StraightSmile Solutions®

Is it “OK” to Take Off Invisalign Attachments from another Doc’s Patient?
1. Initial Context: Invisalign is a removable form of braces. When patients have attachments, they are under treatment and the care of a particular orthodontist. Removing these attachments implies that the orthodontist is now part of the treatment plan and responsible for any potential damage.
2. Patient Relocation: If a patient moves states and requests the removal of their attachments, the orthodontist may discontinue treatment. However, this requires several procedures and necessary paperwork.
3. Required Procedures include deep bonding (polishing the teeth) and taking vinyl records before and after the procedure—a clear understanding of the patient’s condition and the type of retainers used.
4. Type of Retainers: If the patient is unaware of the type of retainers used, the orthodontist should not remove the attachments. The orthodontist becomes responsible for the patient’s relapse and retainer retention visits, thus necessitating the proper documentation.
5. Scenarios for Removal: Situations might involve checking with articulating paper, scanning, and x-rays. If the patient’s occlusion is unbalanced, the orthodontist may need to bond the teeth while working on bite settling. If complications arise, the orthodontist must start the Invisalign process again unless the case has been transferred formally.
6. Proper Protocol and Charges: Proper procedures and documentation are crucial for a patient’s relocation. A complete evaluation of the patient’s teeth, airway, and contacts is performed, considering the new case. The orthodontist may charge at least $1,000 for retainer work. Additional costs may apply for other services.
7. Refunds and Old Dentists: Patients may have already paid another doctor for the procedure, and it’s their responsibility to seek a refund. While some may wish to return to their old dentist, this is not always possible. Issues arise not because of patient relocation but because the original doctor discontinues treatment.
8. Standard of Care: Withholding treatment until the patient pays their bill often leads to a messy situation and can negatively impact the dentist’s reputation.
9. EO Release Form: When a patient moves, the dentist should provide an EO release form with all pertinent information. The charge should remain at $1,000 without fluctuation. If the dentist isn’t familiar with removal procedures, the patient should be referred to an orthodontist.
Please consult your liability insurance and dental practice for any questions or concerns.

Ordering New Vivara Retainers for Archived Patients

We all like to hope that our patients will see great results after finishing cases, but often, they may still need follow up treatment plans to ensure they’re keeping on track and not slipping. In line with this, today’s brief guide looks at some of the key things you need to know about ordering new Vivara retainers to help.
Ordering New Vivara Retainers for Archived Patients
If you have an archived patient who has finished their case(s) over five years ago, you may assume that you’ll have to completely set up the retainers again. However, with Vivara, this may not actually be the case. In fact, it’s possible to get Vivara retainers for archived patients, even five years ago.
To do so, use the following steps:
– Find the archived patient
– Unarchive the patient
– Go to “new Vivara subscription”
– Select “use upper arch from the previous retainer”
– Pay the retainer charge
It’s worth noting that archived patients’ scans will usually be deleted after ten years. However, you may be able to cloud store models to secure them.
Should I Rescan Patients Before Giving a Retainer?
In many cases, it’s worth checking your Patients individually to decide whether you should rescan. Sometimes, you’ll find that archived patients’ old Vivara retainers will still fit perfectly after many years. However, this may not always be the case. You should ideally do a virtual visit to be sure, but if you’re concerned, make sure to rescan if they need it. This will naturally cost a lot more, though.

Phase 1 Retention Retainer Options
● Dr. Amanda from Straight Smile Solutions
● Updated video on Phase One retention options
● Originally thought there were four options, but there are six
● Emphasizing the importance of patient-specific choices
II. Purpose of Phase One Treatment
● Interceptive orthodontics explained
● Focusing on correcting bite issues and creating space
● Addressing transverse, sagittal, and vertical problems
● Mention of class II, class III, and vertical issues
● Connection to habits and their effects on dental health
III. Factors Influencing Retention
● Retention needs depend on the specific treatment
● Stability of expansion, lower jaw growth, and upper jaw growth
● Importance of vertical correction and its stability
● Impact of canine eruption and habits on retention needs
● Consideration of parental preferences and patient compliance
IV. Retention Options
A. No Retainer
– Sometimes a retainer is not necessary
– Parental consent plays a role
B. Phase One Hawley Retainer
– Traditional Hawley retainer
– Adams clasp recommended
– Customizable with colors and designs
C. Bonded Retainers (Upper and Lower)
– Indirect bonding option
– Considered for its durability
– Cosmetic concerns and potential breakage
D. Thorough Retainer
– Explained as a modified Essix retainer
– Covers permanent teeth and palate
– Effectiveness in addressing transverse issues
E. Modified Lingual or Palatal Arch
– Used primarily on the lower arch
– Aesthetic concerns on the upper arch
– Emphasized durability and stability
F. Preformed Eruptive Guidance Appliances
– Mention of HealthyStart (with caution)
– Cost-effective and effective for eruption guidance
– Mention of alternative brand UConcept
V. Pricing Considerations
● Approximate cost ranges for each retention option
● Factors affecting pricing, such as customization and lab work
● Note on HealthyStart’s retainer cost and alternative options
VI. Conclusion
● Dr. Amanda’s preferred retention choice: Preformed Eruptive Guidance Appliances
● Encouragement for viewers to explore different options
● Reference to additional content and resources on the topic

Each option has advantages and considerations, and the choice should be made after thoroughly evaluating the patient’s case. Ultimately, effective phase one retention ensures the success of subsequent orthodontic phases and the patient’s long-term dental health.

Nighttime Clear Aligners: Are They Any Good?

Have you ever thought about trying nighttime clear aligners for your orthodontics cases? There are countless possible ways to use clear aligners, but do nighttime clear aligners really work? We’ve outlined some of the key things you need to know about nighttime clear aligners as follows.
What are Nighttime Clear Aligners?
Nighttime clear aligners are a type of aligner used only during the nighttime hours, meaning they provide intermittent force to the teeth. They can be much more practical options for patients, but this doesn’t necessarily mean they work well.
Can Nighttime Clear Aligners Work for Orthodontics Patients?
When nighttime clear aligners first became popular, there was very little data available on whether these can actually work. Unfortunately, when attempting to move or realign the teeth, inflammatory responses can occur. Intermittent forces (i.e., non continual pressure) can make this feel even more uncomfortable.
As such, on the whole, we generally recommend going for full-time aligners rather than nighttime aligners to reduce the discomfort experienced by the patient and to lessen the amount of pressure and force applied to the teeth (which can reduce the risk of complications).
Overall, the most effective approach to moving teeth is to take a very slow and gradual approach. Try to use weekly aligners with marginal movements (0.2 to 0.25 movements are usually effective) instead of going for intermittent forces instead.

Wearing a Theroux Retainer for Too Long

When finishing cases with Phase I treatment plans, Theroux retainers can be an excellent option for retention. However, wearing a Theroux retainer for too long may be problematic, which is important to keep in mind.
What are the Options for Phase I Retainers?
Phase I treatment plans are carried out as the first set of orthodontics in young, growing patients to fix bites, usually between six and nine years old.
Some of the different options for retainers when finishing cases with Phase I (and before ortho starts on Phase II if needed) include:
– Bonded retainers go behind the lingual teeth on either the top or the bottom
– Pre-finished / healthy start G retainers are highly effective (albeit expensive) Phase I and Phase II retainers
– Theroux retainers aren’t always advertised as often, but they are thicker than regular retainers and can provide excellent results.
You may not always need to use retainers, depending on the type of orthodontics work you have done on the patient.
If you decide to use Theroux retainers, it’s important to check patients every three to six months to ensure that the retainer still fits properly.
Unfortunately, though, Theroux retainers can potentially be worn for too long, which can leave the uncovered teeth prone to continually erupting (while others are not). This can mean that only the uncovered teeth will have contact once the Theroux retainers are removed.
In other words, you’ll have both posterior and anterior openbite in the patient. Fortunately, this can be fixed in Phase II, but it’s still worth finishing cases with regular checkups.
Get Professional Support
If you need professional support, please don’t hesitate to contact our experts here at Straight Smile Solutions. Our team can help guide you through your Phase I orthodontics cases, helping ensure you’re well-equipped when ortho starts.

Have you been looking to invest in general dentistry or orthodontics training? There’s only so far that online orthodontic courses can take you; as such, ensuring you’ve chosen the right dental school that equips you with the full orthodontics training and education you need is vital. Luckily, we’ve summarized some of the key things you need to look for to find the perfect dental school for general dentistry and orthodontic education.
How to Choose the Right Dental School
When looking for a dental school that offers general dentistry and orthodontic classes, the following factors are crucial to keep in mind:
1) Costs: There are a lot of costs associated with dentistry and orthodontics training. These include room, board, supplies, equipment, and the like.
a. Make sure you’ve asked for the total cost over the four-year period; contacting other students to see what sort of financial support and costs are associated can also help.
2) Graduation percentage: You don’t want to be retaking courses or giving up on your degree part-way through. So, always check the percentage of students who graduate successfully (first time) within four years for national and state boards. Look for a less than 10% fail rate at most.
a. Don’t go to a school that doesn’t have good stats here; otherwise, you could end up staying (and paying) for even longer.
3) What states are covered? Not every state will be covered by your training and licensure necessarily. Always check the states your course training can cover and ensure these align with your working goals. Not having the correct licensure can cause a lot of problems long-term.
4) Is there guaranteed reciprocity? It’s important to check whether the course offers guaranteed reciprocity.
Always check when procedures should be completed by when making your decision, too. Other key factors to consider include the facilities and whether the school is likely to continue operating or if it’s at risk of closure.

Which Comes First on Phase 1 Airway Cases? Ortho, ENT, or OMT?
I. Introduction
● The perplexing dilemma in orthodontics and airway cases
● The need for collaboration among ENTs, OMTs, orthodontists, primary care dentists, and physicians
II. Comprehensive Assessment
● Importance of a comprehensive assessment
● Steps in the assessment process
Sleep Screening
Cephalometric X-ray
CBCT scan for airway evaluation (e.g., Beam Raiders)
● Uncovering issues such as adenoids, lingual tonsils, and facial growth patterns
III. The Role of the ENT
● Determining when the ENT should lead
● Addressing concerns when parents resist orthodontic intervention
● The potential consequences of expanding a child’s mouth with existing nocturnal breathing issues
● Using CBCT scans to support the case for ENT intervention
● Involving the primary care physician or pediatrician if needed
IV. Timing of Orthodontic Treatment
● Optimizing the airway before orthodontic expansion
● Considerations based on patient age and skeletal maturity
● Addressing functional problems with OMT
● The variability of the order of intervention in different cases
V. The Role of Oral Myofunctional Therapy (OMT)
● Correcting habits related to breathing, swallowing, and speech
● Importance of a qualified oral myofunctional therapist
● A collaborative approach involving orthodontists, ENTs, and OMTs
VI. Ensuring Proper Sequence for Treatment
● Preventing compromised treatment outcomes
● The significance of collaboration and communication
● Risks of not following the correct sequence
VII. The Value of Interdisciplinary Care
● Additional fees vs. life-changing results for patients and families
● Satisfaction in achieving positive outcomes
● Impact of interdisciplinary care on patients’ lives
VIII. Conclusion
● The nuanced decision of intervention order in airway cases
● Emphasizing collaboration, communication, and sequence for optimal outcomes
● Making a difference in patients’ lives through precision and teamwork in healthcare.
IX. Alternative Options and Resources
A. Continuing Education
● Introduction to the C course covering expansion, evaluation, and on-demand credits.
● Cost-effective learning opportunities through collaboration.
B. Free Resources
● Dr. Amanda offers free resources, such as the phase one CEC course.
● Availability of courses for less than $500 at Straight Smile Solutions.

Have you ever wondered about developing a treatment plan for class III growing kids? In many cases, coming up with a class III orthodontics treatment plan can seem a little difficult, but this shouldn’t have to stop you from finding the right approach. Fortunately, our experts have outlined some of the things you should know to help in diagnosing the correct treatment plan for children with Class III cases.
Class III Growth Tendencies in Growing Kids
When coming up with an orthodontics treatment plan for growing children, it’s important to consider the different growth tendencies that growing individuals can express.
Of course, before you go ahead with this, making sure you’ve taken a Ceph is the gold standard of your orthodontics treatment plan. However, you may be able to get an idea of the correct diagnosis by eye.
Mandibular Excess vs Maxillary Deficiency Cases
Generally speaking, maxillary deficiency cases will show up in much younger patients than a mandibular excess. Indeed, mandibular excess cases tend to worsen as the patient’s growth slows down towards the end of their growth, often at the worst point around the end of puberty.
Always consider skeletal growth when addressing mandibular excess and maxillary deficiency cases. Luckily, Class III cases in younger patients is generally easier than in older, non-growing patients, provided they are enthusiastic about the orthodontics treatment plan.
Depending on the case in question, you may be able to move the lower teeth back, the upper teeth or upper jaw forward. Always complete an airway and OMT evaluation before progressing with these cases, to be sure.

If you’ve been working with a clear aligners company that allows proper sequential distalization, it’s worth noting that these cases will usually be quite time consuming, and you may end up doing one or two refinements, even if you take it slow and low and tackle things properly. But how should you handle refinements for these?
Tackling Refinements for Sequential Distalization
With a typical refinement, you’ll usually take a scan, a set of photos, get bite marks, take a panoramic x-ray, and so on. However, with a sequential distalization refinement, you’ll need to go a step further. In these cases, always map the spaces in the back of the teeth in addition to the usual checks.
To get an accurate measure, especially for open contacts, you’ll need to use an IPR gauge. Usually, gaps will be no larger than 0.5.
Include these in your progress notes or an IPR form; this allows you to cross reference with the ClinCheck to ensure the spaces are being picked up (especially smaller ones). If needed, you could potentially add ghost IPR to the next setup to make the treatment plan more accurate. This also allows you to demonstrate to the patient that yes, the treatment plan is progressing – even though they may not be able to see much change in the front of the teeth immediately.
Of course, before making any decisions on refinements and revisions for sequential distalization, always take a Ceph to check that the movements won’t cause adverse effects to the soft tissue and the bone.

How to Break Up with Your Orthodontist
Introduction
The journey toward a straighter smile can sometimes feel like a relationship in orthodontics. Dr. Amanda, an expert from Straight Smile Solutions, delves into the delicate topic of contemplating a “breakup” with your orthodontist.
● Dr. Amanda from Straight Smile Solutions addresses patient concerns about orthodontic treatment dissatisfaction.
● Emphasizes the variability in treatment duration and the importance of patient satisfaction.
II. Factors Affecting Treatment Duration
● Orthodontists estimate treatment duration, but various variables can impact progress.
● Factors: tooth movement rates, patient compliance, missed appointments, external factors (e.g., COVID-19).
III. Recognizing Treatment Timelines
● Stress the importance of understanding that treatment timelines are estimates, not fixed.
IV. Handling Dissatisfaction
A. Initiate a Conversation – Patients should contact the orthodontist’s office in advance to request a meeting. – Meeting with the orthodontist and office manager for comprehensive discussion and evaluation.
B. Review Treatment Contract – Patients should refer to their treatment contract for terms and conditions. – Discuss provisions for discontinuation or transfers.
C. Alternative Actions – Mention options like filing complaints with the State Dental Board or insurance, but not as a first resort.
V. Orthodontic Relationships
● Compare orthodontic relationships to dating, emphasizing their long-term nature.
● Normalize occasional considerations of discontinuation.
VI. Seeking Second Opinions
● Encourage patients to seek second opinions from other orthodontists if dissatisfied.
● This can provide valuable insights and improve communication with the original orthodontist.
VII. Maintaining a Friendly Yet Firm Approach
● Advise patients to communicate openly with their orthodontic team.
● Orthodontists are willing to make adjustments to address concerns.
VIII. Conclusion
● Dr. Amanda provides a comprehensive overview of handling orthodontic treatment dissatisfaction.
● Highlights the importance of communication, understanding contracts, and seeking second opinions.
● The goal is patient satisfaction and a successful orthodontic journey.

By offering guidance on understanding treatment contracts and seeking second opinions, Dr. Amanda empowers you to make informed decisions and ultimately achieve the best possible outcome on your orthodontic journey, reinforcing that a successful relationship with your orthodontist is built on trust and open dialogue.