it's dr amanda with straight smile solutions straightsmilesolutions.com and today we're
going to talk about posterior open bites in braces cases so i have a ton of videos about
posterior open bites in aligner cases the ideology somewhat overlaps but it's somewhat different so
if you're interested in the liner ones or the invisalign ones um you can go as always
into my channel straight smile solutions find that tiny itty bitty magnifying glass that's
there within my channel and search up the keyword posterior open bite or just open bite
and you probably will see a lot of videos about dealing with those i also have videos um a
full-length video stored at my archive webinar channel which is letter g letter p so g as in
i don't know goodness grover and p as in paul gp webinar.com all one word gpwebinar.com
and there's a posterior open byte archive video there and how to deal with them too
but today we're going to talk about them with braces what happens when you have them what
causes them and how can you fix them and of course you can't fix them until you know the ideology of
it right as everything so what caused it is it that you bracketed it improperly like maybe you
um like in this situation it's not the best picture but you can see here
that these are like bracketed at all a bit incisally you know there's not that much tooth
in between the bracket and the tooth and you know your bracket's supposed to be in the center of the
clinical crown of the tooth so if you break it too incisely you know things can be off or you break
you know as opposed to bracketing more in the middle of the tooth to in that case if that's the
issue you could just move the bracket scoot the brackets you know a bit gingival but this
shouldn't even be happening of course if you're using indirect bonding because if you're using
indirect bonding you won't be bracketing wrong so again that's a whole other series of videos
on indirect bonding and the why behind it and why even orthodontists use indirect bonding sometimes
so that's one major issue that i see most common the other major issue that you can get
in terms of why you might have a posterior open bite would be an anterior interference and that
means that like maybe in this circumstance where you didn't quite calculate the bolt and
discrepancy remember a bolt and scraps is a tooth size discrepancy the nice thing about invisalign
is that there's a little button that calculates it and you can look and you're like oh okay
well you know i have mandibular access by our maxillary deficiency by 0.5 millimeters
so we'd have to add a little bit of lower ipr in order to even things out so we don't have
an anterior interference or we could put some veneers in seven and ten upper twos
um oh okay so all you gotta do is even if you in braces and you don't have the ability to calculate
bolton it's pretty obvious once you've closed all the spaces on top and bottom um you're class one
k9 and you're looking at the byte and you're like huh i've got contacts on two to two or seven
through ten well you know okay all i gotta do is add a little ipr on the bottom power chain the
bottom get rid of that interference and hopefully the bottom the bite will suck down once i do that
so yeah those are the two major reasons one would be anterior interference due to a bolt
and discrepancy and the second would be that you bragged it wrong so and that's easy to fix i mean
there's one third major ideology which would be skeletal but the skeletal should actually
there's four i'm going to give you another one you know you would have seen that probably at start
unless they were growing and they grew improperly that can happen which is why you take cephs and
why you get numbers on steps right because it can predict growth in different directions um
so that's the benefit of that so that that's the third one it's very very rare and you should have
seen that at the start but if it was a really long case um could happen i mean in that case you're
just kind of screwed you're gonna have to finish like that i guess you know and and the patient
could consider jaw surgery but that's really where i don't think i've ever had that happen to
me in all these 20 years i mean i've seen cases that started with skeletal deficiency you know
issues discrepancies and i just told them they had to get jaw surgery but i didn't try to fix
them with braces right and then say oh how come there's still a posterior open bite at the end
last thing that might cause it would be a interference with second molars
or third molars so you can get that obviously second molars you go ahead and bracket them um
so again articulating paper is your friend here just use your articulating paper to solve the
puzzle and the mystery i mean um and it should solve the problem if you're going only anterior
contacts it's probably a bolt and a little lower ipr and chain the bottom if you've got posterior
contacts uh no anterior contacts and a you know open bite everywhere but on the sevens or eights
then you eights you just pull them easy should close right down right um sevens you can go ahead
and bracket and intrude them for the most part but anyways hopefully this was helpful so finishing
and remember like a long long time ago just to you know give you guys our long long time ago back in
our day lecture when we before invisalign was a thing when we did everything in brackets and wires
and before there was vivera retainers and really es6 retainers were more of the exception than the
rule every patient pretty much got holly retainers and if you got holley retainers then you know
everything settled so assuming there wasn't a bolt in discrepancy you didn't have interferences on
the sevens and eights um if it was a bracketing error everything would just settle down you know
um we'd do maybe bonded retainers upper and lower front teeth do some wrap around retainers um and
everything just settled down really really nicely and problem was soft so all right thanks so much