hey it's dr amanda with straight smile solutions straightsmilesolutions.com and today we're going
to do a follow-up on the whole invisalign with ma and specifically want to talk about the inclusion
criteria and the reason why i want to talk about this is that i actually really love this appliance
when they first started out i had a lot of concerns and there's a couple funky things
that do happen it doesn't quite go as predicted you can watch my other mma videos with some
tricks and tips but as long as you kind of know what to expect it really works well and i find
especially well in little kids and older kids i mean before what was my go-to overjet corrector
well you could use the healthy start g appliance but that's only worn at night and at home for the
most part because it's a one piece of plants like a bionator so you're not gonna get the 22 hour
day compliance that you need to really get good mandibular advancement in a rapid amount of time
so that just wasn't gonna happen especially in older kids twin blocks were okay but again they
look like retainers and having a metal bar in front of your teeth is just probably not going
to fly it might work in an eight or nine year old but it's not going to work in a 10 through 15 year
old they're just not going to wear it so and i don't like doing distalization like the carrier
because that's backwards movements not forward movement at the lower jaw so you know just a
friendly reminder elastics don't grow jaws so when they came out with invisalign with ma i found that
it was a really great way to harness mandibular growth potential in all different ages of patients
so i've really loved it seen and done quite a few cases so one thing you need to keep
in mind and this has happened to a few of my clients um is that your patient may not
get accepted to the program and i like to say unlike invisalign or clear correct i mean shoot
is if you put a patient in they're going to do something they're going to let you do something
they're not going to say no well they'll say no to m.a invisalign will say no to m.a because
there's certain inclusion criteria and maybe as the product and the system develops over time
they'll be a little more flexible letting more cases go through but a big part of it is retention
and unless you have enough teeth that are erupted like if they've had a lot of teeth extracted due
to caries or if that you know how little kids will go through a latency period so around eight eight
and a half nine you know they're gonna have um usually two to two in top and bottom that's the
front four teeth top and bottom seven through ten twenty two through sorry twenty three two twenty
six we'll be in you know around eight and a half or so and then they're gonna have a period where
nothing's gonna happen for like a year where they won't probably maybe lose seas and that's okay
but you know they're not gonna lose their d's in their ease everything's just gonna be the way it
is there's not gonna be a lot of changes that is the time when you need to do your invisalign
first with me there's a very small window a defined window once they start losing more
teeth in the back and they're rapidly losing teeth there's going to be about a year and a half where
they're just going to be there's 12 teeth that are going to come out and it's going to be like every
month or two it's going to come out that you will not get accepted if you're in that window
so you have to time it right and here's the difficult part is sure you can say i'll just
wait till they lose all those teeth well here's the problem after they lose all those teeth and
their chronological chronological age may not line up with their schedule age may not line up with
their dental age so if you don't understand the difference between those three different ages and
how that affects your outcome in orthodontics you need to understand that that's like basic
fundamental go back because i made a video about that i parked it in my interceptive ortho playlist
which is on my home page straight smile solutions or you can go this is how you do this go to your
youtube site go up to the top where the search bar is put in straight smile solutions that'll take
you to my youtube site once you're in my youtube site which has a green banner there are 10 to 12
playlists on the home page scroll down till you find the one that says interceptive ortho airway
emt habits it's all all that stuff is looped into one and there is that video is in there it's like
it's called like skeletal age chronological age and dental age three different ages um if
you can't find it within the playlist you can also search as a magnifying glass towards the top right
corner on any youtube site but you need to look within my youtube site and put in skeletal age
and it should pop that video up definitely watch that first if you don't understand that concept
before you listen to the rest of this video okay so yeah sure you could wait until all the teeth
are lost and more teeth come in but if this is a girl there's a decent chance this patient eleven
a half may be done growing a decent enough chance maybe maybe not if they're done growing guess what
it may not gonna work so yeah invisalign might accept it but it's not gonna work so that is
why it's critically important to time your ma at the right time and this is something where really
invisalign aligned technology has greatly dropped the ball like drop the ball massively because
they they have educated a little bit about mma but i mean orthodontists know this stuff but
now that you're letting general and pediatric dentists use mma they don't know this stuff
um and i work with them all the time and it's like well invisalign said i could do it yeah well
it's not gonna work because your patient finished puberty two years ago so sorry it's not gonna work
so what are your other options jaw surgery you can take out eights and do sequential distillation but
the profile is going to look terrible and you're going to compromise the airway you drop the ball
doctor you drop the ball not online technology that's not their responsibility to to know when
your patient has their skeletal maturity it's they don't even get into that they just move teeth
it's a feature it's a tool you need to know how to use it so anyways this is the inclusion criteria
you have to fall within their windows and remember in most countries but not all invisalign with
ma is available in the invisalign first module which is one feature which again that has its own
separate list of criteria it's an 18 month program it's generally a cheaper lab fee it's about 40
cheaper than the comprehensive lab fee but it's only 18 months and it's only for those kids
in the two to two stage that i was telling you about before you can just do a lining you can do
something a little bit of arch but not skeletal expansion you can close spaces and you can do ma
nma is the most useful feature um i highly highly recommend it and remember if you do invisalign
first you can do invisalign second later which will have a decreased price and you can read the
tos it's in there if you want to search it they don't quite say what it is because i think there's
not a lot of patients that are there yet you get a 10-year window after you finish invisalign first
to do your invisalign second there is a reduced lab fee from the non-visual and comprehensive
so a plus b doesn't equal c but listen there's a couple workarounds and i'll get to that in a
few minutes but anyways let's talk about the inclusion criteria because your patient may
get rejected from the program because they lost too many teeth so i'm just gonna read it i know
you guys know how to read but just in case you're in the car um the teeth under and adjacent to the
precision wings okay so these are the precision wings right here so basically it's just an aligner
with these little wings molded to it okay so it's just in a wine a liner with a bubble in the back
the bubble in the back on top is going to be more towards the back towards the sixes and e's the
aligner the bubble on the bottom is going to be more around the premolars a little more anterior
okay so the teeth under and adjacent to the precision wings these teeth and these teeth
must be present and stable throughout the phase of treatment that means if they've lost some ease
or these they will not be accepted to the program so you'll either have to do it before they lose
those teeth or you'll have to do it after those the permanent teeth come in and you could do it
in invisalign comprehensive the problem with that is your patient might be done growing and then
this is not gonna work c's d's and e's or fours and fives should be stable i.e not expected to
exfoliate or to be erupting during the anime phase because they cannot do those um eruptive guidance
politics or anything that they do that eps eas whatever we're calling them with invisalign okay
eruption compensation is not available for premolars during the primary and they face
of treatment please note that ec eruptive compensation for premolars is only available
in secondary orders including additional aligner orders oh okay okay so i guess if you start this
and then you have to do a refinement then they can do the ec eruptive compensation for premolars okay
um that's fine invisalign first clear aligners patient inclusion criteria also applies the use
of invisalign first clear aligners requires that they patients have erupted first molar
so you have to have your sixes in and at least oh this ic this is for invisalign first this
is written very awkwardly um you have to have at least two incisors in at least two thirds erupted
um you have to have at least two primary c d's or e's and also inter interrupted permanent teeth per
quadrant in at least three quadrants so yeah if you're missing multiple teeth you will be rejected
from the program anyways just things to keep in mind because i guess i guess what i didn't realize
i thought oh if you have them at the scan they'll accept you that they can reject you if they notice
in the x-ray or whatever that it looks like they're about to exfoliate so i think the moral
of the story is you don't want to promise your patient and take the money up front say oh you're
going to be getting invisalign first with mma or you're going to be getting invisalign with mma
because they might get rejected from the program and that changes your entire treatment plan and
unless you're prepared and the patient is prepared to do bionators twin blocks or something else
well you're gonna have to refund the money so you know and you're gonna look like a fool
and this has happened to my doctors before you know they're like oh great mma case yeah
in theory it is a great anime case but guess what you're not accepted to the
program so i usually like to say if you're thinking about mma just to tell them look
it's kind of a relatively new program for invisalign they're very selective what cases
can be accepted i think you have a good chance of being accepted let's just take your scan and
see if you're accepted if you're accepted then we'll work up the treatment plan from them i'm
not going to open your contract or take any of your money until they know that you're accepted
boom that's exactly what i would do so contrary than what you would do with a regular invisalign
case and that's just something where i think align technology has failed a little bit
in the education especially of the gps and the pediatric dentist of course i'm happy to do that
um i'll keep making more videos as i learn more about the product i've taken all their webinars
and stuff it's just really devoid of of knowledge so um i'm learning as i go too i understand the
concept 100 how it works it's just the nuances of the whole invisalign software is a little bit
different so anyways hopefully this was helpful and i hope you have a fantastic day take care