hey it's dr amanda with straight smile solutions straightsmilesolutions.com and let's talk about
invisalign express i see this probably every week one of my clients will pitch me a case and
say hey we want to do express or hey i've got this express case not sure why i have four refinements
so i just want to clarify a few things if you want to know a little bit more about invisalign options
what's included what's recommended pros and cons i suggest you go into my invisalign playlist it
is free orthodontic education and it is unbiased orthodontic education that means the stuff that
you're going to learn within your invisalign portal is helpful and i don't think that their
classes are wrong and i think it's great but the stuff that we have is free and totally unbiased
we're going to tell you the total truth everything within the invisalign portal that's education
is biased take it with a grain of thought and a lot of it's wrong so uh i would recommend
you learn from us you know at the beginning and then look at their education with a grain of salt
keep in mind that i'm not going to go into that because i don't want to get any letters from
there from their lawyers again so anyways but here's my opinion okay so first of all go how
to get to our invisalign playlist i think we have almost 200 videos today that are
all different things about invisalign so if you want to learn more about invisalign
um menu different products you can put in the word express comma invisalign and search that express
or invisalign comma go invisalign kind of moderate and and check it out keep in mind that the i don't
know the menu and what's available is a little bit different in every country so i'm speaking from
what it's like in the united states in terms of costs and what's included
and features and things like that i have found in other countries it's very different so i do often
work with clients in many different countries so you know just keep that in mind you'll need to
look at your own terms of service talk to your own territory manager and see what's included
but in the u.s we do have an invisalign express 5 invisalign express 7 and invisalign express
10. i never ever ever recommend using 5 and 10 because they come with zero refinements whereas
seven comes with one refinement so the funny thing is that means you get 14 aligners instead
of seven so it's better than a ten right so duh and it's cheaper than the ten so i don't it's
a no-brainer to me if but it's very very very rare then i can find a case that could be an
invisalign express seven and as an orthodontist i feel very confident in case selection and
being able to pick the right thing but i find most general and pediatric dentists make huge mistakes
remember if you submit a case and you mark that you want invisalign express 7
even if it's not a quality case i mean unless it's like way out of left field they are not
going to say no to it they might give you a little disclaimer and be like this may not be
probable or predictable and they might not say it at all but they're not going to tell you no
it's just not going to happen and then what yes you get that one refinement that's great
but you're probably going to need more and those are going to cost you megabucks and you're going
to be spending more than you would have ever spent to have less access to other features and to have
a worse outcome so just don't do it but anyways let's go ahead again and tell you where to access
all of our free invisalign educational resources go to your youtube channel in the search bar at
the top put in the word straight smile solutions that will bring you to our youtube channel i'm
guessing if you're watching this you probably are already in it but you never know sometimes
they show up on like facebook or linkedin or something like that once you're in our youtube
channel you'll be on the home page go ahead and scroll down and there's a 10 or 12 different
playlists the invisalign one should be towards the top somewhere there's almost 200 videos there
this basically could keep you really busy for a few months with free orthodontic education you can
click through the videos you think are important and relevant but this is how i pick an invisalign
express case again i rarely find a case that can do invisalign express what am i looking for first
of all i never submit a case under express never never never or light even i submit everything
under comprehensive i work it up to ideal i use the features that are available and if i find that
certain things are possible and there and it maybe is a good case then i will scale it back
and change it to an express or change it to a light or change it to a moderate does that make
sense because if you submit it under express they're just going to try to make do under the
express thing even if it's not possible does that make sense but they're not going to optimize it
and you won't have access to the features that you need or the tools that you need okay
so if i can teach you anything never submit under express never submit under light yes sometimes i
do it but i know what i'm doing that's the difference so what let's say we put a case
under comprehensive but in our mind we're thinking hmm i wonder if this could be an express 7 case
what am i looking for well when it comes back i am looking first of all i want to click that bulletin
button on the top right and if you're doing this on a phone or a tablet it might be buried under
tools or some of these other sub tabs so you need to look for that big b bolton if you don't know
what a bolton discrepancy is that's a whole other conversation you need to watch my video on bolton
discrepancies again go to my youtube channel then in the little this won't be on a playlist there's
a little magnifying glass that's towards the top right not in the corner but top right put in the
word bolton and watch that video because this this whole conversation is gonna make zero sense to you
unless you understand what a bolton discrepancy is okay so click the bolton tab you need to pick
a case that has no lower 66 bolton discrepancy it could be an upper but it can't be a lower
okay that's key because if i have a lower bolton discrepancy i need lower ipr anytime you need ipr
it is not an express or a like case it has been moved to moderate or comprehensive now sure you
can leave some spaces on the top distal to the canines distal to the laterals but guess what
nine times out of ten patients say that's okay when you do it they don't like it so unless you've
built veneers or restorations or crowns into your treatment plan i still wouldn't even be doing that
with an expresso like case because i think that's super hecka risky um unless you built that in and
the patient has put a 50 deposit down on the restorations it's not happening okay so click
the bolton button number one no bolton described no mandibular bolt and discrepancy on six to six
ignore the three to three okay it can be a zero or it can be a maxillary one but no mandibular one
that's the number one thing number two i don't want to see anything but a class one mild case
no more than two millimeters of crowding two mile is two or less or spacing this basically you're
gonna look at this case and it needs to look just about perfect but a tiny little bitty wonkiness
and a tooth or two either some space or crowding it's got to be like almost a perfect case okay
no bolton discrepancy no ipr is needed um no vertical issues no deep bite no overjet
no anterior interferences no anterior collisions when you check the initial occlusion at stage 0
there should be no anterior contacts there's a lot of things i'm looking for again i want a
slam dunk case a really predictable seven aligner case even though i know i have wiggle room for
another seven aligners but i know if i've got interior issues if i have bite issues if i have
um a bulletin i know i'm gonna need ipr no ipr okay that's the type of case that i'm looking for
and again if you're going if you're just trying to do an improved case and you're
using express you're not fixing everything like oh patient doesn't care about their overjet
you have to always you can't just do that first of all you have to be careful because if you're
doing something like that you cannot be charging comprehensive for insurance you need to charge
limited okay which changes your reimbursement and changes the patient portion about what you get
back so you got to be careful with that that could be considered insurance fraud it's a real gray
area so be careful letting the patient dictate treatment secondarily if you did bill insurance
for comprehensive and you were just doing sniper limited treatment patient has a right to complain
later you know to either your dental board or to the insurance saying you did not give them what
what they built for so you've got to be careful if you have cases like that and i know a lot of
you do it's time for you to really have that conversation with the patient hey i know that
we did an anterior only treatment i know that you said what you wanted um let's make sure we we're
going to put that in writing basically you're going to have to backstep and put it in writing
to cover yourself because they'll have up to seven years to complain about this later and you don't
want to deal with that and have that hanging over your head i like to sleep well at night and by the
way i'm not getting involved in anyone's masses if you did this you know i and if do not contact
me if you're a patient because i'm not helping you guys with this a lot of you contact me hey help me
help me get my doctor in trouble you know you know tell me that my k i don't work with consumers at
all i will not look at your cases if you send us a case through email it'll automatically be
deleted there'll be zero response so do not send us cases if you feel like you've had treatment and
you're not satisfied with as a consumer you need to go find an orthodontist in your neighborhood
and the orthodontist will take a look at it and possibly retreat now if there's a
problem you have with your previous treatment that's really on you to try to figure that out
you know but i'm not going to help you with that i just want to put that out there because
all the time consumers contacted me and i'm not here to throw any other doctors under the bus we
are an educational platform for dentists we teach dentist things now i know consumers watch our
channel that's great always good for people to get educated but unfortunately we don't work with you
that's not part of our business platform you need to go find an orthodontist in your neighborhood
and have a consult with them for a second opinion okay all right so that's pretty much
what i had so moral of the story don't submit under express don't even do express unless you
know what you're doing um take it with a grain of salt submit everything under comprehensive if i
submit it under comprehensive and look like it was a crazy easy case and they told me that it
was supposed to be three aligners you know then i might and with no ipr then i might consider doing
express because guess what anything they tell me i always double it i subscribe to the doublet theory
three aligners is not gonna ever be predictable it's probably going to be a six or seven if they
tell you three if they tell you it's 10 it's 20. they tell you it's 20 it's 40. that's the only
way to make invisalign predictable because they're always rushing their treatment plans and the way
that they do their treatment plans helps them to save money on overhead right you know by cutting
out some of the aligners because they're going to get paid the same regardless but if you want
your case to be more predictable you need to make the stages and the sequencing a little bit slower
slow it down it's going to be first of all more predictable less likely to have revisions and
refinements it's going to be more comfortable for the patient patients going to have have to wear
their liners change more frequently which is going to be healthier and cleaner cleaner for them um
also like i said less revisions refinements better outcomes there's a lot of benefits to that there's
no risk to this so you should always subscribe to the doublet policy all right thanks so much