hey it's dr amanda with straight smile solutions straightsmilesolutions.com and today we're going
to answer this question that i got yesterday when do we do bracket repositioning if it's needed
and the terms of treatment timing and staging i'll tell you the way i do it now of course anything
that i mentioned in this video i just wanted to let you know that i have way more content made on
all the topics and all the main points i'm talking about all you have to do is go within
my youtube channel not youtube in general but the straight smile solutions youtube channel
once you're in that channel look for the tiny magnifying glasses usually towards the top right
and search by keyword whether you want to search by wire sequence or how to place a bracket or
just straight wire in general we have even on our home page of our youtube we have a straight wire
playlist that has i think almost 100 videos in it it's everything you need to know you don't even
have to go to a class everything you need to know is in there just grab yourself a typo not and do
the work anyways i digress but specifically i'm just going to lately go over how i do things and
just a quick shout out to the benefits of indirect bonding as proposed opposed to direct bonding
again if you don't understand the difference you should learn about it um some orthodontists do idb
a lot do db just because we know how to do it yes because we train full time or another three years
on how to place brackets so of course but to be honest sometimes we do do indirect bonding why
because it's only in the direct bonding has to be done by the doctor so it's managing doctor time
so if we do indirect bonding then you can do five starts at 5 pm on a friday you know
which you normally couldn't do so that's why we do it and also i mean hey i'm pretty good at placing
brackets but sometimes i'm not perfect sometimes i just can't see it's too dark i'm standing on
my head or the assistants can bump it when they're light curing it so the benefit of indirect bonding
is that everything goes on perfectly now remember not all idb is the same and i've had the pleasure
in some ways of touring a lot of labs that use idb and i've seen good stuff and i've seen bad stuff
if they're not willing to show you the stl or at least a series of photos of how the brackets are
positioned before you approve that case it is not digitized idb and that is the number one question
so when i work with doctors with straight smile solutions i always recommend certain companies
that allow us to confirm the bracket position first because i've seen some terrible work
that's done with idb and they're selling you an arm and a leg but you're looking at it it's not
right so what's the point of doing idb if it's not going to be perfect right that's the whole point
so anyways if you're doing idb you shouldn't have bracket repositioning so that's all i'm trying to
say is like this should be a one-off it shouldn't be a regular thing if it's a regular thing
then you're not putting the brackets on right which means you should be doing indirect bonding
but let's say you inherited a case or you started a case and you're using direct bonding and you
know you're like oh i don't think these are right when is the right time to move things around well
in general i mean if i see something that's just egregious like obviously wrong like it totally
slid i'm gonna fix that as soon as i see it i see something that's a little bit subtle but i'm not
totally sure if it's wrong then what i'm gonna do is i'm gonna let the initial sequence of wires
express themself okay so i've got other videos about this what this means wire sequencing
deflecting wires and all that if you don't know what that is you should definitely watch those
videos in my straight wire playlist but i'm going to work through my sequence of wires
i'm going to get myself up to 18 nighttime i'm going to let the 18 night tie express
itself and no longer be deflected this is a deflected wire right it should be pretty
passive once the 18 night tie is passive i'm going to do a full thorough look of every single tooth
and bracket position and i'm also going to pull the patient into the conversation and say hey
this is the point where we've done the major movements there might be some spaces there might
be some issues with the bite but in terms of straightening the teeth we've done that
at this point that's what we've done already we're not going to go back and move brackets around
again so if there's some tooth you just think isn't quite the way you want it and there's a lot
of art that goes into orthodontics it's not just a science it's also an art so it's not wrong if
you want to move those centrals up half millimeter it's not wrong if you want to move those canines
down a half millimeter you know sometimes you can't because of the bite sometimes you can so
i want to know the patient's opinion at that point at that 18 nighttime passive stage i actually not
even i'm not gonna put them even on the spot i'm gonna tell them to go home take some time look in
the mirror ask their friends and family the reason being is there's nothing that's more annoying is
you get to the end of the case and you're like thrilled patience done you're like woo we're done
yeah patient out of the chair debonding patient's like doc i don't really like the position of this
you're like what now you got to go back you got to repel you got to work your way through the
wire stevens you probably have spaces you got to chain again now it's another six months if you
caught that way back then you some doctors even give the patient something to sign saying i am
happy with my bracket position positioning will not be asking for any future changes i
think that's a little cold but and there's nothing wrong with that it will honestly
nip it so that they take the time to look at it now and to make an opinion now if they don't
like something you know and i want to know their opinion i don't want them to be unsatisfied at
the end of treatment and feel like they can't say anything right okay so again we take a hard look
you also usually need to take a progress panel at the bracket repositioning stage because obviously
a lot of times you're going to be checking angulations to make sure the roots are all
parallel so that's what i do 18 nighttime progress pano give the patients a voice a platform to go
spend some time check on their own everybody comes back with their opinions i have my opinions they
have their opinions and we do a longer bracket repositioning appointment hopefully not too many
where we're going to move things around obviously i just kind of pick some of these photos because
you can see here that 8 9 don't look symmetrical that's the first thing i'm going to look at do
things look symmetrical i like to see mirroring does this look like this does this look like
this does this look like this i'm also going to check bite and everything like that too and if
something's not symmetrical i'm going to take a progress panel and i'm going to see well did
it kind of look like the root might be going this way maybe if i
you know reposition that bracket a tiny bit counterclockwise it might upright it but it
also might just be where on the mesial incisal so i don't know unless i take a progress panel right
so a patient might see this and it's like oh this is wrong well it could just be where but
you're not going to know without that progress panel right so if it turns out the roots are
parallel i'm going to say hey this is just where we can do a fill here afterwards or yo some pretty
long teeth so we might just be able to smooth them down but that's why you want to have that
conversation at that point because if the patient didn't want the bracket repositioned i'd rather
know then so i'm not losing time then at the end all right hopefully that was helpful thank you