Dr Amanda with straight smile Solutions straight smilesolutions.com and today we're going to talk
about flared incisors and I have a ton of videos about well not everyone that has flared incisors
has over jet so I'm going to specifically talk about flared incisors on their own we're going
to leave the whole overjet thing out of it a lot of patients with a Class 2 division one type of
bite have flared incisors and overjet but you can have class 1 patients that have flared incisors
and no overjet so how you're going to deal with it is really first of all that would be
my first question second of all we need a lot of additional documentation for any case with flared
incisors and it's a completely different animal for Growing Kids than for adults let alone adults
with periodontal disease I'm going to put it in three different buckets growing kids because I can
I can modify this this makes life a lot easier adults with healthy bone and teeth and gums no
recession no past or present periodontal disease no bone loss anything like that and then adults
who have periodontal disease three different buckets so we're going to talk about a little
bit I'm mostly going to focus on the second two because I have tons and tons and tons of videos
about growing kids and over jet or habits because in a growing kid flared incisors is either caused
by a habit or it's caused by class two div one which of course we can fix that right easy so
if you want to watch those videos first of all I highly highly highly recommend my phase one course
which was just launch we have a version without CE and a version with CE the ce1 is actually cheaper
believe it or not and I do have some promo codes they're kind of buried on my website so you got
to go find them dig around on my website you'll find it you'll save a lot of money if you find
that promo code I only have a limited amount so as soon as my promo codes are gone you will not
find it on my website anymore you can't find it you can you can always email me and I'll send it
to you info straightsmilesolutions.com or go to straightsmilesolutions.com but yes you can get I
well it's going to be 125 off so right now the course I believe is somewhere in the 300s for
13 units of credit that's insane you do have to take a 65 question quiz but it's not crazy hard
as long as you somewhat pay attention during the course um you don't have to like take notes or
anything like that I really didn't make it that hard um so do that okay and that's how you'll
learn about growing kids and flared incisors now let's talk about adults flirt incisors
um let's let's not even talk about overjet because I have a lot of videos on overjet if you want to
search those they're free you can go to my YouTube channel which is straight smile Solutions you can
search by keyword there's a little magnifying glass towards the top right within my channel
and you can put in like proclination or something like that and it should pop up but um of course
you need more information right and and the treatment is going to differ you know depending
on what we see so the first thing I would check anytime I have an adult with flared incisors
is I get a ceph I mean I'm sorry I know you guys hate getting sets but you absolutely need a stuff
on these patients I mean yes Invisalign does have that cbct feature and I'm learning how to use that
without numbers and I don't I love it I love it in terms of treatment planning Invisalign but without
those numbers sometimes I feel a little bit like I'm guessing so I still think a ceph is better
if you can do the Seth and the cbct and upload it to Invisalign if it is Invisalign patient that's
fantastic if you have an itero but that's nice too both would be great one or the other if you want
to know about sex how to read them how to get them how to get numbers I have a whole Channel just on
sefs you can go to my YouTube channel scroll down steps are on the home page towards the bottom and
there's lots of videos I also have a SEF handout because it's not my content uniquely I will give
it to you for free anything that I made I do sell in my store so all you have to do is contact me
and I'll be glad to give you a copy of the ceph handout which is an easy way to go ahead and
understand a little bit more about how steps work now if you really want to assess course
that is not something I'm interested in doing so boring to me so sorry Subs are necessary but
it's not I'm not saying I like to teach them so I do have my little friend my big my big friend
um Dr Rishi popat he does the more academic courses he went to Harvard he loves academic
stuff he loves literature review he loves that kind of teaching I like the more practical
teaching so we tag team although he is part of our team he charged charges independently but he will
give you a little discount if you are a street smile Solutions client so if you go through me
I'll refer you to him and he'll probably hook you up if you are one of our clients so um yeah he'll
do a stuffed course for you so definitely and his prices are super affordable in my opinion for his
time given that he's an amazing orthodontist who's done research went to Harvard everything like that
you can definitely learn from him he can teach your study Club whatever you want to do anyways
if you want to access Rishi you can go to Dr popat my website and look under courses you'll see him
towards the bottom on that tap all right so get the stuff get the SEF numbers easy to get if you
don't know how to get the numbers once you get the Seth let's look at the numbers so two points I'd
be looking at on the staff first one would be now granted I like the Steiner analysis that's
just how I was trained okay there's a bazillion different analysis so I don't know all the points
I only know the ones that I know and it's enough for me so what I'd be looking at would be upper
and Sizer upper one to SN that is the reference line stalination which is the cranial base it
is an angular measurement which determines the inclination of the central incisor relative to the
anterior cranial base in layman's terms that means how is our incisor relative to the skull okay is
it Forward is it behind things like that a smaller than average angle indicates that more upright or
retroclined incisor lingually or politely inclined we're talking about upper incisors now um as seen
in a class 2 division two case a greater than average angle and an average standard deviation
is usually around a 103 plus a minus six degrees standard deviation so greater than average angle
indicates proclination or labial version or flared incisors okay which would be more like a Class 2
Division 1K so that'd be the first thing I'd look at second thing I'd look at would be a burncisor
to n a that's another one non-set of the cranial base where we're giving the relative the incisor
relative to n a point which is another Point um nesion is a point that is within your skull but
a point is a point on your maxilla okay so the relationship with the maxillary Central insights
into the n a reference line it establishes the position of the max or incisor relative to the
maxillary apical base both the inclination of the long axis of the incisor and the distance
um blah blah blah okay so labial if it's if it's flared you're going to have a greater than average
angular and linear measurement okay so the um average is 22 degrees plus or minus six degrees
standard deviation the linear is three millimeters plus or minus two millimeter standard deviation if
it's an upright um incisor you will have a smaller than average angle and linear measurement okay
so positive values are recorded if the labial surface of the incisor is anterior to the n a
line and a negative of its posterior okay all right boom so that's what you need to know
in terms of cephs so now if you look at this case and it looks like they're flared um first
thing I want to know is it normal you know is it related to the bone is it related to the to the
the maxilla the position of the maxilla or is it caused by something else and very very often
anytime you see a flared incisor it's related to an external Force so let's talk about external
forces I have a zillion zillion zillion videos on omt and habits so you'll want to go ahead and
review all those videos on omt and habits there's a really great screening for it again it's not
mine so I'm glad to give it to you I think it's called the fairest assessment and it was it's
used by omts Oral myofunctional therapists a lot of things you can look at in terms of the tongue
and habits and things like that but you definitely would want to use that form to screen them
um we're looking for things like tongue thrust mouth breathing I would do a sleep assessment a
kids or an adult one depending on which one you have and see you know could something be causing
this you know could an external force be causing the flaring because if so you shouldn't even try
to fix it unless you get rid of the force first because it's not gonna work I don't care even if
you do a bonded retainer it's not going to work not only is it going to be really difficult and
you may not even get there and you might take way longer than normal if you even get there but it
won't stay even with a bonded retainer even with an Essex over it will not stay I can't tell you
how many times in my practice past present we see patients that come in that have had relapse
that have bonded retainers that have Essex they wear you know it's stuck it's a bonded retainer
how can it relapse well the tongue is a heck of a lot stronger than a bonded retainer and weird
weird weird things will happen so if the doctor fails to recognize that there is a habit you know
by not doing an omt assessment and if you're not comfortable with the whole omt assessment
thing you can work with an omt you can even have your hygienist trained in your practice to be and
OMD it's only a three or four day course and you can build separately it's another great Revenue
stream for your practice but a highly highly highly recommend that you do get trained up ont
whether you take a course and actually certify someone in your office or you just learn about
it because if you're going to think about doing Ortho you need to understand omt or you're going
to have a lot a lot a lot of failures or if you don't want to learn it fine find a virtual one
find one in your town I mean most of the ones in your town there's two different types of
omts there's the dentally related ones and then there's a speech in there and language therapist
once if this is a dental type of problem you know unless the patient's having major speech
issues I feel like you should pick the dental ones which are usually hygienists they're
sometimes dentists retired dentists but in order to be an omt you either have to be a physician
speech and language pathologist therapist SLP a dental hygienist or a dentist those are the
four people that can get certified in just a few days as a moral mild functional therapist which
is basically like a physical therapist for the tongue and mouth okay so many things to learn
about this I just recently went through therapy it was a 10-month series it was a lot of work and it
wasn't cheap I'll be honest with you but I feel like I got an amazing value about it not only in
my sleep in my Airway and the way I pronounce words I did end up having a tongue tie release
which has helped immensely with Oral Facial Pain I mean it was a win-win-win all around for me it
totally unexpected all the benefits I got from it even even health and physical benefits and
you should definitely watch all my videos on omt to learn more about that so those are the
things I would do to analyze a little bit more of what's going on obviously we don't want to be
leaving teeth in an unstable position why because you'll get root damage you'll get root resorption
you'll get devitalization of teeth it'll look bad it will function bad they can become loose
and there's a lot of other things going on so we need to fix it how we fix it well it depends on
what the problem is it also depends on what the step says and we can go from there but
quite often involves inner proximal reduction or usually extraction of the third molars you
can distalize and there's a lot of different ways you can do that and of course if there's
a habit you got to get rid of the Habit first all right hopefully that was helpful thanks so much