hey it's Dr Amanda with straight smile Solutions straightsmilesolutions.com and we're going to talk
about finishing um Ortho cases specifically finishing a liner cases I'm going to kind of
focus more towards Invisalign just because they have some features that other ones don't have
that make it a little bit easier so I've done a few other videos on Virtual IPR slash virtual
power chain you want to watch those videos first otherwise this video isn't going to make sense
because it's going to build on that if you want to watch those videos first put a pause on this
go back to my YouTube channel which is straight smile Solutions when you go there it'll have a
green Banner once you're within my channel you can go across the tabs at the Top If you're on
an iPhone or an iPad you might have to it might be hidden so you have to keep going top right until
you go to the very last tab which looks like a little magnifying glass once they're there you can
put in those keywords virtual IPR or virtual power chain or I might have used the acronym VPC watch
those first all right I'm assuming you've watched them so now I'm going to go ahead and build on
that so the question that came in today is can you explain a little bit more about or ghost IPR and
exactly how it works step by step so obviously let's say we have a case it's looking awesome
remember anytime you're doing a case be it braces or aligners your first step is level and align
so the Arches are Level we've got perfect vertical we've got perfectly straight teeth we love all
that nice class one or however we wanted to finish it that's all done so our transverse
however we want to finish is fixed our AP or our sagittal is fixed our vertical is fixed our
first order alignment is done ins and outs ups and downs we're really happy with all that the
only thing we really kind of don't want don't like perhaps is maybe we go through with floss
to check all the contacts I want to have a catch on all the contacts I'm assuming that's your plan
unless you're planning to do restorative little open contacts in the front is not a problem
as long as the patient is aware of it and doesn't mind it and as long as the doctor doesn't mind it
either maybe you're planning to restart it maybe you're not I don't have an issue with that open
contacts in the back is a problem and a lot of that's also going to depend on what type of
um what type of retention you're going to do in the olden days we always had open contacts at the
end because we were doing bands on premolars and molars and we used wraparound Hollies or bonded
retainers and let things settle and tighten in and they did over time if you gave it time and
you could still do that too if you want to you can use a wrap around or circumferential Holly and as
long as your patient wears it 24 7 it will close those spaces but a lot of patients aren't going to
do that they're just thinking they're going to go straight into an Essex what you can't do is
you can't go straight from loose contacts in the back into an Essex or straight into loose context
in the back into a vivera why because you're basically preventing those contacts from ever
closing and you're permanently cementing perio traps which is terrible for the patient down the
road this a liability for you you cannot do that so you can finish in a wrap around Holly you can
try to finish in a bonded retainer and usually the contacts will settle in close can't promise though
but you could do a bonded retainer in the front and a wrap around Holly in the back a wrap around
a Holly has no wires that cover the occlusal plane you have to use a really good lab to make it has
to be really good I have one it's amazing it's very tight but you have to have a really good
scan you have to have third molars out you have to get all the way behind those second molars so if
you don't have a really good scan or you don't have thermolars out that's not going to work
and again you should look up my videos on circumferential retainers or wrap around
Hollies to make sure you know how to design that properly otherwise it's not going to work to close
spaces a positioner is a great option I have a lot of videos on positioners custom mini positioner
about 350 you can order from TP Ortho they have the patent on that been around for 50 years but
works great at closing itty bitty tiny spaces you only have to wear it 14 to 16 hours a day
chew on it when you're home don't have to wear it to work works great to close tiny spaces let's say
you want to finish those spaces in Invisalign you paid for the unlimited you paid for them
comprehensive you've got another two years why not you know do it for free we don't want to pay for
a big lab fee and you want to go straight into vivera that's totally fine but you're going to
go ahead and have to do something tricky so I call this virtual or ghost IPR that means we're doing
a refinement not to straighten teeth not to fix the bite all we're doing is tightening up those
itty bitty spaces now virtual power chain for the most part it's unpredictable okay so it's
squeezing a little bit tighter like a power chain would Embraces sometimes it works sometimes it
doesn't watch all my videos on VPC before you even consider doing that because it can cause
more trouble than it's worth it's not really my go-to thing I sometimes will build it into space
in cases and I may or may not use it at the end if you use it and you don't need it you
will get crowding so if you got to this point and everything's perfectly straight why take the risk
and do VPC because you might have to it might make things worse right I'd rather you just use ghost
IPR or virtual IPR that is where you're going to go ahead and scan the case you're going to
write on a piece of paper all those loose sloppy or open contacts you know you've got one between
two and three one between 11 and 12. write them down okay chart them then you're gonna go ahead
and scan and submit you're gonna say nothing you're going to say just please close please
close spaces that's going to be your instructions and work towards previous plan that's it that's
all you're going to say then when the clean check comes back you're going to double check you're
going to cross check the spaces that you felt the loose contacts versus what they picked up
you can even tell them where the open space is if you want nothing wrong with doing that okay
um you want to make sure every space that you felt or every loose contact that you felt shows up
with a 0.1 or a 0.2 or at least a 0.1 okay if you don't see that point one in a space then ask for
IPR between that space so let's say there's a 0.1 here but let's say there was a loose contact here
I'm not sure what tooth that is we'll pretend like that's 2 ,021 I don't know what it is please do
0.1 millimeters of IPR between 20 and 21. don't say virtual IPR just say IPR okay now when the
case comes back you're not going to do the IPR you're not going to do anything now if the bigger
space if it's like a really really like open open well that's an issue you might want to rescan okay
I'm talking about for loose contacts that's all I'm talking about it this is for point one so it
comes back you're not going to do the IPR you're just going to deliver the aligner and then that's
it so basically it's going to work just like this did it it just didn't pick up the space
um you could always add the VPC onto that plan say please add VPC just remember VPC you never deliver
unless you need one tray at a time you don't send it home with the patient you wait till you finish
the aligners do the same thing you just did and if you feel some loose contacts that are in the front
then I don't and everything's straight I don't mind you giving one set of VPC trays have the
patient come back check check again everything's still straight maybe it's good you can repeat or
keep going that means every week they got to come in during the VPC phase if you by accident give
it to them and they don't need it you will get crowding and you'll start all over again okay
so that's how virtual IPR works I know it's a little bit frustrating which is why sometimes
I like the wrap around Holly positioner method it's way easier it's like set it and forget it but
um those are different options the fixing open contacts all right thanks so much