it's dr amanda with straight smile solutions straightsmiles solutions.com and today we're
going to talk about extractions and you know i'm not a huge fan of extractions
but occasionally they happen with invisalign and the sequence of appointments and kind of
the timing of appointments and i'm going to make this video for both consumers and
doctors who are learning and just want some opinions and ultimately there's no
easy answer here i think if you're a consumer you should ask your doctor how that's going to work
if you're a doctor here's some tips and tricks as to what i recommend so different types
of extractions right you can have impacted tooth extractions like a wisdom tooth that's
under the gum and bone or a baby tooth that maybe just needs to come out or maybe you have like a
like in these cases a central incisor or a lateral incisor that we need to take out just due to the
bite or due to crowding or due to periodontal disease um because we can't move them forward um
until we got those and then also we have sometimes we take out premolar or premolars you know always
for me that's usually last chance you know last choice only when we have no other options
so ultimately like i said extractions and whether we take it out before or after we scan depends on
what tooth it is so here's what helps me make that decision so for example if it's an impacted tooth
and it's under the gum of bone like a wisdom tooth which is either tooth number one 16 17
or 32 or in some countries we call those eights i am if it's impacted or under the bone i'm probably
not going to rescan because it really isn't going to affect the fit of the aligners right
now excuse me if it's an erupted wisdom tooth you know let's say it's up and we need to take it out
just because it isn't healthy or because we need to distill eyes or something like that um if we
are moving the back teeth and if we need to fully capture the molar that's in front of it like 2 15
18 or 31 and we're actually translating that tooth then i will rescan afterwards because it i do need
to capture the entire tooth because if you don't rescan you just the software is just guessing what
that portion of the tooth is like that's covered up by the other tooth that you're extracting so
it's a guessing game so you may have more fit issues come up which may not matter if you're
not really moving it but if you're moving it you need to have it really really accurate right
central incisor is a tough call because this course is going to be way more accurate if you
were scan afterwards and you're less likely to have issues like nicking the bone and stuff like
that but a lot of times patients want something to wear home so a workaround could be is you could
always make them a temporary retainer or even just a bleaching tray put a pontic in it that's real
soft you know something very very very soft not rigid not moving the teeth and you can have that
immediate retainer ready to go you can watch some of my videos on how to make a pontic and you can
deliver that and then when that heals you can scan that would be my suggestion um but if you
really really want to start treatment you could i just don't really like moving teeth when there's
still inflammation it's really not a good idea so you could always make your first aligner a passive
aligner they will do that if you ask for it like no movement and you could throw a pontic in it
that's another option but you may want to trim it back so it's nowhere near the site that's healing
that would be my suggestion but you have to strategize that and put that into your clin check
same thing goes with premolars if the patient wants something to wear home it's a good idea
to do something like that or you can make that temporary soft temporary retainer option and put
the pontic in it and have it ready for immediate delivery so again ultimately it depends on
and also depends on what type of invisalign you're choosing if you're choosing you know
light or express or moderate or go you're going to have limited refinement so of course you're
going to want to have that scan be as accurate as possible so of course you're going to want to
rescan afterwards maybe use my retainer suggestion of course it's going to cost you a little bit of
something but it's going to make the patient happy and more confident so i think it's the best way to
do it if you're using comprehensive invisalign you get as many reboots as you want so if something
doesn't fit it's really not a huge deal it's just a matter of the patient understanding that there
may be more fit issues than normal if we do it this way and they may need to get rescanned
you know at an inconvenient time so ultimately as long as the patient is cool with that and
understands the process that there might be a delay if we wait and they're not going to
be upset then i'm cool with trying trying it out and seeing if it fits you know it's a bit
of a crap shoot a gamble so in any case all right hopefully that was helpful so the moral
of the story is you do need to strategize this and i think it's one of definitely the top 10
issues that can come up with complaints i hear from patients so not with my patients but um i do
communicate with consumers quite often you know they give me suggestions and complaints and
certainly we don't work directly with them but i like to hear their feedback because that's
how i create these type of videos um so they get really stressed out about it so if you're a doctor
listening to this remember that it's important to your patient so you should definitely let
the patient knows how know how it's going to work and get their feedback because you know
ultimately you're there to give them the best possible smile but you also want the experience
to be a positive experience so don't assume you know what your patient is feeling because unless
you've been in their shoes you don't know what they're feeling alright thanks so much