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all opinions are those of straight smile solutions
we are an orthodontic consultancy company that helps general and pediatric dentists with their
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now enjoy the show
unless you understand what it takes to be successful in aligners you're not going to
be successful and there's a lot of variables and i find a lot of doctors do some things right and
a lot of things they don't understand what they're doing wrong so the first thing is going to be case
selection and that is something obviously it's an orthodontist i'm great at case selection for me
there's never a no for aligners everyone's in a liner candidate i because i've mastered aligners
and africa i've never said no to an aligner case it might be a situation where there's a case that
might be more efficient with braces or another way you know but we can still do it you know um a long
time ago i used to say no all the time but now i don't every everyone's in a liner counter right
you want it matter of fact we've gotten to the point in in our practice my husband has a practice
um and soon we're gonna have a few more practices where everything's aligners and
removables there's no fixed at all so um and we feel very confident with our skills but
you as a new you know orthodontic provider may not have that skill set so i really
really recommend the first maybe a couple hundred cases that you bounce them off in orthodontist
doesn't have to be me it can be anyone there's lots of orthodontists that will help you and
not many will do it at no charge um especially if you're a good referrer to the orthodontist
it's it's really worth and ask to talk to your local economist community and say hey
you know i really want to get started i want to start doing better ortho
not everyone always wants to refer out i'm still going to refer you out you know as needing for
certain types of cases but would you be willing to sit down and have a study session with me so i
can go over a few cases they might say no but they might say yes and as my auntie always said don't
ask don't get so you might as well ask right but there's you know support your local orthodontist
first if that they say no and you still want help there's a lot of orthodontists out there that are
hurting right now because as ortho has changed you know over the last 20 years we don't quite make
what we used to we're not even close so um you know support the orthodontist in their community
um second one would be design and treatment plan again this is something that you can learn over
time you always want to have an independent person who doesn't work for that company to help you with
the design and treatment plan now i've seen i mean i've worked with invisalign pro sometimes
it's good sometimes it's bad so it's terrible sometimes and you won't know so that's why i
like the idea of having an independent person who has a similar philosophy as you to help you with
your designs and treatment plans they should be a licensed orthodontist in the u.s though there's
a big difference in quality and i like i said i've worked with a lot of people so that would
be my suggestion um third would be production of course you shouldn't have any production issues
if it's invisalign clear correct sure smile reveal major brand companies um it's all been
really good i mean it very rarely are you going to have a one-off manufacturing warranty issue
i very very very rarely see it so it used to be an issue maybe like 15 years ago um
if you're making in-house that's a whole totally different story um we'll kind of lightly touch
about the white label in-house bad phenomenon we do do that in our office we don't we don't
space is really expensive in hawaii so we don't have our own lab so we outsource the
manufacturing we do this on simple cases so we use invisalign and i like i said i'm not going
to promote any products but that's what we chose to use just because we feel comfortable with it
there's a lot of different reasons nothing wrong i've used clear cork before i'm fine with that too
just maybe not for me um but we also do white label where we outsource all the production to a
local lab it's a little clunky it can be you have to really be on it with the organization there's
no good dashboard there's a lot of negatives to it but it's crazy cheap okay like crazy crazy
crazy cheap um as low as 99 for the setup decent treatment plans um and 20 per liner and this is
only in the us i don't know what's available in other countries so it's it's pretty smooth in the
us so again happy to make intros if you'd like to meet there are a lot of great white label design
companies that are out there that are all us based the ones i work with are only us based and i feel
comfortable with them i have about three that i work with so i'm glad to introduce you um if you
want to reach out to me there's no deadline on the introduction of course because it's just an intro
and lastly would be compliance and compliance is something that again orthodontists are great at
and general dentists are not so great at and as a mom you know i'm pretty honest with complaints
but you have to have a compliance program you have to have an accountability work loop
a lot of things and that's going to be my last slide and we'll definitely go into that but if
you don't do this i mean you're never going to finish cases you know they're just going to spin
in circles basically and speaking of compliance you should know your revision refinement rate
if you do not know your revision refinement rate like how what is your frequency over
five minutes in our office is somewhere it's pretty low like way less than 30 and when it's
just me practicing it's like five percent because i nail my treatment plans the first
time and i'm on it with compliance i use virtual accountability loops and a lot of different stuff
um but the average rate is much higher i mean if i had to guess and invisalign doesn't really
publish the rate although there's a way you can ask them about your analytics on that so
you should reach out to your tm about that if your rate is more than 50 you are doing
something wrong and you should definitely fix that because you know patients aren't going to be happy
you're not going to be happy your staff's not happy no one's loving it but if you can
what what if i told you you could do an aligner case in just three visits well most orthodontists
do that i know um first visit is going to be the records and the scan this is assuming you're doing
a scan um second visit's going to be delivery attachments and ipr and we're going to get into
ipr later of course and third business is going to be d bond we're then deliver retainers that's it
super super super easy you know how profitable that is i think it's crazy profitable and the cool
thing about aligners is that pretty much your team or staff can run the whole show you as the doctor
is you're the brain of the operation you're just doing this puzzle creating this cool plan it's so
fun i love puzzles uh but that's all you have to do everything else can be done by your staff and
you know i'm not going to go into um the whole like practice limitations and things like that
you know in california um depends i mean um and right rdaef can do certain things they can put on
the attachments it's a bit of a gray area so i'm not even going to it but most doctors have their
assistance to everything except the ipr obviously ipr has to be done by the doctor as far as i know
in every state um and the d bond oh no some states the rdief or the hygienist can do the d-bond but
in any case pretty pretty easy stuff fun okay so before we get into our we haven't even gotten to
our 12 tricks and tips yet and um i don't know if i mentioned this is going to be like a solid solid
hour usually this presentation takes me two and i'm going to talk crazy fast because it is late
um so that's why i want to extend those additional resources to you if you want to learn more because
i have tons more information this is a crazy abbreviated version at the end of the hour
um we will show the code y'all can jump off if you want to jump off go enjoy your night go to
sleep have a beer um those of you who want to ask questions we will stay on another 10 minutes or so
for questions after we give the code but before we get started we need to get oriented we need
to make sure you're thinking the way i'm thinking you're speaking the way i'm speaking let's talk
about different ways to move teeth and in my world there's five different ways to move teeth
and most general dentists are only familiar with a few usually not all five so i'm
going to kind of take you through the most simple to the most difficult well maybe not
but okay so let's get started and i can't see myself so i'm gonna try to center i have some
like things to show you i'm gonna try to center them in front of my face because i know you
can see my face so hopefully this works um i like demos so the first one okay let's do this
the first one is going to be arch expansion i know you know about this so arch expansion
is taking an arch where somebody's crowded right and widening it if i widen the arch i
get more space right easy so it's kind of like an archwire here this is a typical archwire in
braces this is the arch form let's say it's like narrow i make it wider everything that's crowded
can now have space to straighten up we call this an occlusogram how we measure it in ortho but
anyway so simple i think you get that most all atlantic companies even direct to consumer do
arch expansion okay mostly it's okay but it's not always okay so certain patients i don't
want to do arch expansion on and remember whenever you're doing an aligner treatment
plan we talked about optimizing the treatment plan to get best results you need to know is it
okay for me to do this i i can't always tell you there's a lot of things a lot of this is clinical
um we're looking at the bones we're looking at the root we're looking at the roots scalloping
um we're looking at the periodontal conditions we're looking at the perio probings
so a lot of things you need to think about in making that decision if i have a perio patient
i do not do this nope i just say in the treatment plan no arch expansion that's it or i say only
one millimeter of arch expansion the defaults in clear correct are well over two millimeters
invisalign has two different defaults when you go into your preferences you can set it for less or
more depending on what you do mindset is more but i just undo it when i don't want arch expansion
so healthy young patients great unhealthy older patients no okay easy to remember when in doubt
don't expand arches because you can push the teeth through the bone and devitalize them
and you can lose a lot of teeth and i've seen it happen it's not good okay number two is going to
be proclination and proclamation again done in all the liner companies as well as direct to consumer
proclamation means flaring or proclining or tipping the teeth forward to get space
again okay and healthy patients not okay in unhealthy patients as an orthodontist most of the
time i am taking seth x-rays and i love steph's just because i can look at a set i don't have to
get the numbers and i can tell you exactly what's going on what i should do what i can't do at least
in terms of vertical stuff okay ap or sagittal stuff um so that means backwards to forwards
like this direction vertical this direction um can't see transverse nsf it's a lateral seth um
but there's a lot of things so obviously for example this step and my eyes trained to do this
so there are and a lot of general dentists get freaked out on sets and i'm not even going to go
into the do you need a cf do you not need a stuff because obviously invisalign doesn't require sex
clear correct doesn't require sex i love them because it tells me what to do i don't like to
guess so i take them you don't have to take them when i work with my private consulting patients
sometimes if you've worked with me i'm going to say i'm sorry i can't tell you without a set i
mean this is just too big of a decision i would need to see the stuff i'm not sure you know it's
kind of like guessing without a road map so steps are really really really useful you can take a
step slice on a cvct um a lot of doctors i know do it you're going to need to talk to them about how
to do it because every setting is different it's a lot of just like practicing to get the slice
in terms of numbers there's a lot of places you can send it off i do have a stuff playlist i'm
glad to share that with you everything that i know so far um again reach out to me if you want a copy
of that but um they're very useful but yeah that if i know whether or not i'm gonna proclaim or not
um sometimes i'm looking at the anatomy of the teeth sometimes i'm looking at the root scalloping
um looking at the bite there's a lot of things that go into that decision on whether or not i
can proclaim teeth or not okay so that was two we said there was five right number three is going
to be ipr and obviously i like ipr because i'm here and garrison is in my opinion the best ipr
company to buy and we'll go over their product and that's part of the reason i started lecturing for
them is because i started using their product and it was just second to none and it's what we
totally use in our office so and i'll explain the why behind that definitely want to sign up
for ipr webinar it's going to be awesome may 17th um but yes ipr if it's done accurately is awesome
um you can remove up to 5.5 millimeters of tooth structure per arch that's going to
give you a lot more space to straighten things up and it's especially great on perio patients
i don't normally do it on kids so it's usually for older patients because um kids can get sensitive
with ipr so i just don't do it on kids you know i find other ways to do things um what else what
else okay next one is one you probably never heard of and it's called distalization okay
so distalization means let me see what i've got for a demo here we'll look at my typing on okay
that means scooting sequential distillation means scooting teeth one tooth at a time
backwards and i know i talked about forwards orthodontics and that's mostly when i'm pro
but sometimes you know if we don't want to take out teeth there's
limited options right um or sometimes we maybe the teeth are crazy flared we see it in this app
and we want to tuck them back a little bit um so you can do this i think on most aligner companies
and some of the direct-to-consumer companies it's an option but you have to ask for it it will never
ever be the default you will never get it in your treatment plan unless you ask so that's just one
of those things little tip ask for sequential distillation but the trick is you have to check
the panel for example on this case right here cannot do it why we've got one and 16 our upper
eights are impacted obviously they're right at the height of contour not gonna happen can't scoot
you know the upper sevens or the second molars back so that we can scoot the next one back so
they can scoot the next one back because it's going to run into it and damage the teeth it's
just not going to happen so if you ask for it they're assuming you have your third molars out
um you can do it on the top or the bottom um on the bottom you can do less i can usually get up
to about a millimeter millimeter and a half on the top i've done up to five six millimeters i
can do a lot but you have to check the bone too um there's a lot of things you need to check so
like for example in this picture here can't do it here we can assuming there's nothing impacted
we have some ridge there can do it here so you have to ask for it and it takes time this is not
something and it's not offered in the express or the light or anything like that it's not offered
you need to do comprehensive to do it um so sequential discussion that my daughter
gave me this demo because i'm always looking for visuals i'm a visual person is scooting each tooth
one tooth at a time it takes time you are not going to finish this case in less than 50 aligners
it's going to take time it's not a quick fix okay so just keep that in mind but it's really really
great you don't have to do ipr if you don't want to do you don't have to wear elastics
and you get a really nice outcome cool cool trick right and lastly we have our extractions
so lower incisor extractions fine great i'm cool with that especially perio patients or slight
class 3 edge to edge patients um primo extractions not my thing i'm not saying i don't do them it is
always always always last resort for me i'm like i have no other options you know for whatever reason
so do i do it yes very very very rarely but i was trained to do it all the time so
you know and i'm always untraining doctors you know please don't do that unless you need to okay
you