hey it's Dr Amanda with Street smile Solutions straightsmilesolutions.com and today we're going
to talk about expander design a little bit more for patients with State mandibular plane angles
or long faces and I've done plenty other videos on long faces on expanded design with long faces
how to manage patients with long faces steep mpas but we're going to talk specifically about
the expander design now specifically if you've watched my other videos and you do need to watch
those first so to watch those you can go to my YouTube channel you can scroll down to the phase
one playlist you can put in the search little search tab there's a little magnifying glass
on my page straight smile Solutions you can put in expander rpe long face anything like that and
this the video should definitely pop up you should watch those first this is going to be a follow-up
video so basically in a nutshell anytime you do any type of arch expansion sorry paddle expansion
specifically maxillary paddle expansion of course any expansion on the lower is just tipping
um still a useful thing especially in the mixed dentition I'm a big fan and you can watch my other
videos on expansion why you do a lower when do you do a lower what I sometimes do lowers might
be different than a lot of other orthodontists do so whenever I have long faces I want to try to
get as much intrusive forces happening during that expansion as possible because expansion in nature
is an extrusive type of mechanic so if I already have a patient with a steep mandibular plane angle
or a long face it's gonna get worse while I expand that's bad bad bad or an anterior open bite or
something like that right if it's somebody who's you know hypodivergent short face square jaw great
fantastic I want to open up so we're talking specifically about long face kind of people
anterior open bite kind of people um Airway kind of people things like that things that are people
that are looking long and we want to avoid them getting more long during the expansion process so
here's four different things that you can do and I apologize these photos may not be the best some
were my images some were stock images I could do the best I could so the first one is to do a fix
kind of hyrax but then you have them the lab build acrylic onto the back teeth so Pros for that is it
works really really really well obviously there's no compliance issue it really works amazingly I've
done the flip side well we'll get to that where I've done a regular one on top no acrylic okay
um and I had a removable acrylic block on the lower that's called a gel or a gel but
I have other videos on that problem with that it doesn't tend to get worn because it's easy
to take it out so they're usually tape popping them out at school and whatever they want so
when it's on there and it's glued well it's on there for 24 7 so it really really works
um that's the positive part bad part is of course difficulty speaking um what else carries terrible
I mean just the I mean you're even if you use fluoride kind of cement you know your ketak or
something like that it still leaks in there still a huge chance for bombed out teeth you just have
to do this fast quick and be done I wouldn't be using this even for attention necessarily maybe
I'd put on a TPA or something more hygienic for retention just during the active turning features
and then get the darn thing off okay odor smell food traps carries just gross gross gross gross
not a very fun patient experience I have done a few of these but for the most part I hated
it and so did the patient number two you can get again terrible photo they kind of cut it off but
you could have a Band-Aid hyrax okay but you could have them run rests over the occlusal plane I've
seen quite a few and then you usually put drops of glue on the rest that helps to prop the bite
open I often prefer in those long cases to make sure I'm getting a little blob of composite or
some ketak or some irm on every single tooth that has a contact so every posterior too
that really helps to balance the forces along with the rest that works for me okay remember
if you're putting composite bumps on you don't want to etch and bond them or your it's or it's
basically a filling you're gonna have to drill it off I prefer just to bond it and stack it no Edge
obviously no problem because it's not we're not going into Denton um and if it falls off it falls
off you know who cares I mean it's it's meant to be able to pop off easily so they may come off
and you can replace them but it's you don't have to drill them off usually so that's nice so rests
and bumps are just bumps only on every single posterior tooth that has contact the third one
would be you could have a removable kind of shorts and do bumps just like I said and then fine with
that too that's another option again you need to use your your articulating paper see where the
occlusion points are on all the posterior teeth and you can pick upper you can pick lower I don't
care obviously if you're doing this version where you're doing a combo of composite bumps and rests
you need to have it all on the same Arch so it's all going to be on the upper if you do removable
you can do an upper and lower another option is to build like I talked to you about earlier the
posterior acrylic into the actual expansion device this is a lower you can do that too again often
doesn't get worn so you really have to pick the right patient usually I like to know what part
of me likes to look at the kid I mean if they're coming in and they're younger and they don't seem
to care about how they look you know like they're just quirky and they'd be loved to wear something
funny and talk funny like you know they're seven eight maybe even nine they're just cool about
getting colors and rainbows then it's going to be fine if it's somebody who looks very put together
the kid's already like pre-teen really worried about how they look how they act how they dress
they're probably not going to wear this because it's going to affect the way they talk and look so
you know that's kind of how I pick my kiddos for these things and I also kind of explain it to the
parents and get their opinion usually they do have a strong opinion on fix versus removable
um obviously the fixed ones are going to be complaining more about the ability to eat and
talk it's going to be a huge upfront adjustment whereas the removable they can kind of gradually
ease their way into it and if there was a major event they could pop it out but it really depends
on whether or not the parents and the patients are going to be compliant how well the parents
are going to force the compliance at home you have to kind of just get the
you know get the whole picture get their feedback you get your gut feeling if it doesn't match then
you can always do something where you say hey we can try this version but if this doesn't
work out for you we'll have to change to another version there will be an additional fee of X Y and
Z usually for me it's going to be the lab fee plus a tiny bit more for my time so three four
five hundred dollars extra to switch from fixed to removable removable to fix you always want
to put that in writing have them sign it because I can't tell you how many times maybe at least 30 40
percent of times you're going to deliver one and they're going to switch to another just because
they didn't like the experience it wasn't for them so the more you can explain it up front give them
their risk benefits and Alternatives document it on paper let them choose here's what we recommend
to here's what you recommended okay you didn't pick what we recommended so if you choose to
change your mind later there will be an additional fee all right thanks so much that's pretty much it