dr amanda with straight smile solutions straightsmilesolutions.com and today we're
going to talk about severe anterior open bite cases in adults and what would i define as
severe well first of all not all anterior open bites are the same everyone is unique and the
treatment is all going to be unique so it's very difficult for me to put all that treatment in just
one bucket but i'm definitely separating adults from kids because when i say kids i mean growing
kids an adult could be a 14 year old girl you know an adult could be a 17 year old male you need to
go into their growth charts you need to do a hand rest x-ray you need to contact their pediatrician
you need to look for signs and symptoms and really dig into whether or not they are still growing
if they still have growth potential you need to treat them like a child and try to grow okay so
that's separate let's say we have an adult 100 done growing patient is 30 you know they have
an anterior open bite first thing you need to do and i have a whole nother video that goes
into this point by point but you have to do your due diligence one of the biggest beefs
i have with align technology and clearcorrect and really any of these treatment planning companies
is if you submit them a case they're going to make it look like it's possible and for the most part
it's not always possible and it's extraordinarily unpredictable because there are a ton of variables
that cause this anterior open bite unless you know what caused it and simon find out the
etiology and treat that simultaneously and all its sequelae and i'll go into that a little bit more
you can't expect this outcome to happen it might depending on what caused it and it might not and
the problem with i feel like doctors this happens like three times a week i see a case like this
and it just makes me absolutely infuriated now us orthodontists know better than this we know
that's not possible so we just laugh at these clint checks and we fix them and we do what
we need to do and we get good outcomes because we can tweak things and we're very careful about not
taking compromised cases that aren't predictable you know um or if they're not we're going to have
a ton of disclaimers and really cya cover year you know what to make sure we're not going to get sued
on this case by making the patient worse because sometimes when you try to treat open bite cases
worse things happen many many worse things and what may not be considered worse to a patient
or a doctor might be worse to another patient so you really have to outline all the risks up front
so that's why i really really don't like general and pediatric dentists i'll say general because
i'm talking about adults taking anti-open bike cases now it's a millimeter anterior open bite
maybe okay but i'm talking about something severe more than five more than six millimeters of
anterior open bite and remember if the patient is crowded and has an anterior open bite it's
gonna get worse when you straighten it hello and of course you have to have a ceph and of course
you need to know how to interpret this f and you have to have stuff numbers because you can't blow
those teeth through the plate the bite's going to get worse you need to dig into the whole ideology
what caused this open bite is it skeletal was it dental was it related to habits again one of the
biggest mistakes i see is that doctors are like oh well they had a habit when they were a kid well
yeah they maybe did but guess what the bones it caused the bones to deform and now we have
a problem an invisalign is not going to fix this even if the clinch x says it is guess what i'm
telling you in my experience says it's not and even if it just miraculously did and occasionally
i see something i'm like whoa guess what one year later it's not gonna retain that's the thing
what caused it will continue to cause more problems even if you have a bonded retainer and an
essex over it i see this time and time again where doctors get stung where they they feel
like they got tricked and even if it did happen which mostly it doesn't later it relapses and the
patients are furious and it turns into litigation and other problems and they're like i should have
known like i didn't know why did align technology show me a plan that was bs and this happens time
and time again again align technology is just doing what you're telling them to do you send
them this case they're going to straighten it but doesn't mean it's really going to happen
so you need to get yourself you need to get your ceph numbers you need to screen for osa you need
to scream for habits and habits is not just active habits putting your finger in your mouth
it's habits that might happen at night time best way to do that is send for an osa screening you
know you're not going to know you're not going to sit in their room and watch them you need to look
for tongue thrusts you need to do a whole tongue through evaluation you may need to involve an omt
this is outside something that i know that much about and omts are not always covered by insurance
so these sometimes i recommend putting in a habit of plants for six months first and see how that
goes you're not going to just jump right into invisalign or clear correct that's a huge huge
huge huge mistake that's all i can keep telling you huge mistake please please please don't do
this and i'd actually prefer you just don't take these cases at all i want you to send these to
ortho because most of the time these are going to be surgical cases for the most part for perfect
maybe depending on the staff they might elect to do a compromised outcome where they might pull
one two or three or four premolars not my favorite i wouldn't do that certainly without sending for
an osa release and a screening because i know i'm going to decrease the space for the tongue
i don't want to you know cause more problems for this patient if they're at risk for osa for sure
um i 100 would have them sign some disclaimers i have some stuff for that um so what's going
to happen let's say you decided to just go for it i know my patient says they don't care yeah they
sing they don't care now but they might care later and you might be in more trouble and once you
screw this up you're not gonna be able to fix it without surgery so who's paying for the surgery
when it gets screwed up it most likely will be you in your practice paying for this patient's surgery
and i'm just being quite transparent here because they really have they have reason to complain you
shouldn't have done what you were had no business doing i'll be really honest and i know i'm very
pro-general dennis doing ortho but not these kind of cases this is a no please don't do these cases
so please please please pass these cases to the orthodontist i just seen so much damage done over
the years a lot my 20 years of experience and these people are basically maimed permanently
you know and if you take teeth out now you're basically i want to throw another point if this
patient has difficulty eating functioning speaking already if you take teeth out and do something
and make it worse or if you just try and make things the worse you may prevent them from being
able to get to the point where they can get jaw surgery later to help them to have a better airway
to have a better quality of life you know if their back teeth are the only teeth that are touching
um they're not having a good quality of life those teeth are going to become damaged over time
and they're going to have difficulty eating functioning chewing speaking you are damaging
or maiming this patient so please please please even if you think you're going to take this as a
compromise case even if the patient has signed their life away saying i don't care it's fine
i'll sign whenever you want me to i still want you to send this patient to ortho for a full surgical
evaluation it's free they're going to get the information they need they've been fully educated
because remember part of your basically what you need to do the due diligence the responsibility to
this patient is to explain the risks benefits and alternatives and unless you can explain
the surgery you shouldn't be doing the compromise someone else needs to explain the surgery you need
to get a copy of it and document it and if the patient declines that surgery sometimes the reason
why i really want to say this is sometimes if the patient is bad off enough and if they have good
enough insurance sometimes the surgery is fully covered by insurance i've seen it happen time
and time again and it is a life-changing surgery so by pushing the patient to get a compromised
outcome and not explaining that that might even be possible can't promise but why not try it's just a
day surgery sometimes it's not that big of a deal and sometimes they can even do it with invisalign
and some in fixed plates and stuff like that this doesn't have to be wires and brackets and not
sometimes i mean that's that's not my thing that's really up to the surgeon and what they're doing
but sometimes we can we can do most of the initial alignment invisalign and maybe throw
a few brackets on for the surgery at that time you know just for a few months and i've seen
people do it full invert invisalign and just do fixed plates and screws for the surgery
so why not give the patient the ability to make the most educated decision for them
that's all i want to say so this was kind of my psa here i realized i was on my soapbox
but it's just people are not getting the message so i had to post this video all right thank you