StraightSmile Solutions®

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.

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.