StraightSmile Solutions®

If you are a frequent reader of my blog (www.straightsmilesolutions.com/blog) or a subscriber of my YouTube channel (https://www.youtube.com/c/Straightsmilesolutionsortho), you’ve become accustomed to my tricks and tips on attachment and auxiliary design and placement. And you probably know that I think “optimized” attachments are mostly an over-hyped, proprietary feature of Align Technology. Below, I have compiled some tips and tricks for attachment placement and design. These aren’t from any book or class, they are just tricks that I’ve learned over 18 years as an Invisalign provider.

1. You CAN put attachments on both the lingual and palatal of teeth, if there’s space and clearance.

For rotated teeth, just ask! We do this all the time in braces with moments and counter- moments with buttons and chain, why not in aligners? Fun fact: many white-label aligner companies also let you do this. Make sure you remove the palatal ones towards the end of treatment before they affect the bite, though. Treatment timing is critical.

2. Invisalign needs more attachments than other systems because of retention. If you don’t use Invis, you’ll need FEWER attachments.

Invisalign’s very scalloped and low-profile trim and elastomeric, thermoplastic material necessitates the use of copious attachments. That’s just how it is. Often, they are only there to hold the aligner in. This is why some direct-to-consumer companies have higher trim and still get good outcomes.

3. Always put attachments on for extrusions of incisors, even if the software doesn’t recommend IT.

Anytime I see incisor or canine extrusion, I ask for attachments. If it’s a lot of extrusion (more than 1mm- aka a blue or black dot), ask for a “full-sized horizontal, rectangular attachment”.

4. Always put attachments on for rotations of incisors or premolars more than 15 degrees.

Anytime I see big rotations on premolars or incisors or canines, I ask for attachments. If it’s more than 20-25 degrees, I ask for “full-sized vertical, rectangular attachment,” or you can ask for a counter-moment with an opposite attachment on the lingual or palatal (see #1).

5. Power ridges are uncomfortable and cause the plastic to jet-out. There are other ways to get torque but they involve either hybrid treatment (with braces) or attachments.

I’m not a huge fan of power ridges, but they can work for single tooth torque in a patient who can tolerate the irritation of the plastic. Orthodots are great aligner band-aids.

6. Chewies are necessary to FULLY engage your attachments.

All your patients should be using aligner chewies regularly. They are a $1 key to success that you should give to every patient, and you can buy all shapes and flavors on Amazon.  Sometimes gaps or tracking issues aren’t related to the actual tooth where you see them but are related to an adjacent tooth that is intruding and not tracking. For example, if you are intruding #8 and the intrusion isn’t tracking, you might see a gap/tracking issue incisal to #7. Doctors can get puzzled because there was no extrusive mechanics in the treatment plan, but this is just relative to the movement on the adjacent tooth. Using chewies everywhere around a tooth that isn’t tracking, not just on the tracking gap, will help to fix the case without a refinement. Usually, it is best to “backtrack” one or two aligners and start the movement over.

7. If you are using precision cuts and elastics, it is best to bond to the TOoth and not use slots, because this causes retention and tracking issues and requires way more attachments to anchor the aligner on the mouth.

I stopped using slots and only started to use buttons on class 2 and class 3 movements. Yes, it’s a few more minutes to bond, but ultimately, you’ll need fewer attachments for retention and will have less tracking issues.

 

8. Open bite cases will need large attachments on the premolars to support the extrusion.

I actually think it is EASIER to treat open bite cases with plastic than with braces, but don’t forget to put full-sized horizontal attachments on the premolars AND eliminate any myofunctional habit prior to starting aligner treatment (tongue thrust, mouth breathing, finger sucking). Believe it or not, some adults still do these things and it will unravel your outcome. The tongue is one of the strongest muscles in the body. I always say that open bites come from somewhere, so you must be a detective to find the source and treat it as well.

I am a huge fan of FitStrip for IPR but here’s a non strip option for those of you who have STRAIGHT TEETH and need IPR. (I don’t recommend this on rotated teeth).
https://www.strauss-co.com/index.php/en/dental-homepage/dental-kits/282-ipr-kit

Here’s what you need to do to start facemask therapy in a growing patient with a retrognathic maxilla:
(note links are just suggested- you can buy from any vendor):

Buy it from ebay (or any ortho company) https://www.ebay.com/itm/J-J-Ortho-Orthodontic-Protraction-Facemask-Reverse-Headgear-for-Underbite/221863787243?hash=item33a81cbaeb:g:soQAAOSwoRFdFsW3
Also need extra oral elastics: https://www.pearsondental.com/catalog/product.asp?majcatid=744&catid=6538&subcatid=26057&pid=79161 or https://www.henryschein.com/us-en/Search.aspx?searchkeyWord=extra+oral+elastic
I usually do 8oz 1/2 inch but some people do 16 oz but you can always work up to that if you aren’t seeing results.
So around $50 ish  and the elastics can last for many patients.

There has been a lot of interest about orthodontic aftercare opportunities. Below is a summary about Retainers for Life, one of the corporate, branded orthodontic aftercare opportunities. Note, that my emails and attempts to contact the owners of this company were unsuccessful after several months so these notes are based on what I understood from their website and also from a webinar that was hosted by Forestedent on 7/24/20:

1. This opportunity is for orthos only. GPs not allowed (for now).
2. You must have a scanner to participate
3. There is no cost for the ortho office to join and onboard
4. Cost to the patient is $798 to join. Once one of your patients join you get a check for $300.
5. You will upload your final scan at your final records appointment into their portal.
6. Patients can order unlimited replacement retainers for $39 each
7. There is no yearly (aka like Amazon Prime) fee to stay a member. You get $39 retainers for life. I see this is a major liability for practice sales.
8. If a patient needs a new scan because of shifting or dental work, they need to visit their dentist for a new scan. New scans are $100 for the patient.
9. No lab fee to the doctor
10. There are also Phase 1 retainers and “blinged out” retainers (decals) on essix retainers (may cost extra?)

Would you like to do more Invisalign cases and reduce your revisions and refinements?

Our team at StraightSmile Solutions has over 19 years of experience with setting up successful ClinCheck outcomes. We’ve done tens of thousands of aligner cases over the past 20 years.

If you would like to add Invisalign to your practice, but do not have the expertise or knowledge in using Invisalign software, then let us help you.

We have a variety of plans that work with all skill-sets and budgets and treatment plan philosophies.

Make Invisalign a profitable hassle-free part of your practice!

We do the work, you just hand out the aligners.

We can “coach” you or just do the set-up for you. You decide what works best for you. www.straightsmilesolutions.com/services

Contrary to Align Technology’s claims, aligners are NOT invisible. Attachments and precision cuts can be very unsightly and often patients are looking for a night-time only aligner. Buyer be warned, though. The elusive “night time only” aligner is more of a myth or legend than an actual clinical fact.
That said, an important trade-off to keep in mind is treatment duration. Let’s say you have a very simple case, with a maximum of 2-3 mm of crowding. Normally, teeth can move 0.25mm per aligner so I can treat this case with less than 10 aligners or so if it is worn 24 hours a day. With weekly changes, this means it would be completed in a maximum of just 10 weeks.
If you want to go just the night time route, it doesn’t mean that you only wear them when you sleep; you need to wear them during the “night,” which means a minimum of 12 hours a day. Also, that 10 aligner plan would be slowed WAY down to probably 20 to 30 aligners to make up for the missed time. So in essence, you are paying double or more for something that could be done quicker by skipping the luxury of wearing it just at night. I have had success with my own patients doing night-time only aligners this way. There is nothing novel or special about this. Any aligner can be turned into a night time only aligner.
For the cheapest and most accurate night time only aligner, you should consider the “OG” custom positioner. https://www.straightsmilesolutions.com/blog/retainer/
Positioners have been around for 50+ years and are the most overlooked but most effective retention solution. They can either be custom or semi-custom and have excellent retention, not only in the Phase 1 to Phase 2 period, but also long-term, comprehensive retention. Although they are bulky, they are very effective and can only be worn at night. If a minor relapse occurs, the positioner will correct it. Positioners also help to guide unerupted teeth between Phase 1 and Phase 2 (eruptive guidance) and encourage nasal breathing and proper airways.

Drawbacks to Nighttime Aligners
At this point, nighttime-only aligners might sound too good to be true, but they’re not without flaws. Before you make your final decision, it’s important to understand the drawbacks that come with this unique treatment schedule.

1) Treatment Takes Forever

2) The Pain!
The see-saw movement to night time only aligners isn’t healthy for your teeth. The instant you remove the aligners, your teeth start to shift back to their original positions. The longer you go without them each day, the more your teeth shift. Not only does this slow down treatment, but it also puts additional strain on your teeth, constantly shifting them in and out of their new position. This may carry a small, added risk of injuring your tooth roots. Since there has been no published clinical research on the risks for this, I don’t recommend it.
3) Only Suitable for Minor Cases
In general, at-home aligners are better-suited for milder cases of crowding and spacing. I would recommend less than 3 mm of crowding or spacing.
Plus, because of the additional back-and-forth wiggling involved with Nighttime Aligner plans, your teeth may be more likely to shift back to their original positions after you wrap up treatment. This is an especially big risk if you don’t consistently wear your post-treatment retainer – which is a good habit no matter which provider and treatment you choose.
Looking to scale ortho? You can click here here to schedule a call: www.straightsmilesolutions.com/contact
Check out some of the new services we’ve launched in 2019, too! www.straightsmilesolutions.com/services/
Our YouTube site has a ton of great information on all kinds of orthodontics and tips to save money on lab fees. Click here to check it out and subscribe!

Back by popular request, StraightSmile Solutions now offers custom, 1:1 Orthodontic Classes in Waikiki, Hawaii! Doctor provides the venue. Subject to mutual availability. Contact us at [email protected] for course options and pricing. We do not offer CE credits at this time but we do offer an itemized receipt for your tax preparation. Our most popular courses are our hands-on straightwire course and aligner Phase 1 consulting courses. VIP and Concierge doctors get 50% off any courses after 1 year of membership. This offer isn’t valid with any other discounts.

As an orthodontic consultant and the CEO of StraightSmile Solutions®, I am frequently asked to report on the pulse of the orthodontic industry. Three years ago, I was one of the first bloggers to report on the Invisalign Store® experience and franchise developments. As an initial team member of the SmileDirectClub®, a Bay Area native, and a citizen concerned about corporate cannibalization, I openly welcomed the opportunity to visit both the Candid Co® and Uniform Teeth® stores in San Francisco, learning more about the future of DTC orthodontics.

Since then, I’ve kept an eye on some of the newcomers in the DTC aligner space. Byte™, ProAlign® and OrthoFx® are all new companies on my radar. To learn more, please listen to my VLOG: https://www.youtube.com/watch?v=GMijQkfHiPE

Our team at StraightSmile Solutions, has been supporting dentists for years to launch and scale ortho in their practices and lower their lab fees, but that isn’t all we do.

You may be the best dentist in town with the most ideal restorations, but if nobody knows you’ll be unsuccessful!

Nowadays, just hanging a shingle isn’t enough but most dentists get little to no marketing education in dental school. When I first graduated, marketing was all about direct mail. Now it is all digital and guess what? It can be totally FREE!

Content, content content. Organic content. Don’t buy you content. That is for lazy people and it isn’t effective.

If you’ve watched my YouTube videos and read my blogs, you know a lot about content and how it can be shared amongst multiple platforms but Instagram and YouTube are where you should focus if you are a general dentist.
If your demographics are for the more “senior” population, add more Facebook. If you demographics are teens and kids, add TikTok.

Most of us need to “do the work” to grow our Instagram base. I’ll be honest, it’s initially like watching grass grow. You need to put in 10-15 minutes a day to get it to grow, not unlike a farmer or anyone who can appreciate long term appreciation of their investment.

Here are the steps:

1. Set up your Instagram account. Insta is paired with Facebook so create a business account that pairs with your FB business account.

2. Start creating content and bank it in the cloud as a library. Instagram content is either photos or videos less than 1 minute long. Personally, for the last 2 years since I started focusing on Insta, I aim for 1 piece of content a day.

3. Every day you need to spend 10-15 minutes connecting with your followers and growing your followers. I do this while I watch some trashy TV. It allows me to indulge my guilty pleasure while I grow my business.

4. Scroll through the posts in your feed and make thoughtful comments, not just likes.

5. Search relevant #hashtags in your business and connect with those that follow them. Try to follow at least 20-50 new people a day. Unfollow people who don’t follow you back after a period of time. Binge and purge and repeat. It is a bit tedious but over time you’ll see the ROI. When people like or follow you, thank them with an organic and thoughtful comment. Don’t cut and paste because Insta’s algorithm will catch it and put you in “Insta Jail”. I’ve been there more than I would like and I’ve learned the hard way.

6. Post several times a day. I use Buffer as a posting platform. It costs me maybe $200 a year but I can load up my content and have it post automatically for me. It saves me a lot of time.

7. Research every new follower to make sure they are a quality follower. If not, remove them. For example, if I was a dentist in Oakland California, I would only be looking for followers in the metro Oakland area. If they lived in Texas, I would delete them. This helps to teach the Instagram algorithm to suggest better followers for you and for others to find you as well. Also, if you decide to boost posts “like your followers” you’ll get more quality with the boosts.

Please connect with us at StraightSmile Solutions if we can help you launch and scale your ortho in your practice at www.straightsmilesolutions.com

It always surprises me when patients ask for braces when they have complex restorative work when they could have Invisalign or other clear aligner brands.
Below is my scripting and verbiage to explain the importance of why clear aligners are superior in these situations.

1. You’ll need to damage the crowns in order to get some adhesion which will lower the lifespan of her crowns and/or she’ll need to pay out of pocket to replace her crowns after treatment

2. You can put bands on the crowns but this will likely damage her periodontal tissue long term and add to the risk of needing periodontal surgery later and also it is very attractive (think pirate teeth) and they also collect a lot of bacteria which can cause an odor and are very uncomfortable. Tell her this is how ortho was done from 1900-1980 and you want her to have “new” ortho which means aligners.

3. Just tell her you have confidence that she’ll wear them.
We can also slow down the treatment plan and have her wear it at 2 week intervals which gives us some wiggle room for compliance.

StraightSmile Solutions® is a web-based, orthodontic consulting service that supports general and pediatric dentists, dental labs and the dental industry. We can support you to launch de-novo orthodontic operations or scale your existing orthodontic operations. Our team supports you with every aspect of the process: case selection, team training, operations, case support and treatment plans.

Most of our doctors who fully utilize the support with the Concierge Plan or VIP Plans, scale their cases 200-500% in just 6 months. This can bring an extra six-figures in revenue. www.straightsmilesolutions.com