Amanda with straight smile Solutions straight smile solutions.com and it's 2023 now so it's
time for me to do an updated clear aligner delivery instructions video I will also make
a Blog to follow this for those of you who like to read and not listen but in any case I have
several of these already on my YouTube channel as well as in a whole like Invisalign playlist
a whole non-invisalign clear aligner playlist to access those you can go to my YouTube channel and
scroll down on the home page or you can shoot us an email at info straightsmilesolutions.com
or go to our website straightsmilesolutions.com as always this is just my own clinical experience
from over 20 years in the orthodontic industry as well as goodness I think we're going on 20
years being an Invisalign provider woo anyways um this is just my clinical opinion if any online or
company has an issue with what I'm saying first of all it's all totally true so but you can come talk
to me I don't want to hear anything from your lawyers it's just my disclaimer I'm required
to put these on front on the front of any video that mentions companies by my attorney because
I'm tired of being sued alright anyways all right let's go so the goal of this video is to give you
better more predictable outcomes to have your patients have a better experience to have you
like aligners more for you to do more aligners so I don't see why any aligner company would have an
issue with what I'm saying here although it's slightly different than what they teach okay
um first of all number one any case you do should never ever be flex light moderate
go Express or anything that's limited all cases should be worked up as unlimited or
comprehensive or Advanced or whatever your system that you're using doesn't mean that
it's going to end up there in the end but if you put it in a limited system there's going to be
limitations to the movements and they're going to not say no they're going to try to make it
work but it doesn't mean it's predictable and also even if your patient's saying I just want
this tooth moved or I just want up or I don't want back teeth moved that's not ideal ever
and part of doing risk benefits and Alternatives is that you have to show your patient perfect even
if you don't want to offer perfect you have to show them and educate them about perfect
even if you're gonna if an orthodontist would do perfect if you then you need to send them
to the orthodontics first and then when they come back to you and they've already been educated you
have the document saying what the treatment plan is then you can show improved so that
is like number one Ortho 101 that they teach us in residency no trash no garbage no alternative
until you've shown and explained perfect and the patient understands it and has written that they
understand it in writing once they've seen that then maybe there are alternatives okay
so that's why all cases are put under unlimited comprehensive or Advanced all right so we start
there number two you never ever accept what the treatment planning what technicians give you you
need to understand what you want you need to understand why you want it you have to learn
to drive the bus you have to learn to direct the treatment plan if you don't know what you're doing
um should I you know this crowd there's so many ways to to fix crowding there's expansion is that
good for this patient or will this cause damage there's proclination is this good or will it cause
damage uh well round tripping cause damage can I flare can I not flare should I add IPR can I add
IPR where should I add the IPR should I extract the lower incisor what are the benefits and risks
for that should I do sequential distalization and so on there's so many ways to address crowding
you have to realize what's right for this patient and sometimes there are options sometimes I have
one two three four versions I can show a patient version one this version two we do it this way
and there are pros and cons to each one it's it's actually not hard it's a puzzle and that's why you
need to work your first 10 20 30 40 50 60 cases up with an orthodontist not a technician and not an
orthodontist on the team of the aligner company that is a disaster a mistake I see them all the
time they are beholden to the Atlanta company needs to be an independent orthodontist that
has nothing to gain or lose by optimizing this case that only is there just to help you and
in the interest of you to make sure you're doing things right okay so I've said everything going
at the beginning okay so assuming you've done all this okay um and you realize that you've submitted
the case the case has come back you know you've had an orthodontist check it it's not limited
it's comprehensive or Advanced then what first thing that I do and I'm hoping if you're doing
this you're not taking Impressions please don't take Impressions it just doesn't work out it's
just way more compromise and you have way more fit issues and it's frustrating and it's icky and it's
not good for the environment so if you're doing this use a scanner so when the case comes back you
open the box right you want to make sure that you know which is the attachment template I'm assuming
you're doing this with attachments please tell me you're not doing this without attachments please
um you need to know what the attachment template is some companies will say attachment template
some companies will say aligner zero so you need to make sure you know where it is it's usually the
first and the long string sometimes it's separated you can write attachment template on it if you're
not sure call your aligner company and explain what it's going to look like next thing you're
going to do is you're going to look at the system to see if there is IPR in a proximal reduction and
when it's due Invisalign might have it do all over the place clear click correct might have
it do all over the place you can control that a lot of other aligner companies it's always do it
the first appointment so you need to see when it's due I like to say IPR is like a library book you
have to do it anytime before it's due so you don't have to necessarily do it on that aligner that's
due however if they start out with spacing you're going to have to do it when it's due
so um just you want to kind of figure that out and work that into your appointment because if
you are doing attachments and IPR all at the first visit that first visit might be two hours
so along with the instructions you need make sure you set aside and y'all are going to be
a little bit clunky the first time you're going to streamline it over time as your systems get up but
you want to make sure that you know what you need to do on the first visit and schedule accordingly
okay next thing you do is you go ahead and not put the attachments on First and not do
the IPI first I want you to try in a liner one first okay open it up show the patient what it
looks like look for any Jagged edges or anything like that seat it teach them how to use chewies
I have a lot of videos on chewies everyone should be using chewies give them a set of chewies bite
bite choo choo see if it drops down it should drop down like a custom wet suit like a custom
anything there should be when you look and Shine the light on it you shouldn't see any gaps between
the aligners and the teeth if you don't know what tracking is watch my tracking videos we also have
a tracking handout we're glad to give you all of our handouts are free for anyone that's one of
our VIP concierge or premium clients and I've even extended that to a la carte clients I definitely
will give each a la carte client two or three handouts you don't get 50 handouts but you can
have a you can have a few of your choice if you are an A La Carte member otherwise our handouts
are 20 a pop you can go to our handout document store on my website um so if you see any gaps air
bubbles between the aligner and the tooth um stop don't don't don't continue don't push go um first
thing I want you to do is look for interferences I want you to look for tissue blanching if this
is not Invisalign if it's any other company that maybe doesn't have a super scallop trim I want
you to look for any compression on the gingiva any blanching that's going to be a remake don't
try to trim it because you have to trim every single one you're going to contact the Liner
Company you're gonna take a new scan and you're going to have them do what we call warranty fit
sorry for the patient we don't want them to be uncomfortable we don't want to cause prayer damage
um if it's still not seating fully and there's no tissue soft tissue issues um but it's just like
minor minor I want you to have them go home come back in a week or two use their chewies regularly
and see if it's do not put the attachments on I repeat do not put the attachments on
do not do the IPR just send them home with the aligners easy breezy it'll look like there's
attachments on but you didn't put them on and have them see if they can seat it if this happens it's
probably because you didn't slow down and Stage your treatment ideally you probably made your
steps too aggressive if you watch my other videos you know that I always recommend for Invisalign
doubling your aligners for Clear correct tripling 2.5 to triple um for spark it's also a double
um it really depends on the system I have to look at it so somewhere between two times and
three times what they say is what I recommend why because it makes it more predictable it makes the
forces lower it makes it healthier it makes it less likely you're going to go off track
it's more comfortable it's cleaner it's just a win-win-win-win and that's another reason why
we do unlimited and comprehensive cases and not light limited or moderate cases because then we
can do that it doesn't cost you any more they're from my experience sure smile sometimes vetoes
that and that's just from my clinical experience when I've seen cases done sometimes they say no
you can't that's a big ant for me if you won't let me do that then I don't want to use your system
but you can give it a try maybe they've relaxed on that that's been that was historically in the past
I've seen them say no or put a put a cap on how much you can do it obviously if the case is 20 and
you want 300 aligners that's not that's a little unreasonable but I've never seen Invisalign say no
to doubling and I've never seen clear crack say no to 2.5 or tripling ever and I've seen hundreds if
not thousands of cases okay so patient came back everything was tracking again custom websuit no
gaps no anything anywhere great we're good to go let's go ahead and put those attachments on I have
a lot of videos about putting on attachments to be honest it just takes time to learn to do it right
can't rush it you have to pack it in a dark room you gotta pack it ideally maybe got a little
primer on the back of it and then go ahead and do it clear any flash off try that aligner back
in a liner one again now with the attachments it's going to feel a lot tighter and again it should be
fully seated like it was before there shouldn't be any gaps or anything like that between the
aligner and the tooth there are gaps between the aligner and the tooth you need to take it off and
check for Flash again one of the best ways to check for Flash is to use one of these little
um black flashlights black lights um the ones that shine purple that you can have fun Googling that
one and what you're actually supposed to use it for on Amazon but it has to do with hotel rooms
but um I actually own one and they're really quite cool but it's disgusting because once
you start using my hotel room you're never going to want to go to a hotel room again so maybe you
don't want to own one but they're great for the dental office hopefully you don't find composite
anywhere else but it'll show the composite the composite should be limited only when you turn
off the light to the attachments you shouldn't see any flash take all the flash off Trey again if
you're still having issues with seating and you're using chewies we're going to send the patient home
and the seven days now assuming you've doubled or tripled it's seven day wear once fully seated so
if it hasn't fully seated the seven days haven't started yet okay they start when it fully seats so
one week might be seven days one next aligner might be nine days it might be 11 days okay
um this shouldn't be happening too much assuming the patient is wearing at the 22 to 23 hours a
day if the patient is not wearing 22 to 23 hours a day and you intentionally doubled it or tripled
it there's something fishy going on okay either you did something wrong with your attachments
which is why we're checking the flash or the patient is full on lying and I can say this
with 100 certainly I've seen and done enough cases this this is a lie so I mean obviously
we're not going to say you lied but this is why I feel so super strongly and every single time
I make one of these videos I'm gonna say it again I'm gonna say it again I feel so super
strongly about putting your patient on a virtual accountability Loop anytime a doctor does this
literally the issues go out the window there are no tracking issues assuming you've done everything
else I said properly most of the time you get what you're supposed to get a to z no refinements boom
bang you don't even need to see the patient in between you can give them a whole box of
aligners because they're checking in virtually you're gonna get a ping on your phone it's gonna
say so and so just checked in virtually they're gonna have their Liners in they're gonna have
their liners out you can see if it's tracking you give them a go no go great it's tracking move on
to your next slider me not that dwell tracking can you put on your last line or can we take another
look or let's try this for another week and see it is just night and day in terms of success it's
gonna cut your overhead dramatically it's going to make your success rate go up dramatically the
patients are going to be happier you're going to be happier your staff's going to be happier you're
not wasting chair time I don't see any reason it's not a win you've got Invisalign virtual is
free for all Invisalign patients you have to pay like 30 cents for the retractors it's a no-brainer
personally my personal preference would be in hand dental and if you want to get that awesome price
point which I think is about forty dollars per patient they have a per patient price point that
stays with the patient all the way to the end of treatment I think you have to per I don't know I
don't know what the fine tuning is but they have a new deal besides the monthly I think they have
two different price points yum shoot me an email and I'll introduce you because you're not gonna
get that price point without an introduction info at straightsmilesolutions.com take the demo check
it out it's really great I think it's the most affordable in terms of quality I personally I'm
okay with Invisalign virtual and we do use it in our office um but I don't love the idea of being
beholden to an aligner company that sometimes will freeze your account when you don't pay your bills
so I've had a few issues with them on that with you know not only our account but also
um you know as long as it happens when you have multiple offices and some one of the
offices didn't pay the their their bills on time and then they freeze your account weird things
happen I don't want my patients to be hijacked and that's another small issue I have with Align
Technology I think they're they can I don't love their billing systems and they know I don't love
them how they do it I personally think it's better if they charge you on the front end for the case
I want to be charged in the front when I submit the case charge me that 19 100 then don't Bill Me
Down the Road 60 90 days because guess what it compounds then there might be interest I
don't know how that works and then you freeze my account if you just charge me as we go there's no
issue there's no issue and charge and require that office to do it especially when you have multiple
offices it's way cleaner because if you have multiple locations and they all have different
billing systems and one person doesn't pay it this happened to me personally maybe 15 years
ago I was working for a couple different dsos and some private practice and everything was under my
account and when one of them didn't pay you know because they were Pokey and slow all my patients
Got Hijacked I couldn't access I couldn't get in I couldn't do even refinements I was Furious
and they had this stupid yellow Banner that hung over my account which never went away and it made
me really mad so anyways I know you guys know about that yellow banner I think it's rude but
sorry Invisalign that's just my opinion everyone could improve so um you guys get the idea use an
accountability Loop Dental monitoring is a great system too it's very expensive but it's fantastic
um you're gonna pay about 10 times the price I think as you would for in hand I've heard but
that's just what I've heard I haven't checked into their prices but yeah I mean that's pretty
much it and then rinse and repeat next aligner same thing try it in if it's not fully seating
use your chewies one two three days if you can't fully get it seated make sure you're
saving all your old aligners you need to save all the old aligners in between appointments why
first of all if you're having an issue with one fitting you can always go back and find
the better fit and try it and wear it again for another week you don't want to move forward
ever number two if you lose little liner you have the last one you put it in and then you
contact your office to have them um order the the replacement one so that's how it works if you do
this you will have no problems with aligners tracking you probably will have significantly
fewer refinements revisions everyone's going to be happier and it's going to be a successful and fun
experience this is where the 99 of the doctors who get frustrated with the liners this is what
if it's not that they're not doing the treatment plan right it's that they don't do this section
right once you get this section down and every single member of your staff should be able to
recite what I'm doing I'm not reading something they should be able to recite it backwards and
forwards from the front office to the back office to the doctors plural do the hygienist that way
when someone comes in and they have a question everyone's on the same page what to do it's just
gonna keep you guys all in sync and we don't want to always be deferring back to the doctor this is
just general stuff is it tracking what aligner you're on are you saving your old aligners
it's just going to be really fun hopefully this was helpful thank you so much for listening