hey it's dr amanda with straight smile solutions straight smile solutions.com and today we're going
to talk about doing posterior elastics to fix a posterior open bite or alternatively you can do
posterior or any type of elastics with aligners specifically to help to extrude a tooth we call
that bootstrap technique so i'm going to be talking about both today and this type of as
you can see here has upper braces lower aligners but i'm going to show you how to punch your own
precision cuts in your aligner so for example if you're using clearcorrect or one of these
companies that doesn't um have precision cuts you'll have to punch your own in now of course you
can't use a retainer you need to use an aligner where they actually have the extrusion built in
so maybe it's a liner that isn't fitting optimally or it's in a liner that's gone off track you can
use this technique if you're using invisalign or white labels some of the white label companies
um they can punch these in for you so you might as well just have it done it's gonna be so much
easier but i'm just gonna show you so this plier um a couple places you can buy it i actually have
a video on it on my youtube so contact me if because i can't remember their names of where
to buy it it's a little bit trickier given the trim so this is more of a clear correcty kind of
you know um higher level trim so it's gonna be a little a little trickier to punch this in so
keep in mind right now if i'm looking a little shaky i'm looking through the lens of the camera
to do this so but this is um yeah so that's not bad so remember when you are punching this
you want to be able to get the bracket on fully without touching the gums so you might have
to be a little bit more aggressive with these punches so oopsies that was definitely not it
and then if you have attachments on there you got to make sure your punch doesn't go near your
attachment because that's not going to work very well right so you can see now we've got this kind
of sharp areas so this is also going to affect your retention i would take this one i'm not a
huge fan of doing it yourself but i mean you get the idea right i'm totally destroying this aligner
so this is actually really satisfying you might even be able to honestly
just do this with a um hole puncher too it's possible but anyways you get the idea seated on
then you're probably this one's gonna be good right here as you can see i've got a nice
area to put it on i'm gonna get my i need like a hemostat or something to hold this
let's see sorry i got the background music going on my phone ignore it okay
phone's going off the hook today okay so you can basically try this on
and it'll definitely center itself you'll be fine here you know at this location i put it on upside
down but you can see if i move it you don't want to be right at the edge but you don't want to be
at the gingiva so this one will be fine this one will be fine this one's a bit off center so i'll
probably have to refine these a little bit so i'm going to play with these a little bit right now
and then i'm going to put some buttons on and if you wanted to do a bootstrap technique let's
go over that too for example so bootstrap technique means that you're going to put
a punch on both the buckle and the lingual okay and then you're going to run an elastic
over it probably 1 8 or something like that so let's say we wanted to bootstrap this tooth
okay so now we have a punch on both ends okay cm both buckle and lingual
you're going to bond your buttons button buckle and lingual this is for a tooth you want to
extrude okay and then you're probably going to use like a 1 8 heavy or one-eighth medium to
hook over would be my guess probably one-eighth but we can try in a bunch of sizes and see what
works best it really depends on the the shape of the tooth a really really teeny tiny elastic and
the patient will have to hook it on um quite often basically the patient will have to hook it on um
they eat you know then they brush their teeth they floss their teeth they put their aligner back in
and then they hook the bootstrap on so this is gonna have to happen four or five times a day
but it will help to extrude that so that's another little um fun fact if you want to really get some
oomph into your extrusion you know instead of running it so for example here we've got braces
and aligners let's say we had nothing let's say we had the upper denture or something and we couldn't
hook elastics to the maxillary arch we could bootstrap all the teeth we needed to extrude
you know buckle and lingle just in that on those teeth that are there so all right hang
in there i'm gonna go ahead and get my buttons on and i'll be back with part two of this series
hey it's dr amanda with straight smile solutions street smile solutions.com and we're here today
with part two of our video about putting buttons on the back teeth to help to settle a posterior
open bite or the bootstrap technique to help to seat um a tooth that needs to extrude if
the attachment isn't working so we'll be talking about both make sure you watch the first half of
our video first for context anyways so i've gone ahead and i've bonded buttons on my type it on
as you can see in the earlier video i showed you how to cut the precision cuts if you're
using invisalign or global they'll do it for you you just got to tell them that you got to do it
remember buttons come in all different shapes and bases i personally like the metal ones i think
they stick way better invisalign ceramic ones are decent ceramic's going to be a lot more expensive
than metal these are some very petite buttons so it really depends on the size of your teeth you
really should have a variety of different buttons but these stick pretty well they're just regular
lingual buttons with a mesh base pretty inexpensive and easier to get off into d-bond
so i would have there's some ones with square bases rectangular bases round bases these are
very petite part of the thing you have to think about when you think about buttons is you want
to think about the lip and is it going to be able to hold the type of elastic that you need
the thicker your elastic and watch my video about the different diameters of elastics and
different strengths and how that's different but depends on whatever elastic you need
some types of elastics may not fit on such a petite low profile um
button because it may not it might come off so you're going to have to try different things
remember with elastics you want to try to get the smallest diameter elastic that will comfortably
the patient can comfortably get on and off it should feel tight but it shouldn't be breaking
off the button right so if you use something too strong it's going to break the button or
if you use something too thick it's not going to hook on the lip so you have to kind of try it in
now this is 3 16 it's kind of lady medium 3.5 ounce i'd call it lady medium
not really my first choice but it's the best one that i had in my armamentarium
ideally probably for this for bootstrap i'd probably use 1 8 medium or 1 8 heavy i don't have
that right now it isn't something i use very often so um i'm just showing you what it would look like
but let's go over the bootstrap first so remember bootstrap is when you put a button on the buckle
and the lingual okay and you're gonna run the elastic over and you can see how this can you
see how this is like not fully seated can you see that can you see that the the daylight
now you can see it right behind tooth number 31 um lower right seven so we want to go ahead and
extrude that tooth a little bit more so we're gonna go ahead and run the elastic
over we call that bootstrap i don't know why maybe boots have straps like that
and if you need it to be a little tighter you can put a twist in it which is what i just did
a little bit trickier for the patient they're not gonna have a plier like this
you can use an elastic hook i definitely have videos on how to use elastic hooks
it's probably the best thing to give them let me see if i have one here i'm looking around i
always have elastic hooks and of course when i want to find them i can't use it but yeah
you can put a twist in it almost like a figure eight and that will make it tighter so it's pretty
tight but ideally i'd probably have it a 1 8 and i think it would be better so this is this was
3 16 lighty medium and i probably would want to have 1 8 but that will work for boonstrap right
so it's going to seat that a little bit down a little bit more now what if i wanted to do
vertical elastics to help with extrusion from top to bottom that's another option if you don't have
braces up top you'd have to do the same thing with the aligners up top that will also work so i'm
just showing you just because this is the type of dom that i had and i already had braces on top so
just showing you what i would do remember sometimes these buttons are going to break
especially if the patient's going to yawn or like laugh so you got to realize when you put these on
you're going to most likely have to re-bond them sometimes and this one again remember this
you want the smallest diameter elastic that's tight the comp patient can comfortably put on
this is a little too slack i feel it it's too slack okay you can see
you know they can talk so sometimes i do one elastic for daytime like a 3 16 and a 1 8 for
night time so it's tighter but i think this is a little bit too sloppy here but yeah you go ahead
and and every patient is going to be different it's going to depend on the size of the teeth
the crown height we already bootstrapped that one so we don't need to do that one
oh i don't have hooks on these so that's not going to be possible but we'll do this one
so you'd have to put kobe's on if you did that sorry it's really hard to look through
the lens of the of the camera and do this it's probably easier to start with the um
it's probably easier to start with the button on the bottom and move your way toward the top
okay but anyways you get the idea okay vertical elastics all kinds of vertical elastics as tight
as possible so the patient can talk a little bit during the day and even tighter at night time
you're going to want this is going to go really rapid so you're going to want to check them like
i would say every two to three weeks in your office if you can do virtual check-ins through
one of these virtual check-in processes that would be even better another option is to do like a box
elastic right here you could do that too if you wanted to let's try that go like that that might
work good see that a box would work there lots of options okay the main thing is that you want to
get just get them all socked in so that everything extrudes nicely and you get a nice posterior bite
and this is really similar to what we do in braces we do something called z elastics same idea so we
do that all the time we're just trying to sock in their bite to get a better occlusion at the end
whether you're gonna use triangles or whatever you're gonna do like this see
but it's a tricky time and the patient has to wear them all the time if they're not
committed to wearing them all the time then i recommend not going the elastic rod and instead
just doing attachments and taking it slower it will take probably two or three times as much
time to do the attachment so the benefit of the elastics is going to go a lot faster but it's
only going to work if the patient wears them 22 hours a day if not it's going to not work at all
and most often depending on the size of the crowns you can't have both the precision cut and
the attachment it just there's no space for it if you have gigantoid molars maybe but for most
patients you cannot so you have to pick a pathway so it's one of those don't make an assumption for
your patient it's one of those things you'll want to talk to your patient explain what the options
are right so we can say we can do bootstraps or we can do elastics vertical elastics with precision
cuts but it's going to go faster but they have to work 22 hours a day you need to explain to them if
they wear it 16 hours a day this isn't going to work at all it's they're going to have to come
back get the attachments get the buttons off get the glue off get re-scanned and takes another few
weeks to get the attachments put back on if not a month so you're going to lose a lot of time so you
want to explain to them and there's some people that are super compliant and will do whatever they
need to do to get things done however i find more often they are very compliant and they're excited
about but when it comes to the reality they don't wear it you know and then it's going to waste your
time it's going to waste your money it's going to waste the patience time it's going to waste
no the patient's not paying any more probably but you want to be really realistic
and make sure your patient is picking the right path which means you're explaining the
risks benefits and alternatives of each pathway so hopefully this was helpful thanks so much