and today we're going to talk about invisalign and elastic specifically what happens if the patient
gets like really off track and is still using elastics and really why you need to be using
virtual monitoring especially on your elastic cases so first of all there is like zero research
around this this is just based on my experience and the experience of other orthodontists i
don't think invisalign has any position on this i haven't seen anything published on this
i just have the kind of eyes where i've seen so many invisalign cases probably as much or more
than almost any orthodontist in the world and i hate to make that assumption but i just because
of what i do i see a lot and i see a lot of bad i see a lot of scary um and i'm the person people go
to when their invisalign cases get messed up and i know how to fix them so anyways um what i've
noticed and i've actually stopped using a lot elastics a lot with my invisalign cases because
and the ones that doctors are working on because i found you really don't need them that often
it's completely different than with braces with braces you must have elastics in most cases where
they're class 2 class 3 and your open bites i mean there's just no other way a lot of times you just
need anchorage the elastics are super useful and by the way if you are doing invisalign and you
don't do braces already i think you should not be taking these kind of cases because you will never
fully understand how they work when to use them how to troubleshoot what to do
unless you've done elastics on braces patients which is why i just keep saying i don't think
anyone should be taking harder invisalign cases unless they're also doing a lot of braces cases
or have done you know because there's just a fundamental understanding of orthodontics you'll
never get from invisalign because invisalign is a type of braces it just moves slightly differently
and this is why a lot of orthodontists who graduate from residency have zero experience
with aligners i mean like basic like remedial level like my general dentists are way more
sophisticated than them and they often have to contract you know and work with orthodontists
that do have experience with aligners in order to get their speed up because all of a sudden
they're going into practice and they're expected to take these hard invisalign cases i mean in my
hands i've done everything with invisalign i've done four by extraction cases molar uprighting
canine exposure surgical cases everything everything can be done with invisalign it's
not always the most efficient it's not always the fastest but sometimes it is more efficient
in some of it is faster and it just takes that experience anyways so question came up today
with one of my doctors um case was not tracking at all it was off by maybe two three four elena's
like quite off to the point where i'm like whoa pause let's not keep going we need to either
backtrack go back and see what fits or we need to refine patient was in class 2 elastics this
is class 3 obviously in this stock image but just an example of and by the way even more so
i really want you before you listen to this video to go back and listen to all my elastic videos
i may still have a playlist if you look on my homepage if not you can go into my youtube channel
to get to my youtube channel go to your youtube channel put in straight smile solutions in the
search bar that takes you to my youtube channel which has a great banner green banner there's a
magnifying glass in the top right corner you can put in elastics comma invisalign it'll take you
to all my content when you use elastics when you need elastics when you don't need elastics
what size elastics cutouts versus buttons slots versus buttons these are slots here i hate slots
lots are dumb with invisalign i know people think it's great because you don't have to glue
something on the teeth but it's terrible because it's a counter force right we want the aligner
to always be seated that's why we use chewie's you can see it's not seated here and it's not
it's not this is not that bad it's definitely not seated here we're off quite a lot definitely not
seated here top is not bad bottom is off off off off um but why is it off well it's probably off
because they're using elastics and it's pulling it up right at the same time you want it to be
pushed down so this is like a counter force and that makes movements inefficient unpredictable
i know that this is the default for elastics but i hate them so i always change my default to buttons
buttons buttons and to be honest i mean a lot of times they're never going to recommend elastics
on cases you're going to have to say you want them and you're going to have to know when you need
them but i've found that first of all elastics are really meant to can't the occlusal plane
they're you know you could use them in situations maybe where you didn't want to do more ipr you
didn't want to take out a tooth you didn't want to do more sequential distillation you just wanted to
count the occlusal plane to fix the class two or class three a very very very minor one in that
case fine use the buttons i'm cool with that okay totally cool we do that in braces all the time
we finish a case we get to the end we've closed the spaces we've aligned the teeth we're at say
two millimeters of overjet and a two millimeter class two malocclusion great bust out those
elastics okay bust up those clasp two elastics finish up the case one or two months we're done
you can do the same thing with invisalign okay but i normally don't recommend throwing elastics
into a case until you get to i mean i like to think of it the same way that i do with
um with braces and that sometimes you don't know if you need until you get to the end
i want to see how much sequential distalization i can get first if that's what we're doing
now let's there's a few exceptions if it was a full step class two you know
um you know eight millimeters class two we were doing sequential distalization
or we had taken out upper bias and we had 13 millimeters over yet yeah fine let's do
elastics i completely agree okay but you need to be constantly checking to make sure your aligners
getting back to the topic are fully seated what happens if they're not fully seated well then
the forces aren't going the right way the clinch shock is not going to be accurate i don't know
what's going to happen but i know something weird and unpredictable is going to happen it could be
canting it could be rocking it could be one size higher than the other might be uneven bite it's
just not going to be the way it's supposed to be the clincher is only going to turn out it's very
accurate listen clinchack software is very very very very accurate as long as you've staged it
right slowed it down a little bit optimized it and your patient's wearing it 22 to 24 hours a day if
your patient is not wearing it 22 to 24 hours a day it's not going to track if it doesn't track
it's not going to move predictably and i certainly wouldn't be introducing an additional variable
which is the elastics into the force there's too many things going on at one time so no i don't
know what's gonna go wrong but something's gonna go wrong so don't do it which is why i
definitely don't want you guys doing elastics on your invisalign cases unless you're seeing them
every two to three weeks or maybe three weeks max almost like you would do in an in a braces case in
a brace's case i'm either going to put my patient on virtual monitoring to check their elastic wear
and see them maybe every eight weeks and this is what most orthodontists do eight to ten weeks this
is what they do or they're going to see them in their office every three to four weeks you do
the exact same thing with your invisalign patients you don't just give them 10 trays and say buy away
your class 2 elastics they need to be checking in every single aligner um to check on tracking
to check on bite i love the idea of giving them articulating paper to use at home so you can check
if they start to and it's the same thing with your ma cases exact same thing because you know
it works in a kind of a similar way but different so anyways just want to keep reiterating if your
patients have elastics with invisalign make sure they are tracking make sure they are on virtual
monitoring if they're not coming in your office every two or three weeks all right thanks so much