it's dr amanda with straight smile solutions street smile solutions.com and today i'm going to
talk to you a little bit more about the sequence of appointments for impacted canine exposure cases
and first of all if you are already doing invisalign and you get one of these cases
and you've never done braces before it's a no so even if you think it might not come down it's
a no refer it out refer to ortho because on the level of one to ten in terms of complexity these
can be a 10.5 and you don't always know until you get yourself in the middle of it so i don't want
anyone taking impacted canine cases um unless they know how to do braces and i'm not talking
about just six months miles or something like that i mean you've done a lot of braces a lot
of cases you know how to place brackets you know how to do all the different movements coils chains
um etc etc overlay wires piggyback wires you should know how to do all that but if you have
a lot of experience with straight wire you feel like feeling confident and you want to attempt
an impacted canine case you should pick an easy one to start the easiest ones are the
buckle ones and if you don't know if it's buckle or paddle use the buckle ones you
can always feel the bulge in the vestibule so if you don't see a bulge and it's pretty low
it's palatable so and of course you can all we have to verify that with a cone beam
or a series of pas with a slob rule you know like we did in the olden days just to make sure younger
the patient is the easier it's going to be and the more success the higher the success rate is
going to be so look for somebody under the age of 18 for sure do not attempt ones on adults
even better if they're under 15 i would say and then of course also um if you want to know more
about gauging how complex they are um you can check out the my phase one smile um you can
you can purchase that on my website um my phase one smile is available and we talked
about the angulation um you know as well as um how many teeth it overlaps is it overlapping the
the lateral is it overlapping the central what percentage so this is actually a very complex one
that i did but um it they can be very complex i could be really honest so and they can take
a lot of time like years and also you can run the healthy tooth into other teeth so
run the impacted tooth and other teeth it can be very complicated i'll be honest i really
hate impacted canines they're very difficult sometimes and sometimes they just don't turn out
you know everything you could have done everything right and they could be enclosed
and you're really not necessarily gonna know until you know um and in the times when
that's happened to me um patient was always like about 16 and up adults run a very high percentage
of ankylosis i mean like over 50 50 60 70 80 i just stopped doing adults after a certain point
i just said sorry um it's not something that i do anymore i recommend that you just get it extracted
because i've done enough of them where you know i had them sign waivers saying it might be enclosed
but what would end up happening is the patient you know we get frustrated and then they try to get
their refund and they go to the insurance or they you know they make complaints and even if you had
everything documented you're you gotta give them a refund i mean it just causes too much drama
so it's just pretty much a waste of time in adults um you know because the chance of a success is so
incredibly low so i'm just warning you you know what you're getting yourselves into um you need
to be very experienced ultimately i really think most general dentists should refer these out
unless it's an easy one but now that i've given you the whole you know the whole spiel behind
what i think you should do and not do let me tell you the sequence of appointments so the sequence
of appointments would be you're going to go ahead of course do your diagnostics let the patient know
it's impacted let them know that there will be a surgery needed if you have not done many many
many impacted canine and post-bond surgeries don't do it refer it out to perioral surgery
um because they know what they're doing they know how to lay the flap they know how to do it i mean
if you don't do it right it's either not going to stick on or you know it's not going to come
emerge right the angle of emergence is going to be ugly so that is going to be additional fee
for the patient depending on insurance could running anywhere from a couple hundred to a
couple thousand dollars depending on the type of sedation they want for their surgery so i always
recommend that you send to the surgeon first sometimes when i do that and i say console only
they still go and get it done so no no no don't get it done at the beginning you you're going
just for the prep work so they can get an idea of what the cost is they need to realize that this is
part of the plan and they have to go when you say they're ready to go not when they're financially
ready you know so you're giving them you know usually 6 12 18 months to get prepared this
depending on how much you have to do before then um you're getting them all prepped
the cana exposure is really the last step in the ortho so it's going to be towards the end
of the treatment so they're going to have time to get prepared but they need to be prepared
if somehow you get to the point and they're ready to go it's time for you to go and they're not
financially ready you need to just take those braces off you don't just sit around and wait
um and they will have to get prices another time together with the surgery and you need to let them
know that too i've had that happen more times than you even know so um a really important thing to
explain to the patient that this is going to be part of the treatment you're going to give them
a few months notice you're going to give them a gr you know a rough area about when this is going
to be but they need to go when you say they need to go you know plus or minus a month or two um
because at that point there's nothing else for you to do except for the surgery um you can always put
them in retainers and they can always get the braces put back on later when they're ready of
course there'd be an additional fee for that um and you need to outline that and it might even be
something that you want to put in the paperwork because it does happen quite often actually
if you don't cover your bases so just going to work your way up just like there's no impacted
tooth you're going to work your way up the wire sequence um getting yourself ready aligning the
teeth obviously in this circumstance we have to we had to take a cbct to make sure this wasn't
transposed it wasn't upright this tooth put it where it needs to go um before we can start
dragging that tooth where it needs to go this tooth had to be derotated
but it can take like i said six to 18 months to prep to get ready for the actual surgery now you
can do impacted canines with with invisalign it is significantly harder from experience like 10 times
harder i would not recommend it um you know family members maybe but it is not fun it's a lot of work
and the mechanics are very complex so i would not recommend it stick with traditional braces
you also need to think about anchorage um in most cases with impacted canine cases i will put in
some type of ex internal anchorage um some people use tads but for me that's when you don't have to
do something surgical why would you want to right um it's more uncomfortable it's more expensive so
i usually use a tpa you can use a nance too it depends on where the impacted canine is because
when they lay the flap the gnats might be in the way so and you want it to stay on you can put it
on the beginning of treatment or you can put it on before the surgery but usually i'm going to brace
against that appliance in order to retract that canine it really helps from keeping the arch from
collapsing unless you get yourself in a super heavy steel wire but i usually won't send them
for this surgery until they're in a heavy wire at least a heavy rectangular like an 18-25 wire and
remember in order to do this you can't be doing this with junky brackets you have to have good
brackets that have torque and everything like that so anyways hopefully this was helpful thank you