hey it's Dr Amanda with straight smile Solutions straight smile solutions.com and today we're
talking about whenever you have like an expansion case be it a Schwartz or a rpe an rme you're
doing paddle expansion on a growing child or a teenager to try to develop the Arches before you
moved on to this second part let's say you're doing this all in phase two or even if you're
doing it all in phase one you're doing it all in comprehensive it doesn't matter a lot of times
your first step is going to be fixing the bite and developing The Arches with some type of appliance
it could even be a twin block you know anything like that so not just expansion an appliance let's
put it that way fixed or removable it's it's pretty normal to do you know before you move
on to your either your braces or your clear aligners your Invisalign so one thing that I
see that goes wrong a lot in these cases and I I see these cases every day for the last 20 years
is that a lot of doctors rush to finish the appliance therapy and move on to the alignment
stage without realizing that not only is should there be a retention phase in between where you
stabilize hold the segments so that the bone can fill in the teeth can solidify in the bone
but there also sometimes needs to be a settling face and let's talk about that so I've definitely
talked about the retention phase before if you want to watch that video on how long when how do
you know you should go to my phase one playlist which is still available at the moment for free
in my YouTube channel subject to change as we have just launched a phase one interceptive course as
of this week there is a course it's available on my website without CE but with help on two cases
and there's a course of going to be available and sponsored by CE Zoom which is a separate
company they're going to be offering 13 CE units and a 65 question quiz yes I had to write it so
that you guys can get CE 13 units of on-demand CE so anyways if you want to access those that
free information at the moment you can find the free information at my YouTube channel which is
straight smile Solutions go there scroll down on the playlist it's also available on my website you
can find it under education I think it's the first or the second tab I think it's the first it says
like educational materials or something like that anyways so watch those videos first matter of fact
you should watch the entire phase one playlist or take my phase one course it's pretty much the same
thing it's just the course is extremely organized and goes has chapters and goes in a particular
order if you just go to YouTube it's going to be random and then it's going to be hard to know
where you should go next so um but hey that's what happens when you want free so the question
was how do we need to take a pause or a break to let the bite settle well how do you know well a
lot of that really just depends on it's really easy it's a very easy question all you need to
do is use articulating paper articulating paper it doesn't even have to be that if you have a
scanner you can scan I mean particularly papers is the OG scan scanning to see bite marks right tap
tap grind grind bite around see where the marks are I want to see solid pretty solid bilateral
contacts and most if not all the posterior teeth you know premolars molars whatever's erupted
if you only see like one or two points of contact no bite's not settled if you only see contact on
one side of the mouth no bite's not settled okay settled bite so sometimes you know you can get
interferences classical interferences or if you're doing like an anterior bite plate or a fixed bite
plate on your appliances yeah I mean that's normal to not have the bite settled you know after the
retention period everything's stable let's give it some time for the bite to settle otherwise if
you don't first of all you sometimes you can have weird shifts that you're kind of unaware of and
I'm pretty good at noticing shifts but trying to build that shift into an Invisalign clinchack is
you know it's that that's not possible you're probably gonna get articulated wrong to get an
articulated wrong you're going to have a weird Canty outcome that's going to probably take you
an extra year to fix and this is the biggest problem and Invisalign is not going to tell
you that this is happening they first of all I don't think they even know second of all they
don't care second of all it's your third ball is your problem you're the dentist okay and this is
probably I would say top three reasons I see Invisalign cases fail is something like this
it was not articulated properly to begin with and that is something that they never teach in any of
these engine courses gather courses bolus courses uh fundamentals Invisalign no no they don't they
never mentioned that it's such an easy fix just do it takes one second your assistant
can do it they can even do it from home you can mail them a piece of articulating paper and use
a HIPAA compliant program like um like there's HIPAA complaint Zoom there's all hit kind of the
hippocline apps you can use in hand Dental which is one of my favorites you can use Invisalign
virtual I don't really care check it check it from home they don't even have to come in just make
sure you can scan them all scans usually show you the articulation marks make sure that you've got
nice solid bilateral occlusion before you start your Invisalign case if you don't yet take the
appliances away assuming they've done their normal retention period of three to six months with their
appliances depending on what Appliance you had and where they started and how compliant they
were take them away I actually really want you to take them away and let them settle for a few weeks
try again not settled a few more weeks try again so there's a really important
Loop there where you need to be keeping an eye on your patient and you have to know when the right
time to start is it not a lot it's hard because I know a lot of times patients are really in a hurry
to get those that Invisalign started really hurry to get rolling on their case now this is much more
of a problem with clear liners because we do have to set the articulation and much less of a problem
with braces I don't think I ever wait for bites to settle with braces because I really don't care
it's going to settle Embrace this I'm not worried about that it's not like we're predicting the
future and we have to get the bite perfect now so that we can get set it to the end you know
braces it doesn't matter bite's gonna settle I can just give some box elastics so not a big
deal so I'm more talking about Invisalign all right hopefully that was helpful this is like
literally probably like I said top three issues that I see in cases every week all right thanks