solutions straightsmansolutions.com and today i'm going to talk to you about a blog i just posted
and if you want to access our hundreds of blogs you can go to our website straight smile solutions
click on about us and under about us you'll see read our blog and there's a little place
to put in keywords and you can search by different topics if this one isn't the very top one anymore
but today we're going to talk about protocols and people are always asking for that secret sauce
that secret cut and paste thing that you put in your invisalign comments section in your
clinical press rinses to make that case turned out just perfect and guess what i don't have one
i don't believe in them i think they're they mess things up more than they benefit and i think that
they're a trick and a trap and i think that you go to courses to get this secret little
cut and paste protocol that you're only gonna get if you take our course and guess what i've
undone so much damage from these little cut and paste things on cases like in real life
there's just no secret sauce that can fix every single patient so i hate them i tell doctors to
take them out and each patient should be looked at uniquely each patient is different and you
can't have a cut and paste secret sauce it just doesn't work just my opinion but in any case so
you won't be getting one of those from me because i don't do those so let me tell you how about how
us our philosophy we do have a philosophy i mean this is the philosophy so um and if you
work with me for a little while you kind of get used to this philosophy and you know what you may
come up with your own philosophy based on what you see and what works right in your hands and how you
do things this is my philosophy it works for me it works for lots of doctors it may not work for you
so there's eight points to our philosophy um i got asked this today so i was like all right i'll type
it out so first of all we don't have some blurb that you cut and paste in your comment section of
your invisalign clinical preferences i just said why this never works all it does is slow down your
treatment planning and confuse the technicians and i've talked to enough past invisalign techs
that used to work in costa rica and they hate they hate doctors that do this so they're just like oh
my god they roll their eyes okay next we don't only move anterior teeth i'm not saying i won't
let you only move anterior teeth but enough doctors of mine have gotten this lecture
so i'm going to tell it to you one more time standard of care is making everything perfect
you can't make assumptions as to what the patient wants unless you've educated the patient on the
risks benefits and alternatives alternatives means ideal they need to see ideal and understand ideal
before they can backtrack and choose anterior only movements if you are in office that only
chooses to do anterior alignment short term ortho that's totally fine but for example
yesterday i was in a course that was taught by an attorney
with my college and it was a dental course but the ortho whole anterior only um short term ortho kind
of anterior ortho stuff came up and he said he goes you can't do that you know you can't you have
to give your patient options you have to explain the options and ideal and if you want to only do
that in your practice that's fine but you need to disclose that and every single patient needs
to understand that this is what you choose to do in that office but they do have a choice to go
to an orthodontist to have ideal and ideal might be better and if you don't have the knowledge or
the skills to explain and show ideal you have to send them to ortho to have ideal explained
so this is where i recommend the doctors work up the ideal it doesn't mean you have to do it you
can say this is what ideal looks like you know it's 40 aligners you're going to have to have
elastic you're going to have to have your wisdom teeth out blah blah blah blah blah it's going to
take a little longer but i don't choose to offer this in my practice because it's a little more
complicated than you know i feel comfortable with so you'll need to go to author to have this done
i'm just showing you so you can see it you can totally do that okay but you can't just only
show them anterior you know only movements that's a mistake so you're gonna you could potentially
get yourself in some hot hot water and i've seen it done and i've been involved in situations where
i was the orthodontist that was the second opinion and these general dentists got themselves in
trouble with insurance with the dental board so i'm only going to lecture you ice totally
strongly against doing that against believe doing this unless you can also explain the ideal
and you need to document that conversation in writing and the patient needs to sign
and also there's disclaimer forms for compromise versus anterior only treatment short-term
treatment so be careful okay i said how can you expect predictable outcomes when you're
only moving some teeth yeah it never turns out that well right um and also if you end up
getting a posterior open bite which is a very common side effect from any kind of aligners
and you're gonna have to move back teeth in order to fix it so this can be incredibly expensive if
you're paying for a flex or a light or a go or express you might end up paying double in a lab
fee and you really can't go back and charge the patient more that's not cool you know you promised
your patient this and something went wrong you need to fix it under that protocol and you're
gonna have to absorb the extra costs so okay let's see number three i believe in correcting habits
before invisalign starts so this is not just not just talking about kids habits can be many many
different things and i've got tons and tons of videos on this so you can just go into my channel
and search under habits or tongue thrust or thumb sucking or finger sucking or mouth breathing these
are all habits okay and many are habits in adults and don't discount habits in adults adults do suck
their thumbs there's things i can tell if a patient sucks their thumbs and they lie all
the time so you have to really explain the why i have to know the truth you know but i can look
at someone's mouth and finger and thumb and i can tell you if they suck their thumb whether they're
telling the truth or not i'm always right on that um okay all habits oral habits mouth breathing
tongue thrusting thumb sucking must be fully corrected that doesn't mean oh i stopped because
even if they were thumb sucking they still often might have mouth breathing at night they don't
know if they're mouth breathing you know but there's certain ways we can find out so that
has to be corrected that might mean you might need to work with an omt you might need to put a habit
appliance in before you start invisalign what's going to happen if you don't do that well guess
what you're not going to get the outcome that you predicted it's not going to turn out because the
tongue and the mouth breathing and the fingers and the thumbs are a very strong counter force
and teeth won't move predictably if you don't do that and so often doctors skip over that part
also in straight smile solutions we don't believe in doing compromised orthognathic cases that means
if it's a jaw surgery case if it can't be done you know with just invisalign then don't do it
now invisalign doesn't say no you can't do this they're gonna set up every case
not i've never seen them say no they're just it's just not gonna happen i can look at a case
and this happens very often you know especially with new doctors is they'll get this set up and
like uh-uh you can't take this i'm sorry i can't help you with this patient i just they're like
well i paid for this and i said well we'll use it on another patient then because this isn't going
to happen and i can't help you with a case that i know isn't going to happen this is not going
to happen they'll invisalign will give you a set up and they'll put a ton of black dots on it you
know and they'll say well this may not happen yeah it's not going to happen so um that is the
worst thing especially with class three patients do not so class two patients okay if we don't get
all the overjet correction okay it's not that bad right so at least we're better than we were
with class three patients you could make them worse than they were functionally the ability
to eat the ability to talk so especially class three patients and open bite patients that's an
i don't take them i don't i don't help doctors with them i reserve the right to decline a case
if i look at it and i think it can't be done um what else we stage our treatment two to three
times longer than a lot of these courses do um and even more longer than what invisalign says they
need so usually invisalign gives me a case and they say it's 15 aligners well now it's 40 for me
and it doesn't mean it's actually going to take longer because actually my cases get
done faster because the vast majority of our cases don't need revisions refinements
if you're doing everything correctly that's the disclaimer and a lot of doctors don't
but so many invisalign treatment plans i i don't know why they shortchange you on these trays
trays should have small incremental movements in between the steps and they they're getting to the
point where they're doing bigger and bigger jumps which makes it much less predictable and it's much
more gentle forces for the patients if you have a very predictable treatment plan i know you guys
are going oh my gosh 50 aligners that's so many well guess what you're starting out at seven day
changes i look at these cases and i tell you i can tell you in braces this is an 18 month case
that means if this is 50 aligners this is still less than a year which is less than it
would have been in braces so this is making it very very predictable seven day changes
and if somehow this is a teenager or a kid and then they're trying they understand the concept
of tracking and they're using their chewies and they're actually wearing them 22 hours a day
and i don't base it on what they say i base it on what i see so what they say has zero feedback
for me we look at what what you know what's the evidence here if the evidence is showing that
they indeed are tracking they get the concept of tracking everything's fitting like a glove they're
wearing their elastics like a champ i'm seeing the bite changing well guess what we're probably gonna
speed it up we're gonna do five day changes or four day changes it's always better to under
promise and over deliver than the other way around and that's the biggest mistake a lot of general
dentists make that a lot of orthodontics get you know you'll find orthodontists do way more traits
than a general dentist does per an average case you can't do that all you have to do is ask for it
you just say make this case at 35 stages case at 45 stages case of 50. and patients love having
fresh aligners every five to seven days they don't want 14 day changes that's disgusting have you
seen how gross trays get by day 11 12 i wouldn't do that so why would i want my patients to do that
okay number six we love love love bite turbos bite turbos are the best things ever i love them
and if you work with me you'll find they they show up on many many cases if not most cases
and i think invisalign is starting to get the get the wind of this get the
believe this as well because they created this g8 protocol which basically puts bite turbos on tons
of cases although i haven't seen them using it but they're saying that they're doing that but
i really love bite turbos of course the secret sauce of the bite turbos
is that you have to remove them a few aligners before the end or you'll end up with overjet which
nobody wants right who wants over jet so that's the secret of bite turbos why bite turbos well
number one a horse on any patient that's slightly deep we're going to use bite turtles because that
helps to take the pressure off the back teeth so you can level the curve of speed better if you are
clenching and biting on your teeth all the time the teeth aren't going to level out and they're
not going to move as freely it also helps to take the pressure off the back teeth so to
fix crossbites better if you are doing a dental crossbite it's really really helpful so that's
why i love them in addition there's things that you don't see that happens with the patient and
i've noticed that bite turbos really really really help when the patient is clenching or grinding and
grinding you can often tell looking at the teeth but clenching you can't and so often you'll do in
a liner case and you'll develop this crazy crazy iatrogenic posterior open bite and you're like
where did this come from i didn't start with one that's because your patient's clenching or
grinding and what it's doing is intruding the back teeth so if you have bite turbos on that
can't happen so that's why i love bite turbos so majority of the patients i work on get bite turbos
but we take them off before the end they're not on the whole time maybe like two-thirds of the time
and of course if the bite starts to open up in the front then we take them off
earlier so um okay number seven is kind of cut off here so i'm going to tell you verbally what
they are oh we already went over this we believe in weekly changes but also virtual tracking for
an accountability loop so virtual tracking you can use the virtual tracking resources
within invisalign if using invisalign however they make you buy these 10 retractors per patient that
gets kind of expensive you don't have to do that there's tons of virtual traffic tracking software
programs that are out there that have popped up i mean there's like gp ortho tracking dental
monitoring a line flow there's a bunch of new ones that showed up um use whatever one you want i mean
yes it might cost you a little bit more you can theoretically create your own within your office
but you have to be hypocompliant and email and texting is not hipaa compliant
so you need a way to get the data from your patient every week before they change the
aligner to indeed verify that they are indeed tracking and then you give them the thumbs up
to change their aligners now you can do it every other aligner every third aligner but
the tighter the accountability loop that means the more frequent you're having them check in with you
the less revisions refinements you'll have later that's just how it is so you know it's not unlike
having kids you know when you have kids and you give them chores and you just say do your chores
are they always going to do it probably not but if you're checking their chores they're going
to do it so i mean and patients actually like it they like knowing that the doctor
is double checking what's going on every week or every two weeks and then lastly let's also
cut off um phase one inhabits well we talked about habits but phase one we believe in early treatment
for growth modification you're going to get a much better outcome if you correct that overjet
um or that crossbite like we talked about before if you do it in a phase one treatment
when they're early and they're growing then if you try to do it with elastics or whatever later
as an adult and invisalign so the more early treatment you can do to correct the hard stuff
the easier the invisalign case is later all right hopefully that was helpful thanks so much