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Facemask

Good question, the S and Z sounds are similar tongue positioning sounds. I wonder if your open bite is fully corrected if you are still having open bite issue sounds. You may also need myofunctional (tongue positioning) therapy (you can do free exercises on Myofunctional Therapy UA-cam videos for this). I would suggest to have your orthodontist take a look to see if there is anything else that can be done to help your speech.

Great question. In the absence of space, the only option is to create space via IPR (shaving between teeth) or extraction of teeth. If you have large teeth, then it is possible to do more IPR to move teeth in more. If you got to my before/after website photos or IG, you can see some retraction plans without teeth removal.

Good question. Expanders widen at unclosed sutures where 2 skeletal bones meet and your body will build new bone along the suture. These mid-palatal sutures generally close around 12-14 years old which is why expanders are mainly used on kids and teens and not for adults. In general, expanders are not recommended because it can cause bone loss, gum recession and possibly loss of teeth. Definitely go see an orthodontist if you are considering expansion because there are other methods to expand as an adult.

Good question, No crossbite; just an open bite closed with Invisalign. All the teeth are on the correct side.

@@drpassamanobut why is the middline of his top teeth not a the same spot as the middle line of his bottom teeth if that makes sense to you

@@paulshekanena Good observation, There's a 3mm jaw asymmetry (in the left to right positioning). >50% of the world has some level of jaw asymmetry. Many people are off by a little. This is best fixed with teenager braces. It's very difficult to fix as an adult.

@@drpassamanoOh ok cool ! I’m interested in anything concerning medicine and dentistry that’s why I asked about it ! Hope I was not annoying, the job is well done !

@@paulshekanena Happy to help! That's why teenage braces and bite correction is so important. If it's not done during this teenager growth phase, then you can't fix it (easily) as an adult. Many adults that are now educated want to fix their bite but can't because it's too late (without jaw surgery).

Good question, I recommend you get a lateral cephalometric x-ray to determine how much retraction/reangulation is needed. From there, you can determine if you need IPR retraction less than 8 degrees or extraction which is generally 10+ degrees of change needed. Figure out the goal first and then work backwards.

Interesting comment. 10 teeth x 0.6mm IPR is 6mm and a lower incisor is about 5.5-6mm so it sounds like your daughter's teeth are too protrusion/flared forward and the goal is to move the teeth inward more. Why not do IPR on the lower as well instead of extracting a lower incisor. I think it would be best to get a 2nd or 3rd opinion on this one especially considering she previously had straight teeth and the goal is to get back to the same smile so a similar plan might be recommended. Definitely get another opinion.

Great question! That is a very normal treatment plan in my office too! As long as the IPR is done safely and within the enamel then no sensitivity or cavity issues. Often times, IPR is used to put teeth in a better position to avoid grinding/wearing down teeth so I'm all for it. Sounds like you have a good orthodontist. Go for it!

Interesting ... a diamond metal strip is used for the initial contacts procedure for IPR. That's usually done by a licensed orthodontist (or dentist). I've never given my patients the ability to do that. So, no, I don't think that's normal. Go see an orthodontist instead!

@ sorry correction, my ortho gave me a file to use during Invisalign treatment.

@@reneeclaire___ Again, not normal.

Good question ... it depends on your treatment goals. Why are you fixing a narrow palate? Esthetics? Space for the tongue? Improved nasal breathing? Wider smile? There's many reasons to expand and many reasons not to (like gum recession). Go see an orthodontist for your specific issue/questions.

The short answer Dr. Passamano should have given you is no. Adults have maxillary bones with sutures that are much harder and more rigid compared to children, making them extremely difficult to expand without surgical assistance. Using a these expanders on adults would only tip the teeth outward. While this might create the illusion-or even provide a small amount-of extra space, it can damage the alveolar bone and cause permanent pain in some of your teeth. Unfortunately, many orthodontists still use outdated approaches and cause many issues. For adults, the most effective solution is a piezo-corticotomy combined with a 6-8 TAD custom MARPEs, MSEs, or FMEs which are bone born expanders.

​@@examinetruth5392 Great response and your comment is the recommended approach for most adults (not all). Can an expander (Invisalign or traditional) be used in 18+ y.o. ... sure under the correct circumstances. When evaluating whether or not an appliance can/should be used, it is a personalized and custom treatment plan for that specific individual. For most adults, an expander alone would not be recommended. Have I seen sutural opening on an adult without surgery, yes, I have. The option of surgically assisted expansion (the recommendation above) can also be used depending on the treatment goal. I appreciate the response and discussion on this topic. I just don't think there's 1 approach for everyone because there are so many variations in clinical appearance and treatment goals to say one method is the only method. I stand by my previous comment to the question about if an expander "can benefit an adult with narrow palate" ... it depends on the treatment goals and if you want specific answers, then go see an orthodontist for a full evaluation.

@@drpassamano Whatever the goal is, if the goal is aesthetic, in what way would pushing the teeth by putting more and more pressure on the alveolar bone achieve anything aesthetically for this person? It would tip the teeth out. Is that good for bite alignment? No. So if someone wants to solve the malocclusion, they might as well get Invisalign if simply moving the teeth is enough to correct it. If the goal is better breathing, we both know only proper parallel splits will result in a wider nasal airway. Even traditional surgical assists like SARPE won’t do the trick. It seems your overarching point is that not everyone 100% of the time needs a midpalatal release and a multiple-tad MARPE. To me, that’s a moot point because even trying old approaches on adults comes with consequences. Even in the rare cases where you have 22-year-old female with extremely thin bone could split with something tooth-borne, it’s again not worth it-the teeth as anchors are too unstable and this is why over and over again you will see asymmetries in such expansions. Anyone who truly needs a wider palate shouldn’t consider different methods for different goals because it’s all interconnected, he should just look for the best possible way to do it. If aesthetics are the primary concern, a good bone-borne expander like FME has a much lower chance of causing asymmetry compared to a Hyrax, hybrid Hyrax, or Schwartz-type devices and is far less invasive the a 3 piece le fort or SARPE. Even though FME protocols, EASE, or custom MARPEs were designed for maximizing breathing benefits and resolving conditions like UARS, they’re still better for aesthetics (expanding the mid face) and far less risky than pushing on teeth and alveolar bones in the hope of achieving a split in an adult. for me these kind of expanders should be for kids range 4-8 years old. I wouldn't even give this to a 13 year old, I would just use MSE (which will become better in 2025 as Dr. Moon is upgrading the design) But let's agree to disagree. Cheers!

@@examinetruth5392 I appreciate the response and very impressed with your understanding of dentofacial orthopedics. I can't disagree with anything you wrote above. I also agree with these removeable expanders work best in that adolescent 6-9 year old range the best (I know you mention 4-8, but 4 year olds rarely have compliance needed for this treatment). I am finding that the Invisalign expanders are tipping the posterior teeth much more than a traditional metal expander would (even with Invisalign's anti-tip attachment design -- it doesn't really work that well). I don't see the Invisalign expander taking over the traditional expanders at this time. I'm in agreement that MSE has the brightest future in expansion. Cheers to you!

The expander widens in the SAGITTAL position (that's LEFT-RIGHT). If you want to move the maxilla forward, then you may need surgery or if you are between the ages of 7-11, then a reverse headgear for underbites (see my other UA-cam video for Underbites in Kids). I would suggest seeing an orthodontist for your specific concerns.

@ I think my maxilla is receding and it’s causing sleep apnea , is that possible

Let's go!

Good question, orthodontic treatment generally does not work with bridges. We (Orthodontists) usually have to maintain the position of the bridge, not change it. If you were to make this work, then you would have to section / cut / remove the bridge to move the teeth and then redo the bridge/crowns after the treatment. It's best to get an orthodontic consultation.

Good question. It depends on the inclination of your posterior teeth as well as the bone housing size. If you have enough bone to accommodate a 5mm increase, then the answer is yes. If you don't, then you'll get gum recession. It's best to get a consultation to see if this is even possible. I hope it works out for you!

Interesting situation ... narrow arches could be a result of many factors: low tongue position, open mouth sleeping, narrow face, etc. I wouldn't say that a narrow palate can cause health problems, but certain health problems (tongue tie, sleeping with mouth open, nasal blockage, etc) can cause narrow palate. I think this is worth looking into see why you have a narrow palate in the first place.

Interesting situation ... narrow arches could be a result of many factors: low tongue position, open mouth sleeping, narrow face, etc. I wouldn't say that a narrow palate can cause health problems, but certain health problems (tongue tie, sleeping with mouth open, nasal blockage, etc) can cause narrow palate. I think this is worth looking into see why you have a narrow palate in the first place.

I have a narrow palate due to a tongue tie. The research I am finding is it stresses out the body to breathe primarily through the mouth. It can cause poor breathing at night, because the tongue can block airways or the airways are small for other reasons (that lead to a small palate). This can be mildly to severely detrimental for your health. A severe case can lead to a heart attack when your airway gets totally blocked. Other issues are elevated blood pressure, lower IQ, increased risk of Alzheimer's, MS diagnosis, other autoimmune conditions, etc.

Orthodontic treatment is not the same from doctor to doctor especially orthodontist to dentist in terms of training and expertise. You will get a wide range of treatment outcomes based on the skills of your doctor. The Invisalign treatment I provide is not the same Invisalign treatment another doctor would provide. It sounds like you need to get a second opinion from an orthodontist. Good luck!

Great question! Invisalign can be used for a variety of dental and potentially skeletal movements based on the treatment plan you have. For your specific question, you would need to see an orthodontist to determine what's practical and what's not. Good luck!

@@drpassamano Thank you dr. I asked many doctors, some of them say that surgery is necessary because I am past the age of growth. My orthodontist said my bite was bad and gave me 62 plates. I was not given any information about the jaw. I wanted to ask you.

I have a before and after gallery on my website. Feel free to click the category Invislaign and see what I've been able to accomplish. You can also see a similar gallery on Invisalign's alignglobalgallery.com. I have a couple cases in that gallery too.

Good question. It depends on the treatment goals and what you want the final result to look like. Many orthodontists can provide a smile simulation so you can see what the final result would look like before you get started. Give that a try!

Good question. I doubt it because the removable expander will just fall out of the mouth with the tension needed for facemask. Facemask is generally only used with FIXED appliances, not removable ones like this Invisalign expander.

I run a digital simulation on all patients to analyze tooth size analysis (bolton). IPR is often needed even when it's not obvious. 3D scanning and computers help me provide better care.

Thank you! I have a class 2 and both upper and lower incisors are flared the doctor told me to do jaw surgery and extractions, i dont want to do either of those do you think ipr and invisalign is enough?

@@latincicemma3213 I think it would be best to get another consultation or 2 (or 3). I won't be able to give you specific advice without a full exam, so go get another full exam and see what another orthodontist recommends. The more information you have, the better you can make a decision. Good luck!

Good discussion! We've had removable expanders for 50+ years and the Invisalign expander fits into that category. I use non-Invisalign removable expanders when indicated. Orthodontic treatment should be customized to each patient's needs. However, if I'm looking for optimal expansion, then I agree with your statement and I'm going with traditional fixed expanders. BTW: Nearly all of my Invisalign expansion gets some level of sutural expansion so I would disagree with the idea that Invisalign expander only tips teeth. That's fake news.

Good question. I find that I won't get as much flaring reduction with braces vs Invisalign. It has to do with the mechanics of braces vs clear aligners. You will still get reduced flaring, but not as much as Invisalign/Clear Aligners would. You can still get a very good result with Braces and IPR, just know the limitations.

Good question. It's much harder to change facial features after growth is completed (adults). However, I think you can get marginal improvement by improving lip competence, eliminating mouth breathing, improving tongue position and fixing the bite. The improvement will just be less which is why it's super important to get these issues fixed as a kid.

Great question. Unless the posterior molars are extruded, then I usually don't do TADs. One of the side effects of clear aligners is posterior intrusion, which is good for open bites and bad for deep bite patients. Hence why clear aligners are very poor at correcting deep bites. No TADs were used for this patient.

Appreciate the support!

Wishing you all the best on your Invisalign journey! Love your name too.

It's very little if any changes to the shape of the face. It does change the shape of the smile and lip support. It depends on the age of patient, shape of the jaw, amount of expansion, etc. Many variables. So it could be no change to a little change depending on what is done.

Great question! Yes, you can do IPR with either Braces or Invisalign. I do it both ways. However, I find that I get MORE flaring reduction with Invisalign then braces due to the mechanics of the clear trays. Hope that helps!

Great question! Wisdom teeth usually don't have much effect on the front teeth / lips because they are far away from the front teeth. I could see a recommendation for extraction of 4 premolars. If you have protrusion, then it's usually IPR or Extraction of 4 teeth. The amount that you need will determine which option you go with. Go get a third opinion if you are uncertain Thanks!

Great question. The hard skeletal palate has 2 bones that are connected with a suture that closes around 12-15 years old so expansion of the upper will fill in new bone. This means you can widen the upper jaw. The lower jaw's suture closes <1 year old so there's no such thing as a lower jaw expander. The lower jaw dictates how much you can widen since it's a relatively fixed width. Braces or Aligners can widen the teeth which effectively can mimic low jaw expansion though. So if you expand the upper, then you'll need braces or aligners to match the teeth width together.

Good question. The expander WIDENS the posterior arch (back teeth) --> No effect on front teeth. It sounds like you need Invisalign Treatment (not Invisalign Expansion). Go see an orthodontist for an evaluation. Thanks!

Great question. Invisalign retainers are designed to be trimmed before touching your gums so there's no covering of gum tissue. It sounds like you got a generic clear retainer and not an Invisalign branded clear retainer. There's a difference in materials and manufacturing between Invisalign Retainer vs Generic Retainer. Most generic retainers I see cover the gums as well, which sounds like you received. Go find someone that uses Invisalign retainers (not the cheaper alternative).

Thanks, Peter for being a part of our orthodontic family. You have an amazing family! Enjoy the beautiful smiles!!!

Great question. If your arch width is smaller than a normal orthodontic wire, then yes. If it is the same size or bigger, then no. However, you will get a nice curve of the smile and that usually helps create the illusion of a broader smile so the orthodontic treatment will give you an overall better smile. Good luck with your braces!!!

@@drpassamano Ty 😀

Hi Chandra, I have pinched my cheeks when I’m putting my tray in. To avoid this, I place a finger between my cheeks and the tray while I’m placing them in. It has really cut down on those painful pinching😬

@@TiaNT16 Thanks for that tip. Will those white marks on my cheeks eventually go away and is there anything I can do to help them disappear?

Interesting question ... I'm not aware of my patients getting a cheek irritation when inserting the Invisalign trays. It sounds like you need to use another finger to pull your cheeks off your teeth to avoid this. If the question is about the white horizontal line on the buccal cheeks that is adjacent to your teeth's biting surface, then that's called the 'linea alba' and caused by the friction/biting of your teeth. It's very common and sometimes goes away on it's own when the bite improves. Hope that helps!!!

Hopefully an improvement in your alignment of teeth and bite would help the linea alba go away. You can also brush your cheeks too!

@@drpassamano Thank you for your response. Yes, I was referring to linea alba. I didn’t have this prior to starting the Invisalign treatment. One side has cleared up with the tip you suggested with using my fingers to protect my check. I will try brushing cheek on other side.

I routinely provide Invisalign treatment for patients that are missing molars. However, if you are looking to move those molars, then sometimes braces are better. I recommend an orthodontist consultation. Good luck!

@@drpassamano I already had orthodontic treatment with braces. I had braces for 5 years and now regularly wearing retainers. However, I have noticed that my teeth are relapsing. I probably think Invisalign could help. Also, I don’t plan moving my molars

@@BionicNerd19682 Then Invisalign would work great for you! Invislaign works best for those that previously had braces and want to get back to that perfect braces result. Go for it!

Yes, this patient did have a lot or pre-existing dental issues like recession on multiple teeth including that Max left incisor. That's what a decade of neglect will do. We turned him around and he's on a path to maintain his awesome new smile though.

I think the Invisalign Palatal Expander has more speech issues than the traditional metal one. The Invisalign one is bulkier and covers most of the area where the tongue creates sounds. The metal one has less coverage so less speech issues. I use both Invisalign Expander and Slim Metal Expanders and I'm still doing much more regular ones. Sometimes new isn't better.

Glad I can help! These are the instructions that I give my patients. Good luck with your Invisalign treatment.

Great question. The mandibular symphysis closes by 1 year old while the maxillary suture closes around 11-15 years old so there's no such thing as skeletal expansion on the mandible. HOWEVER, the lower teeth can be tipped (dental tipping) to give the appearance of a wider jaw and that's exactly what's done. It's best to do orthodontic treatment around 12-16 years old to avoid gum recession issues that occur when big orthodontic changes are done as an adult.

Great to hear! Keep it up to prevent staining. Invisalign is not so invisible when you can see the stains. Good luck!!!

The last example was 20 months. It's slightly longer because I was trying to do lip retraction which is more difficult with Invisalign than Braces/extraction. Hope that helps!

@@drpassamanoHi! What is lip retraction?

@@reneeclaire___ Great question. Lip retraction is when the soft tissue of the lips moves inward so lips are less protruded or full. From a side profile view, if you draw a line from the nose to the anterior interior point of the chin, the lips should be within 2 mm of that line showing if the lips are too far out or too far in. The soft tissue lip position is based on teeth position (remember that soft tissue follows hard tissue). Hope that helps!

Good question. The tooth soreness is dependent on pressure on teeth, so it will depend if your doctor programmed movement on some teeth or has delayed movement. It's very case specific, but I'm sure you will feel something soon. Good luck!

Not sure I can help here! Good luck!