dr amanda with straight smile solutions street smile solutions.com and today we're going to
talk about long spans of wires missing teeth and how to deal with this with traditional straight
wire braces and i'm going to take you on a trip down memory lane mainly way back in the olden
days aka 20 years ago when i was in residency um we really didn't have invisalign it was a new
product it kind of stunk we didn't really use it um certainly couldn't it wasn't mainstream at all
um so you know we use braces on pretty much 99 of cases so we are pretty good at dealing
with this stuff but did we like dealing with it no it was a pain and it makes your cases take
away longer it's frustrating for the doctor it's frustrating for the patient so i want to encourage
all of you if you are doing both braces and invisalign in your practice first of all if
you're not doing invisalign you should be doing it there's just no reason not to do it
i know i mean you're all well i don't have the right scanner you can take impressions i know it's
a pain you know but in any case i don't work for a line technology but at this point it's just so
much more superior to every so it was a really bad english but so superior to every other aligner
company in my opinion out there for difficult cases not for easy cases but for difficult cases
so i'm totally cool with lots of different aligners for easy cases anyways so first of all
if i get any of these cases i'm doing invisalign on i'm not even offering braces i don't care if
you're interested and you only want braces i'm going to tell you my reasons and you can
go someplace else because it's not worth my time and for the most part when patients come in you
explain the why and how the experience is going to be really quite not so good for the patient they
may think they want them but they're going to hate them later and let me explain why so first of all
when you have spans this one's not so bad or crowns that's another thing um bridges spans
crowns you know it is very very it could be a pain when you have a long span why
because especially in the initial stages when you're leveling and aligning and uprighting
um you know there's that span of the nighttime wiring you're gonna have to be in a lighter night
wire and you can try to be in the biggest one that you can possibly be in maybe you can avoid
the 12s and the 14s and the 16s and go straight to the 18 if you can but you might not be able to
but that really flexible nighttime wire is bouncy and when the patient eats they the food bounces
against it and it causes the brackets to break sure you can band instead of bracket you know
and of course sometimes you have to that's always i try not to but now we got perio issues in food
and hygiene and smells and it's still frustrating because the wire can still break the brackets
adjacent to it will still break um and it's just a lot of emergency visits and you know assuming
i'm assuming that most of these patients that have long spans or missing teeth are adults very
rarely are these kids i mean they can be kids if you're missing a premolar or something like that
and maybe a primo is a different story than a molar right because it's a much smaller span
but if there's a molar missing uh-uh i'm doing invisalign and i'll explain to them why it's
gonna be frustrating you're gonna have missing appointments you're gonna broken brackets you're
going to get frustrated you have to come in it's going to poke you it's going to be uncomfortable
every time something breaks it's another month in treatment you're going to get frustrated it's
going to end up taking longer in the long run than doing with invisalign which isn't going to break
plus with invisalign we can put a pawn tick in you can look really nice no one's gonna notice but
anyways let's say you started a case already and let's say you don't want to try you know you've
already started it you don't want to change it over to invisalign what do you do okay so here's
a few tips how to deal with these long spans so of course it helps if you get on the sevens which
are the second molars because the more anchorage you have the less it's going to flex right so you
want to bond as many teeth as possible of course if there's crowns that's a whole nother problem
you may have to switch from brackets to bands again that's not very healthy for the patient
but sometimes you have to another thing you can do is you can put over the span like here or here
over that span you can slide a piece of closed coil spring or comfort tubing slide it over
and that prevents the span from flexing of course you have to trim it to the right size
but that really helps a lot and lastly the thing you can do is you could
flame or cinch your nighttime wire you mean make it a little bit long trim it to just about two
or three millimeters beyond the um buccal tube you flame it outside the mouth till it glows and
i have videos on how to do this so if you can't find them within my channel really easy to search
within my channel just go within my channel go to the magnifying glass in youtube search cinch
c-y-n-c-h and the video will come up on how to do it and you just cinch it in the mouth and bend it
down with a plier so in any case hopefully this was helpful these are suggestions but
it will be frustrating and yes i mean there's a point where i would just when i had crown cases or
missing teeth cases it was just no sorry this is an invisalign case only and if you really really
really want braces and brackets and wires here's why i want to do invisalign because you're going
to be miserable i'm going to be miserable and we're both not going to like the experience i'm
sure there's another orthodontist who'll be more than glad to do it for you it's just unfortunately
i don't want to start something that i know both of us are not going to enjoy you know and just be
really honest with them but if you change your mind and you want to do invisalign i'm super on
board with it of course just a tip if you have your prices you in order to do this successfully
and to be kind of firm on this type of thing you have to have your invisalign and your prices and
wires prices the exact same you cannot charge more for invisalign if you do that they're going
to think you're trying to upsell them and it's not going to go well if you have the same price then
you're like what's the problem if they're worried about not wearing them that's where i kind of
even teenagers i go okay tell me what do you do do you go to work in the morning yeah you know
for adults okay do you go on time to work you have how long have you worked at the same job 10 years
i know you're responsible then if you can go to work and you know brush your hair every day and
take a bath every day and go to work every day you can definitely keep your aligners in
every day and you know what if you're worried this is i'm going on a tangent here but if
you're worried about having to take them out when you eat and brush there's a workaround for that
what i do is i tell them great leave them in while you talk what you eat then they just stay in all
day yeah they might get a little funky what we can do is we can double the aligners we can take a
treatment plan that's normally a a solid 30 or 40 now if invisalign says it's a 20 to me it's a 40
because i'm already turning into a 40. if you're telling me you're gonna eat with a man i'm turning
to an 80. sorry invisalign i know you don't like it but guess what it works because now they can
change their their uh aligners every three days instead of once a week you know and if they're
changing their aligners every three days because they're eating with the main first of all it's
super healthy for them because it's super slow on low forces they're probably gonna track amazingly
and they're they don't get icky because in three days they throw them away and get a new one
they think this is fabulous and it totally combats the issue of non-compliance because you
just leave them in right you leave them in when you get home you take them out brush and floss
you know soak them brush them put them back in you leave them in when you eat all day
at work all day at school it's a non-issue once you introduce that suggestion just say
no worries i'll make it you know i'll make it so you can change your liners you know twice a week
you can you can eat with the men there's really no reason not to choose invisalign because it's
that easy so i basically all the push points all the objections i just covered you know there's
no reason not to have it so the only reason would be price and that's something you can control in
your office because you know what you're gonna find these cases have so much less chair time i
mean especially if they've got long spans they have they're going to have ridiculously less
chair time and there's a value to your chair time there's a value to your staff's chair time there's
a value to your office chair time and your front desk is going to love it because it's going to
be no frustrations so anyways no i do not work for a lime technology and i would never to be
really honest i don't drink that kool-aid but in this situation i am 100 on board and i do think
align technology by far has the best politics out there and again i don't work for them
i wish other companies would be as good of them but they're not so yeah anyways i can't
believe i'm even saying this but it's true so anyways hopefully that was helpful take care