hey it's dr amanda with straight smile solutions streetsmouthsolutions.com and we're going to talk
about low angle cases today and masseters and why me as an orthodontist i have really good eyes for
catching gotchas catching cases that might be trickier than you think and if you've worked with
me on an orthodontic case before it's one of the first things i look at why do we sometimes i get
doctors who only take screenshots and they're showing me their their patients pictures from
screenshots from the scan and like no i need to see extra oral photos there's so many things i
look at in an extra oral photo i'm looking at the shape of your face i'm looking to see if there's
symmetry i'm looking at your masseter muscles it's one of the main things i look at and this is a
great image here of this patient has some pretty bulky masseter muscles like i can just see them
can you see them right here and there's a way that you can measure your masseters and if you want to
know more about masseter muscles definitely check out the other content i've made on the subject
you can go to my youtube channel to go there go to your youtube channel put in the search bar
at the top straight smile solutions that'll take you to my youtube channel which has a green banner
from there there's a tiny magnifying glass towards the top right you can put in masseter
or botox and that'll take you to my other videos on um administering masseter botox and all kind of
things like that uh but and how to measure but this is actually when if you ever had masseter
botox or if you go to a day spa and there's a lot of dentists that do it too personally i think all
dentists should be doing because it's incredible pain relief it also can help to shape your face
if you have a very square or boxy face it's huge in korea they do this all the time and this is
actually how i learned to do it i learned it from a korean physician who does a lot of um
aesthetic sculpting so um really slims your face really cool stuff but if you don't want to
slim your face you can lower the dose just to help with the symptomatic with the masseter pain or the
jaw joint pain but this will really really help now what will happen if you took an orthodontic
case in a patient like this well you might have some really unpredictable results if the patient
is doing aligners why because if you have really really chunky thick bulky masseters that are like
three fingers thick um you will get likely a lot of clenching from that muscle force on the plastic
the clenching on the muscle force especially during the day and at night can cause intrusion or
a posterior open bite now that's all okay if you have invisalign because i can build anterior bite
turbos into the case and not be worried about it but on other aligner systems that don't offer that
feature it turns into a train wreck as a matter of fact a lot of doctors that i worked with and
you may be one if you're listening to this there's sometimes where the poster open by gets so severe
that we have to switch the case from clearcorrect to invisalign now they do offer anterior bite
turbos but they don't call them that they call them engagers on the lingual or the palatal of
seven through ten and it's really difficult to get them and they're not quite the right thickness
and they don't quite work as well because they're just basically engagers and they're like at least
invisalign when i ask for anterior bite turbos they measure them they do the right shape it's
just not quite the same thing so i really strongly recommend on your low angle cases or you deep by
cases that you do not use clearcorrect and many other aligner systems i don't even remember who
has them who doesn't i think reveal has them sure smile might have them definitely the white label
company that i use has them and they do a great job with them so think about your case before
you just throw it to clearcorrect because until they fix this whole anterior bite turbo problem
um there's going to be a lot of issues with their cases and it's going to be a struggle
and personally in my opinion if they took that case and an answer in a major poster open by
developed you need to call and complain and get your money back on that case and i've had many
doctors who have gotten it they don't get the cash back but they'll get a credit for another case
so you have to fight that one a little bit if the bike got screwed up they'll say you can fix it by
adding um posterior engagers and and doing a lot of extrusion but that's not the right way to do
it because you're not attacking the problem at its source so if you really have to stick
with clearcorrect then i recommend sending your doctor sending your patient to the esthetician or
doing it in your office just loading them up with masseter botox keep in mind that the price point
is well around thousand dollars for one of these doses so it's not cheap because it's a heck of a
lot of botox that they have to use and botox is sold per unit i think what they do mine is 30 40
units per side which is easily where i live close to a thousand dollars some places like taxes might
be cheaper so phew just wanted to let you know all that definitely consider it and take a look
at your cases a little more carefully in terms of the shape of their face all right thanks so much