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This appointment comes after the patient has already had a pano repo, typically the appointment following the pano repo.
1. After the patient has been seated, untie the upper and lower arch wires. Remove any power chain or clear threads. You do not need to remove metal wire untie, unless there is space that needs to be closed. If you see the space you may remove any wire tie you think necessary.
2. Before the patient goes to brush, take the small mirror and check for any spacing, especially between the molars. Proceed to check the bite. Confirm if the patient has been wearing the rubber bands and what formation. Observe and see what you think?? Do you see a change in the bite? Has the patient not been wearing rubber bands? Is there a different rubber band formation that you would propose to the doctor when he comes to take a look??
3. After you had written things from step 2 down, then take the large mirror and observe..... Check the teeth we repositioned at the pano repo. Are they still not in the most ideal position? Is there any rotations? How does smile arch look? Do any of the anterior teeth need torque? What does the teeth heights look like? Make sure none of the teeth need to be repositioned before placing the SS wires.
4. After you have written down what you observed from step 3, take both 16x25 SS wires and cut them as needed. Rest each wire separately in the patients mouth laying in the brackets (no need to close the doors) and with a sharpie, mark the wire in between each tooth all the way distal to the 5's. Do this for the upper and lower wires so that when the doctor comes to the chair the wires are ready to be adjusted if needed.
***The wires are not always adjusted when they are initially placed, but always have them both marked just in case***
5. You may now let the patient go brush and floss before the doctor comes to take a look.
6. While the patient is brushing, make sure the station is ready for the doctor. Have the initial photos up on the screen so the doctor can easily see the patients name (and the parents names). Make sure you have the large and small mirrors, with a torquing plier set.
Key #1: Round the Wires: Before placing the wires, make sure they are cut and then taking a round football bur, round the ends of the wire. Go in a circular motion around the last millimeter of the wire making it round. This helps the wire slide through the molar tubes more easily (especially the 19x25SS).
Key #1: Round the Wires: Before placing the wires, make sure they are cut and then taking a round football bur, round the ends of the wire. Go in a circular motion around the last millimeter of the wire making it round. This helps the wire slide through the molar tubes more easily (especially the 19x25SS).
7. When the doctor comes to the chair, hand him the large mirror, with the small mirror in hand ready if needed. Inform the doctor of what the appointment is scheduled for today, how long the patient has been in treatment, etc. Discuss with the doctor what you see. If the doctor confirms to place SS today, he will want the upper SS to broaden out. If no adjustments are being made, then hand the doctor the small mirror to confirm rubber bands. Make sure you have confirmed everything before the doctor leaves the chair so he doesn't have to come back.
8. Before placing the wires, make sure that there is wire tie 3-3 or power-chain, or any other auxiliaries that will be placed below the wire. Place the upper and lower SS wires.
9. Key #2: Once wires are secure and all the doors are closed, since it is the first time placing SS wires, crimp hooks on all quadrants in between the 2's and 3's. Make sure they are crimped on tight! Use the hook crimping plier to lightly crimp the hook on first, closer to the 2 bracket (distally). Then, using the ligature cutter, squeeze on either side of the hook to tighten. You want to make sure that you do not squeeze to tightly because you can torque the wire and distort it, which WILL affect the teeth!!
9. Key #2: Once wires are secure and all the doors are closed, since it is the first time placing SS wires, crimp hooks on all quadrants in between the 2's and 3's. Make sure they are crimped on tight! Use the hook crimping plier to lightly crimp the hook on first, closer to the 2 bracket (distally). Then, using the ligature cutter, squeeze on either side of the hook to tighten. You want to make sure that you do not squeeze to tightly because you can torque the wire and distort it, which WILL affect the teeth!!
10. Key #3: Place k-ties from the hook on the wire to the first molars on all quadrants. If there is power-chain 6-6, k-ties are not needed. The k-tie is place by grabbing one end of the k-tie with a mathieu. Place the end that you did not grab around the hook on the 6 molar bracket. Then pull the tie underneath/incisal of the 4 and 5. Then finish the k-tie by connecting it to the hook that was crimped on in between the 2-3 on the wire! You never want to place the k-tie on a drop in hook, always a hook attached to the wire.
10. Key #3: Place k-ties from the hook on the wire to the first molars on all quadrants. If there is power-chain 6-6, k-ties are not needed. The k-tie is place by grabbing one end of the k-tie with a mathieu. Place the end that you did not grab around the hook on the 6 molar bracket. Then pull the tie underneath/incisal of the 4 and 5. Then finish the k-tie by connecting it to the hook that was crimped on in between the 2-3 on the wire! You never want to place the k-tie on a drop in hook, always a hook attached to the wire.
**The k-tie can be placed starting at the 7 if the patient has a slight space or feels the contact is loose, but you want to slightly stretch it before placing it.
11. Make sure any other hooks that are necessary for rubber bands are placed if needed. Go over any rubber band instructions.
12. Most patients will ask around this time how much longer they have in treatment. Once the final wires are placed, to get the proper arch width they will be in for 4-6 months IF the patient is compliant with all rubber bands. The patient will be seen every 4 weeks (unless specified sooner by the Doctor) until finished with treatment.
*** IF the schedule gets booked fast, you can always schedule the patient out for the next couple of months since you know they should be seen every 4 weeks, and so the patient can get the appointment time they would like***
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