Amanda with straight smile Solutions straightsmilesolutions.com and today
we're going to talk about fit issues with your rpe and I know you're probably saying hey that's
not an RP that's a Schwartz so I'm kind of putting rpes in a general category rpe stands
for Rapid paddle expander now this is a fixed palatal expander whether you do it rapid or not
that's a whole other conversation if you want to learn more about expansion expanders how to
design them how to deliver them how to turn them how they work how to treatment plan them I have
an entire phase one playlist as well as a phase one course to access all our videos for the phase
one playlist you can just go to straight smile Solutions and click on classes free videos if
you want to take our class and get to e-credit the phase one you can also do the same and then just
go to the phase one course the price is pretty low it's well under 500 and I might still have
some promo codes so if you want one just shoot me an email info streetsmilesolutions.com and
I will see if I can get you that promo code for a discount but anyways just wanted to start with
that so I'm using the term rpe for anything that does expansion be it fixed or removable be it
upper or lower just for the sake of this video so if you're having fit issues I mean ideally
your expander whatever you choose to use whether it's fixed or removable should just drop right in
so first thing of course let's let's kind of break it out into fixed and removable and some of the
common issues that might happen with fit and what you should do about it so first I'm going to talk
about fixed fixed means banded when you band you can either band sixes or first molars or you can
band E's or second baby molar baby teeth which are the two-year-old molars obviously I have
videos on how to choose which one to band don't ban baby teeth if they're going to fall out or
be loose during the course of treatment that makes no sense so it depends on the age of the
patient and the dental development if you decide to ban E's or sixes E's are always my preference
if the patient is young enough to be able to handle that because it's way more comfortable
and also I feel like it centers the expansion a little bit you can always send arms extension
arms going back to the molars to help to push them out so that would be the first thing so
that's for banded expanders now in the olden days what we used to do is we'd have to stock
and hire a huge box of bands in like dozens of sizes and we'd have to fit the bands first
which is a function usually of a certified RDA EF or an RDA depending on the state
takes it takes time to fit the bands and then we would take a pickup impression with some alginate
we pop the bands off we lay them in the impression we hold them down with some guide wires while we
poured it up in plaster or stone and then we'd ship that whole thing off to the lab nowadays
there's zero reason to be fitting bands that's a complete waste of time first of all especially
with really accurate scanners so I would not even recommend stalking the bands or fitting the bands
and it's just way more accurate just to take the scan so even if you do braces in your office it
just takes it's faster and more accurate just take the scan so all you've got to do is just
take a scan any type of scan and Export it to whatever ortholab you're going to do and they
will digitally fit the bands for you so that's pretty sweet you still need to drop spacers in
at least a few days before delivery unless there's an open contact so check your contact with floss
and that's one big issue is to make sure you've dropped the spacers in a few days before a few
days to a week it'll be more comfortable for the and you'll have fewer fit issues if you do that
um so when you pull the spacers out you put the banded expander on whether it's upper or lower
it should just drop right in it should not be loose when it drops in you actually should have
to push it down bite it down if it's so loose that it just drops down and you can like pull
it on and off without any struggle at all that's too loose send it back have it remade tell them
the bands weren't fitted correctly sometimes it is a little bit more accurate I mean it's an extra
step and I'm not saying you have to do this but now that you've created the space with the spacer
try re-scanning again and you'll probably get a slightly better fit I'm not saying you have to do
that every time because I feel like most of the time it works out great if you don't but if you
did have a fit issue then I would rescan and have them fit the bands again and just keep sending it
back until they put the effort out to fit the right bands that's sloppy if they're not doing
it should just drop right down there should be zero issues you should be able to use just
you know regular ketak or you know one of these type of just lighter you know temporary cements
to put it on obviously if it's a little bit loose and it was borderline then maybe I'd use like a
you know hybrid glass ionama um or something like that like a Fuji but yeah it shouldn't be like
flopping in and out just don't even bother trying to cement that because you're just gonna struggle
if it also is really loose sometimes if you give it a turn after you cement it it will tighten up
but then you're going to keep having that issue every time the pressure releases so okay so that
is the issue with bands pretty much thoughts about it I mean obviously look for any other
obvious interferences that maybe they made in the construction but most likely it was just an issue
with the band's fitting which is something that the lab should do so that should be a free remank
if you have to remake it it's unfortunate but I'd rather you have it remade then have it be falling
out because that's going to be way more of an issue throughout the turns because not only do
you have to keep it on for the turns but you also have to keep it on for retention so I mean that's
a lot of months so you have to keep it on we don't want this to be falling out you know randomly on
the weekends and then you're gonna have to dial it back okay so let's talk about removals be it
upper and lower we call those Schwartz's this is a lower same concept has a keyhole but you take
it out to eat and brush and turn and put it back in it needs to still be in 22 to 23 hours a day
um obviously same thing I mean if you're using a scan it should just drop right in it should not
be loose and floppy um sometimes they you gotta find the right lab for these because sometimes I
feel like they don't do a great job adapting the clasps I would rather you not mess with the clasps
um you know if you if it's not dropping if it's not dropping right in obviously look for points of
interference um you know if there's like a little bit of acrylic flash or something like that or a
class maybe got bent in transit but ultimately the less complicated you make it the better it should
fit especially with a scan so stay away from doing any um Z Springs or finger sprayings or I mean I
even I'm not a fan of labial bow just some regular ball clasps and Adam's class should be fine no
labial bow um there's a few situations well I will recommend a labia bow and if you want to
watch those videos again it'll be in that playlist that I mentioned earlier as well as our course
um but the less you know bling you put on it the more likely it should just drop in
if if it's not dropping in it could also be if you're in mixed dentition that a new tooth is
coming in or out so obviously you know just use your dental brain sometimes you're gonna have to
get up the slow speed and adjust around it but if it's still too loose or just not dropping
just have it remade so don't don't struggle with these suckers because they're not going
to get worn if they're not really comfortable or if they're not nice and snug and then one
more thing again sometimes the Cog wheel will turn in transit so if you can't get it to fix
go back where it's on the Cog wheel and see if it's all the way backwards um you know so this
is forward see the arrow go backwards and maybe that will solve the issue you can try that or
sometimes if you even Advance It Forward one notch it'll be nice and snug but it needs to
be snug and seated not snug and rocking so all right thanks so much hopefully that was helpful