hey guys it's dr nate here and thank you
for watching this this is gonna be a
very important video because this is
mainly meant
for our assistants maybe some other
people are gonna watch it too but it's
mainly meant for our assistants
and what i'm gonna talk to you about
today is the basics
of orthodontic assisting so most of you
guys and gals probably have some
experience with the general dental side
and now we're going to kind of move you
to the ortho side with me or with one of
the other orthodontists
so i want you guys to know the basics so
the basic terminology
what different brackets are different
kind of stuff i want you to know and
that's what these videos are going to be
about
so by the end of these probably it's
going to be a couple videos you are
going to know the differences between
the different brackets different wires
how we
do consults how we do binding bonding
what's a
band how the different materials all the
different tools
you will have the basic knowledge of all
that so then we can kind of
keep amplifying that knowledge as we go
through the days but
today is gonna be the basic intro so
let's get it
[Music]
[Music]
all right guys so step number one what
is an orthodontist and i need you to
know this so that you can help
tell the patients and tell whoever is
wondering what is an orthodontist
because i swear i don't know if
everybody knows this
so every orthodontist is a dentist okay
but not every dentist is an orthodontist
so an orthodontist is a dentist who
decided to do more schooling
uh in general three years on average to
do
basically braces invisalign anything
that has to do with tooth
movement so that is what an orthodontist
is that's an orthodontic specialist
somebody just asked me yesterday is
there a difference between an
orthodontist who is board certified an
orthodontist who isn't board certified
and a little bit a board-certified
orthodontist is just
an orthodontist who decided to do or
take an extra test
and present these cases to these board
members
and that's how we became board certified
so there's still an orthodontist there
wasn't any more schooling they went
through
they just did this extra test and
presented these cases and now they
become board certified
okay so let's start with the basics and
i want to talk to you about brackets and
braces and all that fun stuff
so let's talk about the size differences
and we get this question pretty often so
they say hey can't you just transfer
this case because your
metal braces aren't all metal braces the
same and they're not the same
so in general there's two different
sizes in north america anyway
there's an 18 size and a 22 size
and what that basically means is that is
the size of the slot
area that's the area that takes the wire
that's the size difference so somewhere
but smaller
some are a little bit bigger we use an
18 slot um just because that's what
we've been using since day
one that's why i'd like a little bit
more but no there's nothing better with
the 22 or nothing worse
than a 20 slot we just use the 18 slot
here
um obviously there's metal braces which
you can kind of see here we got clear
braces
and then there's invisalign those are
the three kind of most common things
that we use
now let's go through tooth numbering and
this is different than
pediatrics and this is different than
general dentist we
use a different system where we count
from the middle
so everything is counting from the
midline right here okay
so centrals are called ones
so this is a one and then this is a one
laterals are called twos canines threes
premolars fours five six seven all the
way to the wisdom teeth that are the
eights
and if you have more teeth there'll be
even more but we count
from the midline and that's why it's a
little bit different
um we normally would say hey um bond
the upper right three and that would be
the upper right canine
so three in general dental terms is
different than a three in ortho terms
three in general dental terms would be
the first molar yeah the first molar
but three for us is canines so sometimes
i hear me saying okay we're going to do
a full mouth case
but we're going to extract all the fours
that would mean hey we're extracting all
the first
premolars so that is kind of something
you need to know you need to know the
basics
and naming of the teeth or numbering of
the teeth is important
so remember everything's starting from
the center and we go
out from there so ones twos threes four
same
thing on the bottom ones twos threes
fours
all the way the back so that's the
numbering of teeth in orthodontics
some more basics of orthodontics is the
difference between the nighttime wire
and the stainless steel wire there's not
necessarily a
size different and that's a common
misconception you can have the same
size dimension of a nice high wire which
is a nickel titanium wire
versus a stainless steel wire that can
be the same size
size is not the issue it's not the
difference
it's what it's made out of so let me
give an example here so this
is a nighttime wire super helpful you'll
be able to see this
super flexible no matter what i do i can
bend it i can
shape it i can do making the o's and it
always goes back
to that same shape this is a nickel
titanium
or nitei wire so you will notice that in
virtually 100 of the time we will start
with a night high wire
and the reason for this is people's
teeth are crooked they're crowded
they're all over the place
you can't put a stainless steel wire in
because it doesn't have that same
give so you almost always start with a
night high wire
this is a stainless steel wire very very
different
it starts same kind of shape but if i
bend it
boom it stays like that okay so that's
the difference between the night high
wire
and the stainless steel wire so let me
go through the
sizes too at our office we have a 12
14 16 16 by 16 and 16 by 22
size of wires and that can be either
nighttime
or it can be stainless steel but in
general the only stainless steel wires
that we really have here
are the 16 by 22 and you're like what
the heck
what is that what are those numbers i
don't understand that doesn't make sense
to me
and the wires sizes are basically the
dimension
of the wire okay so let me go through
this a little bit
if i were to take this wire this is a
stainless steel wire
and i did a cut i did a cut right
through
and i looked at it from the side that
would determine the
size of the wire so say i do cut through
this wire right here
and i look at the side dimension this is
a this is actually a 16 by 22
wire so if i did a cut and i'll private
and the infograph right here
the dimensions would be 22 by 16 or 16
by 22. if i was doing to do a cut
through a
16 nitai wire if i did
cut through that and looked at it from
the side the
the diameter would be 16 and it's
actually not 16. it's 0.016
millimeters it's the actual thing but we
just always call it a 16.
so that's actually in millimeters it's
0.016 millimeters
so that's the difference between a 16
nitai
or 16 wire versus a 1622 it's the
thickness so in general when you go up
in
thickness or if you go up in the
dimensions of the wire
you go up in the thickness that's why
you can have a 16
by 22 night eye wire which is basically
the exact same dimension
as a 16 by 22 stainless steel wire
but as you know the stainless steel is
quite a bit stronger than the nighttime
so i need you to understand that and
hopefully the infographics will help a
little bit
this is always a little harder for me to
understand or to explain
without having some models here so i
just got this question asked also a
couple days ago and they're like hey
what's the difference between
uh 16 night time versus um 16
22 like i get it it's kind of kind of
stronger but what is it really doing
and then normally the smaller wires the
16 knight ties let's say
is used for straightening of the teeth
it doesn't work on the torques the back
and forth
okay so that's the normally the 16 night
ties or the 14 knight ties or the 12
knight ties
those are working on the straightness of
the teeth
once you start getting into the 16 by 22
night high wires or 16 by 22 stainless
steel wires
that's working on the torque and that is
the back and forth
so the round wires in general are
working on the straightness
and the other wires the 16 by 22 or some
version of that
are working on the torques the back and
forth of it and once again it's gonna be
a little bit easier once i have those
little info graphics here
because you'll see the 16 by 22 night
tie or stainless steel wires
are going to fill the brackets a lot
more so when you have a 16 nighttime the
smaller knight ties um it basically just
goes in the bracket and it's kind of
it's pretty has lots of wiggle room you
know it doesn't really kind of fit in
the bracket that good
but when you get a 16 by 22 night tie
that's going to fit
in the bracket slot really really well
and that's how you get the
torques of the teeth all right so let's
talk about the difference between normal
colors
and power chains so
colors or o-rings or elastic ties
that's these guys here that's what we
most of the time start off with
that is going to help put the wire
into the bracket so it kind of forces
the the wire into the bracket
these are power chains here this is way
different
than this this is used most of the time
for closing spaces
and you can see this right so if you
basically put this on the tooth
you kind of force it on there it
stretches it always wants to come back
to its normal form
so you put it on the tooth you stretch
it and it basically wants to close
close close close up that is a power
chain we don't normally start with this
it takes us
quite a while to get to that point so
normally we start with these
but this is a power chain that's the
difference between an o ring or elastic
elastic tie or colors versus
a power chain all right as far as
instruments go we got the bracket holder
straight cutter math out plier distal
end cutter
and then also an explorer if we go to
the banding instruments
you have a band plugger band pusher a d
bender this is a bracket holder and you
can have the separating pliers
if you go to the burrs pretty standard
white stone
have a donut burr and that's an ortho d
bond burr
all right guys so now you know the
instruments the difference between
banding instruments and bonding
instruments the one thing i want to go
through is whenever you're cleaning
these
it's slightly different than if you're
going to clean general dental
instruments and the reason is i don't
want them to corrode
so you're going to be using this
obviously it's going to come in
different bottles depending on what
office you're at
but this is an ortho milk solution and
when you're doing it make sure when
you're cleaning the instruments
obviously if there's any debris on them
you're just going to clean it off with
water
but then you're going to take this milk
solution and spray it on the spots
or the surfaces that are inside the
mouth you don't want to spray it on the
handle too much because this stuff is
super slippery so when you're using
these instruments if you put it all over
the place
if you put this all over the place the
instruments are super slippery and it
sucks to use all right let's review what
we've learned so far
you know what an orthodontist is you
know what um the
different types of wires are you know
the different type of brackets or braces
remember there's different two
two different types of slot sizes within
that there's also different name brands
and there's different prescriptions
within those brackets
that's why there's like hundreds and
probably thousands of different brackets
just because there's so many different
manufacturers but you know that
um you know the different sizes of the
wire why somewhere
called just 16 nighttime why some are
16.2
you know that the sizes even though they
can be the same the flexibility of the
wires can be way different depending on
if it's a nighttime wire
or if it's a stainless steel wire what
else you know you know the different
instruments you know some of the basic
terminology on how to
name the teeth so now that you have that
decent knowledge we're going to go
through the console form and try to get
some terminology down because i want you
guys to know this stuff because it's so
much easier to talk to you
if you know some of the basic
terminology so i'm actually going to go
through this
i'm going to go through the console
format form that we use
every time basically that we do a
consult we've been using the same form
for a long time it may get modified a
little bit but
now at least when we go through it
you're going to know what the different
names or the different vocabulary so i'm
just gonna go one by one and i'm gonna
explain
each category and what it is oh
straightforward that's oral hygiene
that's how good their hygiene is if
they're good brushers flossers if they
have
gingivitis or their bone loss if they
have anything obviously that's going to
be towards the
bad end of things if they're good that
would be good obviously
classification this is important and
most people don't know this yet which i
thought they taught in
dental assisting school but i guess they
might not teach it and this is
classification
okay so there's difference between class
one class
two and class three and this is really
important because we use this
every single day and this relates to
basically everything we do
when we're talking about rubber bands
we're talking about face or talking
about any of that stuff
so class one is an ideal
bite an ideal occlusion and i'll
probably have some infographics here too
but class one is when the canines go
in between so the top the maxillary
canine goes in between the lower canine
and the lower premolar that is a class
one bite i have molars and canines
here on the on the console form because
sometimes you can have a class 1
molar but not a class 1 canine
and the left side can be different than
the right side
but in general class 1 is a good bite
class two is when you have a big
over bite or big over jet over by normal
jet or
later on in this um this form so i guess
i can just go through it right now
so over bite over bite
is when the top teeth overlap too much
vertically okay so it's like this
overlaps too much
that is a big or deep overbite
everybody everybody has a good bite has
an overbite
but it can be too deep and that's not
good or if it's too little
that's not good either but that's over
bite
over jet is when the teeth stick out too
much
so this is a horizontal thing okay so
over
bite is when it's too vertical over jet
is when it's too far
out that's the differences most people
don't know that definitely the
the general population definitely does
not know that but that is the difference
between them
so let's go back to class two class two
is when you have a big over jet
okay most time when we're talking to
patients because they don't ever hear of
over jet
will commonly say over bite when in
reality i mean over jet i just don't
want to confuse the patients
so class two is when you have a big over
jet
sometimes you'll see their face and
they're mandible their lower jaw is
gonna look really far
back that is class two all right
and that will help you later on when we
talk about rubber bands because that all
relates class three is the
opposite basically that is an underbite
sorry like this
when the lower teeth are head of the
bottom teeth
that is an underbite or that is class
three
so that's the difference between class
one normal bite class
two too much over jet and class three
and under bite okay keep in mind when
you're talking about things
your bytes can be different but you can
still have different types of over jets
and over
bite so when we're talking about over
jet and there's a class
three so the lower teeth are ahead of
the top teeth
you might have a negative one or two or
three or four millimeter
over jet but your over bite sometimes
actually can be not that bad
because we just talked about the
vertical overlap so sometimes for me
i'll say hey you know what they have a
negative over jetta say one millimeter
but i'll say hey potentially the over
bite is okay even though the bite
doesn't look very good
because the vertical dimensions are
actually pretty decent
so that's for me that's how i do it but
now you'll know the difference between
class one
two and three what an over jet is and
what
over bite is okay so we've gone through
that a little bit
let's go through the the look of the
head
so sometimes we'll say it's straight
we'll say it's convex or it's concave
and what the heck does that mean
concave in general says concave
that is in general a class three looking
bite
that's when you look at from the side
and it has a
bite where the lower teeth seem too far
forward so it's like this that's concave
okay convex is the opposite that's the
opposite
where it will look like the lower teeth
are too far
back that is a convex profile
majority of people in terms have a
convex profile where the lower teeth
seem too far back and yeah less people
have a concave profile this because
there's less class threes
in the world basically than there is
class twos there's a lot of people have
class twos
and if you start working with me you'll
know that we do class two rubber bands
on a ton of people
because so many people are class two it
just happens all the time
okay as we keep going down the list
you're gonna notice the difference
obviously between primary dentition
and permanent dentition or mixture and
so primary you already know this that's
all baby teeth
mixtures you have some baby teeth you
have some adult teeth and then obviously
adult teeth is all adult teeth
and remember when we talk about teeth
numbering the same
thing goes for baby teeth so remember we
start from the center
the centrals are ones laterals are twos
threes fours fives goes out like that
for adult teeth baby teeth it is
different
baby teeth you still start from the
center but it goes
a b c d e f g so it goes
backwards but you use um
alphabet letters instead of numbers so
that's the difference between
baby teeth and adult teeth in ortho
remember baby teeth our primary teeth
start with a in the middle
b or the lateral c or the canines and go
back from there so that's how you know
the different types of teeth all right
as we keep going down the list you'll
notice there's a spot for
spacing or crowding that should be
pretty obvious
crowding the teeth are crowded they're
curved there's no space for them spacing
exact opposite lots of spacing easy
peasy all right as we go down the list a
little bit more we talk about
over bite we talk about over jet which
we already talked about
remember overbite vertical over jet
horizontal
and then there's also something called
open bite and sometimes you'll see this
in patients who are sucking their thumbs
fingers pacifiers they have some sort of
tongue habit
and that's when they bite down but
nothing their front teeth don't touch
so an over bite is boom your front teeth
overlap too much
an open bite is they don't come together
at all so that is the difference between
that all right then you have a spot for
cross bites and so this can be in the
bat on the posterior in the back
or the anterior or in the front and a
cross bite is just basically
opposite of normal i guess we can say so
in the front you know you want your top
teeth to overlap your bottom teeth
if it's the opposite if the top teeth
are on the inside
we call that a cross bite and the same
thing goes for the outs or the backs
of the teeth you want your top teeth to
overlap your bottom teeth if it's the
opposite
we call that a crossbite if the lower
teeth are kind of on the outside of the
top teeth
that's a crossbite it can be so far that
they don't even bite or it can actually
be the opposite sometimes we call this
scissor bite
different names for it where the top
teeth are too far out and they don't
bite at
all but in general most time crossbite
is the top teeth
or on the inside of the bottom teeth and
then you have another spot there for
midlines
so most of the time what we're looking
at for this is we want
everything to line up we want the nose
in the middle here
to line up with the middle of the teeth
so sometimes because you have a lot of
people have asymmetries
top teeth will be too far to the side
too far to this side the bottom teeth
will be something like that too so i'll
say hey you know what
the bottom teeth are to the left three
millimeters you just write that down
and that just has to do with a uh
symmetry the last couple things are tmj
which you guys should probably know
about
tmj is the temporal mandibular joint
that's the maxilla
and the mandible and there's a little
piece of cartilage in between there as
well
hopefully most time it's normal
sometimes it's not and it clicks and
cracks or there's something called
crepitus so clicking
is when and you can go into this more i
might have some videos for that too
clicking is when you have the mandible
the lower jaw
clicking on and off of this piece of
cartilage that's right there
crepitus which you rarely hear but you
hear sometimes
is when this disc this joint that kind
of allows the
the jaw to open to close smoothly is
worn down as totally
basically broken down and the jaw the
mandible and the maxillary are kind of
grinding on each other
so that's crepitus but most of the time
hopefully it's wnl
or that's within normal limits or it's
just great so
a couple last ones again the
pathological findings that's just if you
have anything unusual
if we see a cyst or we see something
hopefully not
cancerous or malignant we will mention
it there
we'll talk about the tmj which we did
and then lastly is
frenum so frenum is basically all these
pieces of tissue
that connect from your lip to your teeth
or your gingiva
so sometimes if you lift up like that
you'll see people have a big big frenum
in between the two front teeth
sometimes that's why their teeth aren't
together you might get that same thing
on the bottom and that's frenum so
sometimes i'll say
hey you know what we have frenum
involvement on the maxilla or on the top
i know this mark that right there and
then at the end of it we're going to
talk to you about treatment time
so we typically do treatment time
increments all the same so it's really
straightforward really easy
we say it's anywhere from six to 12
months or 12 to 18 months or 18 to 24
months
or 24 to 30 or beyond that but we really
try to keep it within those dimensions
to make it as easy as possible for
everybody for the patients
for you for the assistance for the
managers for the treatment plan
coordinators for everybody we really try
to keep it within those realms
all right guys and gals so there you
have it that is the intro this is
part one there's going to be the next
parts where we talk about when the
patient actually comes
in what we do how we take pictures how
we take panels steps and how we get the
patient started
but this is it so you guys have a good
good foundation of knowledge
you know a lot now you know the
different materials we use you know the
different instruments we use
you know the basic vocabulary of ortho
which is important
you know how to number teeth you know
what convex concave profiles are
you know the different classifications
you know class one class two class
three you know crowding you know spacing
you know asymmetries you know
freedom involvement i know we went
through a lot and you can re-watch this
over and over but i
really really expect you guys to know
this after the first week or so if
you're working with me i'm gonna be
quizzing you like crazy to make sure you
get this
and the other trainers are gonna be
quizzing you like crazy to make sure you
know this so it's really important
watch this over and over if you have any
questions remember ask
me or ask one of the trainers or ask
somebody who's done this a lot
so they can help you out so know this
stuff and i will see you
in video two
you