Dr Amanda with Street smile Solutions Street smile solutions.com and we're going to talk a little bit
more about getting mid lines on with braces and aligners when do you do it how do you evaluate it
how do you avoid from getting in trouble while you do it so let's go ahead and talk about how
I do it and how I evaluate first of all if you're using Invisalign it's going to be and using their
app okay using their patient facing app and Doctor facing app you're going to have more resources for
midlines than if you're using not using that part of Invisalign or if you're using any other aligner
company or any other braces company so that would be my standard if you have a funky midline case I
highly recommend Invisalign remember I don't work for them I get no kickbacks from them they don't
even say thank you to me I'm just telling you because it's a really good product so you want
to use their in face feature if you want to know how to use their in-face feature you can watch
all my other videos and content I've made on that you can go to my YouTube channel which is straight
smile Solutions put it in your search bar then there's a little magnifying glass near the top
right you can put it in face and it'll take you or in face comma Invisalign and show you how to use
their in-phase feature if you don't have their app or you're not using Invisalign my suggestion with
an aligner case is don't even think about the mid lines all I want you to do initially is to
do a line and level on your first treatment plan okay don't even take it to the point where you're
adjusting mid lines or adding IPR or thinking about elastics or anything like that just align
level then you're going to go ahead at this stage in a refinement and drop the virtual line or the
actual piece of floss between the eyes going down the middle of your nose and see where the midlines
land you want to also evaluate the smile the smile line what shows in the smile is it the upper teeth
is it a younger female or is it the lower teeth and or older male whatever is showing is what you
need to adjust so for example here old Tom Cruise pre-2006 before he had his smile transformation
upper shelling lower is not showing whoa crazy off right this guy upper and lower is showing I'd
probably adjust both this guy upper and lower showing up probably adjust both but again I'm
going to go ahead and align a level first and hit that on a refinement okay and then I'll reevaluate
that if you're using the in-phase feature you can more accurately treatment plan at the beginning
okay so that's the liners now let's talk about braces braces I'm pretty much going to do the
same thing I mean braces you're not thinking the treatment plan way in advance you're just kind
of rolling with it right you automatically do the alignment level and then once we get
into the heavier wires we've done our repo visit we're going to go ahead and tackle the midlines
depending on what's showing we're going to make sure we get the upper one first on with the face
and then as needed we can always adjust the lower one I am not at all a fan of midline elastics the
only reason I'd use a midline elastic is if there were spaces and if I was doing different units of
power chain and shuffling spaces around you know left right if there's no spaces midnight
elastics all they're going to do is just can't the occlusal plane they're not going to do anything
I don't know why you guys think that they're powerful they're not they're garbage okay they
can maybe help facilitate things a little faster if you have spaces whether you have them already
um or whether you are creating them with IPR but remember you're going to have to have your
Anchorage and do all your other mechanics too to go along with it all it's going to do is just
help make things go a little faster and always cracks me up when you've got these dentists that
are talking about midline elastics and I'm like these don't do anything so anyways all right so
that answered that question do midline elastics work the answer is not really you need to have
space okay and of course you also have to keep in mind let's say in this situation here we had mid
lines right and we're trying to put them here how am I going to move them and people say oh let's
do midline elastics well that's not going to work so in this case you're going to have to probably
do if there's no gaps unless you're going to do sequential distalization and there's no impacted
molars which is going to take a very very very long time because you'd have to scoot each tooth
back one tooth at a time it would probably take you 80 aligners to get these mid lines
on with two ears with sequential distalization if you want a quick fix you could do some IPR
but you can't just do the upper because if I do the upper I'm going to run out of overjet
right so I'd have to do the lower first and then the upper or about the same time but you have to
have clearance because you don't want to be getting framitous or getting hard anterior
contacts during the midline shift all right hopefully that was helpful thank you so much