Working as a general dentist can come with numerous key challenges, and if you’re newly qualified, things tend to be even trickier. With this thought in mind, it could be worth looking at some of the most common red light cases you should avoid – in other words, the highly specialized cases that require expert orthodontic support. Fortunately, we have outlined the most common tricky cases you should know that are likely to present an issue for your own ortho work.

Red Light Cases You Should be Avoiding

There are several critical red light cases that you should avoid when it comes to your work as a newly qualified orthodontist or general dentist. These include the following issues:

• Negative overjet up to 2mm, class three
• Non-buccal impacted canines (buccal cases may be fine if you have experience)
• Full step Class 2 cases (especially among adults – this may be a little easier in children)
• Open bite of up to 4mm (all open bite cases should have a sign-off from OMT first anyway)
• Moderate to hard periodontal cases (these can still be tricky to tackle, even if they don’t seem it at the outset!)

If you get any of these cases, it’s generally advisable to refer the cases to a specialist team. Remember, these cases can be very fiddly and difficult to handle.

When to Tackle Red Light Cases

If you’ve got experience with several hundred “yellow light” cases under your belt by now, you could consider taking on a few of the simpler red light cases. However, this is provided that you still have support and supervision from an orthodontist. Don’t try to tackle these cases alone until you have a great deal of experience in treating similar issues.

Green Light Cases You Should be Accepting as a General Dentist

Have you ever wondered about which cases you should be taking (or not) as a general dentist? It’s not always immediately clear which cases you should or shouldn’t be taking as a general dentist, and this could leave you feeling a little unsure of how to proceed.
Fortunately, in this three-part article series, we’ve outlined a few of the key things you need to know about case selection for general dentists to help you take on the right cases for your experience. Today, we’re focusing specifically on green light cases; in other words, these are the cases you should pretty much always be accepting as a qualified dentist.
Cases to Accept as a Qualified General Dentist
As a newly qualified general dentist, selecting your cases very carefully is important. Indeed, there are many conditions that may require a more qualified dentist’s support – and in such scenarios, you may want to just step back and learn rather than tackling the case directly.
In line with this, as a newly-qualified general dentist, focusing on young patients is generally the best bet. Simple cases might only be a small percentage of cases taken by a clinic, but focusing on these can help you hone your skills.
When you take on a case, you should ensure that the patients have less than 6mm of crowding or spacing. If you want to take on a slightly more complex case, make sure to get orthodontic support.
What to Avoid as a Newly-Qualified Dentist
For your first 150 cases or so, there are several common issues that you may want to avoid until you’re more experienced. While these cases may not always be a problem, encountering any of these issues may make a case more complex, making it harder for you to resolve.
Some common issues you should avoid when accepting your first cases include:
– Missing teeth (ensure patients have not lost teeth between second molar and second molar)
– History of periodontal disease (for example, probing issues or attachment loss)
– Limited view of the lower incisors due to a severe overbite
– Open bite or crossbite cases
Hopefully, these simple tips will help you find the optimal solutions for your case planning.

What Are the Side Effects of Expansion in Schwartz and Rapid Palatal Expansion (RPE)?
Orthodontic expansion is a common procedure for adults and children alike. But what are the side effects of Schwartz and Rapid Palatal Expansion (RPE)? It’s important to be aware of potential risks before you or your child undergoes this procedure.
The Potential Side Effects
One potential side effect of Schwartz and RPE is root resorption, which occurs when the root of a tooth becomes exposed. This can cause pain and sensitivity; in some cases, the tooth may have to be extracted. Other risks include teeth tipping forward or backward, soft tissue trauma, displacement of teeth, displacement of the maxillary midline, and temporomandibular joint (TMJ) dysfunction.

Another risk associated with RPE is post-operative pain. This can occur due to muscle strain and inflammation caused by the device. In some cases, it may take several weeks for the pain to subside. Patients should also be aware that there is an increased risk of gum disease if they do not maintain proper oral hygiene following their procedure.

It’s also important to note that patients who have previously undergone orthodontic treatment may experience delayed results with Schwartz or RPE procedures because their bone structure has already been altered. Additionally, people who are missing permanent teeth are not candidates for these procedures because it could lead to further complications such as malocclusion (incorrect bite).
Conclusion
Are you considering expanding your palate? There are options for a fixed or removable device; however, rapid expansion may lead to more side effects than slow ones – so it’s best not to rush the process. The most common side effect is nosebleeds occurring once or twice during treatment – if they keep happening, then make sure to schedule an appointment immediately and consult your doctor.

Maxilla surgery is a common procedure, especially in younger generations. Millions of cases have been done with distraction osteogenesis, which involves stretching and popping the maxillae bones to create space for teeth eruption or jaw growth. For kids who lack development due to soft diets, improper breastfeeding, or other habits – these procedures could provide them with necessary expansion that an average mouth may never experience otherwise.

In many cases, fitting clear aligners such as Invisalign can seem difficult, to begin with. However, if you’ve been struggling, don’t worry – we’ve outlined some of the key things you need to know about the latest Invisalign delivery instructions to help make your efforts to fit Invisalign a little more successful.
The Latest Invisalign Delivery Instructions for Fitting Clear Aligners Successfully
If you’ve struggled to get good results from your Invisalign delivery instructions, these suggestions could help! With the following four simple changes, you should have very few revisions with your Invisalign clear aligners going forward.
– Optimize the ClinCheck: Learn to use and optimize ClinCheck successfully to help patients understand how their progress should go.
– Only send patients home with fully seated aligners: If aligner number one is not fully seated, send your patient home to use chewies. Once the patient has learned how to use chewies and tracking, recall them in around two weeks; the aligner should now fit.
– Create an accountability loop: Before your patients change their aligners, make sure you see them in person to approve moving to the next aligner.
– Provide instructions to patients: One of the most common issues people face is patients not knowing how their Invisalign clear aligners should work. As such, provide patients with clear instructions on using their aligners to reduce the risk of revisions due to mistakes.
If you’re still struggling with fitting clear aligners and need further support, please don’t hesitate to reach out to our experts here at Straight Smile Solutions; we’re here to give you the skills you need to fit Invisalign braces perfectly every time.
Don’t forget, though: if your patient needs restorative work or if your patient has mixed dentition, there’s only so much you can do to prevent revisions.

Keywords
Invisalign
Invisalign delivery
Clear aligners

Serving young patients for orthodontics can be tricky, as kids develop differently despite their ages, and every patient’s needs differ. Phase 1 treatment is important for children who need it to avoid possible conflicts in the future, but starting too early can be harmful to children and possibly their teeth too.

What is the Right Age for Phase 1 Treatment?

Each patient has a skeletal, chronological, and dental age, but grade can also be a factor in phase 1 orthodontics. Chronological age factors the least in determining whether it is time to start phase 1 treatment.

First and second grade is often too young. Teachers in these grades are less experienced with the needs of orthodontic treatments and rules, and children might get singled out for being the first child with orthodontic treatment. Because of this, third through fourth grade is the sweet spot, but second is a ‘maybe’ if another child in the class has expanders or other orthodontic treatment.

Skeletal age can also factor into whether or not starting phase 1 in second grade is okay. Some children, especially girls, might be early bloomers, and physical development happening younger is a clear sign that expanders should be considered in second grade.

Emotional age is a potential detractor from starting a child earlier. Emotionally immature patients, such as those crying when they visit the orthodontist, usually indicate that a child is not emotionally prepared for orthodontic treatment.

For dental age, the requirement is for the number of adult teeth that have erupted. At least six to eight front teeth are preferable, as are the first molars. These teeth are necessary for treatment, and it makes it more difficult if these teeth are baby teeth that could risk coming loose.

For orthodontic specialists, offering Invisalign treatment is a cost-effective way to provide quality care. But how should associates be paid for these types of treatments? Let’s explain the best ways to structure orthodontic associate payments when providing Invisalign treatment.
Case-Based Payment Plan
The most common payment structure is based on cases. This means that the associate will receive payment for each case they complete. The amount of money they receive depends on the case’s complexity, and they generally get paid more for complicated cases with longer treatment times.
Per-Diem or Hourly Rate Payment Plan
Another option is paying your associates a per-diem or hourly rate for their services. By paying them a flat rate, you can ensure they are compensated fairly. It also makes budgeting easier since you don’t have to worry about fluctuating case fees.
Performance-Based Payment Plan
A third option is to pay your associates based on performance metrics such as patient satisfaction, number of cases completed, and number of referrals generated. This plan rewards associates who consistently deliver high-quality results and encourages them to go above and beyond what is expected. It also incentivizes them to stay up-to-date on the latest techniques and treatments to improve their performance even further.
Wrapping Up
Set up a compliance loop, utilize virtual monitoring systems, and make sure associates are aware of estimated completion times and additional fees if they become non-compliant with the system. It is important to note that orthodontic procedures take longer than other dental treatments, so cash flow can be negative initially until it becomes profitable over time.

As an associate, it’s best to use the owner’s doctor account when working with Invisalign, as this reduces liability. Write verbal agreements in a contract or addendum so both parties understand their obligations regarding Invisalign treatment plans.

Phase 1- https://www.straightsmilesolutions.com/classes/phase-1-interceptive-online-course/

Phase 1 Interceptive Online Course | StraightSmile Solutions®
You sent
Here’s the promo code for $100 off- https://www.straightsmilesolutions.com/about/deals-and-discounts/


Here’s the straightwire course- https://www.straightsmilesolutions.com/classes/digital-straightwire-class/

Digital Straightwire Class | StraightSmile Solutions®

The discount for that is already “baked in” for another day or so.

Here’s my Invisalign content- https://www.straightsmilesolutions.com/classes/educational-videos/

Educational Orthodontics Videos | Orthodontics Training | StraightSmile Solutions®

Here’s my clear aligner webinar- some are free- https://www.straightsmilesolutions.com/classes/webinars/

Orthodontic Webinars | Orthodontic Courses | Best Orthodontic Consultants

My suggestion is invest a few hundred into these course (plus she’d get 27 CEU) Watch all the content for the next few months. While doing that, start to have your team scan EVERY patient in your office with teeth. https://www.youtube.com/watch?v=3GuO5kSt6kc&t=12s

How to Make Six Figures in Six Months with an iTero 2 or Above

and come up with your IBP/KPI for the office https://www.youtube.com/watch?v=wWsyI2Fm6kc&t=112s

Getting Patients to say “Yes” to ortho- Setting up Incentive Bonus Plans for Ortho

Once you have a lot of records (scans/photos/pano) BANKED- sign up for my Concierge membership- heads up, price goes up Jan 12 . We lock your fees in indefinitely once you subscribe so you will save a lot of money before Jan12. www.straightsmilesolutions.com/services

Orthodontic Consulting | Orthodontic Consultants | StraightSmile Solutions®

We’ll help coach you, your team, your TC, your back office on getting these treatment planned and sold. Any cases (Phase 1, aligners, invis, braces). I think 3-6 months is more than enough time to get her up and running as long as she preps first and you bank a lot of records so we can hit the ground running. That’s about it!!

https://www.youtube.com/watch?v=kBi42T-LTM0&t=7s

How to Make Money with your iTero- the 2-2-2 Ortho Recall Plan

Occasionally, as orthodontists, we get a stubborn tooth. We try and try but the tooth won’t move. Here are some of the solutions and resolutions for this issue:

1. Reassess your mechanics. Is what you are doing even biomechanically POSSIBLE? Check articulation. Check contacts. Call a friend who is an orthodontist for a second opinion.
2. If it’s aligners, maybe the patient isn’t compliant?
2. There is a bony defect (can’t do it)
3. It’s ankylosed (can’t do it)

ANKYLOSIS:

if it hasn’t budged at all after 2 refinements or 12 months in braces (it looks EXACTLY the same!)- it’s not going to move – first go back to step 1 and make sure it’s even biomechanically possible.
It might be ankylosed. Try taking a good PA or CBCT and try to follow the pdl.


NON COMPLIANCE:
https://www.youtube.com/watch?v=AkVf08CFxyo&t=20s

This is a hard one but after this many aligners it should be mostly there if it wasn’t ankylosed so either he’s non compliant at les than 22-23 hours a day or it’s ankylosed
Put the patient on on weekly Invisalign virtual check ins or try In-Hand-Dental to rule out the non-compliance issue
Maybe he switches to 24/7 wear with and eats with the upper one in. that often works.

BONY DEFECT:

I recently had an issue like this with a patient – it was a bone defect (we caught it on a CBCT that was professionally read by a dental radiologist) the bone was too ossified and we couldn’t upright the tooth. It wasn’t ankylosed per-say but the bone wouldn’t remodel.

So rule all of this out before jumping to conclusions and placing TADS and wasting the patient’s time and money.

I married a general dentist. We met at UCSF Dental School and we were in the same anatomy lab group. I always knew I was going to specialize. I was “gunner” (that’s what we called the high academic students back at UCSF in the 90’s). I was there for one reason only: to become an orthodontist.
Once we both started practicing, my husband wanted to start doing orthodontics, but that door didn’t open until both ClearCorrect and Invisalign launched to general dentists around 2006.
Ever since then, I’ve been helping general dentists launch and scale orthodontics in their practices. I see 4 major roadblocks/push-points that prevent a general dentist from really scaling aligners in their practice:

1. Inaccurate and Ineffective education:

Unfortunately, Invisalign and ClearCorrect don’t teach aligners the right way. They do it backwards. You need to understand basic orthodontics FIRST and then extrapolate that into aligners. The most successful doctors are the ones who did braces and Phase 1 interceptive FIRST. They don’t just take a course, they actively do this kind of orthodontics in their practice. To account for the lack of quality orthodontic education for these doctors, I created my own FREE educational system for aligners on Youtube and it’s available for every doctor all over the world. https://www.straightsmilesolutions.com/classes/educational-videos/

2. Lack of a Proper Accountability Loop for Compliance:

Compliance and removable appliances go hand-in-hand. General Dentists have zero experience with compliance. Orthodontists are masters at it. We know when patients are lying (which is often) and when they aren’t. That comes with experience. For those who want a short-cut, I recommend one of the new AI based virtual monitoring systems like: In-Hand Dental or Dental Monitoring System. Yes, Invisalign does have one that is free, called “invisalign Virtual and although it’s very limited and clunky to use for both doctors and patients, it’s better than nothing. You want your patients checking in EVERy Aligner with their aligners off AND on and trying in both their old aligners and new ones to check bite and tracking and compliance.

3. Manufacturing  and Technology Issues:

This is very rare with Invisalign but I see it all the time with ClearCorrect, Sure Smile, Reveal and In-House Aligners. That’s adding another variable into the equation. I always recommend that doctors OUTSOURCE their first 50-100 in-house aligners so that they can remove that variable and just focus on compliance and treatment planning. https://storagy-itero-production-eu.s3.amazonaws.com/download/en-us/JDC-iTero.pdf  https://austinpublishinggroup.com/orthopedics-rheumatology/fulltext/ajor-v2-id1021.php

I don’t recommend that any dentists get started with any clear aligners  (or Invisalign) without an Intra Oral Scanner. Unfortunately, the USA, Align Technology only permits use of the iTero® scanner. Analog impressions are outdated and do cause additional manufacturing issues to present more frequently and lead to poor outcomes too often. 

4. Interdisciplinary Care: 

Lastly, it is CRITICAL that terminal molars be 100% captured for best outcomes and additional impacted molars, supernumerary teeth, active periodontal disease and oral habits be remove and resolved before treatment begins. This may mean that treatment has to be delayed so that a patient can collaborate with an OMT (Oral Myofunctional Therapist) https://www.straightsmilesolutions.com/get-started/help-with-3rd-party-solutions/beyond-straight-teeth-orthodontics-and-total-body-wellness-cervical-chiro-and-omt/ or an Oral Surgeon or Periodontist. This additional and often unanticipated interdisciplinary care can also add to the expense of the treatment plan to the patient. The good news is that often in a general dental office, these procedures can be kept in-house and add to the overall production of the case and improve outcomes.  

In 2002, when I was an orthodontic resident at the University of Connecticut, I snuck out of my residency program for a long weekend with the defense that I was “visiting family” for a so-called “family emergency” in San Francisco. Although I do indeed have family in the Bay Area, this was no crisis! Our program director had DECREED that “no residents would become Invisalign® certified under his dead body”—and believe it or not, it was grounds for expulsion!

Keep in mind that 2002 was a generation before the “#MeToo” movement. Although the true stories of the atrocities that occurred in that residency is something for a Lifetime movie series, this blog is not a rant about power inequities that still exist in our residencies but, instead, about how to successfully move teeth with plastic.

Contrary to his evil successor, my true mentor, Dr. Charlie Burstone, was benevolent and brilliant. Although he passed on before being able to see how his principles and techniques could be extrapolated into removable aligner orthodontics, I know he would be proud and fascinated.

I have discovered over the years that like many orthodontists, I have a superpower; I can see a case and predict precisely how the teeth should move within the complex puzzle of orthodontics. Because I’ve focused so much on plastic vs metal over the past 18 years, I just quite possibly might be the most talented, self-proclaimed “aligner orthodontist”, certainly in the US, if not in the world. I can quite definitively say that aligners, especially Invisalign®, can do EVERYTHING braces and do, especially when married with interceptive, functional, habit and airway removable appliances. Not only CAN aligners do it ideally, they also can do it healthier and more quickly than braces.


Tip #1:
Understand the five primary ways to move crowded teeth with plastic:
● Proclination
● Expansion
● Sequential Distalization
● Extractions
● IPR
Not all aligner companies can move teeth all five ways, nor is it healthy or predictable to move teeth in all these ways for every patient. Orthodontics is a puzzle, and every patient I see is an algorithm that must be solved.
Direct-to-consumer aligners don’t move teeth using the last three methods because you’d need an x-ray or an in-office visit to predictably move teeth with these methods.
Younger patients with healthy teeth, gums, and bone can handle more expansion and proclination. Older patients may need to rely on the latter three.

Tip #2:

Understand attachments but don’t get caught up in the hype about OPTIMIZED attachments. Remember, the attachment is just a handle for the aligner to grip the tooth. The teeth don’t know or care if it’s optimized. It’s my personal belief that most of these attachments are just proprietary and often unnecessary features that help to validate a high lab fee.

Depending on the trimline and rigidity of the plastic and the size and the morphology of the teeth, you may need more attachments for a particular case. It’s not UNUSUAL for an Invisalign case to have over 20-25 attachments! That’s because their material has a healthy, gingival-trimline and is very light and elastomeric in nature.

Truth be told, I haven’t had much success with attachment-less Invisalign aligners. I also don’t normally change around the recommended attachments too much. Instead, I like to put FULL-SIZED attachments on max laterals that are displaced and need rotation, root correction, or extrusions.

I also check the treatment plan for those dreaded blue or black dots and scrutinize every case to make sure they have nice, chunky attachments if it involves those more complicated movements referenced above.

Tip #3:

Don’t venture into Lite, Express, Moderate, In-House, or Flex unless you’ve implemented successful virtual tracking on all your cases AND if your refinement rate is less than 10%. You’ll end up losing money in the long run, either through additional lab fees, extended treatment, and chair-time overhead, and of course, through the frustration of unhappy patients. Patients who are unhappy don’t send internal referrals. A good ortho patient will often refer 2-10 friends and family members. Ortho is a walking advertisement. When you do a good job and are EFFICIENT in your treatment, friends and family notice your expertise both through social media and personal interactions and will seek you out as an ortho expert.

Tip #4:

Never, ever do single arch treatment.
It rarely works out, and patients expect it to be quick, easy, and cheap. It isn’t.

Tip #5:

Buy an accurate IPR system. Don’t use burs or disks. Learn to do it right. Good IPR takes time. If you are sloppy with your IPR, you’ll have an unhappy patient, and the case will take longer.

Tip #6:

Understand the concept of round-tripping and avoid it when possible. Unless you tell the lab “no”, you’ll likely get this on your IPR cases. I’ve seen countless cases with devitalized or lost teeth due to excessive round-tripping. Orthodontists use round tripping all the time, especially with IPR cases and straightwire cases where OCS (open coil springs) are needed, but we also know how to pick these cases and take cephalometric x-rays. We also know when not to round-trip on inappropriate cases. Now, I know Invisalign has announced they are now allowing CBCT submission to factor into treatment plans, but would I really TRUST a technician to make that decision for MY patient? No. I am the doctor, and I make that decision. Not a lab tech.


Tip #7:
Double check your articulation on EVERY. SINGLE. CASE. I can’t tell you how many times I’ve seen cases get royally screwed up, even if they were scanned by iTero because the doctor didn’t double check. The issue happens more with refinements than with initial cases, but now, with the “occlus” (green-dot) button, you can easily check both initial and final articulation. Finally, ClearCorrect has implemented this feature as well. It’s the very first thing I check before reviewing a case.

Tip #8:

Habits are the bane of an orthodontist’s existence. You MUST eliminate habits before starting any treatment OR work with an OMT (Oral Myofunctional Therapist) to eliminate them concurrently, but that is an additional third-party fee and step for the patients. It’s very easy to train your RDH in a four-day course to be an OMT, and a dentist can do it as well. I highly recommend it, and it’s an additional revenue-builder for your practice.

Remember, habits aren’t just fingers, thumbs, and pacis. They are also tongue thrusts and mouth breathing which often goes undetected in adults. From my experience, a severe habit will undo and unravel an amazing ortho outcome, even WITH permanent retention.

Tip #9:
Be wary of big masseter or low-angle cases. They can cause havoc on your aligner cases if left undiagnosed or improperly treatment-planned. Have you ever had a posterior open bite in an aligner cases? What a pain! Based on my experience, most could have been prevented by using bite turbos. The issue is that many aligner companies don’t offer this feature. I would never use an aligner company that didn’t have anterior bite turbos. Masseter Botox is also a great solution for these cases.

Tip #10:
Less is more with movements and staging per aligner. Did you know that slower and lower forces actually makes the treatment go FASTER and more predictably, causes less discomfort, and is healthier for the patient? I’ve never had an issue with Invisalign and Clear Correct in slowing down the plans. I take every Invisalign plan and double the number of aligners. For ClearCorrect, I triple. Unfortunately, SureSmile often refuses to let you slow down their plans, so for that reason, I refuse to use their product. (Also their dashboard is horrific and non-functional and looks like it was coded by a 2nd grader).


In conclusion, my orthodontist as a teen was the president of the AAO, the American Association of Orthodontics. He was also a member of our church and a friend of the family. I won’t name him by name because, although he had so many accolades and awards and was a very kind man, he damaged my teeth so severely that I can’t even bite into an apple now. Braces are dangerous, and as a result, I’ve dedicated my career to finding healthier, more esthetic, and more humane ways to create smiles.

I’ve poured myself into aligners and removable appliances, and now, with this blog, I am going to give YOU access to my carefully curated list of tricks and tips to idealize aligner outcomes! If you follow my guide, you’ll also be able to enjoy and efficiently and successfully build your own removable appliance practice. If you want help with a case, we offer 1:1 support. Visit
https://www.straightsmilesolutions.com/services/to book a session today!