dr amanda with straight smile solutions street smile solutions.com and today we're going to
talk about bracket repositioning appointments when you do them how you do them different
types of appointments now before you listen to this video make sure you've listened to
my whole straight wire playlist which has i think about 200 and something videos in it
or at least the ones relative to wire sequence and bracket placement bracket repositioning
so in order to reach those videos you want to go to my youtube channel which is straight
smile solutions my youtube channel has a green banner once you're there you're going to see a
magnifying glass in the top right you can put in keywords like reposition or repo
or wire sequence and make sure you watch all those appointments or what i'm going to say now is going
to build on that it's not going to make sense so the most important thing is that first of all you
want your brackets to be put on right to begin with if you put your brackets on right to begin
with with indirect bonding on your first 500 to a thousand cases you will not have this issue so
i just can't say this enough even orthodontists you we don't even we're not perfect you know i
kind of know what they should look like but if i freehand it i'm going to make mistakes
if i use indirect bonding which many orthodontists do let the computer place the brackets
print out a template slap it on you know and um etch prime and then your assistant can do it as
long as you're in the room in most states and in most countries and it's really easy and there
should be this whole step will be wiped out you won't have to do it most likely and it's going
to save you six months on the treatment which is going to save you a ton of money so the cost of
the price point in the us is 350 for this service including 3m unitec brackets i mean it's it's
basically a no-brainer to me um if you'd like to be referred to the team that i use which is the
cheapest possible team there's a lot of services that do this around the world but they're using
really really really cheap brackets like plastic brackets like ones that don't have torque in
them don't use those you have to use brackets that orthodontics use if it's not unitec or if it's not
roth 022 slot or if it's not mbt-022 slot ask what it is you're not using good quality brackets
and you're not going to get a good outcome so if you want that referral go ahead and reach out to
me if you're in another country and you're still interested the team that i work with
they still provide the service and then they will send the export to your country
and you can print it out on any lab on any lab on any um 3d printer in your country
and then you can just stack the acrylic on it it's not that hard so anyways
so we're going to assume you did not use the service because if you use one of these services
we wouldn't be doing this step so let's say you free-handed the brackets and then we get to the
point where we are an 18 nighttime now this photo is a no-no it has some mistakes in it because i
was looking for a good stock photo that i could share that had what i wanted to talk about but
if you followed my steps you would know if we were in 18 nighttime we would not have chain
no chain on 18 nitai no chain on round wires no chain on 18 nighttime no chain on wrong wires
single single singles only and by the way these are self-ligating brackets so there shouldn't
be any rubber ties on there anyways at this stage you would just have the wires but anyways pretend
like you don't see the chain so let's say this was 18 night tie let's say we had no chain and
if you want to know the why behind that watch all my wire sequence videos and the wire is
now passive if you don't know what passive wire means non-deflective wire you need to watch my
videos on that the wire must be passive the wire must be non-deflected and then we look at it and
we're talking about symmetry and aesthetic bracket repo now for the full repo you also need to take
a progress panoramic x-ray because there's certain things we can't tell some types of movements we
can tell just by looking like for example these lower incisors should all be the same height right
well they're not this is up this is down these are about the same this is halfway up which one is
right well i won't know unless i see the patient bite down so this whole appointment has a lot of
art in it so i can't always tell you what to do a lot of times doctors will tell me well which one
should i repeal well i say look you're gonna have to talk to the patient you know part of it is okay
these should all be the same height which ones do we like which ones do we not like do we like
this one do we want to move these all down and bring these up well it depends on the bite right
so if i had to guess probably these are right this needs to get bracketed more incisal this needs
to be bracketed a little bit inside so this needs to be bracketed a lot incisal to bring these down
cusp tips of the three should always be a few millimeters higher than lower two to two so
that's why i know this is not right unless these are wrong too right obviously these need torque
but that goes into having the right brackets and being in the right wires you're not gonna
get torque and round wires so what am i looking at we're going to go through the mouth and i
we orthodontist we do this all the time we eyeball we look at the upper ones are they symmetrical
and this is pretty decent um i mean it's so minor off that you could just sing that later
these need to be the same height these i mean obviously sometimes these are different shapes and
if they are there's nothing we can do these teeth should be about a half millimeter more incisal
sorry half a millimeter more gingival than these okay so it should go like boom boom boom so this
is correct right here this is exactly what you want to see these should be the longest teeth in
the mouth these should be the longest teeth in the mouth you can smooth the edges off patients
will sometimes complain about that but it should fit cusping fossa you know or cuss in an embrasure
and if they don't like the pointy tip at the end i will round it off for them but i tell them these
are your directing teeth these are your guiding teeth if we grind these down you're not going to
have function which is going to cause issue later you ever you know i say you ever see older people
that have completely worn down teeth if we start messing with these now you're not going to have
them to use later so the only thing i'm going to do is round the tip because you need these
you know use your stability teeth i'll round that tip around that tip around that tip around that
tip but not now at the very end so this is what i want to see boom boom boom boom boom boom okay
this is correct as long as these match these match and these match i'm good in terms of the premolars
use articulating paper do we have occlusion when we bite down if we don't one of these needs to be
repot a little bit gingival which one the heights of the marginal ridges in the back should be the
same boom boom boom it should be like a train track okay if one of them is sunken down one of
them is wrong you need to repo it okay boom boom boom same thing down here boom boom boom boom boom
should everything should touch with articulating paper okay when you bite down in front the over
bite should be somewhere between 10 20 and maybe 30 and no more than that if you're seeing less
lower incisors than that well then we need to figure out what's up are we going to intrude these
teeth are we going to introduce these teeth are we going to do relative extrusion of the molars
by adding some anterior bite turbos or an anterior bite plate remember all of this is done in the
leveling and aligning stages which we're still in in the 18 night tie we do not move on to any
heavier wires any power chain until this is done done done done done and you need to take a panel
and verify that the roots are all parallel and of course double check your sevens and your eights
and see if they need to come out at this time or if the sevens need to get bracketed now's the time
we think about it so that is what an aesthetic or symmetry bracket repo position pointing is
you don't have to have a progress panel for that you could get started just with this there's
a lot to do clearly but you will need to take that progress panel next visit and finish it up
um i like to just wait until the wires are passive again and unless i see something jump out at me
we're ready to go ahead and move on with our rectangular wires and our next steps which are
what we finished level in a line that means our transverse is corrected all our teeth should be
110 straight our bite in the front the vertical should be perfect between 10 20 30 percent so
we fixed vertical we fixed transverse we fixed alignment all we should have left to do is ap
if that exists what's ap or ap or sagittal is overjets and negative over jet so if there's
if we bite down and we have a significant overjet or negative over jet we can fix that
perhaps with some elastics eights might need to come out first uh if there's spaces we're gonna
close them in the right direction that's and torque which is gonna be built into those wires
that is it then we should be done if you keep things on a sequential
step by step and don't skip steps your braces will be extremely efficient but you can't let
the patients bully you into skipping steps because they will they'll be like hey i want
this space clothes well we're not there yet we can't close that space until we're in this wire
we have a lot of things we need to do before this wire i know you don't like the space but
if we try to close the space now it'll actually make the treatment more complicated and take
longer because we're doing things in the wrong order so i need you to stick with me as i tell
you we've got to follow the steps okay boom that's all it is all right thanks so much