StraightSmile Solutions®

How to Build an in-house Aligner Lab and Launch Phase 1

Some of my favorite podcasts on the topic:


Feel free to buzz us at to schedule a complimentary consultation to help you get started.

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Coronavirus and your Dental Practice

I have friends and family members who live in Asia and right now their life is being severely impacted by Coronavirus. They are unable to make a living, simply, because everyday life is shutdown. People are staying in their homes. The only people who are flourishing are those who have careers which can be sustained with telecommuting.

This is concerning for my own family and clients who have patient/people-facing jobs. It is just a matter of time before we are in the same situation. Unless you have already set-up some systems for tele-dentistry, you will be severely impacted.

Now is the time to get the systems started:
1. Virtual Consults

The Virtual Orthodontic Consult- Smile Snap

2. Removable Ortho (Aligners/Phase 1)

Finally!-Affordable, Dental- Monitoring Alternative for General and Pediatric Dentists

At StraightSmile Solutions we are glad to talk more to you about launching or scaling ortho in your practice. Just visit

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How to get out of Invisalign Jail

I’ve been in Invisalign jail. I have family members currently in Invisalign Jail. I have clients in Invisalign Jail. Align technology has one of the most unfriendly financing policies and procedures. Once you get yourself in jail it can take years to get out of it.

This is one of the top three reasons doctors I work with switch to white label or other aligner companies. Now that other aligner companies are offering some of the once proprietary bells and whistles like bite ramps and precision cuts, it makes the leap a little bit softer.

If you’ve been in Invisalign jail, I would like to hear your story. Hopefully we can encourage Joe Hogan to change his policies. Please email me at [email protected]


How to Get Started with Phase 1 and RPE in your Practice

Many doctors are interested in integrating Phase 1 Orthodontics in their practice. Early treatment with Phase 1 Orthodontics has life-long health and esthetic benefits.

We have several resources we recommend to get started:

1. Read Our Blogs:

2. Listen to our Podcasts:

3. Watch our YouTube videos:

4. Watch our archives webinars:

5. Get a 1:1 consultation- it’s free! Go to to schedule or

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Schwartz vs RPE- Which is better?

Should you pick a removable or fixed expander?

Read more about expanders here:

Benefits of Expanders in Phase 1 EARLY MIXED DENTITION:

Develops the arches to the ideal width. Hypothetically speaking usually when the arches are developed in the early mixed dentition to the ideal width, the teeth tend to come in straight/straighter, there is less risk of impactions, there is less crowding, less risk for orthognathic surgery, less chance of premolar extractions. Of course we are just “paving the road” for the future. We can’t always predict the future. We can just make it more likely to turn out better. It also decreases the chance that they actually “need” braces. You can do this in combination of an EG appliance (eruptive guidance) for retention and you should have a super-nice outcome. Most likely you’ll only need a few express/white label aligners for Phase 2. Again, no promises! It just just more likely.


Some patients/parents come in with a strong preference for fixed or removable. You should go over the benefits and risks of each one and still make a clinical recommendation.

REMOVABLE (aka Schwartz)-
* Can be done in upper or upper/lower. Look at the arches. If there is lower crowding do upper and lower. If there is posterior crossbite, do 2 turns a week on top and 1 on the lower. If no crossbite and just v-shaped arches or crowding, do 2 turns top, 2 turns lower per week.
* Sometimes when you “untrap” the lower arch you can get some growth of the mandible and some natural expansion of the lower arch. A lower schwartz is just for arch expansion. There is no suture in the mandible so you aren’t growing jaws there.
* Schwartz is WAY better from the patient experience. Hygiene is better, discomfort is better, they can eat whatever they want, they can pick colors and bling it out. Schwartz is “fun”. Most patients are very compliant. Give them a case with a necklace or clip so they don’t lose it at school or at lunch.
* Build in a compliance contract/agreement with the price if they do lose them or the price to upgrade to fixed if they elect to.
* Schwartz expanders also can be customizable to add screws/pistons to jump anterior crossbites, distalize molars or facemask hooks to help to bring a maxilla forward.
* You can add acrylic to the front plate to open the COS (fix deep bites) or to the posterior teeth to intrude the molars (open bite)
* You can also embed a tongue/thumb crib for habits
* It is easier to turn because you can take it out of the mouth

* Often parents like the idea of fixed initially but from a patient experience, it is pretty miserable. They are bulky, hard to talk, hard to eat and uncomfortable. They are also smelly and trap a lot of food and plaque. More often than not, parents who elect fixed tend to regret it in hindsight. It is also hard for the parents to turn because they need to do it intra-orally.
* If you have a severe thumb habit, a fixed might be better because they will take out the removable appliance.

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Easy Wire Sequence for Straightwire

Doctors often ask me about wire sequence for patients. It can be impossible to create a cookbook/cookie-cutter wire sequence but in general this is how I do it:

1. 14 niti (but sometimes you go go straight to 16 if not that crooked)
Very rarely do I need to start with 12 niti. It is only if it is crazy crooked or with very high canines.

2. 16 niti (but sometimes you can skip this if it “cooked” good in 14)

3. 18 niti ( you can do front teeth power chain only in this wire but go mesial to mesial only from lateral to lateral and put a single tie on the distal)

*** stop here*** wait until 18 niti is 100% passive and then re-eval bracket position and rebracket to ideal prn.

Once all the bracketing is perfect and both you and the patient are 100% happy with the alignment and leveling of the teeth you can move on.

4. 17×25 niti
(in this wire you work on bite and close spaces so elastics and power chain if needed)

5. 18×25 niti

Usually done after this unless there are transverse issues still and then you can go into SS wire like 18×25 Stainless


If you still have deep bite or open bite issues you can go into RCS/ACS wires

Contact us at  or for support on any ortho case.

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Why are my Patient’s Invisalign Aligners Cracking?

There can be numerous reasons why Invisalign, ClearCorrect or clear aligners aligners crack but this blog will discuss the most common reasons. In order to diagnose the issue you need the following records:

1. The Treatment Plan
We are looking to see if the treatment plan was indeed “good” and even viable. If it is too rapid or unpredictable, this may be a cause of the breakage.


2. Compliance
I always recommend creating an in-house aligner tracking system but there are turn-key resources out there like You must have tracking pictures to measure the patient’s compliance.

3. New dental work or new teeth
If new molars are popping up like 12-year old molars or 3rd molars, this can act as a lever or pivot and cause flexing of the tray. Consider rescanning and be sure you capture the full distal aspect of the terminal molar.

If you have a patient who is breaking aligners, be sure to connect with us for a complimentary consultation at or

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RPE, Expander, Schwartz

PURPOSE: The purpose of this appliance is to widen the arch(es) usually to aid in the correction of a crossbite (usually due to a functional shift), resolve crowding, and/or expand overly constricted arches, particularly in the posterior region. When designing your appliance, make sure you communicate your goal to the lab so that the design is optimal.

DELIVERY: Seat the appliance with your fingers. If teeth have been lost or new teeth have erupted since the impression, you may need to adjust with an acrylic bur. The appliance should seat evenly with no rocking and adhere securely to the teeth. The patient should be able to remove and reinsert the appliance properly.

Week 1: The first week is an adjustment period for the patient. The patient should wear the appliance 24/7, except for eating and sports.

Subsequent Weeks: The patient should activate the appliance 1x-2x per week and continue to wear the appliance 24/7 except for eating and sports. The frequency will vary with the skeletal maturation of the patient. Do this on the same day consistently and chart the number of turns completed. It’s best to activate the appliance at night after brushing teeth to minimize discomfort.
Turn the appliance in the direction of the arrow. Make sure you are always turning the same direction and completing the turn fully before removing the key. You should see the next hole before you remove the key. If you can’t see the next hole, the turn isn’t fully completed. If they key doesn’t have a safety handle, tie floss on the key before sending it home with the patient. Tell the patient to bring the expander and the key to every appointment.
APPLIANCE CHECKS: It’s best to check the appliance every 4-6 weeks to ensure that the turns are being done properly. At each appointment check the jackscrew length with a periodontal probe and document. Also check the fit of the appliance to ensure it still fits properly. Adjust as needed to accommodate new teeth or loose teeth. Check the teeth that are being activated with floss to see if contacts are opening. Usually after 2-3 months, you will see the crossbite correct and/or the crowding begin to resolve. The arch form will become U-Shaped. Once you have acquired the optimal amount of space, retain for 3 months full time. This stabilizes the outcome. Palpate the roots around the buccal plate for any fenestration or pathology. You will have some relapse, so it’s best to expand a little bit more than needed.

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Invisalign and Elastics

Precision cuts with Invisalign can be a bit scary for a general or pediatric dentist.

Here’s a few of my favorite videos. My suggestion is to make your home care and demonstration videos eventually with your own patients and post them on your website.

(note- she’s using slot to slot which is different than is slot to button)

Contact us at StraightSmile Solutions for sample home care and tracking instructions.

You can buy the 3/16 medium elastics and buttons from the Invisalign store.

3/16 medium is for slot to button (1/4 medium if they have big teeth)
3/16 light is for slot to slot
3/16 heavy for button to button


Elastics need to be changed at least 4 times a day.

Check the bite as well as the tracking at every appointment or consider using a system like

To schedule a complimentary ortho coaching session, please visit or

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