amanda with straight smile solutions straightsmiles solutions.com and today we're
going to talk about clint shacks or it doesn't have to be clinch x it could be any eyeliner
company could even be braces um and treating to gum lines versus treating to incisal edge symmetry
and really i can't answer that question for you that's a personal choice um combination of the
doctor who's going to be restoring the case and the patient what they want what they're looking
for i can tell you the vast majority of patients 99.9 couldn't give a beep about their incisal
um about their sorry about their gum lines they usually don't care it's something that
i feel like doctors care about more than patients so you know what i do on every case and it's just
part of an orthodontist brain is i'm looking at it and thinking well first of all okay when
you're in a computer situate simulation there's no way invisalign or any other liner company can
predict the gingival how the how the gums are going to go any periodontist can tell you that
i mean in theory if you're intruding the gum may or may not follow the intrusion in theory if you
are extruding the gum may or may not follow the extrusion so you can't predict it it's a wild card
so i kind of hesitate to treat to it don't don't predict just because they say the gum's gonna look
like this doesn't mean that's the way it's gonna go so i kind of move the tooth the way that i
want the tooth to go gums can easily be adjusted later with a laser or center of deperio whatever
and if you're doing a restoration than that you're treated to the restoration that makes
sense i see a lot of doctors that go nuts trying to get the gum lines even and then it never looks
like it did in the clincheck and then they screw up the teeth so most orthodontists don't but we
asked the restorative dentist like obviously if i saw a patient like this which is why i threw
this picture in here like clearly there was trauma on the tooth so my question if this patient came
into a consult for me as the treating orthodontist i'm going to go back i'm going to ask the patient
first hey what happened to your tooth obviously i'm going to look at an x-ray and make sure that
tooth is okay make sure i don't see any lesions you know make sure i don't see any um you know
exposed pulp or anything like that and then i'm going to say oh you know what's your plan for
this tooth a lot of times they already have a plan yeah my doctor's planning to put a crown
on it after ortho treatment okay that's great you know and then i'm going to go to the restorative
dentist and say where do you want me to put this tooth you know do you want me to even out the
gum lines do you want me to just get extruded as much as possible and you're going to laser the gum
lane later you know where where do you want it and the restorative dentist is going to tell me where
to put it and then i'm going to double check show them the clinch check and then we're good to make
sure it's good right that's how i do it um what else so anytime i see a clint jack for example
like this one this gum is a little higher than this one but obviously we're going to be root
correcting this tooth and extruding this a bit maybe moving the root more this way which will
bring this inside the edge down so the gum should be pretty even it's a kid anyways i'm not going to
even think about it um other thing that you're going to be checking out would be the smile
so i'd want to see the smile line that makes a huge difference and if you don't get that
big cheesy smile picture in your extra oral photos then cannot do a good treatment plan so that's why
it's super important that you have really really great initial photos right um also might look at
the ceph if you got one that plays a you know plays definitely a part in it in terms of where
we put the incisors so let's look at this picture for example this is another good example looking
at this case we see the incisal edges aren't even so i'm thinking okay well if i extrude this tooth
and bring it down the gum line may also follow it might not which will make the gum line lower um
or i could intrude this one which will make this gum line higher i'm going to look at the patient's
smile line i'm going to look at the patient's bite to make that decision probably at the end i'm
going to get these teeth as close as possible and i'm just going to smooth the edges off these teeth
so now i probably wouldn't worry too much about the gum lines but that's just how i do things the
main thing is to communicate with your patient and if you have this is super important if you have a
restoration any type of restoration restoration be it incisor composite a veneer or a crown
that is affecting your ortho outcome you want to make sure you have that treatment plan locked in
and i always always have the patient put down a deposit on that restoration that way we are locked
in i have my plan i know how i'm putting the teeth the patient knows and cannot change their
mind because they've already put 50 deposit down on the restoration i will not treat personally
to something funky you know like if they're asking me to do this do that leave it high
unless i know for sure the patient is locked into that restoration because i could tell you as an
orthodontist 98 times out of a hundred if i don't do that the patient changes their mind later and
says you know what we get to the end i'm like you're done oh you know what can you just bring
this tooth down i changed my mind i'm okay if you just bring it down and if the gum lines are uneven
so and then that takes me another nine to 12 months you know in ortho and that's
frustrating it's a waste of my time it's a waste of the patient's time it's a waste of my money
so i want this treatment plan to be locked in so that means i'm gonna want to get it in
writing from the restorative dentist this is the plan i'm going to want to get it in writing from
the patient this is the plan this is how we're treating any other changes to this treatment plan
will likely have additional fees write it down have them sign it you don't have to
say what the fees are or you can't say what the fees are extra 500 extra 1 000
whatever because this is more time from me so i really want them to know what their price is
and make sure they understand their procedure from their dentist and if you are doing both the ortho
and the restore restorations together yourself that makes it a lot easier
you just bundle that whole price up front and give them one big price strongly recommended
for bridges implants anything that's over a hundred bucks all right thanks so much