hey it's dr amanda with straightsmilesolutionstreetsmountsolutions.com and
about once a week one of my doctors comes to me and says they're struggling with their
buttons coming off on their invisalign cases and it doesn't just have to be in
design there's a few other aligner companies that do have precision cuts and buttons
and of course the first question they ask is can i just go back to doing slots and if you want to
know more why i don't like slots and why i do like buttons i do have a lot of content around that i'm
not going to really go over that right now because i've made a ton of content around it already
you can search slash for slots versus buttons in my channel if you don't know how to search for
content within a channel shoot me an email at info straightsmilesolutions.com or shoot me a website
message at streetsmilesolutions.com and i will be glad to hand deliver you those videos anyways so i
still want you using buttons and not slats so we need to figure out why the breakage is happening
and it's not that hard to figure it out you have to put your detective cap on and once you figure
it out you will be money and gravy and it's all going to be good but don't just give up because
that just means you're giving up and you shouldn't be giving up right so let's find out first why the
breakage happened okay so a lot of times you're like oh i want to change the treatment plan
or i just don't want treatment plans with any type of elastics but wait ha you can't do that
because if you're going to take hard cases i'm saying hard cases that have ap changes
or need bite corrections it is below standard of care to just show the patient the sloppy easy
treatment plan that is below standard of care as a matter of fact you can't even necessarily
build that as a comprehensive case because that is now a limited case potentially depending on
what it looks like which could be insurance issues and i'm not going to go into the whole
insurance fraud thing but your your borderline there also remember anytime you do a case you
need to explain the risks the benefits and the alternatives to the patient key being alternatives
you can't just show them what you want to do you have to show them all the options and again i have
tons of videos about the risk of doing this and why you can't do this so since i have other videos
on it i'm not going to go into this right now if you want me to send you more about this the
liability all that kind of stuff insurance stuff you need to shoot me an email info at
straightsmilesolutions.com or send me a website message or just search within my youtube channel
real easy for um compromise versus uh it's probably under compromised cases or buttons
anyways there's a lot of stuff it depends on which way you want to go okay so first question
i asked the doctor when they tell me they're having chronic button breakage is when did the
breakage happen and you should have a quick answer for this for every single patient if you don't
well then you got to put your detective hat on when did the breaks happen so this is where
when you ever you put buttons on a patient same thing with brackets you tell them we warranty
breakage you know up to three buttons brackets or whatever and you really may even want to put this
in writing it's up to you or you can just verbally say it if it becomes a problem then you can start
putting it in writing um any breakage that happens when the within the first 24 or you can say 48 but
24 is fine 24 hours is covered by us that is our mistake apologies give us a buzz within 24 hours
we'll fix it no problem at your convenience at no charge just say that now that being said if
they call you in 72 hours or one week that's not 24 hours so they have to call you immediately
you know in order to activate that so i mean they might call you a week later and maybe it happened
within 24 hours but the way it goes to me unless you called me within 24 hours it's not 24 hours
you get what i mean so you have to let the patient know that so anything that happens within 24 hours
after bonding is the fault of the doctor and the team it's not the fault of the patient never ever
okay so this is where there's a lot of things that could be going wrong it could be your isolation it
could be your glue your glute could be expired anyways i've got a whole video all about this
ask us for it and i will send it to you because you need to do some major team training and or
throw out all your stuff and get new ones um or both i've even had it and this goes with brackets
as well where if it's becoming a chronic problem especially if it never was a chronic problem
we got to see what variables are new if it's i'll go back and find out what team member it's
happening most frequently if it's one particular team member then we have to have your best team
member train that team member up that means for a little while we have to slow down and have them
partner up and double up and watch what they're doing it's a little embarrassing i understand but
we got to fix the problem right all right so let's focus on this because this is probably more common
maybe not and this gets a little more complicated if it happens more than one day after the bonding
could be the fall of the patient could be the fault of the team and the doctor could be both
but this is the way i usually tell my doctors to manage it first of all if it happens tell
the patient to come in also the patient needs to save the button or bracket this is really
really really important first of all they cost money second of all always tell your patients to
save it it's very very rare that it falls off and disappears you know patients just think oh i don't
need it and they throw it away but there's a lot we can learn from that button plus we can reuse it
so they need to bring it in in a ziploc next thing i'm going to do um once you get that is
we're going to look at where the residual glue is is it on the bracket or is it on the tooth it's
rarely both it's usually one or the other okay and that tells me a lot bracket or tooth right
if it is on the bracket or the button okay and it's not on the tooth guess whose fault it is
it's yours doctor and team okay again this is the same thing as this same thing okay it's you guys
it's your glue it's your process it's your isolation i don't know what it is you didn't
prep the tooth you prepped the tooth with fluoride instead of or they patient had mouthwash before i
don't know you need to i usually use pumice unflavored pumice just lab pumice or they
sell pumice in profi cubs and pumice it or you could just use you know a two by four
you know a two by two and just wipe all the plaque off but that's your fault okay if it happens that
the adhesive is still on the tooth and not on the button it could be the fall of the patient or it
could be the fault of the doctor and this is where it gets a little more complicated next thing i do
is a couple a lot of questions okay first thing i'd recommend if it keeps happening if happens the
first time don't do this but if it happens more than once patient gets to keep a diet journal yay
so i'm still not going to charge them because we don't know whose fault it is yet right um even if
it's been a few but patient gets to keep a diet journal and i expect to see a one to two week
diet journal coming in um they might want to keep it on their phone they can print it out i want a
copy of it better if they can actually if you keep like little notebook you know um you can buy them
go to target in their dollar aisle and just get a bunch of these tiny little bitty notebooks because
i want it to be extremely detailed down to exactly what they drank with every meal every single snack
um details details details you know if it's just real rushed then they put the effort out and
that's making me think it's more the patient's fault i want to see details every single snack
everything they ate drank everything for at least one week if not two weeks one week should be fine
though um they bring it back in they come in for a week later and we're gonna audit that journal
and find things so for example if they say tacos i'm gonna ask what type of tacos was it was it
soft taco was it crunchy taco was it doritos locust taco you know okay show me how you ate it
and i'm not gonna prep the patient first because i'm going to ask questions you know tell me about
it i just picked it up a bit into it can't do that you know so um i ate flaming hot cheetos etc i ate
pizza okay what type of pizza okay did you eat the crust how did you eat the crust so buttons
for invisalign work just like brackets same rules apply so then you're going to need to go get your
food list we have the food list in our store if you want a copy of our food list it's free for
anyone who's a concierge or vip member part of all of our documents totally free so um yeah so
you're gonna have to work on on eating how to eat foods things like that uh what else so that's diet
other thing could be bite of course check with articulating paper are they biting on the bracket
if they're biting on the bracket are they biting on the sorry bracket the button are they biting
on the button only when the eyeliner is out or with the aligners in um if they're only biting
on it with the aligners out then my suggestion is to take the treatment plan and slow it down by two
or three times so if it's a 20 you make it a 60. if it's a 30 you make it a 90 and then they do two
to 3d chain through two to three day changes you can do warranty fit or just a refinement on that
yes you'll probably have to take a new impression or scan um but that way they can eat with the
aligners in because it gets nasty you can't do one week or two week changes and eat with your
liners and that's absolutely disgusting but if you're doing three day changes you can eat with
your aligners and of course they're going to want to still take them out after they eat but
just don't bite down right when they're brushing and then pop them back in first of all that's
going to make the case go crazy faster anyways and it's one of my cool hacks that i do all the time
um but that's a bite very rarely are they biting on the bracket with the aligners in
it's usually when you take them out to eat okay so that's an easy hack lastly what size elastics
now my default normally for button to button for elastics is going to be 316 heavy which is six to
six and a half ounces but that's not always right for everyone i can't tell you exactly what elastic
size because you have to try them in it's like a pair of shoes right so the normal ones i recommend
keeping stocked in your office if you're using button to button in those slots and of course
if you listen to me you know that you should be doing that anyways but um i would stock one
quarter medium um one quarter heavy 316 medium and 316 heavy and you might want to stock 1 8 medium a
heavy but you'll use that pretty infrequently for invisalign okay so mostly just those four you can
buy them from ebay you can buy them invisalign store doesn't have them all um any orthodontic
company the thing i like about ebay is that you can just get a few you know you should probably
have a few sample packs for trying in you know because you want to try in certain elastics to
find the right size so the goal is to find the smallest diameter elastic that the patient can
comfortably take on and take off themselves without a hook without stress and still talk
you know yawn and do things so again you're going to have to ask more questions about this
if it's more than 24 hours you want to know when did it fall off did it fall off after you ate did
it fall off after you gone i wouldn't even prompt the patient because i feel like sometimes they
they're hesitant to say something because they think they're going to get charged so you have
to let them know it's just for detective purposes you want to know more sometimes it loosens it and
it cracks the bond and it comes off later at night so if they say oh it came off at night well that
doesn't mean anything to me so um most likely either you're you're using an inappropriate size
or an inappropriate strength or an inappropriate diameter for that patient you have to try try it
in right and sometimes if they're on the border and they're like yeah i can get this 3 16 heavy in
um but when i laugh or talk the bracket breaks well then you probably want to do one quarter
or you can do the 3 16th at night when they're sleeping and the one quarter during the day
i do that sometimes so anyways hopefully that was helpful put on your detective hat find the
mystery of the broken button and fix it and you know this is stuff that it happens even in ortho
offices we get breakage all the time but we just are pretty good at figuring out what happened
but most common issues are usually one of these three if it's more than 24 hours and like i said
some of it is just the doctor messed up and picked the wrong size um some of it
you didn't notice that they were biting on the bracket when they took the aligners out
and maybe you need to slow down the treatment plan so they can leave the liners in
otherwise you're just gonna have to eat a soft diet until it shifts around
and of course diet is the patient but if unless you instruct the patient on what they should eat
and not eat um that's your fault so all right thanks so much sorry to be blunt