Dr Amanda with straight smile Solutions straight smilesolutions.com and today we're going to talk
about what happens when you want to do paddle expansion be it an rpe rme whatever you want to
call it a shorts um and you're worried because the patient has a really steep mandibular
plane angle maybe with antigonial notching all signs of the backwards growing instead of the
forwards growing a long dolichocephalic face not a brachycephalic phase nothing wrong with that often
these are related to Airway issues these type of growth issues but you know if it's in a someone
that's either almost done growing or it's a kid you're looking at this case and you're like okay
I definitely need to expand I have a very narrow maxilla the bite isn't integrated you know I have
a vaulted maxilla it's going to help the airway et cetera et cetera but you know when you expand
a patient like this it's going to actually make them steeper so that's something you keep in mind
just like when we have a flat mandibular plane angle and a deep bite and a forward grow we might
put anterior bite turbos on the case anterior bite plate on the case fixed bite plate on the
case opposite is true when you have a long dalica face antagonal notching and a man steep mandibular
plane angle and this is something where this is why you got to take thefts I mean obviously I'm
looking at the face I'm looking at the profile picture I'm looking at the length of this face
I'm looking at those thirds remember those thirds third third third you know you want your thirds to
be even so all kind of things to think about right so one of the tricks you can do is you
can build some type of intrusive Force into your appliance design so if you make the back thicker
okay whether you put a bunch of whether you use articulating paper and put like bite bumps on
every posterior spot you could do that you can kind of create your own bite ramp you can build
it into your Appliance and cement it I mean this is very effective it's just kind of the hygiene
and the odor and smell nightmare it's gross and there's always a risk you're going to get a lot
of Decay I've seen these teeth get crazy bombed out if they have like a habit of like juice and
sodas and energy drinks you can end up with just crazy Decay even up losing teeth so you really
have to pick your patients wisely you have to keep a room on a really short hygiene leash
um whether you're going to be building in virtuals Virtual check-ins for hygiene and things like that
whether you're going to have them come into the office more often so however you want
to design this Appliance you can but you just need to make sure that there is extra intrusive
forces on the appliance because an expander in its nature is has extrusive forces right now
on the flip side you could let's say was kind of an adult uh which definitely wasn't growing
and so you knew you were not going to get skeletal expansion so you don't really need this kind of
expander you just want to get Arch expansion then it might be better to do Invisalign because clear
aligners have natural intrusive forces that can be built into them you can ask them with the
attachment to intrude the molars while you're expanding The Arches that's something that you
can't do with braces I mean you can you could put tads on it and do all kinds of stuff but that's
not something that I teach and I've gone on the whole Tad thing what it's like to be a parent
with a child that has tatts and it's not something that I choose to use in my practice I don't do it
anymore let's put it that way there are plenty of doctors who are good and proficient at it
and that's the type of Ortho they want to do be my guest that's not the type of Ortho I like to do so
it's a surgical case I'm going to go ahead and refer that out I take the non-surgical cases and
that's what I teach as well in my Consulting practice I really don't think that General
dentists should be doing surgical Ortho cases I think that's that's the limit you know that
needs to be going to orthodontist um not to mention it adds to the expense the discomfort
the whole interdisciplinary nature of things and really weird things can happen so you need to be
prepared I think if you're going to do any type of like tads and things don't go right you need to be
prepared to Pivot to jaw surgery so unless you're capable of handling that kind of case I don't
think you should be dealing with tats but that's just my personal opinion all right so thanks so
much just something to keep in mind whenever you have an expansion case look at the length of the
face look at the mandibular plane angle and look at the antagonial nacho all right thanks