hi it's dr. Amanda with straight smile solutions and today I wanted to talk to
you a little bit more about up writing molars operating molars I get a lot of
doctors that come to me it's treat smile solutions who want to do this and they
don't realize how incredibly difficult it can be there's a lot of variables
that come into play in terms of case selection there's some easier ones and
there's a lot of hard ones so I just kinda wanted to go over a few techniques
and just list a few variables ultimately I think unless you've done a bunch of
them you really should have someone helping you out initially so that you
don't screw it up so and like with any type of up writing or exposures or
impactions there's no guarantees with this so of course you want to make sure
your patient is signing the consent form your informed consent for braces should
have a section on that but beyond that I like to always create my own like unique
consent form going over the risk benefits and alternatives of molder up
writing or exposures because I've had the experience before where I've had
some of these and they sign the informed consent and we went over it verbally and
all that and we made chart notes saying we discussed it and the parents
understood it wouldn't work something there's a chance it wouldn't work you
know and yeah yeah yeah and then push comes to shove and you know we hit the
wall it wasn't possible for whatever reason we tried you know if they appeal
with the insurance company you're paying them back I mean that's that's the
best-case scenario it could be worse so you really need to write down that
conversation and have them sign it that would just be my suggestion just to
cover your cya but anyways so different variables you're gonna be looking at um
we're really depend on the angulation of the molar you know like obviously this
one is only angulated like maybe like twenty thirty degrees right um easily
elated a little bit you know some are completely horizontal those are gonna
have a much less favorable prognosis than something that's just slightly
angulated you know so I'm gonna say maybe less than 40 degrees angulation is
gonna have a better prognosis than something there what else
obviously root development is there a third molar back here would
be one thing that would make it easier or harder
my suggestion is shut that third molar out even if it's early
get it out it's gonna make your life way way easier what else and let it heal of
course before you start doing it what else what else
bone level root level pareo stuff like that obviously the more bone better more
confident ratio better things like that same thing with the healthy of the other
dentition how much of the other dentition is in do we have a full set
are we missing some obviously it's better if we have a full set because we
need to have a counter moment we need to brace against something and there's not
a lot of teeth there to brace against it's gonna be difficult
you can do it sectional but personally I like just do the whole arch it's just
way way easier and often that Mike gets all funky when you do this you try not
but it's going to you can do it with Invisalign I've definitely done it with
Invisalign but you're gonna need to put an attachment on it a big guy so if
you've got a gold crown or porcelain crown you might have to damage it so
just keep that in mind what else what else third molars of course each of the
patient would be better right younger patient you know 12 13 14 15 gonna have
more success than a 50 year old but yeah I mean that's pretty much it so this is
one of my techniques that I do here like I said I don't normally just do a
sectional layer but for the graphics sake it made more sense but I'll align
the other teeth up first get into a nice heavy night I like maybe a 1925 night I
I will flame the end of it I'll kind of measure it and make sure there's a
little bit extra and I will flame it put in a nice night I open coil spring here
and I will steel tie the adjacent teeth so that hopefully it stays in really
good and I'll activate the open coil spring member has to be a night I not a
stainless steel a little bit extra flash here I probably didn't show this very
well and I will bend it that helps a lot if you don't bend it then all you're
doing is just up writing it if you bend it then you'll upright it and it will
help to route correct yeah that's my technique so hopefully
this helped you if you have any other questions give me a buzz don't hesitate
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