This is an exciting appointment!! They are scheduled to get their braces off, so make sure when you greet the patient in the waiting room you make it very exciting!!

1. Once the patient is seated in the clinic, make sure there are no spaces between the 6’s and 7’s or anywhere else (If all assistants have been checking at each adjustment appointment, there should be absolutely no spaces anywhere).

2. Next, take a look at the previous chart notes. Make sure whatever teeth the doctor adjusted last visit are in the correct position. Once you have assessed everything, Dr Frost will come over and confirm patient is ready for debond. If there is a tooth that you see that is out of position slightly, remove the wire before dr frost comes to the chair so he can make a slight bend and let that bend sit for a few minutes so we can still remove all the brackets today.

If everything looks good, you will follow these steps.

3. Micro etch the back of U 2-2 and L3-3 to remove any plaque or film so we can bond the permanent retainers to a clean surface. Once you have micro etched thoroughly, have the patient go rinse out at the brushing station WITH WATER ONLY!

4. Use a piece of articulating paper to check the patient occlusion. If pt has a deep bite, you are going to have to be super meticulous when bonding this permanent retainer to ensure pt will not be biting on it. If you have to sculpt retainer very close to gum line, use Bond a braid instead of Retainium. These next few steps explaining how to bond the upper retainer is the way you will bond it every time. Some assistants from previous ortho offices were trained to bond and U perm with floss and Dr Frost does not want anyone doing it this way. So keep an open mind. After a few times of doing it Dr Frost’s way, it is super easy and you will love it!

5. Cut a piece of retainium (or bond a braid) about a half an inch longer than you will need and end the end so that when the wire is held straight it is bent at a 45 degree angle. After teeth are prepped, start on the upper right lateral and with the bent end angled up towards the gum tissue, use the handle end of the cotton pliers to burnish the wire against the lateral and apply a small amount of adhesive (use a micro brush that is slightly wet with ortho solo to successfully flow the adhesive onto the tooth). When smoothing the adhesive over the wire, make sure you keep the adhesive away from the gum tissue and the incisal edge. Make sure adhesive is flat and not a mound or bubble. After the wire is bonded to the UR2, you will move onto the UR1 and follow those same steps listed above. Before you bond to the UL2, you will use a ligature cutter and trim off whatever is necessary to match the length of what we started with on the UR2. Once the wire is trimmed, you will use the flat end of the cotton pliers to push the wire flush up against tooth. Once wire is flush, you will use the other end of the cotton pliers to push (gently) the wire so it will be angled 45 degrees like the UR2. Once it is bent and flush, you can add adhesive. *****Once the permanent retainer is bonded, check bite to make sure pt is not hitting on it anywhere

4. Once the upper perm is bonded, you can remove all brackets. Please have the patient bite down on a cotton roll while you are removing their brackets. This helps immensely with the discomfort of removing a bracket. Once the brackets are off, you are ready to bond your lower permanent retainer. If you are worried about spaces on the lower, you can always bond the L permanent retainer first before removing all the brackets (thats why I always bond the U perm first before removing brackets).

5. Prep the lingual surface of the L3’s (or of L3-3 if you are needing to bond to every tooth). The lower permanent retainer is pre made from check debond appointment by the lab with an .022 SS wire. Once the teeth are prepped you WILL use floss to help bond and hold retainer in place.

6. Create a loop with the floss and place the floss (with the loop towards the tongue) in between the lower laterals and cuspid leaving a half inch of the loop to work with. Place one more piece of floss in between lower centrals. Use the cotton pliers to thread the retainer in the floss and, once in place, pull the floss to hold the retainer in place. Use a micro brush moistened with ortho solo to smooth adhesive over wire, keeping away from the gum tissue and incisal edge but not creating a ledge or “bubble” with the adhesive.

Now there are two reason why you would bond the lower wire to every tooth. If they have super mobile teeth you will bond to every tooth. If they have severe crowding at the start of their treatment, then you will bond retainer to every tooth. If neither of these apply, then just bond wire at the cuspids.

7. Once the permanent retainers are bonded, you are ready for Dr Frost to smooth adhesive and polish/contour. Have all of the necessary burs ready (Flame diamond, polishing point, wheel diamond, football diamond-uses sometimes, and sand paper discs) Also have two wet cotton rolls near by for Dr to clean everything off with after he polishes.

8. You are ready to take all records and scan patient for their clear retainers. Photography in our office is a HUGE deal and until the Doctor has cleared you, photos will be taken by the trained records assistant. But don’t worry, you will get there, practice makes perfect! The records assistant will have a separate handout that goes into detail with each photo that we take. You will spend a few days shadowing her learning the steps and process with our records.

9. Last but not least, schedule your patient to come back in a few days to pick up their clear retainers! When they are delivered the records assistant will go over all care and instructions.