How and when to use Invisalign clear aligners bite ramps?
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- Опубликовано: 6 авг 2024
- How and when to use Invisalign clear aligners bite ramps? Should you use bite ramps every time you treat a deep bite case? If you receive a ClinCheck setup or a ClinCheck treatment plan including bite ramps, should you always leave them there? If not, when should you remove them and when should you keep them?
The answers in this C.L.E.A.R. Tip where Dr. Stephane Reinhardt, Director of Education Program for The C.L.E.A.R. Institute tells you what you need to know about bite ramps, when to use them, and why and when to avoid them.
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Timestamps
0:00 Introduction
0:48 What are bite ramps?
1:34 The idea behind the bite ramps 1
2:25 The type of patient it is made for
2:43 The idea behind bite ramps 2
2:57 The problem is…
3:19 Let’s look at a case
4:40 In the prescription
5:06 How bite ramps look
6:36 Be careful of one thing
7:26 Let’s think a little bit
8:30 Force with bite ramp
9:06 Staging your treatment
9:45 My suggestion for Align: the Reinhardt bite-ramp!
10:09 The difference between having a bite ramp or not
10:34 Think like plastic
10:51 Dr. Gerry Samson’s trick
11:36 Conclusion
12:00 Subscribe
12:20 Visit www.theclearinstitute.com and get your rebate
The C.L.E.A.R. Institute's mission is to help dentists, and team members integrate efficiently and successfully clear aligners in their daily practice. We want you to be as comfortable talking about clear aligners to your patient as you are about any type of regular restoration. The vision of The C.L.E.A.R. Institute is that clear aligners treatment become as common as any type of regular dentistry performed in a dental office. We see it as part of any comprehensive treatment proposed to your patients. C.L.E.A.R. stands for Clinical Lecture Education Aligner and Restoration. Whether it is from live face-to-face courses, our digital platform, or this RUclips Channel, our goal is to bring you the information and education you need to succeed with clear aligners. This is why even if we focus on clear aligners, we also cover subjects such as Communication, Finance, Protocols, Roles of everyone, and Restoration. In today's dentistry, everything is integrated.
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#theclearinstitute #biteramp #invisalign 
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This feels like Blues Clues for teeth and I love it.
Thank you so much Sarah! We love the comparison 🤗 Stay tuned for more coming soon...
I love your teaching style with some casual humor thrown in but you still seem very knowledgeable and passionate
Dear Joey Arthur Zooberry, we are glad you enjoyed watching our video. Thank you so much for your comment; it describes exactly what we want to do. Education Entertainment. Who said dentistry was boring ;) Stay tuned for more coming up soon!
Nicely done. Very "CLEAR" and clinically useful information. With compliments........
Coming from the Gaffer himself, what more could we ask for? And thank you for all the tips and tricks coming from you that changes the way we practice orthodontics. For all of you out there wanting excellent non-biaised orthodontic education, visit Dr. Samson's (g)nathos website at www.gnathosce.com
I love this channel. You are amazing!
Thank you so much! That keeps us going and do more! Don‘t keep us a secret!!!
Thank u so much
Dear Phong ca, we are glad you enjoyed watching our video. For more entertaining education, visit our online learning platform at www.theeclearinstitute.com/learn
Q: Do you like them?
A: I'm on day 3 and I really like them. They're comfortable! It feels good to not be overbiting, it had been making my teeth hurt.
Good news! Keep wearing them and keep the motivation! It makes a big difference in the final result! Clear aligner treatment success are a team work between the dentist, the team and the patient.
May I ask what kind of the plastic at 9.50 that you would suggest us to use ? Thank you for the useful clips, I am really appreciated.
This is a suggestion we make to aligner manifacturer :) If you would like to mimic this, you could fill the bite ramps with composite so that the surface of the composite would apply a force on the tooth, therefore eliminating the void. We hope for this new feature we are talking about in the future! Maybe a wish for 2022 :)
Thank your sharing your knowledge and experience. Question: how to cover the internal halos of the bite ramps (fundamental on movements from the lingual side)? Is there an option on the software to ask for that? Or is staging the treatment/movements the only option available (procline incisors first without bit ramps, and only then extrude premolars w/ bite ramps)? Thanks in advance from Portugal
Great question! This is what we would wish for! Fill the space with plastic :) Your idea of staging the treatment with proclination first and then adding the bite ramp is a good way to do it. The other option would be to fill the space with composite (don't do attachments!!!), which means you must do it in all aligners. Not really practical. The other question is: "Why do you want to put bite ramps?". Dissoclude posterior teeth (valuable) or intrusion of lower anterior (still searching for scientific evidence on this one).
Good education. Do u use bite ramp on retainer for deep bite case? How does it benefit?
That is an excellent question *kristine ten* ! It's always possible to do that, and in some cases a good idea (brachy patients with BIG masseters). As long as it's comfortable for the patient, helps his/her condition and maintains the teeth in place. Some prefer that option to wearing an occlusal splint.
If I have a patient that already has braces when she was younger, has been compliant with wearing her retainer from Ortho and has shorter maxillary anterior roots, but is now having traumatic occlusion on #9 banging against #23... There is now class I mobility on #9 due to the occlusion. Would a maxillary retainer with bite ramps on #7-#10 help this patient by opening her bite slightly to prevent the traumatic occlusion? She does not wear a lower retainer due to having a lingual bar.
Thank you for reaching out with your question and providing a detailed description of the patient's situation. While specific cases like the one you mentioned involve complex decision-making, it's important to remember that providing diagnostic and treatment planning without a comprehensive examination can be highly inaccurate and potentially misleading.
In general, addressing a situation involving traumatic occlusion, especially in the anterior region, requires a multifaceted approach. The primary goal is to identify and eliminate the cause of the trauma. This could involve various interventions, such as occlusal adjustment, intrusion, or proclination/retroclination of the involved teeth, among others. Simply adding bite ramps to a retainer might not address the underlying issue of traumatic occlusion effectively. While it might offer temporary relief, it does not resolve the cause of the trauma.
In clinical practice, the focus should always be on a comprehensive solution that not only treats the symptoms but also addresses the root cause of the problem. Each patient's situation is unique, and treatment plans should be tailored to their specific needs, considering all factors, including previous orthodontic treatments, compliance with retainer wear, and the current condition of their dentition.
Again, while we can discuss general approaches and considerations, it's crucial for the patient to consult with their dentist/orthodontist for a personalized evaluation and treatment plan. Only a professional who can assess the patient's condition firsthand can provide the most accurate and effective treatment recommendations.
Thank you for understanding the limitations of online advice.
Just noticed these on my next set of trays, was wondering if my dentist just forgot schedule for attachments now I know. But now I am just curious why they aren’t filled in with plastic
We are wondering the same and Dr. Reinhardt has been saying for many years that the bite ramps should be filled by plastic. Then we would have the benefit of the bite ramps combined with the benefit of an active push by the plastic covering the lingual surface of the teeth.
What about using the bite ramps from 13 to 23 for upper and lower anterior intrusion? Will them cause a posterior opened bite?
Good question! First, bite ramps can be used from 12 to 22 OR on the cuspids. Second, to produce intrusion the force would need to be constant. Bite ramps does not mean the patients will constantly bite on them and apply a constant force necessary to intrude the teeth.Third, in a situation where you would have anterior intrusion, you would have less chance of causing posterior open bites. A lot of time we see POB happening when the intrusion of the anterior teeth does not happen. We hope this helps. Thank you for your question.
I still feel like I know nothing. I don't see how putting ramps behind my 2 front teeth which already completely cover my bottom teeth with a 100% overbite, will not push them out even further. Because it feels like I'm pushing my top 2 teeth out, and I need my bottom teeth to come out!
Thank you for your comment Dot Donahue. It may not be something that applies to your case. Hard to say. We recommend consulting a dentist or orthodontist with experience in clear aligner treatments. It may be tricky if you feel you are pushing on your 2 top teeth and you need your bottom teeth to come out even more. This would increase the force on the top teeth... Unless they need to move out too! Consulting with your dentist/orthodontist should give you all the information you need to take a good decision.
What’s the most posterior molar extrusion can you expect?
It really depends on the technique you are using. Passive extrusion, active extrusion... Aligners only, aligners and elastics, aligners, elastics and TADs? Vertical movements are still the most challenging to achieve with clear aligners. Remember that 1mm of posterior extrusion will give you 2-3 mm of anterior bite opening. That should always be considered when planning your treatment,
I'm on my third aligner with bite ramps and I've noticed after like a day or two the bite ramps turn from a bump that stops the teeth into a literal ramp that the teeth slide back up along when I bite down. How do I stop crushing the bite ramp or is there something wrong with them?
This is unfortunately something that can happen more often when there is heavy grinding or clenching of the teeth. We suggest informing your treating dentist or orthodontist as soon as possible.
i have the bite ramps and behind my 4 front teeth and i only need 1 lateral incisor moved. but it has a bit ramp... now im worried
There should be a reason why your dentist decided to proceed that way. We recommend you ask directly. Dentists always like when a patient is interested in their treatment :)
Just started with bite ramps on my invisalign last week. Should my bottom teeth be pressing under these ramps when i'm relaxing, or should I relax my jaw like it normally is, without any lower and upper teeth touching? My mouth seems to want to bite under the ramps right now. Should I?
We advise you ask your tresting dentist/orthodontist for that question. In general, bite ramps are there to disocclude posterior teeth but also could play a role in anterior intrusion. No studies show that yet, but it was thought that way. We usually say to patients to stay relax and not think about it, but again, your dentist/orthodontist will be the best one to explain to you what is the purpose of having the bite ramps in your case. Thank you for your question Damon!
@@theCLEARinstitute Ok I asked my ortho and this is their response....
"Just bite normal. You don't have to try to always have contact with them. Just relax your jaw like you normally would. If this does not make sense or you have further questions please reach out to us again. Have a great day Damon!"
Do they push the bottom teeth down, or just allow the posterior teeth to come together since you can’t clench in them?
Great question. To push the bottom teeth down (intrusion of the lower anteriors) you would need a constant force applied there. If you bite constantly on the bite ramps and apply a constant pressure, maybe they will help in intruding the teeth. But… who does that? 🤔
Does Suresmile offer bite ramps to help a deep bite?
The important thing to remember with bite ramps is, as any article been published proving it helps in deep bite cases? And if so, how? By intruding the lower anterior teeth? How? From the intermittent pressure it applies on the teeth? Hhmmmm… Maybe it helps in the disclusion of posterior teeth when we want to extrude them, but it is still, at the moment, a clinical opinion rather than a scientific fact.
Guess what,my doctor fill the composite on my bite ramp
Clever! It would be so much easier if they would all come prefilled. And would change completely the mechanics.
You look and speak like Jurgen Klopp.
Go Liverpool! ⚽