dr amanda with straight smile solutions streetsmastsolutions.com and today we're
going to talk about frequency between orthodontic adjustments for straight wire or braces cases
and i'll be glad to tell you what i do there is no wrong or right answer to this it's only what you
feel comfortable with so let's go over that so this is kind of how i do things and this really
developed i guess over the years you know figuring out what's most efficient what's most productive
the biggest mistake you can do is to get your patients in on every four weeks or every month and
that is just dumb because you're just completely throwing money out the window there's just no need
for that and it's actually not even healthy for the patient so you know i mean i really love the
idea of using some virtual appointments in between two and this is just a whole nother this rabbit
hole we can go down but you know at least look for broken brackets and hygiene issues because clearly
those patients need to come in more regularly um this frequency that i'm giving you is a frequency
for patients who are compliant and healthy okay so you need to really figure out who the other
the outliers are and you might have a different frequency for them and also really educate your
patients and parents to check their braces regularly to be checking for hygiene broken
brackets broken wires and to give a call sooner and not just show up for their regular appointment
if something is broken that's really important so let's say on a traditional a regular bracket wire
case what would i do well if you've watched my other videos in terms of wire sequence you know
that i always start with the biggest possible round wire that i can get in it's going to be
different on every single patient so a patient like this might be in a 14 nighttime someone
who's pretty straight already not this tooth might start out in the 18 night biggest possible
round nighttime that i can possibly get in that first wire is probably going to stay in for a
few months four five six months it might stay in a while maybe two that wire stays in let's say we
started with the 16 nine time that wire is going to stay in until that wire is no longer deflected
and is quite passive and you don't know what that means you need to understand that it's a really
important concept so i recommend that you go to my youtube site not your youtube site but go to yours
put in the search bar straight smile solutions go to our youtube site which will have a green banner
then go to the little bitty magnifying glass in the top right um not top right corner but just
top right in general and put in deflection or deflect and that will take you to my videos or
archwire sequence which explain more about that so you understand that concept once that wire and you
can see here clearly this wire is still deflected right it doesn't look like it's the shape
of the arch wire when you put it on a tabletop it's got ins and outs and ups and downs right
whereas this wire is not deflected it's just straight okay so once that wire is no longer
deflected we're going to move up to 18 niti unless that's your initial wire once that wire is no
longer deflective then we're going to do a really really deep dive into bracket positioning i also
take a progress panoramic x-ray at that time and i evaluate my bracket placement now if you're a
general or pediatric dentist i strongly recommend that your first 50 to 100 cases are indirect
bonding that is the biggest mistake that general and pediatric dentists make is to try to direct
bond their cases you will not do it right i'm sorry you won't i've been working with dentists
who are learning to place brackets for some people have been doing it for decades and they're still
not doing it right you just don't have the skills of an orthodontist so why try to be one
have a software company have people who know what they're doing place them for you correct create a
transfer tray and slap them on that way you don't have to worry about it because i can guarantee you
it will just make your case takes at least another six months you will just it won't be efficient and
you'll be throwing money out the window because you're having to go back to other wires you're
having to replace brackets and things like that and the patient will be unsatisfied and unhappy
because of all the back and forth and how much extra time it's taking so just use the indirect
bonding if you don't know how to do that i'm glad to introduce you to some of the companies that i
work with one of the ones that i work with best does not really have a big website or anything
like that it's a referral only company so they need to know who they're getting and so i'd be
happy to see if you're a good candidate and refer you if i think you're a good fit they charge about
350 that is for top of the line brackets 3m unitec victory series that includes upper and lower full
set of brackets that and the software to place them and you will actually see the placement you
will approve it and then they will 3d print the models put the brackets on the models create a
transfer tray and you will be shipped the brackets in the transfer tray all you have to do is etch
prime bond slap on the tray like you were doing some type of matrix for a crown like your peel it
off it is crazy easy a monkey can do it that's how easy it is and you don't have to worry about the
bracket placement because it did it for you and you verified it already ahead of time digitally
so now your assistant can put the brackets on that's the beautiful part you could be doing
something else in the same room and your sister assistant can put it on because you've already
approved the bracket placement and you just double check it before they tie it in super super easy
anyways let's go back to frequency of appointments so like i said in those initial round wires i'm
going to see them about every eight weeks could be six could be ten i say eight because it's between
six and ten which is my frequency certainly not more than ten not less than six unless there's
a broken bracket because there's just no benefit to that and then once they get up to that 18 night
tie which is no longer deflected we go take the progress panel we evaluate the bracket placement
just to make sure it's fine it's usually fine as long as nothing broke and you use indirect
bonding if you use direct bonding forget it we're probably going to have a big mess and we're going
to have to fix that and then we stay again in that wire until all the repos are done expressed and
relaxed and we go through that cycle again if we did repost once that's all good then we're
going to move on to the next phase remember the first stage of any street wire is always level
and a line what a lot of these short term ortho companies and other bracket companies are straight
wire education companies they totally teach you the wrong stuff it's not what orthodontists do
we don't put power chain on in 16 or 18 night time we don't why because it doesn't really fully fill
the slot so you lose your torque and the teeth dump back you get tipping uncontrolled and it's
unhealthy for the roots teeth and gums that's why so you do not close spaces on round wires
you close spaces on rectangular wires and i know some patients get all excited about closing spaces
they have to wait okay so then we're going to move up to after that 18 and all the brackets are
perfect and everything's nice and passive we're going to move to 1825 night tie upper and lower
we're going to go ahead and have that cook for a little while for eight weeks okay and then after
that if we have spaces or we have bite issues and we need to use elastics that's when we're going
to go on a four week frequency once we start using power chains or elastics we're on a four
week frequency after that because power chains don't last that long and they have to be changed
more frequently also when you start closing spaces and fixing bites there's a lot of things you need
to look at it's a little bit more iffy you know in terms of weird things that can happen so you
need to keep a closer eye on the patient so now they're on the month frequency until the end of
treatment and that's pretty much it so starting off with eight weeks and then going to four
weeks once you get into those heavier wires all right thanks so much hopefully that was helpful