dr amanda with straight smile solutions streetsmasolutions.com and the topic today
is why i like expanding lower arches in mixed dentition cases together with the upper arches
to coordinate arch forms to widen the nice arches and to prevent impacted lower canines and scissor
bites from developing phew that's a lot right and i have a few other videos about lower expansion
and mixed dentition and notice i am saying well i even this even could translate into comprehensive
care and i'll explain this a little bit more but basically in a nutshell the reason why i do it
especially in mixed dentition is that what is the reason that we have crowding in the first place
well the first reason we have crowding in the first place is because arches are underdeveloped
due to their tongue tie habits tongue position or just general soft diet um and misuse of facial
emotionals facial muscles as as an infant and underdeveloped muscles as a toddler an infant and
young child because of diet so basically damage is done because we're not doing things correctly and
then the jaws don't grow to the normal width so crowding like i've gone through my other lectures
on crowding that's a first world problem it's not something that's happened historically in tribal
cultures there are anthropo anthropological data that backs this up and if you'd like to hear or
see some of those papers i'll gladly refer some to you there's also some great books on the topic
anyways damage happens and the great thing is that we want to try to catch it while
the patient is young 7 8 9 10 so that we can intervene and by intervening and growing the
arches to the right size the right width the right position relative to their cranial base
then often the teeth come in straight to begin with you know the the mixed dentition teeth yes
we have to straighten the front teeth and fix the bites but if we do that often things are
stay straight which is really really awesome and the new teeth that new sets your threes the fours
the fives the canines and the bicuspids and the second molars come in nice and straight often
so that's the benefit of doing it sure you can just do and i do understand that a maxilla is
a two-shelf piece and i do understand that you really can't split a suture on the lower arch yes
of course i understand i took basic anatomy but you can still widen it and yes if you do widen
the top palette often the lower teeth as long as they're not trapped in appliance will roll out and
meech it need it over time this will often happen however it's very very slow and then it can limit
how much you can turn the top arch and that's the reason why i like to do the lower arch and
mixed dentition at the same time otherwise you're limited as to how much you can do the top arch and
you can't necessarily do it to the full width a lot of doctors end up stopping because they're
afraid they're going to get a scissor bite or a brody bite or a buckle cross bite and so they
don't get to the top to the right width they stop short and they still end up with impacted
canines and they're short on space so that is why i do the lower simultaneously unless it's
clear that there's plenty of space in the lower arch there's no crowding zero crowding at all
and the only issues on the top then i'll do top only but if i see any crowding happening and i'm
going to use the pano i'm going to use do like luzogram or or just visualize the space that i
have in the panel and also in clinically so i know if my arch is constricted with something
super minor usually it will roll out you know one or two millimeters but i'm talking where you see
evidence of actual crowding and mixed dentition that's not right you should never ever have
any crowding in any arches permanent teeth should have six millimeters between the teeth that's
what's normal on the lower you should see spacing you do not see six millimeters of spacing you have
crowding in next dentition so that's why um and that's what i do and i'll even do it in
in adult teeth even in permanent teeth um sometimes especially if there's a case where
there's a lot of crowding and i'm taking a look at the staff or the profile and i see a full profile
i see flirt incisors i don't want them to come forward i know if i just throw braces on or let
things unravel everything's gonna come forward so the nice thing about doing a lower expander
even in permanent dentition on a team is that you can create this space transversely before
you create the space in an ap or proclination direction which maybe is contraindicated
now of course if they're going to invisalign there's really no reason because it
it does the exact same thing but if you're trying to take a case and you're deciding whether it's
extraction on extraction you want to slowly create some space without flaring incisors or
worry about pushing them through the buckle plate that's the nice thing about lower expanders and
permanent dentition as well nice and slow and i do personally i have done both rapid and slow
expansion i tend to do more slow expansion in my consulting business just because and that's how
i tend to teach my doctors because there's it's so much more dangerous to do it rapid in terms of
side effects and things that can happen pushing teeth to the plate
losing track of the patient and also discomfort tends to happen a lot less you don't see that
really ugly space that develops between the front two teeth so that's why i like to do
slow expansion but i understand many of you have been trained on fast expansion that's something
you're trying to do it just doesn't work well on the lower to do fast okay so it's a different type
of anatomy so that's another reason if it's an upper only then maybe if you're trained on fast
so be it you understand what the risks are um i can tell you scary stories about things that
have happened with bath dentition and it might change your mind so all right thank you so much