dr amanda with straight smile solutions straightsmilesolutions.com and let's talk
about this case what's going on here i see a lot of things going on here and i love to post this
kind of cases where i'm just like whoa this is kind of a train wreck what are they doing
so um and this is not my case so that's part of the fun so first of all what do i see wrong
with this case and the title of this video is actually when should you do bracket repos
but i kind of wanted to go off on a tangent a little bit here and now that i'm looking at
this case more so let's talk a little bit about sequence of appointments and if you've worked
with me one-on-one in some of our orthodontic consulting sessions with straight smile solutions
we do help doctors one-on-one with their cases um first thing a lot sometimes we have to take
a step back and be like whoa wait we got some bad habits here let's let's break the bad habits
and you know not all orthodontists are taught this way this is the way when we're in residency
we have a lot of professors and and faculty that we work with some are good some are bad some have
really great methods and you eventually pick up on those doctors that those mentors that have
really systematic habits and you learn how to do things in a very efficient systematic way
if you do not have a systematic way of doing your ortho it's going to be a train wreck
you're going to be all over the place and the case is going to take four five six more times
than it really needs to but you have to kind of stay the course okay so what do i see here
first of all there is just some cattywonky crazy brackets here the bracketing is way
all over the place it is wrong wrong wrong wrong wrong brackets so this is why i just wanted to
discuss the whole idb versus direct bonding thing idb indirect bonding db direct bonding if you
want to know more about idb indirect bonding the benefits how it works you should definitely watch
all my videos on idb i also have webinars archived on idb if you want to know about db direct
bonding how to brace brackets place brackets correctly you should watch all my videos on db
okay bracket placement if you want to watch those videos we've got them a couple different ways you
can get there you can go to our youtube site which is straight smile solutions youtube site not your
youtube site our youtube site go into your youtube site put in straight smile solutions it's going
to take you to our youtube site with the green banner from there there's a small magnifying glass
towards the right side you can put in any keyword like idb db bracket positioning all of our content
will come up and we've got tons of content you do not even have to take a class on ortho because
everything you need to know is in our videos and they're totally free why do we do this
i don't know we're crazy so um i just enjoy making them and i want to leave a legacy of good
ortho out there for doctors so that's why i make them at no class and make them available to you
so anyways one of the things we talked about is keeping things you know in a system keeping
things down a certain path and this is what we were taught in residency first stage of
any type of braces case is going to be a line and level that's all you do you do not get
the suppose close space you do not get to fix bites all you do is fix midlines no no no no
you can't do that yet you have to do things in a certain order or it's going to turn into a mess
align and level the key to aligning and leveling is the brackets have to go on perfectly hence the
whole idb versus db clearly this doctor did not know how to put brackets on correctly so and don't
get me wrong i am not perfect at putting brackets on sometimes my brackets move they slip sometimes
you have like a really juicy patient someone's when the doctor when the assistant goes into
light care they tap them or bump them and they move there's a lot of things that can happen okay
so so have i had brackets like this absolutely now normally the way i teach in my classes um
and just to clarify you guys sometimes i do have classes if i'm sponsored to come teach a class
do i do my own anymore not so much it's just too much work and too much money so i prefer to do
things more remotely more one-on-one and i teach you on your own cases that's how we teach now
um but we're always open for teaching classes if someone like to sponsor host them
you know deal with it market for it i'll come and teach it that's not a problem but anyways i
just wanted to clarify that but what we teach you is that brackets have to be put on first
correctly perfectly to begin with or this is not going to work out right then you're going to go
ahead and work up your wire sequence to 18 nikai once you're in 18 nitai and your wire is passive
not deflected but passive you're going to do a full reevaluation at that stage before you move
on before you close any space no space not even a small diastema i know this is really different and
counter indicative to what is often taught in a lot of classes but there's a reason for this okay
so you take a progress panel and then you do your repose you stay in that wire the 18 night
time again until you're sure it's perfect once it's perfect then you can move up to your heavier
more rectangular wires and then you can start closing spaces moving midlines and fixing bites
okay so we're still in the first stage align and level second stage is space closure
and then ap changes so you can see here that these brackets are nuts i mean obviously i'd have
to have a progress panel in order to be sure and i'd have to have a lot more photos than just this
photos on the side upper and lower photos a lot of photos to check bracket positioning but just
just based on this front shot obviously eight and nine are not correct which one is right
which one is wrong i don't know because i don't know if this is the patient's real bite assuming
this is the patient's real bite and there's no bite bumps on it we've got vertical issues so
then i'd probably rebracket this one a little bit gingival to help make it look more like this also
you should be mirroring your brackets so 7 should look like 10 assuming they're the same size tooth
so they're not right either right um what about on the bottom well these are just nuts i don't
even know that any of these are right probably my favorite one is probably this one and from there
we will build we'll find the one we like and we will build the other ones around it however we
have an open bite here so sometimes i like to put my brackets a little bit lower but they're
already crazy low so i don't think i can go any lower than that with an anterior open bite
but yeah i mean clearly this one needs to go counterclockwise and mesial this one needs to
go kind of counterclockwise and this one i don't really know i can't really tell from this angle
probably a little bit incisal and maybe a little bit distal not sure anyways but you gotta level
up these inside edges should all be the same height and should be nice and straight assuming
there's nowhere okay but anyways that's what i had to tell you keep on keep on the trajectory
keep on the sequence of steps don't skip steps get your brackets on perfectly don't move into
heavier wires until you get the brackets right to begin with if you do things in a
certain sequence your cases will and use idb your cases will work out all right thank you