smile solutions straightsmilesolutions.com sorry my voice is still kinda out week two but i'm gonna
do my best to make this video for you because it's been a really popular topic of conversation
this last week so a lot of doctors get confused especially pediatric dentists they feel like they
hear all different opinions about lower expansion and i've done a ton of videos on all kinds of
expanders lower expanders upper expanders skeletal expanders tipping expanders removable expanders
fixed expanders banner expanders if you want to watch all that because i'm not going to touch
on all that right now this is just going to be talking about lower and specifically my opinion
about lower you need to go into my youtube channel and watch the entire interceptive series which is
over 100 videos so to get there you just go to youtube in the search bar you put straight smile
solutions that'll take you to my youtube homepage from there if you scroll down on that homepage
you will see a playlist that says like phase one interceptive rpe airway omt i think it's towards
the top watch all those videos first before you watch this but specifically i'm going to address
my opinion now you're going to talk to 100 different orthodontists and 100 different people
are going to have 100 different opinions you're probably rarely going to hear this opinion because
it's my opinion and this is based on 20 plus years of experience specifically really focusing on a
lot of ways that i can avoid hard movements in older teenage kids what can we do in younger kids
to set this patient up for success so that the teeth will just kind of come in straight
to begin with as much as they could right remember crowding is a first world problem crowding is not
normal crowding is due to underdeveloped uh mouths so tribal cultures don't have crowding
we have crowding because where kids are drinking bottles and pacifiers and not exclusively
breastfeeding until age two they're eating soft diets with baby food we're not meant to do that
we do that to make it convenient for us and as a result our kids have crowding okay so sure we
can do what orthodontics in the u.s has done for a hundred years and wait till the kids are 13 or 14
and now that means they're skeleton mature and do a bunch of difficult uncomfortable painful tooth
movements that take two plus years or hey let's do things differently because guess what it does work
why don't a lot of orthodontics do it well guess what you make more less money if you
do it this way okay that's not actually true but orthodontists are good at doing hard movements
so for them it's like well it makes more sense just do it all in one go when the patient's there
12 13 14 15 and take a whole two years well i think differently because i have teenagers that
age and they're really busy at that age and you know what they don't want to be going through
orthodontics at that age they're not interested um you know compliance is worse they're busy the
parents are busy that was that was the busiest time really this whole 12 13 14 15 age group
for parents because they can't drive yet but yet they're crazy busy after school and more than ever
schools are not allowing kids to miss school for dentist appointments it was very different when i
was in high school so you're like backlogged from two to six pm two to seven pm every single day
basically orthodontics says turn into a profession that's after school and on weekends so what can we
do to limit these patients and make things easier for these parents and make things better for you
as a dentist well we can start offering phase one or interceptive treatment at younger ages five six
seven eight nine there's so many things that can be done just take the hard movements get them out
of the way fixing bites fixing constricted arches so that the teeth will kind of come up straight
ish to begin with so if you go ahead and make the space the teeth usually don't become impacted
and they usually don't need premolars out they usually don't have bite problems and so then later
when the patient is 12 13 14 15 if they even need orthodontics it's going to be something crazy easy
that you can do with some easy indirect bonding or you could do is suggest some easy express
or light or moderate aligners i mean can't promise it could be comprehensive but it's easy
you know you shouldn't need rubber bands or anything like that so there's nothing in terms of
access care that a pediatric dentist or a general dentist could not handle later so you're taking
something super hard and you're splitting it into two equal chunks and these are both because you're
splitting something hard into two chunks it's not hard it's two moderate chunks if that makes sense
so and parents think they're paying twice well if you're doing your pricing right they shouldn't be
because your cost of your phase one and your phase two should really equal your cost of your
comprehensive so they're just splitting their payments basically into two blocks you know
insurance is only going to pay once but then later you know it's not shouldn't be a big
deal and you should be giving your parents a discount if they did phase one on phase two
so yes i do think that a lot of times expansion should be a part of interceptive treatment because
it helps to make space you can do fix you can do removal here's an example of a removable appliance
i don't normally put the bow on it because i think it restricts the movement but it's just
a stock picture but it has a little cog you turn it kids can have fun they can pick colors they can
design it they can put decals they can put glitter in it if we create the space why they still only
have four permanent teeth on the bottom guess what the rest of the teeth generally come in straight
to begin with maybe there's a little space museum just still maybe a tiny bit of rotation
but it is not something that is hard to address when they're much much much older and only in
a few months not two years so yes i do believe in this um every time i've done it i've been thankful
that i've done it and sometimes if you only i realize other thing i need to address is that yes
the maxilla has two parts so when we do a hyrax or a haws or a mini pallex or schwartz on top yes
we are actually splitting the suture yes but sometimes if you only do the top and not the
lower yes the roller could roll out the lower can roll out and match up with the top but it
takes a lot longer and doesn't always happen so it limits the amount of arch expansion that you
can get on top because you're going to turn into a scissor bite if you keep doing that which is why i
like to do the lower and the upper simultaneously in dual arch constricted cases now if it's just
if the lower teeth are straight and we'd have no constriction so like here lower teeth not straight
right lower teeth not straight you can't fully get it with wires in mixed dentition because you
really can't but okay you could bond brackets to all the baby teeth but that's i don't love
the idea of binding brackets to baby teeth when there's permanent teeth underneath i don't know
what type of damage is gonna happen so that's why i like to do the expander because it just tips
them but right it's not bodily moving the teeth and running teeth into other teeth that's just
me so that's why i like to do lower expansion only in mixed dentition and permanent teeth it doesn't
really make sense to me to do it because these are already in so really what's the point because i
can get that with wires and i can buy brackets to every single tooth if it was a brace's case
the only reason that maybe i would do it is maybe we needed skeletal expansion on top and
we were just hanging out on the lower and we couldn't put the braces on anyways yet we're
just waiting till the expansion was done on top um so then might as well do it on bottom two just
so we can start getting some initial alignment then or in a circumstance let's say where we
had some short roots in the front or the teeth are crazy flared and if i threw braces on them
they would just flare forward more so if i do the skeletal expansion first now i'm making space
towards the back so now when i go ahead and bond i don't have to round trip move things forward and
move things back so that's another reason why i might do lower arch expansion in permanent
dentition wow that was a lot of information so hopefully it blew your mind a little bit and
you're really open to learning a little bit more about phase one remember all of our phase one
educational materials are totally free just watch them in youtube and if you want help on a case we
do we do that as well there's a small fee for that you can check it out on our
website at streetsmilesolutions.com we're super glad to help you thanks