amanda with straight smile solutions straightsmilesolutions.com and today
we're going to talk about when to power chains specifically what is the question is what is
the lightest wire you can power chain on and get away with it without having side
effects happening and i have a bunch of other videos on power chaining so again as always
i have over 3000 videos i'm not going to repeat things if you want to know the basics on short
open continuous chain how to power chain how it works picking chain when is your chain old all
those type of videos you can just go into my channel in my straight smile solutions channel
look for that little tiny magnifying glass and put in your keyword which is power chain two different
words and all those videos will come up today we're going to talk about what's the lightest
wire you can power chain on and this is just my opinion which is going to be different from six
month smiles opinion or some other opinions you might get from garrity or pos or some of
these other ones um but this is just i've seen so many mistakes people have made and i've seen
the danger and the damage it can cause teeth when you power chain on the wrong um wire and it can
actually make things not only dangerous but it can also make things take longer um and of course you
know damaged roots pdl's things like that so this is kind of my safe way now remember anytime you
have a patient that has space even if they didn't start with space even if you're just aligning and
leveling and spaces kind of open up that's just what happens as you start to align and level
you just let the patients know hey i see their spaces here i know you're probably super excited
to get these spaces closed but there's a time and a place to close the spaces and we want to close
them safely efficiently and in a healthy manner and if we rush the space closure and do it at
the wrong time dangerous things can happen so and it can actually make your treatment takes longer
as well so we're going to do things at the right time and just keep keep them posted because it is
definitely probably in those top five questions that comes up from patients and parents when are
you going to close my space so um i normally do not even think about power chain until i'm in 18
night i and i'm in passive 18 night time so you can't just throw an 18 night tie in
on the first you know wire when things are still crooked and you haven't aligned and leveled
i mean once you've finished aligned and leveling and if you go through my wire sequence videos
another again another good keyword for you look up wire sequence i take you through the wire sequence
i'm not going to repeat all that but normally um once you get to the 18 nice high stage and it's
aligned and leveled it's done you're almost ready to move up to the rectangular wires i tell doctors
to take a break double check all their bracketing this is the time and the place to do your repos
repos usually means you're going to take a panic if it's been a little while it's a complicated
case i also recommend taking a progress panel double check all your bracketing do your repos
at this stage okay we're still having closed space yet you do not close space until you finish this
stage which is the repo stage now of course if you are not doing direct bond if you're doing indirect
bond and using computerized bracket placement assuming the patient didn't break any brackets you
shouldn't have any repos so again a little plug for indirect bonding it saves you a ton of time of
course orthodontist may or may not do it we do do it sometimes to save time so we can do a bunch of
bondings at 4 pm you know because there's a doctor could only be one place at a time right so that's
why we might do indirect bonding even though we know how to place brackets um but we're also not
perfect sometimes things slide slip sometimes you know we had a hard time seeing um tiny mouth you
know difficult patient and things don't quite go on perfect so you know a couple months down the
road when i get to that et nighttime i'm going to go ahead and check everything slowly with a
mirror and i'm going to do my repos and i usually have one or two repos now of course in the olden
days you would bend wires at the end but from my experience that is way less efficient and very
difficult to learn and to be honest i think it's actually slower so um i know how to bend wires and
i basically don't do it i mean it's like very very very very rare one in 300 cases i mean that's what
i really mean because i do the repos at this stage and i catch it and i also and i'm going
to answer your question about the power chain i haven't gotten there there because i'm telling you
the power chain comes after this stage if you do things out of sequence your case will take longer
because you're going to have to go backwards later right if you do everything in a step by sequence
and explain to the patient why you're doing it this way they will understand they're gonna think
you're super smart so you know you do your repose and then once the repos are expressed and done
this and i love it this is where i actually turn it over to the patient and if the patient's a
minor to the parent too and i say hey this is the stage where you get to give me feedback i want you
we have finished the straightening portion we are done with the straightening portion i know
we have spaces i know we might need to fix the bite a little bit but the first part is done
congratulations now according to you know in my opinion but this i always say orthodontics is
as much of an art as it is a science and there's sometimes little adjustments we can make if you
don't love how they are straightened and when i'm talking about straightening i'm talking about ins
and outs and ups and downs um you know and back and forth so if you think that your canines you
know for example should be a little longer or a little bit shorter we can move them up and down
same thing with your frontie same thing you know obviously there's limits anything that we do you
know there's pros and cons and i can explain to you if you think we should make a change what
the pros and cons might be i might agree i might disagree but if it's something i think that we can
do we can definitely do that it might take another month or two but we'll do that now you know
so if they say no no no i actually don't even let them answer it at that appointment i tell them
i want you to take a few weeks i want you to go home i don't want you to feel rushed
i want you to go home i want you to ask your friends families cousins parents sisters brothers
because there's nothing more annoying to me when i get to the very end and i'm so so excited the case
is done well looks so so good and they're like you know i really think these laterals should be
longer i'm like what why didn't you say something earlier but you know it's really up to me because
i should tell them i should give them an opportunity to weigh in because again
orthodontics and sometimes i'll disagree and i'll say no we can't do this because or this gum line
will look funny i really don't think this is a great idea you know here's why and a lot of times
they'll agree right but sometimes it's fine you know you know you're right i can see what you're
talking about i'm totally cool with doing that thank you for taking the time and i want their
whole extended family to weigh in because if you give them a few weeks you know to discuss it then
they come back and they report to you their answer their answer is either we are super happy and then
even sometimes if i have a difficult patient or parent i'm gonna have them sign for it you
know like i agree i'm i'm super happy with the alignment of my teeth um we are going to move
on to the space closure on the bike fixing stage you know it's not like if it happened at the end
later i wouldn't do it but at least i gave them an opportunity to weigh in and it's highly unlikely
that they're going to want to change things later which is going to save me a ton of time right
so okay so we finished that part so we've done this whole stage the align and level stage now
we move on to space closure congratulations we've moved on to stage two okay which is space closure
now that's when i will start closing spaces and if i'm in the 18 night tie i will only
close anterior spaces so that means anterior chain only on the top that means 7 through ten
only um mesial the mesial single tie on the distal on the lower it means 22 through 27 only
or three to three the mesial dimensional single tie on the distal not super heavy
you know moderate um i don't care if it's continuous open close watch my other videos
on that it really doesn't matter i don't even stock all those different types because there's
no point to that in my opinion it's just a sales thing to make more money for the racket companies
and i tell you all about how that works and you can even see here in some of these videos
that they're using multiple links there's an extra link there there's a double link here
you don't have to put one link around each tooth you can get continuous chain and put multiple
links if you have bigger teeth or bigger spaces right and that's gonna save you a lot of money
because you really have to throw out your power chain at least every year because it does get old
um you should fling it and get all new because if your power chain is not working again another
video you can watch how to tell if your power chain is old it's probably because it's old
and it's not working anywhere but anyways yeah so if you're an 18 nine tie two to two on top three
to three on the bottom that's all you're going to do once those spaces are closed if you're
ready you should be ready to move on to your rectangular wires i put it in 1825 and now we
can go ahead and power chain the rest um there you go so i answered your question um and of course
at that time if you have class two or class three you may not be power chaining six to six you might
be doing things more segmentally or sequentially watch my videos on space consolidation for class
2 cases space consolidation for class 3 cases those are there too those are
good videos for you to understand that and you might be using elastics to power chain
so don't just throw power chain everywhere because if you don't have control of the space closure
you're going to screw things up big time so and it might change you know one month maybe we're going
to power chain six to six top and bottom and then they come in i'm like oh there's a little over jet
okay we're a little bit class two okay i'm gonna change my the way i'm gonna power chain and i'm
gonna do elastics here and then they'll come back a month later and i'm gonna change it again so
so i said it's almost impossible so some of these bracket companies that are um or you
know orthodontic companies that are spitting out these treatment plans where they're telling you
wire sequence from start to finish and mechanics that's impossible you have no idea to know how the
patient is going to respond every month you take another look and you know what if you need advice
this is what i do with my straight smile solutions clients all the time i strongly recommend that
they have their page they use the same you know things that we do in with aligners or invisalign
where we have them checking in from home um with either a dental monitoring system a gpu
ortho tracking a line flow or any of these or your own in-house system that's super compliant where
they sent a set of photos you give them a cheap set of retractors you know a week before their
appointment you send them a text hey don't forget to send us your photos the reason why it's great
to do that first of all if you're learning it's great um because you can learn you know you don't
have to be on the fly they come in the office and you're like uh i don't know what to do here um but
also you can prepare your tray and get everything ready so that their appointment is more efficient
you can schedule them a little tighter together um you know if something's not quite right so you're
prepared um and you can discuss it and think about it because sometimes you know when there's tons of
patients in the chairs you don't have time to uh i'm all stressed out i don't know what to do right
even for me sometimes i have to like take a breather think orthodontics is a puzzle
and you have to be really good at puzzles you know if you were good at that perceptual ability part
on your dental test then you probably would be good at ortho but even sometimes for me i gotta
be like oh man i gotta think about this you know there's the best way to do this and of
course over time you get really good at it because there's only so many different variables you're
gonna see and you're gonna be like oh i got this but for you as a gp or pediatric dentist it's
not gonna come quickly so it's best that you take the pictures a week ahead of time check
in and of course sometimes you find broken brackets in the pictures and you're like hey
there's a broken bracket okay well we need to move your appointments in the morning or give you a
longer slot and it's gonna save you a ton of time if you start doing this it takes the patients two
minutes to do it at home and it's gonna save you a ton of heartache and upset patience but anyways
hopefully answered your question about when to power chain do not power chain on anything less
than 18 night tie and only after the brackets are done and everyone's happy with how straight things
are and you've finished your first order alignment and yeah that's pretty much it all right thank you