hey it's dr amanda with street smile solutions street smile solutions.com and today we're
going to talk about doing aligners or braces but really more aligners invisalign with a bridge and
i want to remind you all anytime you have a case with a bridge it's going to be
very very very compromised even more so if it's in a front bridge than a back bridge back bridge we
can probably manage it we just won't move the back teeth at all we'll only move the front teeth right
um so if it's a super crowded case that may not work out because let's go over how we get space
for crowding again well you can get space for crowding with proclination leaning the front
teeth forward sure we can do that a little bit but that might look weird if you can't move the back
teeth because it might be a really v-shaped arch so that's kind of going to look bad right we can
expand the arches but we can't do that if you have a bridge because even if the bridge is only in one
quadrant um what do you want me to do expand the whole left side but not the right side the whole
arch is going to be weird and wonky so if you can't expand one side you can't expand the other
side it's going to look weird and you can't expand well i mean theoretically if the bite wasn't
fitting together well you could expand one arch and not the other but usually that doesn't work
out so it's better just not to touch it so yeah it's really really limited if you have a bridge
so one of the easiest ways to mitigate this that people get all freaked out about but then often
when they talk to the patient the patient's fine with it is to section the bridge so especially
if the bridge is ugly or non-functional or kind of weak or if the patient's wanting an implant
anyways what a great way for you to get more production for your practice and put something
healthier in your patient's mouth by putting in an implant and taking out the bridge right
so here's the steps to doing that yes you're going to have to rescan after you section the bridge
so i recommend taking an impression with the bridge in creating an interim or temporary
assets for that arch based on the bridge what the bridge looks like right have that ready to go
if you want to learn more about filling pontics you can go into my channel or if you can't find
it you can anything i reference i probably already have a video on it i have over 3000 videos and i
know where they all are what they're all named because i made them all right and remember i'm
doing this for free well no it cost me money to produce them to edit them to make the graphics but
i do this as a way to give back to the community because i have a lot of information and also for
my current clients it's so much easier for me just to reference a video with all the information than
to have to retype it all the time so especially if it's a like a really common question i'm like boom
just watch this video the answer is right there but anyways going back to the whole bridge thing
so i do have a video about how to fill pontics there's a couple different ways to do it just
go into my channel specifically not just youtube but my channel and look pontic and there'll be a
how-to video on how to do that it's really cheap it's really easy so you just load the pontic up so
that when you section the bridge and you take the um the pontic part of the bridge off when you take
the middle part of the bridge off you section it with a disc or a hand handpiece i mean it's gonna
be hard if it's porcelain you're gonna have to go to town on it but um you take the middle piece off
but you already have the essex that goes over it with the pontic ready to go patient can go
home with that usually the tissue is kind of nasty anyway so let it heal up come back in
a week rescan for the invisalign and we're good to go and of course you're going to have pontics
in the invisalign all the time usually what i recommend and don't virtually remove it because
it is not going to be accurate if you do that you always want to rescan after the tissue has healed
if the tissue's been nicked or if it's kind of funky otherwise you can rescan at that appointment
after you section it and you smooth out the um you know smooth out the the contacts where it
was attached you know make it nice and round and everything like that um yeah so rescan they have
their temporary retainer remember they're going to probably be eating with it if it's a front teeth
one so you might want to give them more than one because it's not going to last that long and then
the only thing i do different especially if it's a front teeth bridge if they're going to be eating
with it and i like to talk to the patient about that ahead of time is i'll take a treatment plan
let's say it's 25 aligners normally well i'm going to make a 70 a liner so i know invisalign hates it
when i do this but patient's got they're going to eat with that they're going to want to be changing
this sucker every two to three days so i'm just crazy slowing down the movements so if they bust
up one of the aligners well boom they're ready to do the other one because it's just gonna fall
apart if they're eating with it all the time if it's a posterior one we can just go regular speed
but if it's an anterior one there it's gonna get nasty so seven day changes is not gonna
fly but you know that's the beauty of you know comprehensive treatment so an invisalign should
be happy that i'm giving this suggestion you can do the same thing with clearcorrect however
i think clearcrack has really crappy pontics just my opinion i have never seen a pontic that i like
with clear correct um global white label they have pontics too they're not great so i think anytime
you have especially an anterior pontic you should definitely use invisalign because their pontics
are second to none they're way way better and remember i don't work or i'm not compensated by
invisalign at all as a matter of fact they hate me so not sure why but they do so if i'm telling you
to use invisalign it's because i really think you should use them because i get no benefit
by telling you that i just get grief for posting stuff so in any case hopefully that's helpful yes
my preference is to always always section a bridge than to treat a case with a bridge and i don't
even treat cases with anterior bridges that's a complete waste of everyone's time all right thanks