hey it's dr amanda with straight smile solutions straightsmile solutions.com happy friday and
today we're going to go into some more really fine-tuning kind of high-level orthodontics
discussions we're going to be talking about torque and torque is something that patients don't really
understand and most general dentists don't fully understand it either the difference between
buckle root torque and powder root torque and how you can kind of adapt that into your treatment
plan for invisalign or clear liners or braces and how you can finish your cases more ideally
and torque is the hardest movement from my experience one of the hardest movements in
orthodontics and it can get very frustrating and it's a bit of a tricky slippery slope
because it isn't always that hard to straighten the teeth but getting torque takes a lot more
time and often one of the biggest mistakes i see general dennis making is that they'll be like oh
this looks like an easy case and they'll pick something like invisalign light or express or
even moderate when i look at a case going ha this case is going to need torque i know torque takes
a good four to six months extra an extra 15 to 20 liners an extra six months in braces
yeah i can make the teeth straight but it's not going to look good until i get that torque and you
guys finish a case and the patient's like i don't like the way this tooth looks yeah because it
needs torque and you can't do that in that field of aligners and so patients are upset because they
don't think it looks good you don't really know how to do it and you end up spending a lot more
money in the long run so you got to understand torque so i kind of was looking for some examples
i like to use stock images sometimes because then i'll have to deal with releases and all that
um and there's just you know millions of stock images that you can purchase out there so i've
been kind of combing good ones for torque not my favorite examples but they're pretty good so let's
look at the example on the left on the left teeth are straight right on the top arch i mean we're
in a very light wire i'm doing this in braces just because it's easier to kind of visualize
but same thing if you had an aligner patient so you can see teeth are straight oh yay so this
is what happens and let's let's extrapolate this one more step there's a lot of doctors
out there that are doing some types of branded indirect bond of systems i'm not going to mention
they're in the amps but there are indirect bonding systems out there that you can take a course for
um you have to use their brand of brackets the problem is their brackets are cheap
sloppy and they don't use torque so not all braces are like just because you're purchasing braces
doesn't mean they have torque built into them some braces and systems are meant for round
wires round wires do not do torque got it so you have to fully first of all you have to
have a high quality brac high level bracket system that an orthodontist would use okay
so you want to be asking the prescription of the bracket system and i've got tons of content on
this if you want to learn more about this go into my youtube channel it has to be the straight smile
solutions youtube channel which now has over a thousand videos put in the word um indirect
bonding or idb and you can get more you can even put in torque and get more information
but if you want to do indirect bonding and if you want torque you need to ask the prescription
ray most prescriptions like regular ones that orthodontics will use first of all you got to
know your slot size is it 018 is it 0 2 2 if you don't know your slot size you can't know
if you're getting torque because you have to fill it fully right and that's something that we teach
doctors about in our straight wire course or if you work one-on-one in your consulting sessions
with us we go over all this with you if you want to do brackets so there's benefits to one eight
there's benefits to o2 most general dentists i know are using o2 too there's a little more
freedom um it's a little bit easier a little less harder a little less difficult to use a little
more manageable um i've used both in my lifetime i personally in my own practice did one eight but
there were reasons for that but i recommend you do o2 so um in any case the other two most popular
prescriptions that are out there i would say are roth or mbt so those are probably the top two
really easy the good thing about using a system that most people use is that if and when you
first of all if you can accept transfer patients easier because more people are matching that
system and you can also your patients if they have to move it's easier for you to find a place for
them to go if you're using something super obscure like tip edge or one of these things forget it
good luck you're gonna have to pull the braces off i don't even know how to deal that so that's like
one system i just don't get so um yeah so let's talk in about torque so like i said it needs to be
a regular mini twin bracket system torx should be built into the prescription you have to fully fill
it so obviously we've got tons of videos on wire sequence you can go into straight smile solutions
type in wire sequence and we go over the wire sequence but if you have a case that needs torque
you're going gonna have to fully fill the slot so if it's a o2 slot i mean the biggest one i
usually can get in is a 1925 into that i mean you can probably go one bigger but it's going to be
really hard to pull in and out so and that should work as long as you let it cook in the 1925 for a
little while uh so look at the left patient again we're saying he's straight but it looks funny
right well that's because literally if you took a cbct slice from the side you see that these teeth
are super upright right they're like literally at a 90 degree angle to the occlusal plane they
need torque but there's two types of torque buccal and palatal so for this patient the teeth are at a
90 degree angle they're super upright i call them sharky teeth because it looks like a shark right
um not like a rabbit or a beaver that would be the opposite so we need these teeth to stay the
crowns would stay in the same position the tips of the crowns will stay in the same position
but the roots need to torque palliatively and give it a more natural less upright look hey my teeth
are super are super upright like when i did my braces for the third time i chose not to torque my
teeth just because i have almost no roots because my first orthodontist burnt all my roots off
with too much heavy wires and power chain so i chose not to torque my teeth because i figured
i'd lose my teeth but here this patient needs to work so they need to work their way up to the 1925
uh really figure eight tie these real good and tight and let them torque to get a more
upright look so this this needs paddle root torque the roots need to go palatable it needs
powder root torque obviously we're still aligning on the bottom but an example okay now for example
let's look at tooth number seven here teeth are straight just like here what's wrong let's say
once we close the spaces it still was at this inclination teeth are straight but if we took
a slice cbct from the side and we looked at the roots you would see the roots are super
palatal they're like literally this tooth as at a 45 degree angle to the occlusal plane
it looks funny right the eminence of it coming out of the and definitely periodontists do this
all the time you know when they're setting up implants they're really good at getting the
right angle so it has the right eminence profile or whatever you guys call it so
same thing this patient needs buckle root torque this one needs paddle root torque so we
need to upright that root a little bit more so it doesn't look like it's shooting out like a rabbit
or bunny rabbit or beaver profile it's a beaver definitely a bunny rabbit where the teeth are like
almost tipped even though they're straight the emergence of the root from the socket is angulated
we want this to upright and have more torque same way that we get torque here and of course
there are torquing springs and all kinds of other funky things and bends you can put in to be honest
i really don't even use those i find that they get sloppy they overdo things it's really easy
to screw things up i just give it time now that's in braces so now you understand the difference
between kneading buckle root torque and needing palatal root torque you can take extrapolate this
into your invisalign treatment plans so same thing when you do setups in invisalign you'll
look at a case and be that looks straight but it looks funny well torque isn't something they're
going to put into your treatment plan unless you ask for it so you're going to get straight teeth
quick easy dirty as few of liners as the company can give you to save money but you have to ask
for the torque if you don't ask for the torque you're not getting the torque and you need to ask
for the right kind of torque one of the things that kind of drives me nuts with invisalign
is i'll say more torque and it's pretty obvious for me what type of torque they need to give me
they go what kind of torque and if you don't know what kind of torque you're not getting the right
kind of torque occasionally i get a smart you know treatment coordinator who knows but the
vast majority of them are not orthodontists they're orthodox that work on their team
but they're just lay people in costa rica that are trained to play this video game with teeth they
have no idea what your patient needs now you can go into the 3d controls and do it but personally
i become accustomed as an orthodontist to look at this i need this this is the movement
i need i write it down and now you do it i'd rather have the i'm paying 1873 or whatever
purchasing plan you guys can spend 30 minutes playing with the buttons i'm gonna tell you
what i need and now you can find a way to do it i do not sit there and play with the 3d
controls i got better things to do so i know we need it now you put it in and make it look good
so i know that's kind of ridiculous but that's how i am any case you need to tell the invisalign
treatment planter that you need torque now one of the quick and dirty ways that they get torque
is by putting on power ridges personally i hate power ridges because from a patient's perspective
if you ever have patients that have a lot of power ridges they hate it because it juts the plastic
out and cuts their lip you don't need power ridges to get torque you can use just take some
time additional time additional aligners which is healthier for the patient and more comfortable
or you can put attachments on that help with torque but if you ask for torque most of the time
they will give you power edges which is not wrong it's just not my favorite way but in any case
if you know that your patient needs torque when you're looking at a case to start you should
not be selecting express light or moderate you should be expecting comprehensive all the time
which is why i recommend that you always build all patients up as comprehensive patients unless
they are a limited patient now if your patient is requesting quick easy dirty no molar movement
front teeth only easy improvement only not perfect then you need to have that type of consent form
because what's going to happen and you can't be building necessarily d80 and 80 d8090 you have to
be billing the limited and this is gonna this opens up a whole nother conversation i've got
tons of videos about this as well as you should definitely watch our most recent
webinar which is in my youtube channel it's at the very top you'll see us talking about it we go
into this a little bit more you can't be billing comprehensive if you're only doing straight you
know quick dirty easy front teeth only it's real borderline you know in terms of insurance issues
so if your patient's trying to be cheap and just get a couple teeth moved that's totally fine
but unless you have the right documentation backing that up in terms of what you're offering
the patient you have to you're obligated to give the patient perfect which may mean you're going to
lose money on this case with the lab fee if they don't like the way it looks at the end so keep
that in mind all right again just a reminder if you need help on a case you're welcome to schedule
an appointment at straightsmilesolutions.com go to services to schedule as little as one appointment
20 minutes one case we can help you with that case you can try it out all right thanks so much