Today, we will share with you some of the lessons that Dr. Avi Patel and I learned at the very beginning of delivering clear aligner treatment. If you’re just starting out, this is an excellent episode for you because it’ll help you avoid some of the pitfalls that we encountered. For example, best protocol for attachments or accurately estimating what level/complexity of aligner treatment is needed by a patient.
Protrusive Dental Pearl: Correct a rotated tooth by means of HYPERCORRECTION. This means adding a few extra clicks of rotation so that on the clincheck it looks like you have done a little bit too much. This works because orthodontic movements are NOT 100% predictable.
This episode is brought to you by Enlighten Smiles which is a premium brand of teeth whitening that guarantees B1 in your Viveras. If you want to know more about teeth whitening and get better results for your patients, do check out their webinar, Enlighten Online Training.
The Highlights of this episode:
11:39 Invisalign does not teach you Orthodontics
16:49 Basic rule in Orthodontics
21:49 Patient Communication regarding fees
26:59 Comprehensive Orthodontic Treatment
34:06 Refinement and Additional Aligners
38:02 Patient Communication in terms of treatment duration
41:23 Planning IPR – Best practices
43:53 Best Composite for Invisalign Attachments?
45:33 Protocol for Bonding Invisalign Attachments
If you liked this episode, you should check out Do’s and Don’ts of Aligners with Dr. Farooq Ahmed
Click below for full episode transcript:Opening Snippet: When you will have an adult and you're trying to move their teeth with plastic, that does not mean that you cannot improve their situation, right? You can. So if you are coming from a place of function, health and improving, the clear aligners will check all those boxes. It's as dentists we get hung up, I think on perfection. And I'm not saying to not strive for perfection, always strive for it, but we also have to be realistic. These are humans.
Hello, Protruserati. I’m Jaz Gulati and welcome back to your favorite dental podcast. This one is really for the new dentists, new grads, or maybe you’ve been qualified for some while but you’re new to the world of clear aligners, and I know the title of this episode, and we discuss Invisalign a lot, it’s actually applicable to any clear aligner system, clear correct or any, you name it. It’s not specific to the Invisalign brand. But the lessons that me and Avi are going to share with you today can be applied to all of those different aligner systems. Essentially, it’s about the challenges that we had at the very beginning. For example, I didn’t know what to quote the patient in terms of which comprehensive or light or express like which level of aligner therapy the patient needed ie how many aligners the patient needed, how long the treatment would be little tips for IPR, all these things I just didn’t know, I didn’t appreciate how to do your attachments. We’re gonna discuss all of that in this episode. So essentially, this episode is the episode I wish I had, when I was new to clear aligners or new to Invisalign. By the time you listen to this, the app, the Protrusive app is actually out. And it’s being used by around about 185 beta testers, these are people who signed up to a Splint Course, as a bonus, like early, you know, fast action bonus, if you sign up for Splint course, in this time, you get the protrusive premium. So these people qualified for first access to the app, and they can now get CPD or CPE certificates for all episodes. As in when they listen, they can now answer some questions and get certificates emailed to them by my team, as well as lots of other perks on the app. But when I release the output general sale, I will let you know. So those of you who have been asking me about Hey, when’s the app coming out? Well, it’s out it’s just being used by a very exclusive bunch as we get it fine tuned and perfected, ready for general sale coming to you soon. The podcast is free and will always free. Some concerns I have is that some of the things that I discuss with my guests, I don’t want patients to see it or hear it. This is like dentist talk, right? There are some things we just want to keep between us dentists, like we’re talking about fee setting, and complexity planning that kind of stuff. It’s probably best that it’s not on a public forum like YouTube. So that position or the role that the apps can have in the future is again, you can access it for free. If you want to get certificates, yeah, you got to pay for it. But if you want to actually watch the videos that won’t be made public, the app will be the best place to do that. So more information to follow soon.
Before we join the main episode, let me give you the Protrusive Pearl for you today because we’re talking about clear aligners, let’s talk about planning your clear aligner movements, or for all intents purposes, the ClinCheck for those who use Invisalign. When you’re planning your movements, there’s something called hyper-correction. So for example, let’s say you have a rotated upper lateral incisor, very common. And let’s even back up a little bit and talk about how you describe a rotation, you know something I didn’t appreciate when I was starting out. How do you actually describe a rotated tooth? So imagine you have a rotated lateral incisor, the easiest way to describe it is distal out or distal in or mesial in or mesial out and it’s kind of self explanatory what that means just visualize it. Okay, if a lateral incisor is mesial out, you know that the medial side of it is going buccally, it’s like flaring outwards. Now saying a mesial out is the same as saying distal in. It’s a quick and easy way to describe a rotation. The other way to do it would be if a tooth is rotated mesio-buccally, you know that the mesial portion of that lateral incisor is rotated more towards the buccal, but it’s easier to say mesial out than mesio-buccal, so I like mesial in, medial out, distal in, distal out. And that’s how you describe rotations very easily.
Now, why is that relevant? So, rotations are pesky movements, they are difficult moments when you’re rotating teeth. That’s when tracking can get lost and especially on lateral incisors, smaller teeth, this is where you’re gonna slip up a little bit. So one way you can kind of improve the predictability or get a better outcome is hypercorrect. What that means is that if a lateral incisor for example, as the example tooth can be any rotated tooth, or any movement for any tooth, let me explain. If a lateral incisor is mesial out, and you want to bring it mesial in and correct rotation. In your ClinCheck, if you finish with a tooth perfectly well aligned, then maybe by the end of treatment because the rotation movement is not 100% predictable, you will finish the aligners with it being not quite perfect, it’s still going to be a tiny bit mesial out. Now, if you hyper correct, it means that you go from a scenario where you start off medial out because that’s the malocclusion and then on the clincheck you’re going to correct it, but actually you’re not going to correct it until it’s perfect, you’re going to correct it until it’s actually gone the other way it’s going to go distal out or mesial in and You’ve overdone it, you’ve overcorrected the rotation or hyper corrected it. So don’t worry doesn’t mean that your patient is going to end up with a tooth that’s rotated the other way now that’s very unlikely. By doing that hyper correction and making the ClinCheck look worse off in the other direction means that you’re more likely to finish with perfect alignment. So this called hyper correction. So for example, if you know that your lateral incisor needs 10 degrees of rotation. Why don’t you just add in 13 degrees rotation so hyper correct that movement, make it look slightly worse at the end, and you’re more likely to correct that rotation. So this is called hyper correction.
It’s also really good to use in deep bite cases. So a lot of your deep bite clinchecks, they may finish with anterior open bites at the end. And of course, the patient with a deep bite will never finish with an anterior open bite at the end. But if you show that on the ClinCheck it’s kind of like showing you the forces that you’re placing on the teeth. Now if you need more inspiration or knowledge regarding that area, do check out episode 71 with Dr. Farooq Ahmed, we geek out about this, we talked about all the do’s and don’ts of aligners and what movements are predictable and which movements are not predictable. So once you’ve listened to this episode, and you’re hungry for actual orthodontic knowledge when it comes to biomechanics of aligners, I would definitely check out episode 71 Because Farooq covers that so well. In this episode, we’re going to start from the basics like you know, you’re brand new Invisalign provider. And the reason I’m making this is I kind of wish I had this when I was starting out so I’m hoping this helps you. I’ll catch you in the outro.
This episode is brought to you by enlightened smiles which is the premium brand of teeth whitening. There’s loads of reasons I use and like enlighten. One of them is that they guarantee B1 in your Viveras. So going on with the theme of this podcast episode, you know, invisalign, clear aligner therapy, if you’re using Viveras already, Enlighten offer the guarantee with their own whitening trays which are super sealed, but they offer it with Viveras because Viveras are tightly sealed. So if you’re already in lots of Viveras and you want to give the patient a guaranteed result, you should definitely consider using enlighten. Now if you want to learn more about the system, or just generally you want to geek out and learn about teeth whitening in general, the science teeth whitening and getting better results to your patients, do check out their webinar ran by Payman Langroudi is on protrusive.co.uk/enlighten
Main Interview:[Jaz] Dr. Avi Patel, welcome to the protrusive dental podcast. How are you my friend? [Avi]
I’m doing great. How are you? [Jaz]
I’m very good. It was nice to connect with you on Instagram. We were talking about Invisalign primarily, but let’s call it clear aligner therapy. Okay, you can obviously we’re going to talk about Invisalign. But you know, when we say Invisalign, we’re talking about clear aligners. And what I liked about you was that you over the last few years, we were having a little chat before I hit the record button, you’ve done a high volume of cases, you’ve got gone into the nitty gritty of creating your patients, and seeing all the sort of issues that can come along the way and power through them. But also, you’re fresh enough that you can remember the challenges of that when you’re starting out. So you’ve got you get the best of both worlds. But for those who don’t know your story, just to tell us a little bit about you how you got involved with doing high volume of a line of work and the kind of dentistry that excites you. [Avi]
Yeah. So I graduated Dental School in 2018, I went to NYU. And when I graduated, I was living in the city, but commuting out to Connecticut. So they have a rule in New York where if you want to practice there, you have to either do a one year residency, or you have to have two years of working experience in a different state. So I just wanted to kind of get out there start working. Honestly, I just was tired of school. And I felt like I could learn more in the real world. So I did I dove in. And it had its challenges. But it was, I think, a good learning experience because I was able to be in multiple practices. And it just looking back now It exposed me to many different ways of dentistry, I think, you know, when we’re in school, you tend to assume the practice owners kind of know everything and have everything together. But every practice owner has their own challenges, right. So for me to get that, you know, I call that my real world residency where it’s, you know, these are different offices operating differently. And each one I learned something from them right at the end of the day, you know, not every associate ship lasted that long just because of different challenges fit stuff like that. But yeah, I don’t I just tried to keep a positive a positive mindset for as long as I could. And then two years go by and I’m finally kind of levelled out in a couple practices I was working with to at the time, and then the pandemic hits. So pandemic hits, and, you know, everyone kind of pauses you’re reflecting, you’re going through all the, all the stages of what lockdown does to you as a human. And, you know, part of it for me, I dove into CEE, right. I was like, You know what, let me just use this time and just learn because I was starting to get a little, I guess, bored of this is the bread and butter, and I was looking for a little bit more dentistry to do because at that point, I felt like if I can do more, I can offer more. Maybe that’ll excite me and, and, yes, I took an implant course and then I dove into Invisalign. NYU certifies us. That’s why I didn’t pick a different, you know, brand to go with. So I was already [Jaz]
saying so you qualify from NYU with your Is it okay. If you major in said DDS, right. Correct. DDS, and then with your DDs, you just get thrown? Hey, you can do Invisalign now. So right, [Avi]
yeah, so so so in the curriculum, it was always a joke. It was like modules and like we had a class to go to, but it was the click through modules. There was no like, hey, let’s teach you when you got into clinic in dental school, you could actually do a case, but it was the most difficult thing. It was so complex, you had to schedule specific time with one faculty member. And you had to align their schedule with the patients. And they did the whole like paper, full facial analysis bite, like just overcomplicated it and it was just I mean, the only benefit is that I didn’t have to pay the $3,000 When I got out of school to get certified. [Jaz]
That’s all I want to know. Do you save three? You said this is amazing. Well, [Avi]
my, my tuition, my tuition was through the roof. So I’m sure I paid for it. Yeah, [Jaz]
so I mean, on that note, I mean, it’s worth addressing this, which is, and you kind of touched on it a little bit now, whereby when you have Invisalign accreditation, or you go on the course to learn Invisalign, a lot of dentists when I was at my accreditation, I think it was like 2017. But a lot of dentists came there expecting to learn orthodontics at the same time as learning Invisalign as a system. And they went away hugely disappointed, because actually, Invisalign never has it said they’ll teach you orthodontics, then they don’t promise that they don’t never will. They are someone who’s gonna give you the tools. And they assume that you have prior orthodontic knowledge or you’re gonna get some mentorship. So I think that’s really important that the new dentists who who are considering dabbling are learning about aligners that they need to get some sort of education regarding orthodontics. So where did you learn your orthodontics from is one trying to ask and and what would you advise young dentists? [Avi]
Yeah, so you know, I, I basically, basically took the module, I mean, I’ll be like brutally honest, I did the modules online, I did all like the videos. And then basically, I was just like, I all I want to know, I didn’t necessarily understand all of the orthodontics behind it. But I was determined to make it work. And I just basically I was like, I want to know what is predictable, right? What are cases that I can do? What are cases that I should not do? And then essentially right, giving me like the guardrails to kind of stick to. And then I reached out and I made sure I had support in terms of getting help with clean checks and stuff like that. So that’s it. Again, I know that doesn’t sit well with a lot of people, because you know that it can be scary. But again, I was the real [Jaz]
world. What you said was is a real world GDP general dentist issue whereby we qualify, we have some basic screening and assessment, knowledge and orthodontics. And then suddenly, we’re on this $3,000 course, Invisalign. And now we can, we’re armed with this power to give aligners to patients. And then we need to recognize the A, okay, we perhaps need more education, mentorship, but be you also need to make sure that you put food on the plate. And so you need to actually pay the bills and actually do some orthodontics as well. So it’s a fine balance. But I think the main message is Yeah, find the mentorship, find the education, don’t expect yourself just from having gone to the Invisalign accreditation course to actually give you any superior knowledge on diagnosis, assessment and treatment planning when it comes to orthodontics [Avi]
correct and that’s the thing in this space right now with clear aligners is you hit it on the nail or they are expecting you right to have that that knowledge before you use their systems. But I also just think as a general dentists if you know your I call it your lane, if you know your lane, and you know what you can tackle and what you can treat and it’s sitting in all of our practices, right? It’s the simple crowding, spacing, right, like the basic stuff, but you can still make a huge difference. If you focus on that you’re gonna get comprehensive care to your patients, right, you’re gonna be able to pay the bills because your production is going to go through the roof and it’s just a very, it’s a great service. I feel like in today’s day and age, a lot of patients here in America, at least I know the UK has their stigmas for people not caring about their oral health, but you know, people here like begging for Invisalign. Like you have doctors that are doing too With three cases a month, and I know that they’re only doing two to three cases a month, because they’re I just I always ask them, like, Are you actively talking about it? Or are your patients asking you for it? And they all say, Oh, my patients asked for it. I’m like, exactly. So that’s a whole nother subset that we can kind of get into later. But um, yeah, I think it’s, it’s huge. And it’s critically important for general dentists to know that you, you can’t just take one course you can’t just get certified. You have to dive into this. And that’s what I did. You know, [Jaz]
and that’s in Austin, Texas. I mean, you didn’t get that bit where you went to Texas a&m and many corporate you said that, that that allowed you to fuel this passion and discover your your space in aligners and how you enjoy doing that. But one thing I want to know is that you did the implant course first. Are you still placing implants? are you placing implants now or not? So [Avi]
yeah, I guess we go back to the story. I finished up Connecticut moved to Austin joined the mini corporate spot. And then they basically gave me free rein, they were like, Hey, do whatever you want, we’ll support you. Here’s an iTero. You know, we have a Nobel implant, you know, extra hands on course you can take so I just, I did it all. I started placing implants. Sticking to the basics, right? You’re 90, lower molars, upper pre molars, nothing really too complex. And it was a lot more of a steady growth. I still do place implants, but honestly, not as many. I think I feel like my my growth skyrocketed with Invisalign faster than with implants. So I haven’t abandoned it. But that’s just kind of where my practice is at right now. [Jaz]
Is your patient demographic, younger, older or give us a painted picture of that? [Avi]
Service demographic is like state employees. 50s 60s, I’d say my average patient is like in their 50s or 60s. So it’s not even like, in my opinion, the sweet spot, which is like your 30 year olds, right. So this is like a tough spine like the office I’m at, but it’s like, it’s old. It’s like I think the office is older than me, honestly. But if you go about in a certain way, and I think if you embody the mindset of, hey, this isn’t just an added service. This is part of what I do, right? Being definitive. When you see a cavity that goes to the nerve that needs a root canal and a crown, there’s no question when you see crowded teeth spacing, any issues like that, you know, malocclusion, hey, you have misaligned teeth, you need clear aligners. This is what we’re doing. That is how you ramp up everything. But again, that comes you have to have confidence. You can’t you just start saying that now you gotta treat it right. And it’s like, okay, what what can I treat? What can I not treat? [Jaz]
Well, we can definitely cover a little bit about that today. And one thing I will ask you later is, can you remember a time in your eagerness or early stages of doing ms line where you treated a case? And you didn’t anticipate how difficult it might be? Or how or why perhaps you shouldn’t have treated that specific type of malocclusion. On Me personally, I can tell you straight away, I treated treated a posterior crossbite once where I just shouldn’t have touched it. There was no reason for me to touch it was not aligned with the patient goals. Can you think of a time where you tweeted someone and then you perhaps broke a basic rule? [Avi]
Yeah. I would say I took on a deep bite case that I probably shouldn’t have taken. I didn’t understand. I didn’t realize you know, the I mean, intrusion is the most difficult movement to do with clear aligners period, especially in adults, right. So, yeah, I just didn’t know. But I set the patient’s expectations accordingly, right, the thing that we all have to this my philosophy you have to get used to, when you have an adult and you’re trying to move their teeth with plastic, that does not mean that you cannot improve their situation, right? You can. So if you are coming from a place of function, health, and improving the clear aligners will check all those boxes, it’s as dentists we get hung up, I think on perfection. And I’m not saying to not strive for perfection, always strive for it, but we also have to be realistic. These are humans, these are you know, these are teeth that you know, you can control a certain amount like you don’t know if a tooth is enclosed and stuff like that before, there’s so many variables. So you can’t let these challenges stop you from actually, you know, offering the services. What I’m getting at with this is I realized with my patients, I’m not selling them on a perfect, perfect a perfect smile. I’m not selling them on cosmetics, I am educating them about the oral health implications, and how we can improve that like my patients come out of clear aligners able to floss and they’re like, Doc, I can floss like this is actually not that bad. Like before I used to shred my floss, I stopped doing it, and now they’re like I do it. And you can tell so it’s, that’s it’s a mental shift, which is, you know, a message that I’m trying to kind of get out there. Because I think everybody wins, right? It’s, you can improve someone’s life by 90%. Yes, it’s not 100% But don’t beat yourself up for that 2% that you missed out on because of all the other growth that you had. [Jaz]
Well said and on the topic of a deep bite case. I had seen a few My colleagues struggle with that because they they go in and what they do, they show the patient, the ClinCheck, and the ClinCheck. It finishes up as like, you know, beautiful two millimeters over Overbite overjet. And then what they don’t realize that the ClinCheck, and we’ll come on to this later is a representation of the forces that have been applied to the tooth, not an actual, this is how it’s gonna end up in the ClinCheck is essentially called cartoon don’t take, as I heard someone say once, so that’s gonna, that’s gonna be a big issue. So I know one of my colleagues Farooq, what he taught me was that if you’re going to hyper correct the the deep by IE, make it look like an finish with an anterior open by in your ClinCheck in a way to help the predictability of getting some further degree of and deep bite correction. But you show the patient not the final outcome, you show the patient like you know, halfway through and say, Look, this is roughly what we’re gonna end up with a deep bite. And if we do that, rather than sending the patient the animation and the way they’re gonna, you know, beautifully correct the deep bite, then you’re asking for trouble? [Avi]
Oh, yeah, absolutely. That’s a huge thing. I didn’t even know that when I first started. So but that’s that’s great advice to hyper correct, honestly, kind of my protocol is, if it’s a deep bite greater than four millimeters, I don’t even touch it that goes to the Orthodox like, I’m an advocate to referring to orthodontics I’d like, you know, we’re saying earlier, I kind of know how to stay in my lane, and I figured out what is treatable, what’s not. And then there’s that gray area where if the patient is super wanting to do it’s like, okay, I guess we’ll we’ll give it a shot. But you set the expectations accordingly, right? Hey, this is something we can improve, it’s going to be challenging, if you’re willing to you know, comply wear the aligners, this may take longer than the six to eight months that my case is usually take. But if you want to do it, we can do it. And if you’re upfront with the patient, right, it takes that pressure off for you. And they also are able to comprehend that they’ll know so they’re not going to be upset if it takes a year. But yeah, [Jaz]
well two great points that one is Yeah, patient communication, don’t undersell over deliver kind of thing, which is very important, but also staying in your lane again. And knowing that okay, this is beyond my comfort zone. And there’s plenty more cases out there for you, as a beginner dentist Invisalign, for those listening maybe, and you don’t have to treat everything that comes your way and definitely use that referral. And I think I always say the best thing about being a GDP, and the specialist may want to just shut their ears here with their listen to this is the best thing about being in GDP is cherry picking, right? We can just cherry pick the cases, let’s GPS, we have the most difficult job in the world as well in the world of dentistry, and maybe even the world. Okay, let’s go with that. We have the most difficult job in the world. And therefore let’s let’s enjoy the benefit of cherry picking. But the main thing is for four main things I want to go on, I want you to four lessons I want to pass on in terms of when we’re starting out with Invisalign or clear aligners, I remember my journey, it comes to a point where your patient is interested, you’ve done your diagnosis and whatnot, you’ve had that conversation patients excited. And now the patient wants to know how much it’s gonna cost. And so, in your mind as a new Invisalign provider, you’re like, Okay, I’m not quite sure if there’s going to be a light within 14 liners or comprehensive, like unlimited liners, and you’re not quite sure, but to the patient on the other end of that to difference that you quote in terms of comprehensive and like, not for all, but for some, it may be the make or break in terms of whether they can afford it or go ahead with it. So before they invest in the ClinCheck, they need to be given a ballpark figure. So the question essentially, I’m asking is, as young dentists who haven’t treated enough cases to know exactly which level of aligners you know, light or comprehensive the patient’s going to need, how do you communicate that to the patient? What do you always quote, the highest fee? And then if it’s a lower, it’s a bonus, what do you advise? [Avi]
So we’ll get into little sales tips here. But basically, I like to keep it simple, right? The whole thing about being a provider’s you have to be confident from the start, right, your patient will see when you are not confident this was ah, this is actually one of the hurdles that before I even moved to Austin and I was still practice practicing my first two years out of school. This is one of the reasons why I didn’t even start, I didn’t start cases because I was like, I don’t know, is this a go? Is this a light is this comprehensive? So it’s very common. So but then once I got the advice of hey, every case is comprehensive, right? That my part people’s ears up. And I’m going to explain why but that’s that’s kind of the that’s the way I do it. Right. So to answer the question, every case is comprehensive, but how do you get there Well, when you when you start, again come from a place of providing value, right? How are clear aligners going to impact the patient’s oral health, right? You start listing the issues you show them if you have an iTero show them the crowded teeth, show them the information, show them the where all that stuff dentists like to think that we can like I mean, which we are we are great at speaking to patients and talking about stuff but what we don’t what sometimes you forget is a patient has no idea what some of the stuff we’re saying, oh, crowding, where that’s like, that’s why I love the itera. You put that sucker up there, you show them and you got the colors, you got everything. And then it’s very obvious, right? Any person understands at that point what you’re saying. So if you have an iTero, start doing those scans, because that is going to build your value, right? You don’t have to say as much as showing. And so I come from that place. So already, it is now okay, I’m listening, because the dentist is talking to me about my oral health. Right? They are not talking to me about cosmetics, they’re not talking to me about the way I look. And it’s this might, you know, dentist may not agree, but my opinion is most people don’t really care how their teeth look, okay? It’s not something that they’re willing to spend, not everyone is willing to spend $5,000, you know, to improve the looks, [Jaz]
but you start to think in our demographic, Avi because you said your patients are you know, 5060s. Same here. In fact, the last two clinics I did last week, patient 72 and patient 68, my actual clincheck and my last two, okay, so I have a way older demographic, and I agree with you, most of them when we have that conversation, it’s usually because the teeth are quite worn at the front end. So it’s and it’s envelope, a function issue that they’re now coming around to freezing or lower incisor crowding and calculus and easy to clean, and we’re coming from that angle there. Look, I’m gonna make things look nice when I’m there. But I know that your prime motivation is to sort this out or sort that out, and how that relates to function and health. And so I agree with an older demographic, maybe with the younger one with the marketing and stuff and the world of tick tock and stuff. Maybe there is obviously a cosmetic and people coming in for vintage cosmetic and composite veneers. And Invisalign is a huge market in the UK for that kind of stuff. So yeah, I think in every demographic, you have a different focus. I guess you’re right. [Avi]
No, definitely. But I do think even if you’re so it’s even easier when it’s a younger demographic, because now they’re already thinking cosmetics, and you give them a valid health reason why they’re like, done. I’m doing it, right. Because dentists and physicians, the biggest difference is like, you know, people go dentists, or they’re just car salesmen. They’re just car salesmen just trying to upsell me. And it’s like, no, like, the stuff we’re doing is fear oral health, like it’s for your health, right? And that impacts the rest of your body. People don’t question physicians when they say stuff, because it’s a Association of Health, right and improving it. So when we come from that same standpoint, these more expensive cases that more expensive procedures, you have to build that value otherwise to then be like, Oh, my insurance doesn’t cover it, I’m not doing it, this or that, right. So start from there, you build it out. So you have that box checked, they understand the value of it, right? So now, they don’t really know how much it’s gonna cost, but they understand why they need it and why it’s important. That’s huge. And if you don’t do that, then you’re not going to be able to even get to the next step. So let’s assume you’ve communicated that now. Is it going to be a light go or comprehensive reason why I say everything should be a comprehensive is because one, when you have comprehensive, you have more control of the case, right? So I know when you’re starting out, you may not understand why you would need all that controller all that power, but you want it because the texts when you use like the go or the light, the text that you’re talking to don’t really actually know, like, you think that the person on the other side is like has your best interests in mind and like is able to, like construct this perfect. ClinCheck No, you have to be the provider and you have to actually dictate the movement. And I’m sure when you had Dr. Bethel on here, he said the same thing, where you know, you have to you have to communicate it as the doctor. So with go, [Jaz]
I just wanted to interject there because literally today aren’t we have a telegram group for the producer auntie and identities a message about a dubious prognosis, second, lower secondary molar? I’m saying it in this way, because American Numbering and British numbering is different for teeth. Let’s say we both understand lower secondary molar. Yeah, so lower secondary molar of dubious prognosis. And then she was suggesting that, let me send him this scan and oppression to Invisalign. And then, instead of doing lots of IPR I, maybe Invisalign will suggest to me to extract this tooth. And I said, Well, we’ll we’ll hold up, and then you decide whether you extract the tooth or not, you know, Invisalign Will not they will, if you want them to light it, they will just align everything, they’ll expand everything, they align it, the extraction choice and decision is made by you as a clinician, so just very much as to make it very tangible. Yes, agreed. The technician is there just to follow some protocols, you are the captain of the ship, and you must steer exactly how you want it. And a lot these, you know, as much as we hate to think about it, the technician Invisalign technician at the end there, and we may think, oh, yeah, they know what they’re doing. And they do. But essentially, when you actually see these guys, what they’re doing is they’re literally they’re selecting the teeth, tooth by tooth, and then they’re making them look straight. Okay, they’re straight now. They look nice now next. And that’s it. No consideration of the there’s no condition of biotype occlusion. Yes, they have their basic guidances and stuff, but they really need the direction from us. Absolutely [Avi]
correct. And so again, you know, earlier dentists right? No, don’t let this scare you. This is not meant to be scary. It’s just letting you know how to look at this. You can go about it in the right way. Right? So you go comprehensive, you have that ability. Now, the difference between go and comprehensive is Invisalign go does not move the molars, right? It doesn’t move the molars and you’re limited to 20 trays, and then one set of refinement. Now, that’s ideal, like most of my cases are 20 trays or less. You know, I’ve taken Dr. course, he’s he’s teaches reengage, and its philosophy of not moving the molars, you know, focusing on a little bit more IPR. But the reason is, because when you move molars, you increase the chances of a posterior open bite, right. So I know there’s a bunch of different philosophies out there. That’s the way that I’ve kind of committed to and works. And it’s in this realm of like a six to eight month kind of treatment time you get in you treat the patient, and then you know, everyone goes on to retainers. But with comprehensive, you can do the same thing, you can mark the molars, and you can just say don’t move these teeth. Right? You have that ability in the prescription to now. So now that automatically eliminates go in that regard. And the advantage is with comprehensive, you get unlimited trays for five years. Okay. Now, why is that important? When you have a patient that just finished and even if it only takes six to eight months, it doesn’t matter. 20 Let’s say they took 20 trays, they’re done. They’re in the retainers. Two years later, they lose their retainers their teeth shift, right? This happens, right? People get lazy with retainers, this has called relapse, we all know it. They come in in two years. And then now they’re like, Hey, Doc, my teeth moves. What do we do? So would you at that point, feel more comfortable telling the patient? Yes, let’s do go again. Because you ran out, right? And you don’t have let’s do Gogan? Give me another 3000 or whatever it is you’re charging for? Would you just like to be like, Hey, no problem, we’ll just do a scan, we’ll get your new retainers. And you’re just back in the trace, right? So it’s that added value. And then I even sometimes will mention to patients that are a little weary of pricing. I say, Hey, listen, this is like almost like a warranty for you. Right? It’s an insurance built into the cost. And patients get more comfortable. Whereas the go, it can get, you know, hairy, and then no one likes having those conversations where, you know, they’re like, Oh, well, my teeth moved, like, Yeah, but you just did it. This only happened two years ago, right? And they’re just like, oh, well, you got to pay again. And then it’s just it’s not, it’s not good. So that’s kind of where and I’ve been in that situation where not even the length wise, but I thought it was gonna take 20 trays, but they needed, you know, two sets of refinement. And then now we’re talking about money again, hey, I need another $1,000 Because you know, your teeth didn’t move the way they’re supposed to. So just eliminate those headaches go to comprehensive you know, and it’ll just make your life easier. [Jaz]
I think that’s great advice. And I at the beginning, I actually for my first clinchecks, I use this like ClinCheck advisory service, I think it was invisible TX. And IT guy helped me with my visit and my ClinCheck to the beginning, because I was I was learning I want to make sure I was doing it right and whatnot. And then I email them one saying, Hey, I don’t know whether I should do this patient in within the confines of like, it was like 14 liners or comprehensive. And he actually said, depends how fussy your patient is. I was like, wow, I never I never thought about it that way. But I like the advice you give that. Okay. I think the advice to echo here for those listening and watching is, if you are on the fence, don’t even think about it go comprehensive. If you’re on the fence, if it’s like a really obvious clear, like mine a really minor crowding, it’s gonna be sorted well within 10 aligners, and you get up to 14, then fine. But if you get a really fussy patient for a reason, or you’re on the fence, I think that’s great. Not only because of the warranty thing that you said about you know, relapse happened and stuff. But the thing I love most about it is the thing that you said right at the beginning, is that you need to be confident when you’re communicating to the patient. I know that I’ve disservice my patients in the past at the consultation, where I’ve looked in other made that face and I thought you know what, I’m basically 5000 4000 I don’t know, and then the patient’s like, Okay, this guy doesn’t know he’s doing. Yeah, I knew I was doing but I was just like, I was trying to find out what’s your quote them? So I think for that reason, I think it’s wonderful advice. I think just just go comprehensive. And I think you can’t go wrong with that. So if you’re on the fence, definitely go comprehensive. That is a very, very good way to answer that question. I think a lot of people would have gained value from that. I wish I knew that earlier in my career. Anything you want to add to that before I go to next question. [Avi]
I was just gonna say I like how you said that were you know, I think in the beginning, you start comprehensive and then as you get more comfortable, you know what’s predictable, because you do the more cases you see, you see how the teeth move, okay, and then you get that confidence, hey, we just did this and that, you just know that it’s about 14 That’ll take about 20. So then you can start scaling it back. But to your point. I like that unless you know, stick to the comprehensive [Jaz]
very good and you mentioned refinement earlier. It’d be really good for one of my colleagues, my boss is actually when He started Invisalign. He didn’t know about refinement, he literally was like, okay, they either get that out in their first round. And then he realized that patients weren’t quite happy and what’s going on here? Or there’s something called refinement. And because that he wasn’t told that at the course. So he tells me, and so when I told him that, hey, a lot of my cases go to refinement. And that’s kind of normal, you know, and he’s always that is that, you know, he didn’t know that. So I’d love to learn from you. What percentage of cases go to refinement? And would you like to suggest to those listening, there’s a newbie dentists starting out Invisalign that that is Yeah. Is that a normal thing? Is it expected? And how can we gauge that? [Avi]
Yeah, that’s a great question. I think when I first started out, so first of all, I don’t even know what the word refinement meant. Like, [Jaz]
additional aligners. Now, obviously, they call it additional liners, but yeah, I mean, five minute addition liners, we’re talking about the same thing. [Avi]
Yeah, definitely. And it’s yeah, I still call it refinement. But it’s when I first started, I was like, I don’t even know what this word means. But yeah, so it’s a mental hurdle to get over. But I think, again, all of this is mentality based to boost confidence. So I felt bad that they weren’t finishing and getting to where they needed to be in 20. Trays. Right. In the beginning, I felt bad. I was like, damn, like, Doc, God, we got to we got to do more aligners. Right. Like it’s a failure. Meanwhile, we’ve just corrected the severe crowding, and like we’re just tweaking the end. Right. So I think once you understand that, that it’s expected. You know, again, some clinicians they take pride in is a very minimal refinement percentage, I’m going to be honest, a lot of my cases do go to refinement. But it’s okay. Because I have already communicated that ahead of time. I don’t tell the patients Hey, you’re going to be done in 20? No, you say at the consultation, this will be about six to eight months, right? Depends on and then if you want to go further, because they have questions, they look, there’s a bunch of factors, you have to wear the trays 22 hours a day, otherwise, the treatment will take longer, right? And you have to come to your appointments, all this and all that, right. So you build that into the bidding. So that way they’re aware, because most patients, the really good ones wear it for 22 hours a day. And this stuff works, right? It’s the ones that are a little lazy, and they’re not that you’ll see. And it’s like a well at we’re at the end, and this could be better. So don’t take the onus off of it. It’s not your fault. It’s it’s it could be that the patient wasn’t wearing the trays, and that’s okay, right. They know, they have to wear more trays, or they’re gonna say, Hey, I’m done. Put me in the retainers I’ve done with this stuff. I’ve had patients do that too. And I’m like, Well, we could still improve this. And they’re like, is it better functionally or not? And I’m like, yeah, it’s definitely better functionally, but, and then they’re like, Okay, well, I don’t want to wear the trays anymore. Okay, fine. Because at that point, you know, it’s, it’s their choice to right. So, yeah, we [Jaz]
definitely don’t say for those watching, listening, definitely don’t say the patient, okay. It’s gonna be, you know, 25 liners as you can see the ClinCheck. And then we’ll be done and then be disappointed at the end, and refinements are expected, I said they expected and then sometimes you get lucky. And I said, the expected because we know that orthodontic movements are not 100%, predictable, you know, tipping is, you know, 70 80%, predictable, or there abouts. Everything has, you know, rotations and 50% predictable ability. You know, after this episode, we’re Farukh, again to memorize the figures. But we know it’s not predictable. So we can’t say that within one round, even if you hyper correct and stuff. So I always say to my patients, we do it in different rounds. Or sometimes say it’s like playing golf, you know, sometimes get home one, but most time you get a bit closer to home. And there’s little minor changes at the end little tweaks, we’ll get those right. And I say to my patients, sometimes I’m gonna be the one pestering, you say, can I please do this, and I’ll beg you to let me align. And sometimes you’ll be like, you know, that little movement. And this is what we’re here for. We want to get both of us happy. So So that’s the kind of arrangement I say at the consultation. So they know that the first 20 aligners, fine is there, but they know that they’re gonna have more and then back to your point about the timeline. Yes, it’s more about the timeline, rather than, you know, additional aligners and whatnot. So my next question. So you answered very well, that if you’re unsure about which band they’re going to be in, just say, comprehensive. But what about the newbie dentist who doesn’t know how long movements take yet? How do you then give the patient a range, oh, I can just get six to eight months, six to eight months to 12 months, any guide that you have to actually tell the patient how long the treatment duration might be. [Avi]
So that all comes down to the type of cases you’re working on. Right? It’s all case selection. So going back to what I was saying, staying in your lane, knowing what you can treat, right, you’re crowding, spacing, anterior open bite, stuff like that, if you’re only treating those, you’re only going to be in a six, it’s going to be six to eight months. That’s just how it works, right? Because you’re not moving these massive molars and doing all like this like posterior double, like you shouldn’t be doing double posterior cross, but you can do singular, but don’t do double and even singular, like, if they’re functional and they’re fine. You don’t have to necessarily improve it right. [Jaz]
I learned that the hard way. Yes. Yeah. So [Avi]
you kind of set yourself up but That’s the other thing. It’s my case selection then trickles down to like, Okay, since we’re only doing this, it’ll be six to eight months. And then that’s kind of how I do it. Has there been patients that have gone a little bit past eight months? Yes. But again, it’s because, you know, they admitted they weren’t wearing the trays or, you know, they said there was a tooth that was really tough to move. And when you see them at the checks, you kind of give them updates. And they are they are okay with it. It’s not as scary as you’d think. I think we forget, when you ask patients in braces that are seeing an orthodontist, they say, Oh, it might be two years a year or whatever, like they don’t know the orthodontist keep moving the teeth until they get it to where they one. There’s no like dentists. I think we just like, oh, we ever prep the crown. Today we deliver in two weeks. Like it’s it’s very, you know, but that’s not how ortho is it’s, it’s there’s a lot more variables so you gotta be [Jaz]
agreed. And I think I want to add to that say that you know, if you think it’s going to be six to eight months, just say nine months, you know, the patient will be happy when there’s no harm undersell, oh, no one’s ever said, what, nine months, dentists down the road said eight months, you know, but no one’s ever said that. Right? They said, Okay, fine, nine months, I can deal with that. It’s not gonna make a huge difference in terms of how it is and just gives you a little bit of breathing space. And I think two times, a few times I’ve regretted taking cases on was a Bridezilla where she’s, you know, she’s getting married. And like, you know, just be very careful with those ones. And then also when the patient’s like, Oh, I’m going to I’m moving to New Zealand in six, six months, do you think we can get this right? Don’t do that. It’s just not worth it. Don’t have your treatment done in New Zealand. It just puts too much pressure on you and and try and fit them around when you’re busy and stuff. So I think would you agree that those two kinds of cases, just be careful tread carefully? [Avi]
Correct? Absolutely. And that’s the thing is you have to do this information gathering in the beginning, right gonna get their expectation, see what they want to do. Tell them what you see. Because this stuff comes out. Yeah. Don’t Don’t take the brunt like, and I’ve had that conversation. And I’ve told them like, hey, to get the result. Because if you start it, and then it comes up, and it’s not perfect, then you’re taking off attachments, like the week before the wedding, and then, oh, I’ve been doing all this extra coaching for no reason. It’s like, hey, let’s just maybe do some whitening, right? Get everything nice and wait for you for the wedding and the pictures and then we’ll straighten everything after. Yeah, very true. [Jaz]
Now, last few questions, either sort of very common themes from the community. One is IPR. Like I’ve done so many live videos now for IPR because this is something that people do when you’re starting out. It’s a stressful thing. IPR is so stressful. The first time I did IPR was like, you know, as a restorative dentist, I felt dirty, you know, it felt like it feels so wrong. And then also the technique and you doubt yourself and you’re you see these horrible radiographs online about IPR gone wrong, and you don’t want to be that dentists. So I’ve covered IPR a lot already. But any advice that you have for planning IPR, for efficiency that you want to pass on to the community? [Avi]
Yeah, so whenever you see IPR, this is a huge tip. I got this from Dr. Blocker. Basically, if you have IPR, from canine to canine on the mandible, and it’s point two, right point two all the way across, what you can do is you can actually go into the like the 3d controls and where you can manipulate where you want to get put IPR. Again, this is what you can do in comprehensive you can’t do this in Invisalign go. But if you already have a case, what you basically do is you eliminate the IPR, and you can just add point five to the Museum of the canines. And then that gets you that millimeter of space that you need. Right, so that hack is crazy good, because now instead of IPR in so many teeth and trying to be very precise, you just can literally take like the mosquito diamond bird go to the museum of the canine underneath the contact, feather swipe up on both of those, there’s plenty of enamel on the canines, you don’t have to worry about that. And then you get the space that you need, and the teeth move. That’s and then if you need more space, you can just do distal of the canine as well. I like to try to preserve the interiors as much as I can. I try not to do any IPR on the maxillary if I can avoid it. But that is very key, just to minimize that, I think is redistributing where the IPR goes, gives you a lot more freedom. [Jaz]
Yeah, a lot of people might not realize that you can do that. And that’s a really, really great tip. And especially like, you know, you’ve got like naught point three here, naught point three, they’re not paying for that, then group it up into an open forum and open five and leave the other one alone. And then definitely, you can do that as long as the space that you end up with is similar or the same. So that’s a great tip there. And then also, yes, canines in general, have such a meaty enamel, and they are great candidates for IPR. The only thing the only caveat here is that if you have a tendency for black triangles, that perhaps then still keep the IPR for those lower and sizes which will help the black triangles is one thing to note there, but that’s a really good top tip there in terms of planning for IPR. And the final question of it is before we just have a little chat is which is and I get this all the time, which is the best composite for attachments. So what do you use for attachments at the moment? [Avi]
So I use tetric Evo flow tetric Evo flow I was using like a bulk fill, but my assistant actually request because my system does my attachments. She Questions, we go to the flobo version of it. So it’s tetric Evo flow, and then the flow bubble. And then I actually did try it out. And it is, it’s very nice. It’s not too like soupy liquidy. It’s not too, you know, meaty to where you can’t put it into the tray. But yeah, it’s we do the full version of it. And that’s great, because it’s translucent as well, so you really can’t see it. So the patients like that. And then kind of a little bit more composite tips, I can dive in here. [Jaz]
I mean, it’d be good to learn about your protocol, people ask me, What’s the best way to do my attachment to talk with us? Yeah, you could share each other’s protocols. But one thing I shouldn’t add is, I’m at the moment using a genial injectable for it, I just love how it holds a shape, like you can literally do anything you want to the template, and it just holds its shape so nicely, and I’ve had no issues with that as well. And that’s got you know, it’s a it’s a restorative composite, paste and composite in a fillable form, if you’d like so that I have no worries about it wearing Well, you know, people say that oh, yeah. What if the continual aligner removal insertion is wearing away the attachments? I don’t worry about that with genial, but I think that you’re one that you’d recommend the tetric EBA. Flow is, I think, is one of the official ones that that Invisalign recommend, I believe. [Avi]
Yeah, it probably is. Because I learned that from a course that I took, yeah, yeah. But yeah, it works. It works. [Jaz]
Yep, tell us your protocol for attachments. [Avi]
So protocol for attachments, it all starts I attach. So I’ll attach. And it all starts with controlling your act, right. Because when you do attachments, the biggest thing is you want to minimize the amount of flash that you get the amount of excess composite that’s there. Because if you have that, that will not allow the aligners to seek correctly. And then that is going to obviously cause issues with movements, right. So it starts from the beginning, control your edge only edge in the area where the attachment is gonna go. Right. So you etch their normal protocol that you use for etching, when you do restorative, I’m treating this essentially like a you know, like a filling, right? So that you go to that spot, that’s exactly where you need to be very precise, rinse it off, air dry, and then I’ll take whereas [Jaz]
for restorative, you know, we want to etch beyond, because you want to go and get a seamless margin. For Invisalign wondered the opposite, you want to literally contain it within that square or whatever I completely agree. [Avi]
Right, so you start there and then bond with bond I use like a micro brush to apply it. I believe the bond that it uses Excite, any bonding is fine. It’s just, if you’re filling, put it this way, if your fillings are staying intact, it’s that’s a good etch and bond system to use. Obviously, composites would be a little different, but stick to what you have, you don’t have to go by all different products, but control that bond as well. Right. And I like to apply it. At first I was just using it was like a pen. And so it had that tip on the edge of it. I don’t know exactly what it is. But it was like [Jaz]
I think it’s a brand that one I think is black with the green [Avi]
color. But I was using that at first when my attachments kept falling off. And the reason was, is that’s like an etching bond. And one, it wasn’t because of that it was because of the contamination. So if you take that, and you apply it on different teeth, right saliva can kind of get involved with it, by the time you’re on your second or third quadrant of applying. That has it’s not clean anymore, right. So I made a change. And I actually just used Micro Brush and applied a new Micro Brush in each quadrant. So that way, there’s no chance of saliva really touching it ever since I made that change, attachments don’t come off. So that was keys control that contamination. So you put that on, you know, air dry cure, then now what I do is I cut the trays in half. Okay, so you go to your incisors, cut them in half for the maxillary and mandibular. So now you have your four separate trays, this allows you to really ensure that you have a clean working space if you you know, if you try to do a whole arch at a time, like that’s a lot of isolation that you have to achieve and if you can achieve a great for me that just it’s very difficult to do so and I would just liked the fact that I can pop it on, you know, once I have it on then I use like the little I guess we call it college pliers here to something that you can use to kind of pinch the trays and you can just pinch the trays buccal lingual and what that does is that pushes the composite onto the tooth and then you cure that when you do that. I guess we can go back to where how much you feel. I feel right. I don’t underfill it I don’t overfill it. I tried to keep it very level with the trays. It’s okay if you’re gonna go one way overfill it. Okay, if you’re gonna go in with overfill it because that’ll ensure that you capture everything and you don’t have to worry because if you did if you control your edge and you control your bond that composite that’s excess will actually just it should flick right off with a scalar right or whatever you may use to polish at the end so you do that you cure it and then they’re pretty much on then the other thing that we use is a black light so you can just get a black light when you shine black [Jaz]
UV torch it’s something that we’re yeah I’m advocate before UV torch and that it shows up the flash so well, isn’t it? [Avi]
Correct? Yeah, composite lights up. Then you just go in, remove the floor. Wash them. And that’s pretty much it. [Jaz]
And for that just a tip, I don’t think genial is as fluorescent, I think the Tetrick one that you recommended is like it goes bright purple, right when you put the black ports on it. Yeah. So if you’re going to be if you like the idea of doing this, then I probably would use the, the company that you recommended that just don’t say the name, say the name of it again, Tetrick evil flow, that’s the one. So if you feel like the idea of them shining purple with the black torch or the UV torch, then definitely go for that one. Genial GC products have lower fluorescence, and they don’t show as well. So you may be left disappointed, do use obligate for your isolation. [Avi]
I tried it, but it was a little tricky getting in, we’ll use like an ISO dry, right. So it has basically, prop up your one side of the mouth keeps the tongue and everything out of the way. So that’s nice. And that adds in the whole work in quadrants and halves of the mouth. So that’s what we use. [Jaz]
Okay, now, I’m quite a big fan of the obligate or works well, on my hands. The real big issue I had, when I started working in this new practice two months, or two years ago, is that the this is huge, like, $5,000 light above us, right? It’s like, by evidence, like really bright, and I didn’t realize the power of this light. And so when I be delivering my attachments, by time actually just inserted the template, the composite or cured, and it and actually complained to Invisalign saying, hey, all the last five patients, the the templates you’re sending, they don’t fit the teeth. This is This is terrible. This is rubbish. You guys, you guys suck. But but it was actually it was actually my fault and the light and I figured out and I actually posted on this on Facebook as well, like what’s going on? Is everyone else’s tashman templates not fitting. So it’s basically the light was prematurely prematurely curing it. So be careful if you find is though, that when you put your template in, it’s not seating that well, it’s probably because of competence just cured. And that’s a very simple thing, just control your light environment. That is one thing that’s going to definitely save someone I think eventually we’ll all will remember this tip and figure it out. Any last words on templates, or attachments, even [Avi]
I’d say that’s pretty much it, I think you stick to that and ensure they’re on, you know, emphasize to the patient, hey, if this if you feel like anything pops off, let us know get them in. Because if you don’t, if they go too long, without an attachment, that tooth isn’t going to track and it’s not going to move. So you got to stress that. But [Jaz]
I mean, I remember early on right when I was starting Invisalign, I do something really stupid and funny, right? So because I didn’t have faith in my attachment, because I didn’t because I was starting out. I didn’t know whether they work. Now I didn’t. Obviously I was stupid, because I believe in compensate, wanting to know, why wouldn’t I believe it on the facial the enamel is just a stupid thing. But as soon as the patient left off the attachments, I go on the doctor website, and I preempt the next visit, I’d ordered a template for appointment five, stage five, I just order a template. So by the time the patient comes back, I would have the template ready just in case. And he realized don’t don’t miss. But yeah, it doesn’t cost anything to get to order a template. So I thought let me template anyway. But yeah, I realized I didn’t need it. And those templates, those attachments that are going to come away, they usually come away within like two days, basically. And if they come away, in the first couple days, they’ll stay the long haul, they’ll go, you know, multiple refinements and whatnot, we can talk about that another time. But I think you’ve provided great value to everyone listen, there, you’ve given those faith who are starting out Invisalign. And obviously, you’ve got a bit more experienced now you’ve done more, you know, a bit you’ve been through all the mistakes and challenges. So it’s great to have your sort of lessons there. Please tell us how we can connect with you what services you offer, I think you’ve done some coaching. And I think a lot of people would appreciate that, please tell us about that [Avi]
pretty much this whole conversation sit everything on the nail, in terms of challenges, especially for starting off. So again, I am not like a diamond provider, I am not doing you know, 1000s and 1000s of cases I am very much, you know, I wouldn’t say brand new, but I’m pretty well versed in these initial challenges. And I realized right with with cases that the hardest thing is to start, right. It’s the fear of all the things that we just talked about, hopefully people listening, you know, we’ve given you some confidence to kind of push forward, you know, but again, the biggest a big key is having that one on one support, right? So I created a coaching kind of coaching consulting business, where I’ll work with dentists and help them get started. Right, get them going on the right foot teaching, you know how to pick your cases, how to set up your clean checks, how to keep everything predictable, to where you’re able to really get your feet wet and get comfortable. And get you to a place where you’re doing like 10 cases a month, consistently and no sweat. And I mean that we’re kind of automating you to where it’s like you don’t have to really stress it. Then after that, it’s like you kind of make it what you want, right? And if dentists are comfortable with that they’re great. If they want to further educate themselves, then that’s when the courses are incredible, because you can and this is what I really think a lot of dentists see too is like you can take a course and it’s a phenomenal course. But if you don’t even know how to start. That’s that information just becomes overwhelming, right? And you and you and you get lost in that. So I’ve kind of created this and it’s helped. It’s helped some dentists. They’re pretty Should it and then I’m also looking to start to build like a community to to where people can kind of share and stuff. They’re here in America, we have the ACA, American Academy of clear aligners. So that’s a nice community that I’m a part of. But it does have all ranges of expertise. So it’s, it’s good. And it can be a little overwhelming sometimes, where if you’re brand new, you don’t really know what we can ask. So let’s say [Jaz]
your mission is to help those starting out to get started on the right foot. Right? Absolutely. So how do we connect with you if someone you know would like like to learn more? Yeah, [Avi]
so I have I mean, multiple ways Instagram is one my instagram handle is Dr. Spelled out dot Avi. I have a website for the coaching business. It’s called clear aligner advisor.co. So on there, it has my email, phone number, all that kind of stuff. But yeah, Instagram or on the website, or the easiest. For any newbie dentists that are listening. I did start a YouTube channel as well. Just kind of sharing career advice. Now. It’s not just Invisalign. It’s everything. Like I said, I was in 10 different offices, my first two years out, saw dentistry done a bunch of different ways, the good, the bad, the ugly, and just kind of sharing my insight. So I have a YouTube channel as well. It’s the same thing Dr. Avi spelled out. But yeah, it’s a I look [Jaz]
forward to subscribing and connecting further. I think it’s been nice to remind ourselves of the challenges when you’re starting out. And yeah, definitely the I think the demand for just starting out your first few cases is huge. Like I said, I paid for my first 10 Clinchecks to get help with those. Because I was so lacking in confidence in terms of what I was doing, it actually spurred me on to do a whole diploma in orthodontics, because the thought of not knowing enough was was was haunting me. And so when you arm yourself with knowledge and get some mentorship in many forms, and now online like like you offer is just one of the beautiful things about how we’re advancing in dentistry that we can reach out and get mentorship from anywhere in the world is amazing. So I’ll be sure to put your channel link in the show notes. And if you listen all the way to the end remember that the app is out the protrusive app is out so check it out this video will be on there so for you to enjoy and then you get to see are these cool glasses and it’s cool shirt. I’ll be thanks so much for coming on and sharing your nuggets they may really appreciate it. [Avi]
I really appreciate it thank you for having me.
Well there we have it guys hope you found that valuable you obviously probably only listen if you actually are starting out with liners chances are you probably know it didn’t reach all the way to the end if you’re already quite experienced in providing aligner therapy but if you have for some reason amazing. Thanks so much for listening all the way to the end. Catch you in the next episode. Listen if you could do me a favor. If you found this useful, and you know someone else who’s starting off with Linus send them this episode and introduce them to the podcast. That’s how this podcast grows. And I really appreciate your listenership as always. Thank you