amanda with straight smile solutions straightsmouth solutions.com and today we're gonna
take a step back and get oriented like a compass i find when i work with gps one-on-one in our
coaching sessions for their orthodontic cases that this is one of the first things we need to do is
get oriented take a step back and let's talk about ways we can move teeth and some of the limitations
so some of the resources we might use so first of all you need to know your directions how do teeth
move where can we move them and when where can't we move them so let's take a look at some of these
photos here and some of the diagnostic records i might use in order to help me make decisions
for example uh you're probably familiar with some of these options we can move teeth forward we call
that proclination that's leaning those incisors forward these and these to make space we can also
expand arches see how that u shape is like this well if we widen that u-shape a little bit more
it helps to alleviate crowding because it takes up more space right same thing here how do we
know if that's okay expansion and proclination well there's a lot of records you can't just
assume it's okay just because the cling check or the clear correct clear pilot setup
says it's okay or that six month smile set up says it's okay doesn't mean it's okay you're the doctor
you need to know if that's okay how do i know if something's okay well first thing i'm going to do
is obviously look at the health of the roots and the teeth and the gums
i'm going to look at the panoramic x-ray see how much bone i have
orthodontists love some suffix race and we use those all the time we check out the angulation of
the incisors relative to the jaws to see if they are in a stable position or an unstable position
now that's going into this whole conversation do you need a cef x-ray most orthodontists do
take them do we always use them no so you know sometimes i need them sometimes i don't
most orthodox just take them as standard of care i'm not going to go into that because
i have an entire playlist on all those topics so if you want to watch everything about cephs
how to read them how to interpret them how to get them if you don't have an x-ray if you need them
ultimately if you need them is up to your own dental practice ad in your own state or country
i'm not going to answer that question for you but if you want to access my cef database on all the
resources i've made on zaps you can just go to my youtube channel i'm assuming if you're listening
to this you're already in my youtube channel but you need to go to my actual channel so to do
that go up to the space bar at the top put in the search bar straight smile solutions that'll take
you to my youtube channel which has a green banner from there if you scroll down you're going to see
about 10 to 12 playlists one of them towards the bottom says chefs have fun watching those if you
have additional questions i'm glad to answer them if you really want to know the nitty-gritty on
every little point on the ceph you probably should get a textbook because i can't even tell you that
i know those anymore there's certain ones that i use and certain ones that i don't and those
are the ones that i know and that's what i feel comfortable with so if you want a super easy ceph
analysis to understand just real basic stuff i would recommend a sasune plus because it's
foolishly easy anyone can understand it it puts everything in layman's terms not orthodontic terms
all right so we talked about expansion of arches and proclination again that comes down to perio
bone saps i like to look at root scalloping i can't really see that here but when you retract
the lip if you're seeing that washboard effect of the roots and you can see it prominently or feel
your finger as you run it around it well then you probably don't want to move the teeth more
forward because you're going to push the teeth outside the bone and that will devitalize them
and or kill them and or lose them so let's not do that okay so again i can't say this enough
just because the clint shack said you could move teeth forward doesn't mean it's good or healthy
for your patient you are the doctor you need to decide if that's okay and if you don't know you
probably shouldn't be doing this all right so that was two ways but there's more ways how else can we
make space well this is one that most gps don't know that much about and that's called sequential
distalization now not all aligner companies can do this and it's very difficult to do that in braces
but it's very easy to do it with invisalign if you do not have impacted third molars
boom boom like down here i can definitely get three to four millimeters on the top and up to 1
to 1.5 millimeters on the bottom depending on the ridge and how much bone we have of course we got
to take a panel to make sure nothing's impacted and make sure we have a nice ridge up there down
here down here down here so obviously can't scoot this one back right because there's a tooth there
but if there was nothing impacted there i can scoot this one back a good millimeter millimeter
and a half then i scoot this one then i screwed this one then i screwed this one then we scoot the
front teeth and mass into the space we created we call that sequential distalization scooting
teeth progressively distally one at a time like beads on a string takes a little time not gonna
happen fast cannot do this in some countries with invisalign moderate light or express
you could only do it comprehensive now in the u.s you can do it with moderate but you can't do much
because it takes way more than 20 aligners to do sequential distillation you look at it more 40 or
60 lighters it's not a quick movement but it's an amazing movement and it's one of my favorites so
i'll take sequential distalization any day over doing ipr why ipr is notoriously inaccurate and
by the way since we're talking about ipr you should totally sign up for my ipr webinar which
has just been announced it's going to be on may 17th at pm eastern you can register on my website
if you go to straightsmilesolutions.com click on webinars and you can register
there is a small fee for that course it's being put on by garrison dental i'm not getting paid
they're getting paid but they send you an ipr kit and a typo dot so basically it doesn't cost
anything because you're getting a free kit so that covers that and then you can do hands-on
and practice doing your ipr on a type it up before you do it on a patient it's gonna be awesome i'm
super excited i do one of these webinars every year with garrison so just once a year so check
it out all right so now we talked about expansion which may or may not be possible proclination
which may or may not be possible distalization which may or may not be possible what are some
other ways we talked about ipr yes you can do ipr between the teeth of course you're gonna need to
look at the teeth in the x-ray make sure you have enough healthy enamel probably can't do it on
bridges crowns veneers fills in a proximal filling so some teeth may not be possible to do ipr on
the max amount you really should do and this really depends on the age of the patient if it's
an older patient you could do 0.5 millimeters if it's a teenager i probably wouldn't do it at all
or 0.2 millimeters max per interproximal space so let's say your patient is 60 years old i can get
and has no crowns veneers bridges or interproximal fills i can probably and has all their teeth in i
can probably get 5.5 millimeters from that i can probably get another four or five millimeters
from arch expansion another millimeter or two from proclination definitely can get a few millimeters
from distalization well once this is adding up now why take out premolars when you can do all this
right so like i said lots of options for moving teeth backwards forwards uh transversely and ipr
and of course there's always your extractions primal extractions lower incisor extractions are
also an option i call those last resort but if needed you can always do them of course if the
patient has a lot of perio or something like that or some really decayed teeth and that's
probably what i'm gonna do if they have healthy teeth gums and bones and or they're still growing
i'm definitely not taking out teeth there's just no reason to do that so my goal in my practice
in our practice is to get a zero percent extraction rate uh in older patients occasionally
you'll have a lower incisor because it's like if they have perio and there's crowding that's
just the healthiest way to do it but premolar extractions should be pretty much rare to none
you know especially in teens and growing patients it should be flat out zero so that's my goal um
it's kind of a bit of a mantra for me so hopefully this was helpful and you understand a little bit
more about how teeth move and what the options are and as you do more cases you'll really get
to understand this and i'm super excited to explain it more to you if you ever want help
with the case we're glad to help you you can go to streetsmilesolutions.com all right thanks so much