hey it's Dr Amanda with straight smile Solutions straight smilesolutions.com and today we're going
to talk about how to treatment plan by Max buy maxillary protrusive cases and every single
keyword I'm going to say in this video you can literally look up in my channel so this is going
to to understand the bigger concept so unless you've watched most of my channel you've taken my
Straight wire class you've taken my phase one um my phase one interceptive class all of which are
available on my website straightsmile Solutions or pretty much watched my entire all my videos
in my channel this is going to make zero sense to you so this is going to be an extremely high level
Advanced lecture and I'm going to talk high level and I'm not going to explain things so please stop
if you don't understand what I'm talking about and take my classes or watch all my videos first
okay treatment Planning by Max protrusive cases we're going to break it up into a couple different
buckets first we're going to talk about kids then we're going to talk about adults kids is easier
you know what am I talking about I'm talking about these this typical case that
um where the patient is and again there's nothing wrong with bimax okay as long as
the patient is lip competent and the patient is happy about their profile
even if the patient is lip competent and happy about their profile and not mouth breathing and
has no sleep and no Airway issues you sometimes have you know a staff with the teeth are like
look at these incisors I mean this is like you there's no way you can flare those insiders
anymore if you do you will devitalize those teeth you will ruin those teeth they might fall out
um even if you tuck them back later it might be at the point of no return you might lose those
teeth I see this happen so commonly so often with clients new clients I'm like you killed the teeth
um so you have to take your steps on these cases you have to take progress tests quite often on
these cases you need to have access to a SEF or A cbct sagittal or a full cbct where you can have
someone like beam readers take a slice out of it and read it okay but if you don't have that don't
take these cases for braces or for Invisalign or any type of clear aligners so you should be doing
standard sdb screening standard sleep screening on adults kids as well as omt screening standard
at the beginning and I again I'm going to one more time I have content made on every single
one of those words I just said I have individual content made or it's covered in my courses so
please watch those first okay so let's say we have a kid who is by Max who is lip incompetent
so we're like okay we know not only can we not flare It Forward even temporarily even round
tripping because we're going to kill the teeth um we're really going to ruin their their speech
um but we actually need to tuck things back what are we going to do um and just to boot mom wants
braces and not aligners and remember this is like a million times easier in aligners with sequential
distalization with the ability to lock incisors not flare them you can put it in the preferences
um you can say no round tripping Etc it's just you have so much more control in a good clear
aligner and when I say a good clear aligner it's not all clear aligners out there that are going
to let you do this there's quite a few companies and I've learned my lesson I'm not going to name
these companies I am going to only lightly mention the ones that I know is okay because I've had too
many companies that people have used thinking they could do a case like this these cases are
going to be long they're going to be 60 70 80 90 100 aligners it's going to work out amazing
I mean you're taking a surgical case and you're trying to get into a non-surgical case but it's
not fast and there's plenty of companies that are just going to say nope Max you can do here
is 30 40 aligners sorry and you're going to ruin the case if you do that so stick with the
company you know when they say it's unlimited or comprehensive they're actually going to let you
do do what you need to do and that to me right now the only ones that I feel very comfortable
with just because I've seen cases done and finished would be Invisalign comprehensive
clear correct unlimited and then also my white label company that I work with if you want to be
introduced to them but you're going to pay per aligner so it might be kind of expensive to do
that but it's always an option and you can use any scanner all right so that's aligners it's
super easy breezy I have tons of content on sequential distalization how to lock in size
just all that just go into my channel and check it out um let's say braces so we have a braces case
um if it was a growing kit first thing I would do is I'd plug some expanders in top and top
and bottom it's going to be way easier Crank It Up get them to the to a nice nice width we have
space for all the teeth that should create some spaces in the back and then you're going to go
ahead and lock the expanders top and bottom if they have arms whether it's a lower Williams or
an upper High racks you're going to cut those arms off so you only have the back part on the
six locked and then you're going to go ahead and retract your threes fours and fives into
the spaces you've created once you've retracted them you're going to Long tie them with a long
tie again all everything I'm saying here I have content made in my channel you can look it up okay
once you've locked it and long tied it the threes fours and fives to the sixes and the sevens you
have a unit of five teeth on each side and all four quadrants that are basically braced together
with a long tie with multiple twists okay then that allows you to align the front teeth now I
forgot to mention the most important thing here is that when you run the initial wire in during
11 level and a line you do not want to engage all your front teeth if there is crowding okay you're
seven you're eight you're nine you're ten you're two to two top and bottom because what it'll do is
it'll push it through the bones you only want to decorate it and in a residency we would do this in
sectional mechanics we would only do four pieces of sectional wire and we wouldn't even Bond the
Fret teeth in these situations but that doesn't fly as much now so what I'll do is I'll go ahead
run that 16 18 night tie in but I'll decorate it I won't put a tie on every single wing I might only
put it on two Wings three wings that way it's really just decoration maybe it looks a little
funky but um you know at least it's not going to push the teeth through the bone and it's gonna
look like they have braces on another thing you could do is you could put the tie on all the teeth
under the wire and you could run the wire over and not engage it and there's all kind of ways
you can do it but that way at least you don't push the teeth through the bone so what happened to my
picture okay so that's how you do it then you go ahead and pop those appliances out now that we've
got the long tie bracing everything from three four five six seven back and then you can go
ahead and put a bigger wire in and finish aligning the front teeth because you've created some space
um and it'll go into the space that you created and it's all good in the neighborhood of course
the other option would be taking out premolars I try to avoid that in kids it's almost never
necessary in a child in adults who don't want jaw surgery who don't want tads which I don't teach
anyways who refuse to have sequential distillation for whatever reason with Invisalign maybe they
have some impacted wisdom teeth that are close to the nervous or in the sinus and they just can't
then we might have to take out teeth but same concept right you're going to create the space
first you're going to decorate the front teeth and not engage the teeth and push them through
the bone then once you've created the space in the back whether you're taking out teeth you're
doing a ton of IPR or well you could expand with wires too but that usually doesn't give enough
in adults then you exact same concept you know you're gonna do some type of internal Anchorage
you're going to retract the canines to class one you're going to lock it with a long tie
and then you're going to go ahead and gauge everything and again everything I mentioned
already has an individual video or you can get it in my Straight wire class which is available on
my website straight smile Solutions or my face one class hopefully that was helpful thank you