultation to help with your decision, contact us today and we’d be thrilled to help!
What to Do When You Need a Button or Attachment on a Crown Tooth
If you have a patient who has a severe case and has crown over a tooth, you’ll need to consider the crown material. Crowns are usually made from porcelain, gold, or stainless steel. If the patient has a stainless steel crown, these are usually temporary, so it’s usually best not to do ortho in these cases.
If the patient has a gold crown, you may need to fit a fitted band over the gold. However, you can’t bond or glue a button to metal, so that option’s out (unless you drill a hole in the gold crown).
Finally, for porcelain crowns, you may be able to bond, depending on the type of porcelain. Usually, new porcelain crowns that are shiny won’t bond buttons well, so you may need to drill a hole in the crown to bond. You can also get dedicated porcelain bonding kits.
Always get a written disclaimer before doing the treatment plan so the patient is aware that the crowns may need to be damaged if bonding doesn’t work. Otherwise, you may be liable for the cost of new crowns after ortho finishes.

Can you Expand with RPE or Schwartz the SAME TIME as Lower Invisalign Clear Aligners?
I. Introduction
A. Dr. Amanda from Straight Smile Solutions
B. Upcoming Invisalign technology expansion
C. Need for creative solutions in the absence of expanders

II. Phase One Course at Straight Smile Solutions
A. Resources available (playlist and course)
B. Affordable cost

III. Scenario Discussion
A. The need for palatal expansion in growing kids
B. The desire to avoid braces

IV. Utilizing Invisalign for Palatal Expansion
A. Exploring an unconventional approach
B. Aligning teeth before expansion
C. Requesting alignment with maximum transverse movements
D. Avoiding other treatment elements like proclamation, IPR, etc.

V. Process Steps
A. Preparation before expander delivery
B. Patient communication about Invisalign in stages
C. Upper expander delivery
D. Caution on speed to avoid scissor bite
E. Aligning front teeth

VI. Progression and Bite Settling
A. Monitoring treatment progress
B. Retaining upper bite after expander removal
C. Refinement process with Invisalign on the bottom

VII. Handling Upper Aligners
A. Disposing of upper aligners
B. Explaining Invisalign’s limitations
C. The importance of traditional expansion
D. The need for bone retention and remodeling

VIII. Conclusion
A. Success of the unconventional approach
B. Continued use until Invisalign expanders are available
C. Awaiting the launch of expanders for improved treatment options.
Summary
The concurrent use of RPE (Rapid Palatal Expansion) or Schwartz appliances alongside lower Invisalign Clear Aligners represents a promising and versatile approach in orthodontics. This dual treatment strategy can effectively address upper arch expansion needs and lower arch alignment issues, offering patients a comprehensive solution for their orthodontic concerns. By combining these techniques, orthodontists can provide a more balanced and harmonious smile transformation, ensuring optimal dental health and aesthetics. This innovative approach empowers patients to achieve their desired results efficiently and discreetly, further exemplifying the ever-evolving landscape of orthodontic care.

Can you Delay RPE Palatal Expansion in a Mixed Dentition Patient? Risks
I. Introduction
● Dr. Amanda of Straight Smile Solutions discusses the need for early expansion in mixed dentition cases.
● Promotes her phase one course for comprehensive understanding.
II. Can We Wait?
● Addressing the question of whether expansion can be delayed when the patient is in mixed dentition.
III. Reasons for Expansion
● The main reasons for early expansion include:
➢ Airway issues and symptoms related to airway problems.
➢ Crowding, vaulted palate, and insufficient space.
➢ Eruption lanes, potential impactions, and lack of space for teeth.
➢ Growth issues and unfavorable vertical growth patterns.
➢ Space creation for future dental work and reduced risk of impactions.
IV. Airway Concerns
● Exploring airway issues and their connection with expansion.
● Mention the importance of sleep-disordered breathing forms.
V. Growth Patterns
● Discussing how patients with airway issues tend to grow down and back instead of forward.
● Describing the need to prevent unfavorable vertical growth patterns.
VI. Eruption Lanes
● Highlighting the importance of clear eruption guidance lanes for teeth.
● Discussing the connection between expansion and improved outcomes.
VII. Timing of Puberty
● Emphasizing the significance of considering puberty timing.
● Encouraging practitioners to determine when puberty will occur, especially in girls.
VIII. Boys vs. Girls
● Comparing the importance of early expansion for boys and girls.
● Boys may need it for different reasons, while girls require careful timing.
IX. Advantages of Early Expansion
● The potential to save money, time, and discomfort by addressing expansion at a younger age.
● Discussing better outcomes and patient readiness.
X. Conclusion
● Dr. Amanda recommends starting expansion as soon as first molars and a few incisors are present.
● Early expansion often leads to better success compared to waiting until adolescence.
Summary
Dr. Amanda from Straight Smile Solutions addressed whether to wait for expansion treatment in mixed dentition cases. She highlighted the primary reasons for early intervention, including airway issues, unfavorable growth patterns, space concerns, and timing of puberty. Early expansion improves the airway and growth and can lead to a more efficient and cost-effective orthodontic journey. Dr. Amanda emphasized the importance of early action and shared valuable resources for in-depth information on the subject.

What You Need to Know About Crown to Root Ratios

Have you ever wondered about what crown-to-root ratios are and what the optimal crown to root ratio should be before ortho starts? When developing a treatment plan, crown-to-root ratios can significantly impact the approach you take. In line with this, we’ve outlined some key things you should know to help.
Always Start with a Panoramic X-ray
Before ortho starts, one of the first tips we recommend is to take a panoramic x-ray. Indeed, a panoramic allows you to check more pathology, further helping inform your decision without worrying about blind spots or unknowns.
What Should the Crown to Root Ratio Be?
In most cases, you’ll want to make sure that at least 50% of the tooth is in the bone when creating an orthodontics treatment plan. In other words, the crown to root ratio should be 1:1 or better (i.e., with more of the root embedded in the bone).
Always consider the patient’s history of periodontal disease as well when making your treatment plan. If there was a history of periodontal disease or if the crown to root ratio was not correct when ortho starts, there’s a chance of poor prognosis (potentially even with the teeth falling out).
Always Consider Individual Cases
In some cases, it’s worth noting that individual cases might not be as clear-cut. For example, you may have a borderline case that needs a PA x-ray to check the tooth isn’t inclined differently. A periodontist should also check this before ortho starts to make sure orthodontics is safe for the patient; always get the periodontist’s confirmation in writing before progressing if there’s any uncertainty.
And remember: if you have a borderline case, make the treatment plan as gradual and gentle as possible. Make sure that the patient also returns to their periodontist for a check-up regularly (every few months).
The patient also needs to know at the outset that if things aren’t progressing as expected, the treatment plan may need to stop, in which case the patient will be billed for services rendered. You may need to explain “billed for services rendered” to the patient at the outset so they know how this works.