hey this is dr amanda with street smash solutions straightsmilesolutions.com and today we're going
to do a part two video on ceph x-rays we're going to dig in a little bit more to workarounds if you
don't have a stuff machine what you can get from a snap x-ray please watch our previous video that we
posted right before this and there's a little more information specifically on invisaligns invisalign
patients workarounds and things like that so let's dig into a little bit more what you can
do if you don't have a cef arm if you don't have a ceph machine but yet you know you need some cephs
because perhaps you're treating adult patients and you're changing ap so ap is anterior so
this is anterior and this is posterior this is anterior and this is posterior so if we
are working in the sagittal direction which is moving things this direction or this direction
okay like moving a lower jaw forward moving upper teeth back no matter if we're doing distalization
of the upper teeth are we adding some ipr to the upper teeth and retracting the incisors
are we using class two elastics to procline the lower teeth to get the bite to match up these
are all things that are in the sagittal or ap direction and these are things
where you might need a set of x-ray now if you do not have one i don't it's not saying go out
and buy a 50 000 machine i'm saying you need to first of all decide first of all you need to check
out your dental practice actually if you need to take steps it doesn't say anything about it
in most states it pretty much says it comes down to standard of care professional judgment
what and i always like to say what do i have to benefit from it so yes if it's an adult and we're
making some fairly fairly drastic sagittal or ap changes you know underbites overbites things like
that overjet flared incisors um yeah you should have a ceph because it helps you make a decision
yeah so you need to have an initial and sometimes a final if there's any issues
um growing kids absolutely you know there's so much you can do especially in the ap sagittal
underbites overbites long faces short faces deep bites open bites all those are going
to need that's vertical things deep bytes and open bytes those you're going to need a step for
what can you not see nsf well you can't see transverse which is like widths of jaws that
would be a transverse direction that would be something different but that you can't get from
this x-ray so my suggestion if you're looking for a workaround would be two-fold number one if
you're in an urban area it should be fairly easy to find an oral maxillofacial radiologist it is a
relatively new specialty i did write a blog and i posted some links somewhere you can go to find one
a lot of people didn't even know they exist a lot of them have independent centers the
one near me doesn't even have a website but he does everything he has a cbct he has itero he
takes steps he does ceph analysis if it involves scanning or x-rays that's what he does he has a
nice little compact center where patients can go and he will do it for you at a very reasonable fee
how that works financially if you're going to be outsourcing that component is really up to you and
that center some of them can bill insurance most of them can either build a patient or
they can bill you depending on how you work out the contract personally if you're doing ortho
most patients get a little irritated if they have to pay twice their recessed a fee unless that's
something that you are saying on the front end and it's in the contract hey your fee is 3 900 of that
3 800 will be sent to us 100 will be sent to you know it it gets a little messy honestly with the
contract i'll be really really honest if there's ever refunds or problems personally i think it's
better if they bill you the doctor you know and you work out some type of you know discounted fee
um or volume fee or something like that you know you purchase ten cefs in a year or something like
that and they'll just take them for you that's what i would do and then all the patient has to do
is just stop by and do it um if you do not have an omf radiology center near you if you have a dental
school near you that works too slightly less convenient they're often a bit clunky but usually
all you need is an x-ray referral form they go there they make an appointment and you can even
set it up for them that's probably the best way to go and help them with the paperwork it's just
that you're gonna have a whole another second set of paperwork it's kind of a hassle um lastly the
easiest way might be to do it is to find a buddy um and if you're worried about someone poaching
your patients my suggestion is to find an oral surgeon because they all have these um sometimes
perio can do it some nintendo can do it you know but usually they have smaller plates but it really
depends um call your specialists and worse comes the worst you can always send don't work though
ortho definitely has it my only concern is it better be a really good friend of yours because
patients might get poached oh and or you know patients have free will so they have the right
to go someplace else if they go there and they're like why didn't i pick this place you know
they may get the rest of their families or if they're done at this other office so you know of
course you're looking for convenience um but you don't want your patients to get poached either and
you know it happens so um i personally prefer that you you know call up a you know oral surgeon is
probably the best the best bet if they're willing to do it for you so call up your oral surgeons in
your area find out who can do this and what it how much would cost if it is an omf radiology center
they will likely do the analysis for you if it's anyone else they probably will not you'll need
to do it independently so see my other videos on how to get the analysis done most of my doctors
in the us or even abroad are using one of a few things so they're either using safex you know
you don't have to go buy the software because that gets very expensive there's some online versions
where you literally just pay to use you know or you purchase a bundle um or a membership and you
get so many steps per month um and you just upload them as you go price point for safex which is one
of my favorites because it's really easy to use and you get it immediately and you just go online
um you can purchase i believe ten this is as of fall 2020. i have a few other videos on safex and
i'm gonna put them all in a playlist um the prices are a little off there because they're from last
year or the year before but as of fall 2020 um i believe you can get 10 steps for 350 us dollars
and there's no you don't you can use them whenever you know so that's prob that's a really good value
um on like credits or you can get memberships i think they're like five steps a month or more
um a little more end up being cheaper but you know if you're not gonna do at least five a month um
it doesn't really make sense um also if you're in the u.s there are quite a few orthodontic labs and
um i can tell you if you want to contact me i can give you some of their names where you could just
email them yourself or you send them in a portal and they will do it for you their price point
is more like about 45 dollars so it's a little bit more than this fx but you can just get one at a
time um turnaround time is a day or two or maybe one or two business days at least so it takes
a little bit longer so fs is instantaneous so um but yes you have to get the numbers there are like
hundreds of different analyses and i think this is the most confusing part for most general dentists
i would personally just go with susuni plus it's very very simple and they actually explain
what it means in simple english so if you're just getting started it makes it crazy easy
um i use mcnamara i use steiner i use pos i use a bunch of them so mcgann there's a bunch of
them i know what they mean when i look at it you know i don't have to have it explained to me but
don't stress out now there are textbooks on this if you want to buy it but i wouldn't overthink
it just get this the susuni plus to start and it literally will say lower jaw is too big upper jaw
is too small or it's it's positioned you know posteriorly instead of anteriorly or it's long
vertically you know it's they put it in simple english you can't miss it and these are things
that you can put in your insurance report or um in your narrative or put in your treatment
plan you can literally just lift the information because it's already explained for you and then
it you know it's easy for you to explain it to the patient hey we're doing this because the numbers
say this now remember it's really important that when you're putting the information in
that you're putting in the accurate patient's birth date because the analyses are based on
the patient's age and the patient's ethnicity okay so somebody of african descent is going to have
slightly different numbers because the profiles are different think different things work with
a soft tissue than somebody maybe from northern european descent okay so it's really important
that you're accurately putting in the right information so that you get the right data birth
date and ethnicity okay so anyways hopefully this was helpful for you um get excited about seth's
they're not that scary um and i'd love to help you if you have any questions please watch the rest of
my videos on cephalometrics all right thanks so much and if you have any additional questions
you'll want to go to straightsmilesolutions.com um you're welcome to make requests if you want some
more content created if you want to take one of our classes if you want to go to our gpwebinar.com
site we have even more content posted there and it's all free alright thanks so much