hey it's dr amanda with straight smile solutions straightsmilesolutions.com and
today we're going to talk about posterior box elastics orientation so i have a lot of videos
on posterior box elastic so what i want you to do this is a specific one about orientation i'm not
going to talk about size picking the size when to wear it when to use it anything like that
strength diameter if you want to know all that you probably should listen to all the rest of my pbe
ppe is posterior box elastic videos you know why i call it pbe p b e okay um watch those first and to
access those you need to go into our straight wire playlist to get there go to my youtube channel
to get there go to your youtube channel put in straight smile solutions at the top in the search
bar that takes you to my youtube channel once you are there uh if you scroll down on the homepage
the the playlist for the straight wire playlist oh i used to have the stuff memorized hang on let me
look i'm there right now uh braces braces fixed straight wire is the third playlist down if you
scroll down hopefully i don't change it by the time you guys listen to that but at the moment
that's where it is go down there there's almost 200 videos if you flip around you can watch all
the ones on posterior box elastics or elastics in general or you can search by keyword within
my channel for elastics okay so i'm assuming you've already watched the other videos now we're
going to build on that and talk specifically about orientation and you can see i've got a
bunch of numbers here three four five three four five six three four three five five six okay so
let's go over palmer numbering system that's how orthodontics talk about teeth canines are always
threes first bicuspids our first premolars are always fours second premolars are always five
first molars are always six okay so for someone that has all their teeth sometimes people are
missing t sometimes they're transposed it gets a little confusing but standard numbering system
okay so just a friendly reminder why do we use posterior box elastics okay i said i wasn't going
to go back to the beginning but i kind of got to we use them because well one of two different
reasons the primary reason i use them is during the leveling and aligning phase don't forget
there's three major phases two orthodontics first one is leveling and aligning second one is space
closure and bite correction third one is finishing and detailing sometimes you you know you'll have
a year a really long time in one phase and two months in the other phase and another patient it's
going to be flip-flopped it depends on what the patient needs you cannot i repeat you cannot skip
from one phase to the other and go back to the other phase if you do things out of order
and you don't stay on course in your lane in the right sequence i'm telling you your cases will
turn into a mess you have to be really firm in your steps and how you do things and you cannot
be like oh i see a space let me just close that if you haven't finished leveling and aligning 100
and you try to go into bite correction or space closure weird things are gonna happen
okay so this is during leveling and aligning which is stage one that means we're in light
night wires we are straightening the teeth like all different types of straightening like
leveling is up and down vertical things right aligning is straightening right so while we're
in light nighttime wires we are straightening the teeth and we are fixing any vertical issues level
so that could be open bite issues be it anterior posterior it could be deep by issues usually
that's well it's a combination of anterior and posterior deep bite correction so your relative x
absolute intrusion relative extrusion okay so in this situation where let's say we have anterior
bite turbos on or an anterior bite plate and we are leveling the arches we are encouraging
the nighttime wires to move faster during the leveling stages you do not have to do this you
do not have to do this this just speeds things up it makes the leveling and aligning stage go faster
i don't usually give these on day one um maybe a month or two in i mean it's just too much for
the patient they're very sore already from having the braces on i kind of wait till they're over the
initial soreness and if you've never had braces it is quite a shock invisalign is not at all that bad
braces hurt i mean and and i can take you back going one or two generations if you
talk if you are younger and you talk to someone that had like real braces those first few days
um it's bad like it's one of those things where the kids are crying at school they're having
to eat soft foods for a few weeks it's you know their whole lips cheeps and gums are cut up it is
really torture i mean and it's one of those things that before aligners
and other removable appliances it was just a rite of passage that's just something you have to do
you have to have braces it's going to suck no one looks forward to it right you look forward to if
you're younger for like a day and then you get them and you hate them and you hate them
like when can i get these off and it's like two years of awkward embarrassment and
just pain you know every time things get adjusted every time you come in for a tightening you're
gonna be sore for a few days not as bad as the initial soreness but anyways it is brutal i i kind
of think of it as torture you know we try to make it super fun you know as an orthodox like oh yeah
you're getting braces it's not fun okay so that's why i just love that invisalign and other clear
aligners have gotten so much better over the years and you can really do almost everything nowadays
with removable appliances which is not at all the torture that you had with braces but anyways okay
so we're leveling and aligning that's what they're for so the video is specifically about orientation
so that i can't answer that question and so often i get doctors like well how should i
wear it should i work it wear it upper three upper four upper three upper four upper five
to lower three four five or three four five six to three four five six you know well i don't know
i mean it depends on what you're trying to do so if you're in the leveling and aligning stage
i tell them okay use some articulating paper see what's hating and see what's not hitting whatever
it's not hitting is where you're gonna wear it you can always wear it on other things it's fine
i mean you don't have to put hooks on everything because you can see here as long as the terminal
ones have hooks it's fine right but if you specifically wanted to work on a like if this was
your major tooth then i don't think i would hook it to this i would hook it to that right i'd put a
hook on this like a kobe hook and hook it to that because this isn't going to get quite as much push
as this this this and this right so that's what i'm saying you got to look and see what you need
and why you need it you can see this one right here i mean obviously these aren't touching
right so that's why we're hooking elastics to it but this is touching so maybe we're not hooking
to this one so that's the point right during the leveling and aligning phase just to speed up the
leveling and aligning make it go quicker totally optional don't have to do it it just makes that
go faster and makes the braces go faster if you don't wear it full time it's not going to work so
not a big deal it's one of those things i'm going to give it to the patient during the leveling and
aligning stage i'm going to say if you wear it we will move through the stage quicker so that
we can go into the space closure your braces will actually be on shorter we can go into you know
elastics to fix the bite we can go into the next stage so their choice i'm not going to write them
that hard on it and be like oh okay well we're not there yet so keep going you know if you want to
wear these elastics it's going to speed up so yeah that's it all you got to do is just check the bite
with articulating paper now that stage that's the first time i would wear posterior box collapses
there's a second time and this photo reflects the second time so the second time would be
we already did leveling and lining we finished we got to our 18 night tie all the teeth were
straight we took a progress panel we verified the bracket placement we verified that the roots were
all parallel we did the whole finishing thing we're not finishing the whole hollywooding step
where we asked the patient the parents double check alignment we double check alignment
everyone's happy you know like i say there's a lot of videos about this kind of repositioning
visit so i mean definitely watch all my videos on the repositioning visit because that's one that
so many general dentists and pediatric dentists skip and then at the end they're not it's not
perfect because they forgot to do that step and now they got to go back and start all over again
it ends up taking way longer than it would have done if you just did things at the right time
so we moved through that okay we moved into our heavier wires which you can see we've got on here
maybe we did some class two correction or some class three correction maybe we did some space
closure maybe uprighted on a second molar i don't know we're done now okay everything
is nice and straight the byte is perfect we're class one everything's straight we're socked in
well we're not sucked in so that's why at the very very end we might have another opportunity to wear
some more box elastics now at the very end this is a different story we're gonna be using heavier
elastics again we're going to be checking with articulating paper and then these are required
if we want to finish the case and this is just one of the ways you can settle a bite in the back
and the only reason you need to do this is if you weren't using bonded retainers now if you're using
bonded retainers hopefully you're not making them yourself hopefully you're sending out to
a lab so that they're properly made if we're using bonded retainers upper and lower first
then you can just let the bite settle in the back without elastics you can take the braces off
you don't make the essex yet you just let the bite settle you check them every week every week or two
until the bite is settled you gotta check them very frequently so they can't do this right before
they go on vacation or right before they're very busy because you can over correct okay but then
you let the bite settle and then you make the s6 to go over it if you are only doing essex and not
bonded retainers then you have to sock in the bite like this you can't be making essex unless
you have contact on all the teeth in the back that is below standard of care you are basically making
some teeth non-functional and that's not cool okay so you either got to do the bonding retainer root
let things settle or you need to use these type of finishing elastics and you can use triangles
you can use box elastic you can use the elastics i have a lot of videos on all this stuff so you
can look them up by keyword and just check with articulating paper and have them suck it in with
elastics at the very end assuming everything else is done okay now if they're non-compliant
with the elastics you got to go back to the other idea should i use a positioner should i
use the bonded retainer should i let things settle naturally because that takes the compliance out of
the situation so you can't always have a one step fits all approach but in terms of orientation now
this is where orientation matters more because you're using heavier elastics in the whole
posterior box elastics in the first part in the leveling aligning stage i'm using like light to
medium i mean they're like two ounce elastics 2.5 maybe at most three ounce elastics 3.5
but in the end if i'm doing it on stage three which is finishing in detailing i'm using heavy
heavy six 6.5 ounce elastics you know so the orientation does matter in this situation
so if the patient is class one i want the elastics when i put them in the mouth to be vertical
the patient still has a hint of class two where i'm starting them while the patient is still
you know we're finishing up the bite i might have my elastics have a class two vector
okay if the patient has class three i'm gonna do the opposite i'm gonna do a class three vector
so you can do that like if it's a class two or class three and we still need to sock in the byte
you know if you want to you can kill two birds with one stone it's not doesn't make it quite
as efficient than a straight direct class two elastic or a straight direct class three elastic
because the vector of force isn't there but if you just needed like a millimeter correction it
would be fine to kill two birds with one stone um do a combination class two vector box elastic
so all right but yes that's where the orientation is really most important
would be in the finishing and detailing stage i don't love the idea that you could do a funky
orientation with the light ones at the beginning because it's only two ounces
three ounces and what really can go wrong so all right thanks so much hopefully that was helpful