after Amanda with straight smile Solutions
straight smile solutions.com and today we're going to talk about long face treatment with
braces how to manage long faces vertical growth down and backwards growth Delica cephalic
profiles with braces I've done this exact same video but we talked about same thing
but with Invisalign two different things so we're going to talk about things to keep
in mind remember braces fundamentally have extrusive mechanics that means bites will
generally open up short faces will generally become just by the way braces work a little bit
longer so braces are not great for long faces a long-faced patient I'm generally going to want
to prefer to do Invisalign over braces a matter of fact I might even decline doing braces on this
patient um just an aside if you're offering both Invisalign Braces this is one of those situations
where it's medically better in my opinion to do Invisalign so you need to be charging the same
price because that's not fair to the patient if you have two different prices in my opinion
and we keep saying in my opinion but um so one of but you know let's say there was a situation
or let's say what did I do before there was in design or before this Lane was good let's put it
that way 10 years ago how did I manage this well 10 years ago I would have still treated them with
braces because Invisalign was not as good as it is now and not as predictable for hard cases so I
would do braces and maybe start with the top teeth I mean certainly the first thing I do
with long cases is evaluate the airway um tonsils lingual tonsils Palatine tonsils
um adenoids and go get them out as needed okay a full ont evaluation is also needed
this is all basic stuff taking a sap um seeing if they're currently still growing or
if they're done growing depends on their skeletal maturity hand wrist x-ray I mean obviously if
this is an adult they're done growing we don't have to worry about that the Airways can make
it worse so any type of habits can still make it worse it still can cause changes in growth so we
want to remove all those extrinsic variables from the situation be it mouth breathing tongue thrust
rhinitis allergic rhinitis issues with tonsils it just adenoids those all need to be fixed before
you even get into the orthodontic situation then if we're doing the braces we need to control the
forces so one of the easiest ways to do this is to use something called a Gelb or a Gelb and a
posterior bite plate normally what I do is if I had an expander if it was a kid I would start
with the expander on top and a gel on the bottom no braces yet because this is a fixed this is a
removable Appliance you can put fixed versions on expanders you can put a fixed version in the
mouth and glue it in often these removables don't get worn very much and they have to be worn all
the time in order to work so I'm not a huge fan of these there's a few like younger kids I've used
them on like seven and eight year olds because seven and eight year olds tend to be incredibly
compliant with weird things in their mouth even if they talk funny because they think it's cool
especially if they're colorful and glittery and glow-in-the-dark you know they'll wear weird weird
things they don't care they don't care if they talk funny but it's you know it's the Junior High
in high school and adults where I know they're not going to wear this so you could build it into a
fixed Appliance and then they can't take it off um problem is with those is that they tend
to cause carries you know so you certainly wouldn't want it on for too long and it's
it's not the funnest experience so that's why I just prefer Invisalign but just things
to keep in mind whenever you have a long face so many things you need to think about do not
just rush into treatment alright thanks so much
