amanda with straight smile solutions straightsmouthsolutions.com and today
we're going to do a couple of mock ceph analysis and i have a lot of other content on cephalometric
x-rays specifically when do you need them how do you get them what if you don't have a step machine
what the workarounds are do you need them for invisalign all that kind of stuff you can access
that information i'm not going to reinvent the wheel here i'm just going to supplement whatever
the content i've already made but if you want to watch all the rest of that content you should
really watch that first before you watch this video there's a lot of really great info in there
to access that you go to youtube put in the search bar straight smile solutions that'll take you to
my youtube channel from there scroll down and there's a playlist called seth's and from there
watch all those other ones first before you listen to this or you're going to get really confused
in addition listen i am not at all a set expert i probably was more of one 20 years ago when
i was in residency because we had to trace our own sets get our own angles plot our own points
on every single case and to be honest you get a little bit of rusty after a little while because
first of all you're not getting sets on every case and you're only looking at the points that you
need to look at and now there's automated tracing and everything like that so you get a lot rusty
um remember there's hundreds and hundreds of different types of stuff analysis and a lot
of times i work with doctors and they'll like bust out one that i don't use that one i don't
know i don't know these points sorry you know i know the points that i know and the points that
i use which is really all that i need and it might be different than the ones you're using
so i'm gonna tell you what i know and what's relevant to this case and but i highly recommend
that you do just get a basic ortho textbook now the one that i used in dental school was profit
and that's a really really basic one if you have zero ortho knowledge you need to start with that
one read it cover to cover um there's probably a section in there on steph's a little bit but
stuff's a little more advanced but you need to understand basic ortho first before you can
understand seth's from there i mean i really i did a deep dive into what was out there in terms of
content because i have no idea how we learned it i really don't remember um from there you can go to
a more advanced ortho textbook and you don't have to buy a new one i mean i'm all about you know
reuse recycle so if you go to amazon and you go so my second favorite one for a little more advanced
is graber g-r-a-b-e-r and you could buy an older edition list and sex haven't changed so it's okay
if you're reading an edition from the 80s or 90s because it's not changing so um and they do have
a lot of stuff it's there's not like a good set chapter but it's definitely in there you know you
can look up different terms and stuff and look at it um and that's what i use for reference still is
the graver one so you can get that for like 15 20 bucks the new one's like 160 just get a used one
save money and you'll find that really helpful for your ortho okay um and then i'm gonna be starting
to work on a document perhaps that can help y'all with um basic ceph stuff i think it's gonna be
really helpful but it's one of what month are we we're almost in april 2022 it is not ready yet
so i'm gonna work on that it is going to be available in my store the fees are 20 um
you can get that or if you're one of our clients either our premium or a concierge or whatever we
give you these documents for free or even you know what even if you do an a card session i'll include
you know at least up to three documents for free i'm pretty flexible and stuff like that but
yeah i mean i i don't just give them out sometimes i give them out like special like if we do like
a webinar or something for 24 hours after the webinar but yeah that's only going to be
available to our clients because it does take me a lot of effort and time and money to create these
but um anyways i will be working on that that should be ready in the next few weeks
but okay so let's talk about this mock-up patient so um remember you might need
especially on growing patients if you're taking interceptive or phase one patients you need to
know how to get sets you need to know how to read them and you know how to use them because
you're gonna need them on patients you know maybe not all but a lot of them also if you're taking
harder cases with invisalign you need seps you do because you're not going to know where to put the
teeth so this is going to be simulating a phase 1 patient and maybe why you'd need a seth right so
a lot of orthodontists take steps on every single case whether you need an every single invisalign
case is a different story you need to go by your own standard of carrying your own dental
practice act in your state most orthodontists do take them on everyone just because it's so easy
and it's just part of the protocol it's almost easier for me to have one on every single case
just instead of having the team have to say do i need one you know obviously if if it's
a crazy easy case you know three millimeters of crowding class one no vertical issues you know
i know ap might not take one you know but um certainly on kiddos i think you do need them
um especially ones that are growing a little funky so if let's say someone just took the
staff and showed me this picture i would already know something was off this doesn't look right to
me and my eye is trained to see what looks right and what isn't so a lot of orthodontists are not
going to get numbers on every case we only get numbers when we're trying to make a decision
i mean maybe they do but you don't have to you know um but because you guys are trying
to learn you guys need to get numbers because you're not going to know what i see with my eye
right so what am i looking at i mean i'm looking at the shape of the and the angle of the mandible
the position of the jaws relative to the cranial base i'm looking at the nasopharyngeal airway i'm
looking at the oral airway that looks super small right here so that's a red flag to me right there
i definitely see that the the face is growing really long and there's a gonial notch here which
is a red flag to me i see some chin strain and the soft tissue here this is really this is really
long you know the the face is supposed to be in thirds this is really long down here relative
to this um so that's a red flag to me this is a like a regular vertical grower open bite look
that you see and and most likely has some type of airway issue if i had to guess if you took a look
at this patient's tonsils um i'll bet you there they're nuts so there's definitely some either a
nasal problem with nasal airway or a problem with air blockage in here because you can see how tiny
this is it shouldn't be this small so this patient is a huge red flag to me if i saw this patient
this eight-year-old come in my practice i'd be 100 first of all need to do maybe an omt eval
uh maybe sent the ent then this might be something you can't just address with ortho alone there
might be habits uh we do do a sdb eval this is not something you could just slap some braces on
to fix this there's a lot a lot going on here and if you do not intervene with this patient
the patient's gonna have some funky growth and some funky airway issues that are gonna have
to be corrected with jaw surgery so it's really important to catch these patients and to intervene
quickly so i really like to get so way back when even when i was in residency we were pretty much
trained on steiner that's just how i was trained right but i actually like to have a combination of
both susuni plus and steiner why because sasune is really really so when you're asking for different
types of um analyses when you're sending off and again watch all the other videos i've made
on seth how to get them if you don't have one blah blah blah workarounds um the reason why i
like sasuni is because they actually like make it really really easy to understand they put it
in plain english for you here you know all the things i said i just saw was basically confirmed
by what we say here so we're gonna go pretty much go through point through point um the other things
that you're gonna look at is you're gonna look at all these things with all these different stars
anything that has multiple stars you know more than two or three you want to look at and know
what that means and what does that mean for your case and what does that mean for your treatment
planning now i also like steiner because there's a lot of points that i use that aren't in cecily
like sna snb um a and b pretty much um are the main ones i use but it's funny because you don't
see an awful lot of stars here but i see a lot of stars here so that's why i like to have two
because to me this looks like a problem this makes more sense to me sometimes i'll take one and this
looks makes more sense to me so that's what i like to have too now some self-tracing companies are
going to charge you extra for two some aren't it's a question to ask so so let's go through this okay
um so things i talked about yeah this patient's class one fine great um vertical pattern strong
open bite tendency i told you i saw that in the cef right well they just confirmed it okay so um
what else they said that the upper incisor maxwell incisor is lean is protruded it's luneforward okay
yeah because it's trying to compensate um for the tendency so that makes sense so that's telling me
that this is compensating and that we actually might be almost a little bit class three in terms
of dental pattern um and that we need to fix this open bite or it's going to keep compensating right
we are having a decent growth direction but we do have long maxilla posteriorly so
that's again a sign of an open bite tendency what else what else it's interesting here
flat upper lip okay yeah you can see that i mean look at the nasiolamial angle we don't want that
you know we'd like it to be more more full for sure and normal lower incisor position now let's
see what we see here we talked about this the upper incisor um being flared and that's what
the two stars are there okay impa is talking about the position of the um mandibular plane angle so
let me go ahead and tell you a little bit more about what impa means i'm actually going to read
something out of graber because it just probably makes more sense to read it out of britain
let's see where it is impa the impa defines the axial inclination of the mandibular incisor
relative to the mandibular plane it's a good die from good guide for maintaining or positioning
these teeth and relative to the basal bone so they're just talking about the lower incisors
relative to the lower jaw bone and the angle of fat okay so that is actually normal so these
teeth are normal that tells me i could flare if i needed to
um i have some flexibility in the position that i put those lower incisors so that is important
um what else is good here good information one thing that they really really highlighted here
is the dental alveolar compensation they put five stars that's basically meaning that the
teeth are either extruding or leaning forward to try to compensate for this open bite they're
they're going in a position that really isn't that healthy so that's telling you that something's
going on with the growth there so these are pretty much the points that you need to know so obviously
like i said what does this mean to me all these different stars and and and d standard deviations
and everything well everything is pretty much here but it's telling me this patient
has a growth pattern that is not good it's a long face growth pattern it's a steeper growth pattern
and that we need to fix the airway so that we know what to do so and like i said you can totally see
this is a tiny airway here obviously my guess is something's going on with the nose in terms
of occlusion maybe this patient has allergies maybe this patient has oral habits so we need
to dig in and get a little more information so that we can create our treatment plan
but this cef basically confirms what i'm seeing probably on the patient so hopefully this helps
you like i said there's so many like hundreds and hundreds of points and hundreds and hundreds
of plans you just need to know the basic but i love the idea of getting both a susuni and
um the steiner analysis because i like sna and snb let me tell you a little bit about those points so
um sna is the angle it's so cela they're doing cella they're doing nasion so stella is the
base of maturity gland nasion is oh god i can't remember the actual definition of that let me
um it's a nasal bone but it's the angle of the relative horizontal position of maxilla to the
cranial base so the position of the maxilla to the cranial base is it forward is it back obviously
in a patient that was maxillary deficient class iii maxillary deficient would have an sna that
reflected that right so the range is generally 80 to 84 in a caucasian sample remember ceph norms
were made for a northern european caucasian population so if you have an african-american
patient things are going to be a little bit different they're going to be a little bit bigger
they'll be a little bit more forward and that's totally fine if you have an asian population
often they're going to be a little more back but that's totally fine for that patient so you really
have to take into account the patient's ethnicity when you do this and that is not something that
happens in cef so i take everything with a ceph you know with a grain of salt i look at their
face i look at the harmony and say does this look right to me i don't want to make somebody who's
african-american look like a caucasian face and i'm trying to say this in a really really nice
way i'm not saying this in a negative way i'm saying that if we treat everyone to caucasian
norms it's not going to look right on them you know it looks harmonious on them that look is fine
and when i did some lecturing a couple years ago in thai thailand thailand i remember that was a
huge issue that came up with that we had thai population chinese population we had all kind
of asian population there and they kept saying we do not want our patients to look like a caucasian
face and i totally get that so this is not the bible the cent numbers okay they're just a guide
so you know but if your patient is not northern european caucasian population then these norms may
not be for them so you need to take them with a major major grain of salt all right thanks so much