hey it's dr amanda with straight smile solutions straightsmilesolutions.com
and today we're going to talk about repose the dreaded not the repo man but the bracket repo
process we hate bracket repos they're the worst right um why do we have bracket repositioning
or why do we need to reposition brackets well because we didn't put them on right to begin with
so it happens you know like if you're direct bonding or free handing even happens to
orthodontists um sometimes we don't put them on quite right sometimes the patient's moving around
sometimes it's tricky with a mirror and a small mouth and the lighting and sometimes
our assistant bumps it when they light cure it so it happens right sometimes we move a tooth
and when we're looking at it we're like uh i want to make this count go down a little bit more but
if you have to do bracket reposition of course i'm going to do my little soapbox here if you use
indirect bonding and if you verify your placement of the indirect bonding of the brackets digitally
you shouldn't really have bracket repos or if anything it's a one-off right or sometimes you
do idb and then the patient knocks the bracket off and you have to freehand it to direct bond to put
it back on you don't quite do it right right um so usually what i recommend with my doctors is they
take the case you know through their normal wire sequence which difference differs on every patient
sometimes i'm going to start with a 14 sometimes i'm going to start with a 16 nitai sometimes i'm
going to start with an 18 i type if they're not that crowded and work your way up to the point
where the wire is no longer deflective where the wire is passive and then at the 18 night tie stage
might take six months to get there might take two months to get there might take a year to get there
at that stage you stop once it's not deflected anymore you pause and i recommend to my doctors
that i work with that they take some time to take a series of photos as well as a
progress panel is strongly recommended especially if you have some questions
and progress panos just to remind you our standard of care every year when your patient
is in orthodontics it doesn't mean that people are checking to see if you've done it but if and when
there was a problem or if you had long treatment time and you didn't do this you might get in
trouble especially if there was pathology or root resorption or something like that so that's why
but i like to take progress panels at this stage at the 18 nighttime passive stage
just to verify if i'm doing repost that i'm doing them correctly right especially if i'm not sure so
let's talk about taking bracket repositioning photos so this isn't quite right here but
um bracket repositioning photos are a little bit similar to aligner check-in tracking photos
in that it's not gonna necessarily be like your initial series of photos which is what i've got
here you know your upper your lower you're right biting your left writing you're um
front biting these are fine and you should still take these you know as a progress but
for bracket repositioning and i don't quite have the right photos here so i apologize
but i didn't have releases on the ones i wanted to show but slightly open versions of this slightly
open version of this slightly open version of this slightly open version of this as well as perhaps a
few more slightly open versions from a different angle like right here aiming towards the canines
you know like almost a 45 degree angle right here aiming towards the the canines 45 degree angle
so ideally for bracket repositioning photos just to recap i want the regular ortho series
not the extra oil the intraoral you know that you've got boom boom boom boom boom
boom boom boom boom boom as well as five additional photos all slightly open okay
this one this one slightly open this one slightly open as well as two more aiming
towards the canines coming in at a 45 degree angle so that would be a total of 10 photos at
least for bracket repositions and you need to use retractors and they can't be blurry and they can't
be dark and they can't be foggy we need the best and they can't be thumbnails they need to be high
resolution photos because the way i do this with my doctors is i have them upload their bracket
repositioning photos into our secure mail which is a hipaa compliant way that we communicate i
blow them up super giant on one of my big screens really really big and i get really picky looking
at the brackets and then i mark them up and i give suggestions on how to move the bracket like move
it 10 degrees clockwise you know approximately i'm just estimating you know move it half millimeter
gingival um and that really helps doctors realize what they've done and what they can change and
how they can improve their brackets so and but anyways remember that bracketing is not just a
science it's also an art so the way i do it might be different from the way another orthodontist
does it and it's not that it's right or wrong it's just different so it's whatever works better in
your hands whatever you think looks good all right hopefully that was helpful thank you