Post on 27-Feb-2020
12/8/2016
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© 2015 Align Technology, Inc. All rights reserved.
Lauren Gueits, RDH, BS
The Hygienist’s Role:
Implementing Invisalign® TherapyA Two-Part Series
© 2015 Align Technology, Inc. All rights reserved.
About the Speaker: Lauren Gueits, RDH BS
• Lauren Gueits, a dental hygienist of 20+ years and a recipient of the 2010 RDH Sunstar Award of Distinction, lectures nationally to health professionals on Comprehensive Care and Oral/Systemic links. Lauren received her degree from the State University of New York at Farmingdale in 1991 and post graduate training in MyofunctionalTherapy through the AOMT in 2013. Lauren is a published author and has been seen on WNBC, WABC and the Colgate Oral Health Network raising awareness about diabetes and oral health. She is passionate about the perio-ortho connection and the health benefits of aligned teeth, thus enjoying her role as Hygiene Education Manager for Align Technology.
• *Mom of 3 — all in Invisalign treatment
© 2015 Align Technology, Inc. All rights reserved.
PART II
The Hygienist’s Role in Implementing
Ortho in the Dental Practice
12/8/2016
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© 2015 Align Technology, Inc. All rights reserved.
Our Time Together: Part Two
Part I
• Ortho 101: Perio-Ortho-Systemic Connections
• Long Term Oral Health Solutions with Invisalign Therapy
• Abfractions vs. Abrasions
• Implementing Ortho in the Dental Practice
Part II
• Orthodontic Conversations from the Hygiene Chair
• Hygiene Ortho Exam
• Effective Strategies for Increased Case Acceptance
• Case Reviews
© 2015 Align Technology, Inc. All rights reserved.
Clinical Protocol:
“Prevention” Planning• PERIO
• ORTHO
• RESTORATIVE*
*Restorative takes precedence
if active decay/pathology/pain.
© 2015 Align Technology, Inc. All rights reserved.
Supportive Evidence…
Most Need Straighter Teeth, but Few Get Treated
1. Brunelle, et. al. in Journal of Dental Research (2/96)
2. National Center for Health Statistics
3. Data on file. Align study of 18,000 adults 25-49.
75% of US affected with malocclusion1
Epidemiological study by NCHS2
49% want straighter teeth3
Braces vs. no treatment? Opt for no TX
12/8/2016
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© 2015 Align Technology, Inc. All rights reserved.
Invisalign Therapy
© 2015 Align Technology, Inc. All rights reserved.
Invisalign vs. Braces
Rossini G, Parrini S, Castroflorio T, Deregibus A, Debernardi C. Periodontal health during clear aligners treatment:
a systematic review. The European Journal of Orthodontics. 2015;37(4):345-353.
vs
• Oral Hygiene compromised
• High risk for enamel decalcification
• Must avoid certain foods
• Less esthetic: wires/brackets
• Enhanced periodontal health1
• Less risk for enamel de-calcification
• No food restrictions
• Esthetic clear advantage: No wires
• Less time in dental chair
BRACESINVISALIGN CLEAR ALIGNERS
• Emergency appointments
/ broken brackets
© 2015 Align Technology, Inc. All rights reserved.
Not One Case of Root Resorption
in Over 3M Cases!
12/8/2016
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© 2015 Align Technology, Inc. All rights reserved.
Caries ExamOral Cancer
Screening
Periodontal
Assessment
Hygienists “Duties”
© 2015 Align Technology, Inc. All rights reserved.
Who Is Doing the Ortho Exam? In Many Offices, No One!
• Doctor is focused on esthetics
and restorative
• Hygienist who focuses on
optimum oral health
• Ortho exam should be a
routine part of the hygiene exam
© 2015 Align Technology, Inc. All rights reserved.
CLOSE!
One Second Ortho Exam
12/8/2016
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© 2015 Align Technology, Inc. All rights reserved.
Evaluating Lingual Inclination
© 2015 Align Technology, Inc. All rights reserved.
Easy Way to Visualize Lingual Inclination
12
6
39
1
2
4
5
11
7
8
1030°
© 2015 Align Technology, Inc. All rights reserved.
12/8/2016
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© 2015 Align Technology, Inc. All rights reserved.
Top Five Clues to Disclose Malocclusion (CLAWS)
clefting/Recession
lingual Inclination
abfractions
wearing (night guard candidates)
shifting (slipped the contact)
C
L
A
W
S
© 2015 Align Technology, Inc. All rights reserved.
Barry: Slip the Contact
BEFORE
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Case Selection…Who Qualifies?
• Crowding
• Spacing
• Ortho relapse
• Anterior cross-bite
• Deep Bite (over-bite)
• Narrow Arches (Lingual Inclination)
12/8/2016
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© 2015 Align Technology, Inc. All rights reserved.
Pre Restorative Ortho
Combo case with Invisalign and
veneers with post-op profile shift
Combo case with Invisalign
opportunity for full mouth TX
Pre Profile Shift
Pre Profile Shift
and Veneers
© 2015 Align Technology, Inc. All rights reserved.
The orthodontic
conversation Getting patients to Value
tooth alignment
© 2015 Align Technology, Inc. All rights reserved.
1. They Don’t Feel a Connection
2. They Don’t Understand the Value of the Dentistry
3. You Don’t Listen
4. You Don’t Have a Treatment Coordinator
5. You Rarely Follow Up
6. You Don’t Offer Financing
6 Reasons Dental Patients Say “No” to Treatment
McKenzie, Sally. "6 Reasons Dental Patients Say No to Treatment, and How You Can Change That." Dentistry IQ.
Dentistry IQ, 30 Apr. 2015. Web. <http://www.dentistryiq.com/articles/2015/05/6-reasons-dental-patients-say-no-to-
treatment.html>.
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© 2015 Align Technology, Inc. All rights reserved.
The Orthodontic Conversation in the Hygiene Chair
COST
VALUE
Goal: Patients to Understand the VALUE of Tooth Alignment
© 2015 Align Technology, Inc. All rights reserved.
• Do not offer solutions before discussing problems
• What “not” to say:
– “Have you considered straightening your teeth?
– “Your teeth are crowded, does this bother you?”
“Show and Tell” — “Bib On” and “Bib Off” Conversations
© 2015 Align Technology, Inc. All rights reserved.
“Bib On” Conversations
12/8/2016
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© 2015 Align Technology, Inc. All rights reserved.
“ING” Conversation Starters: This Concerns Me Because…
© 2015 Align Technology, Inc. All rights reserved.
“ING” Conversation Starters: This Concerns Me Because…
• Your gums are receding
• Your teeth are chipping
• The enamel is thinning
• Your teeth are shifting
• Your teeth are wearing
• How is Dr. _____ going to fix this in 10, 20 years?
• “Your teeth are colliding rather than sliding”
“Show and Tell”
INGRecedChippThinnShiftWearSlid
© 2015 Align Technology, Inc. All rights reserved.
Solve Instead of Sell
• Clear Aligner Therapy
• Shifting or crowding
• Align
• “No such thing as
“crooked teeth”
• Ortho / Braces
• Crowded
• Straighten
• Crooked
REPLACE WITH6 WORDS NOT TO USE
• “Teeth out of trauma”(solution)• Invisalign
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© 2015 Align Technology, Inc. All rights reserved.
“Bib On” Conversations:
A Review Goal: Create Patient Value
1. My concern is, If you do not take your teeth out of trauma “something’s gotta give” (law of physics) = destruction of hard tissue/soft tissue. Use “ING” words resulting in fractured
teeth, loss of tooth support, etc.
2. “We really need to consider taking your teeth
out of trauma”
3. Pause: Patient will usually inquire “how do we do that?” … “Do you mean braces?”
4. Offer vehicle of solution: “No, you do not need braces, we use a modern approach; clear aligner therapy” You may have heard of… INVISALIGN
5. NOW IS TIME FOR BIB OFF AND IT’S ALL ABOUT INVISALIGN THERAPY!!
© 2015 Align Technology, Inc. All rights reserved.
“Bib Off”
Conversation
© 2015 Align Technology, Inc. All rights reserved.
“Bib Off” Conversations: Hygiene Invisalign Education
Goal: Patient Consult (5–10 minutes chair time)
• “You may have heard of Invisalign”: Now “bib off” “Let me show you”…
• Sample aligners Typodont in operatory
• Straight talk brochure as chair side tool
• Review Patient Case Portfolio/Gallery: Show Evin
• Explain how clear aligner therapy works: play movie of ClinCheck
• Review Patient intra-extra oral photos/mirror Play Straight Talk Video
• Review findings from Straight Talk Brochure with doctor in front of patient
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© 2015 Align Technology, Inc. All rights reserved.
Teeth Don’t Age, They Wear
• “Anti-Aging Strategies”
• Roman time skull
• “Real Age” 200–400 AD
• “Do you want to keep your teeth for a lifetime”?
• “Teeth that fit together properly, last longer”
© 2015 Align Technology, Inc. All rights reserved.
Malpositioned
teeth causing
malocclusion
PROVIDE SOLUTION
Take your teeth
out of trauma
SHOW AND TELL
CONSEQUENCE
“ING” Words
Chipping, receding, shifting
Hard and soft tissue damage
Tooth loss and costly dentistry:
surgery, implants
PCS: Problem, Consequence, Solution
IDENTIFY PROBLEM
© 2015 Align Technology, Inc. All rights reserved.
Communication Flow: Use Straight Talk Brochure
Teamwork Team Communication
5x Trust Transfer
1. Hygienist to Patient
2. Hygienist to Doctor
3. Doctor to Patient
4. Hygienist to Office Manager
5. Office Manager to Patient
Teamwork Team Communication
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© 2015 Align Technology, Inc. All rights reserved.
Recipe for Invisalign Success Pathway
Patient Value from Hyg Chair“ING’s”PCS ModelBib On
5–10 Minute Hygiene Invisalign Education“Evan” Bib Off
Dr. Exam Confirms RDH Examand PCS Model
TC/OM Sets up Consult GathersInsuranceBenefits Info
Complimentary Consult Dr. and TC/OMPictures/ScanNo Impression$ before Recordsor sending scan
© 2015 Align Technology, Inc. All rights reserved.
When to Refer to Orthodontist
• Class II or Class III A/P Correction (Teen)
• Pre-Teen Mixed Dentition
• Are Auxiliaries Required?
• What is GP comfort level?
• Consider networking with Orthodontists
© 2015 Align Technology, Inc. All rights reserved.
What if a Patient is Periodontally Compromised?
Courtesy of Ben Miraglia, DDS
12/8/2016
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© 2015 Align Technology, Inc. All rights reserved.
Hygienists and Ortho Are Integral to Comprehensive Care!
• Be proactive! Is this condition related to malocclusion?
• Offer patients long term solutions that are
non-invasive; Treat problems not symptoms
• Patients trust RDH’s to give them proper guidance
© 2015 Align Technology, Inc. All rights reserved.
How Could This Have Been Prevented?
© 2015 Align Technology, Inc. All rights reserved.
Invisalign As an Oral Health Solution?
Scientific Evidence + Clinical Expertise=
Evidence Based Dentistry
• Does this make sense?
• Will my patients benefit?
• Is it minimally invasive?
• Pros vs. cons?
• Do my patients deserve options?
12/8/2016
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© 2015 Align Technology, Inc. All rights reserved.
Dental Economics: May 2015 Edition
http://www.dentaleconomics.com/articles/print/volume-105/issue-5/science-tech/invisalign-in-the-ppo-general-practice.html
• Dr. Miguel Casanas went from 0–65 cases
in 9 months
• Hygienists are integral component to
patient education!
• Patients “Happy and Healthy”
• More Referrals
• More productive hygiene schedule with
longer hygiene appointment times
© 2015 Align Technology, Inc. All rights reserved.
FACT
MYTH
Recession Caused by Tooth Brush Abrasion...Really?
© 2015 Align Technology, Inc. All rights reserved.
Monday Morning Action Items
• Use the conversation starters, Try an “ING” or two!
• Avoid the “6 words”
• Use the intra-oral camera on each patient. ( focus on recession, abfractions, excessive wear)
• Schedule appointment with Territory Manager to assist in setting up operatory /tools/role play