Dr Amanda with straight smile Solutions straightsmilesolutions.com and we're here to
talk about Holly retainer design clasp selection and lab slip writing how to populate a lab slip
so let's talk a little bit about Holly retainers because sometimes I get doctors that ask me well
uh what's your standard Holly and I say there is no standard Holly if you first of all I'm going
to be making a really great video it's going to post next week sometime on retainer menus
and I'm actually going to create a retainer menu template which is going to be available it's going
to be available for anyone who is a straight smile Solutions client who's done an A La Carte session
who's done who's a VIP member who's a concierge member or a premium member otherwise it's going
to be available for twenty dollars but in any case sometimes we do promise and give stuff away
um it's a lot of work to create it but let's talk just specifically about Holly's Hollies
are kind of out of style not too many people are using them go through all of our pros and cons of
from our retainer playlist if you want to listen to our retainer playlist you can go to our YouTube
channel which is straight smile Solutions if you go to your YouTube put straight smile Solutions in
the search bar it takes you to our YouTube which should have a green Banner if you scroll down on
the home page you will see playlists retainer one let's you know towards the bottom where it
should be it's retention um and you can see all the pros and cons of all the different types of
retention for phase one for comprehensive for extraction cases for non-extraction cases you'll
get the gist if you go through all those videos but we're going to talk specifically about Holly
clasps now I'm not going to talk about adjusting Holly class because I have a video already on
that and it's in the retainer playlist it's a how-to video you'll see me using a three-prong
and a bird week we're just going to specifically talk about five different types of Holly designs
and how to take into account for each case if you decided they did want a holly for whatever reason
like I said it's not very popular you know I wear a holly that's my personal preference so
I think it tends to be more either younger kids or older patients who maybe had a holly in the
past like I had a holly in high school so it just felt comfortable to me so when I had Ortho
retreat in my 20s I just I tried on Essex I just I couldn't get with it just felt weird you know had
a bonded didn't like it so I decided to go with a holly um which is what I felt comfortable with
I like that my teeth can touch down that's kind of important to me so different types of clasps
um you've got Adam's clasps Adams Adams Adams you've got ball clasps these are kind of funny
Ball clasps but usually they they melt it so it turns into an actual ball um atoms uh that's about
it so labial bows they can go three to three three to three that's canine to Canine three to three
these are wraparounds we'll get to those in a minute or they can go two to two you can see here
there are some guide wires that are going distal to the ones this would be something you'd want to
do if you want to ensure that a gap stays as close you could run guide wires over one to one lots of
things you can do if you have a three to three or a two a two to two bow would be for a phase
one case if you because you would not want to do a three to three because usually the threes aren't
erupted or they're out to follow and you might block your three's eruptions but usually a two to
two works pretty well you still got to keep your eye on the three eruptions but just keep in mind
when you use Holly in a mixed dentition case teeth are coming in and out and in and out and every
time a tooth comes in and out you're going to have to adjust it it's going to lose its retention so
it's not going to last the whole time you know so the benefit of the Holly is twofold in a
mixed dentition case going from phase one to phase two number one it can keep if you do a two to two
bow it can keep the front teeth straight and any space is closed or keeps rotations from happening
um and it can also maintain any Traverse transverse Dimensions that maybe you create
maybe did some expansion or something like that because it does SNAP over the palette
so that would be the benefit of that it isn't really my go-to retainer for phase one and
there's all kinds of videos on phase one retention so I mean it used to be but now there's a benefit
there's better things that are out there so maybe better you know for comprehensive you got to keep
in mind I mean in terms of clasps I I generally don't choose the clasp unless there's something
very very special or maybe if a patient came in and they're like hey I need a replacement retainer
mine's kind of broken I want it to be like this if someone already had one I'll usually copy their
class design I'll usually snap a picture of it if they had a picture of it then just tell the lab to
remake it like that because when you go switching up class sometimes patients don't like it
so this Skype would be good for keeping front teeth straight and maintaining transverse it's
not necessarily going to keep back teeth straight right because they could rotate they could still
flare out there's a lot of things they could do remember Hollies do not control vertical
issues so if you start it out and that's where it goes to like I can't really tell you what type of
retainer you use because you have to look at the whole picture first of all I really love the idea
of doing a retainer menu and you're going to see that posted next week and you're going to
get the why behind that I like the idea of giving your patient one set of the recommended retainers
whatever you think is best for them depending on where they started and again if you go through my
retainer playlist you'll get all the pros and cons to every kind of retainer for every type of case
um if they do select Holly then you need to think about where they started you're right if
they started with vertical issues meaning that um maybe they had extruded incisors or one Sizer was
longer than the other well Holly's probably not a great choice because it's not going to retain that
the only thing Holly is going to do is retain the ins and outs okay the rotations okay and buckle
lingle right and then because it doesn't cover the tops of the teeth so teeth can still relapse in
the vertical Direction one can go one can intrude one can extrude is not can control that and S6 is
better for that because it's going to cover the tops of the teeth and it covers the teeth in all
the different dimensions the problem with Essex is that first of all in order to work they have to be
made properly with proper equipment just using a vacuum former is not proper it's not going to be
done right and it's not going to retain right and they're just going to wear out or warp it could
even move teeth in the wrong directions if it's not made properly also you need multiple Essex
retainers in a lifetime they pretty much need to be on a regular subscription plan you know
or at least have a way that they can trade them out if they get a hole in them if they crack if
they break a lot of it's again going to depend on how you made it by Vera Essex or vivaria retainer
made by Invisalign is made very very well but there's a reason they come in sets of four four
uppers that's they only come in sets of four they don't come as one because they don't I mean I give
a line technology kudos for that because they know if they sold just one people would just get one
and then they'd be like oh this retainer is crap you know it fell apart well they're not meant to
last a lifetime you're like six to 12 months Max after that they start to become worn out defective
stretch out and your teeth aren't going to stay straight so it's not that something obvious is
going to happen to tell you to replace them you need to replace them on a regular frequency and
that's the part where most Dentists get it wrong they just give one set and there's nothing wrong
you shouldn't be giving your patients retainers for a lifetime there's a reason why they have
subscription models for Essex you know 20 30 years ago all they gave for attention well 50 40
years ago all they gave was um positioners and those things last forever they're great and by
the way that's still a very viable option I I've got content made on those I love those retainers
so my husband had he had a black positioner it looked like a giant mouth card it's a one-piece
Giant football mouth guard works great I mean he doesn't have it anymore I did happen to see it
flying around the house at one point when I was cleaning up um wish I saved it but yeah that's
what he got when I had my braces in I don't know it's lately 80s or early 90s yeah we got Hollies
um on the top they gave us a really ugly bonded on the bottom which I had ripped off and then of
course I relapsed um but they last forever even my one from 20 years ago I still have 25 years
ago it's old I still have it it's great you know maybe it's a little discolored but it still works
I never ever had to adjust it never not one time so great for like I said not great for vertical
but great for ins and outs that's that's the main thing and keeping space is closed you can tighten
these u-loops you know if needed you know to clamp down on the space if it stretches out
a little bit you shouldn't really need to this is a modification this is called a spring it's
a little you can see it has a little Heelys and ahilis I don't love them this way there's better
types of spring retainers but you know if you TR if you wanted to try to kick a tooth forward
you could theoretically make a modification like I said I let the labs pick the clasp I usually sand
my lab slip once I say I I just decide what's hypoholic it's going to be a holly it's going
to be a two to two bow a three to three bow or a circumferential which is like this okay these are
circumferential routine cleaners okay so in circum circumferential retainers can be made without
these guide wires the benefit of the guide wire is it keeps the wire from bouncing up and down
the one I have I purposely put no guide wire so it only goes around the back around my sevens there's
nothing that goes over the occlusal table I just didn't like the way it felt so I cut mine off so
um but also when every time I put it on I have to move the bowl up and down you know I have
to actually Center the bow but I know what I'm doing right but I just like to be able to bite
down I don't like anything blocking me from biting down it bothers me and it can cause
weird things to happen with your bite right but most commonly it does come with a guide wire
um I like what they did to this circus circumferential retainer also called a wrap around
retainer is another word for it I like that they put the acrylic on the labia bow like this that
is super super smart the benefit of the acrylic on the labial bow is it really really helps to keep
teeth straight okay so it just it's like almost like an aligner but again not vertical ins and
outs that's it okay so you have to think of where your patient started if it was crowding or spacing
spacing is really great for circumferential retainers like if they if it was a four by Exo
case or it started out in spacing it just does the best to keep spacing closed you never want to have
a wire that goes over the occlusal plane be it a guide wire or a clasp in any place where there
was an extraction space so for example in a case like this or a case like this or a case like this
if this was a four by Exo case you wouldn't want this design you'd want this design because this
is not good because you're having wires between where the fours were where the fives were and that
will actually the tpap memory and the ligaments have memory right and if there's something that's
always resting there it's going to cause it to drift apart and it's not going to be able to keep
it together so extraction cases should never have a regular three to three or two to two Holly they
should always have a wrap like this always always or spacing cases so this is for spacing cases this
is for anterior crowding cases so now you get the difference right this would be for a case
um that started off with maybe an anterior diastoma not spacing in the back but you know
and you really want to make sure that anterior diastoma stayed closed I mean personally I
would do a bonded retainer but um that's what this little extra guy wires here is for so holley's can
be super modified that's the best part about them depending on where we start we can put politics
in them we can have no clasp in a certain place we can have extra Aspen a certain place but if you're
not sure you can always let the lab pick the best class usually they're pretty good without that
they're going to look at the height of Contour of the tooth and which teeth are missing and they're
going to pick a pretty Wise Choice once especially once you have a good lab so basically that is
Holly Design in a nutshell you get the idea I love that you can customize them you can make them your
own when my retainer menu comes out you're going to get some of the verbiages that I used to use
in helping patients just to make sure because patients can give them a little nuts with Hollies
you know with designs and colors and Glitters and it really can boost the price up I used to offer
a color at no charge and a glitter at no charge okay this is Rainbow that's design okay design
this would be free this would be free oh this this would probably be free I mean I don't mind having
the the you have to be very specific and sometimes you want to have your patient draw it out for you
um but certainly if there's artworks decals any type of major more than one color in it
um this would be more than one color right because we've got two colors it's like um a fade
um similar to nail design they get really creative um they are really really cool some
are very very cool but it really jacks the price up so you a customization should always be extra
um and always they pay up front you know before it's even sent out if they want customization they
want their initials they want their team colors anything like that and I mean usually most Labs
will do whatever they don't worry about copyright because nobody's going to see what's in your mouth
but you know some Labs might be stricter about copyright usually the more monpa local labs
they don't care they'll do team team logos team colors I mean they get real creative but you know
you you can ask from any lab that does Hollies you can ask them for a copy of their art their colors
and their artwork um and usually they have a super cool catalog of all the stuff you can do it is you
know especially for a younger patient and even for an older patient I mean the problem is these are
when you lose them you know if they fall out in your bed they're hard to find but these are easy
to find glow in the dark is always smart because if you lose them and they fall on the bed you just
you know turn the light on for a little while and then turn it off and boom you know it pops up our
black light or something like that I'm always easy to find all right hopefully that was helpful and
it gave you some inspiration a little bit more about how to have fun with your Holly retainers
great way to retain patience let them own the retainer process usually they're super happy when
they go home but I never ever force a patient to Have a Holly retainer if they don't want one we're
gonna do something else because they're not going to be happy just remember that if you do do S6
they need to have a plan they need to realize they need to have a plan to replace it on a regular
basis so if you don't already have a subscription model there are subscription models you can
Outsource to where you get a small Commission I'm not going to name any of the companies because
you can Google them that will work with the doctor obviously you don't want a DTC retainer
subscription program you want one that works directly with the doctor where they're gonna
collect an annual fee and they're going to store the STL of the retainer you know the STL the the
digital file of the final STL in their server and then the patient just comes to them if they need
Replacements and you get a small commission off of it so but you could totally do this yourself too
you could 100 do this yourself and I think it's only a matter of time before a lot more local labs
create their own retainer subscription programs um you know and let doctors opt into it but you know
um great way to make additional Revenue even when the case is done having a subscription
program and also a great way to you know build value to your practice um because certainly if
I was looking to buy a practice and they had a subscription model for retention that was pretty
robust and money was coming in regularly um sure that sounds like a good thing I want to buy so
it's a brilliant idea you know but yeah probably shouldn't need to be replaced unless somebody
runs over them or steps on them there's there's a really great book out there I think it's called
like I broke my retainer you can find it sometimes on Amazon I don't think they print it anymore but
um so funny some of the stories I I don't I don't think it's quite as much as it you know now than
it used to be with the clear ones but some of the stories I used to get about things that happened
to retainers were absolutely hilarious I mean running over them I know I told the story about
one of my best friends in junior high that threw hers at lunchtime in the dumpster and it was just
so expensive that the mom made her come and jump in the dumpster and go look for it I was like oh
that sounds awful I would never do that but you know I mean nobody wants to pay couple 500 you
know for a new retainer if they don't have to all right hope that's helpful thank you