Simple Adjustments(.014-.018's)

1. Once the patient is seated remove all archwires. Now take a look in their mouth and assess everything. Make sure all of their brackets on still on. Take a look and see if any new teeth have grown in. Have their 7’s grown in yet? Check their bite to see if they could benefit from starting elastics. If they were already given elastics at their initial bonding appointment, check to see how well they have been wearing them. Also assess their hygiene. See if they are missing any areas when brushing. (if so, show them the areas before they go brush and floss without their wires in)

2. Now that you have the wires out and you have assessed everything, before you let the patient go brush and floss, take a look and see what you recommend for advancing treatment for this appointment. If the 7’s have grown in, prophy paste and prep them. If that is not needed, then you will check the flow of the clinic and the grid. See where Dr will be. If he is about to go into an exam or about to sit down and do a full bonding, maybe have the doctor come over now for a check out rather than waiting until the patient brushes and floss. (if the patients hygiene is terrible, please no matter what have them brush first because Dr will not be thrilled to check everything if it is hard to see due to food and plaque). If Dr comes to the chair first, before pt brushes that is fine. But as an assistant it is your job to introduce the patient to the Dr. and introduce the parent or friend that came back with them to the clinic. Here is an example of what you would say:

“Dr, we have the handsome Johnny and his lovely mom, Ashley here today.” Dr will say hello, etc. “ This is Johnny’s first visit back from getting his braces on and we are ready to move to a 14x25CuTi today. I checked his bite and he is slightly class II on the right and class I on the left so I was thinking about starting cl II elastics on the R with fox today.” Dr says,” Megan that is a fantastic idea, exactly what I was thinking!” Dr then says his goodbyes to the patient and mom and says,” Alright johnny we will see you at your next appointment!- moves on to the next chair.

3. Now there are two ways to know what wire to place today! If they started in an 014 for 10 weeks and there isn’t much crowding today, place 14x25CuTi U/L. If there isn’t much crowding in the upper, but the lower still has some crowding, place 14x25CuTi U and 018 in the lower. What you never want to do is advance the lower further than the upper*** So if the upper has more rotation than the lower, you will place 018’s U/L.

4. If you place 14x25CuTi U/L and there is no rotations, you will steel tie U3-3 and L 3-3 UNDER the wire! There will never be a situation where you place anything on top of the wire, that's the beauty of the Damon system.

14x25CuTi U/L with steel ties U/L 3-3 pt will be seen back in 8-10 weeks

018 U/L NO STEEL TIES patient will be seen back in 6 weeks

These appointment time frames are protocol and there is usually nothing that will alter that. The only reason we would see someone back in 6 weeks after placing a 14x25CuTi after the second visit instead of going the full 8-10 weeks would be because of open coil spring (OCS). Please check with your clinical lead if you are unsure.