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1. Before bringing the patient back to the clinic, make sure the most current x-ray is loaded in TxStudio at your station. You should have gone over the procedure and x-ray prier with the doctor and discussed the expected tooth location and most efficient game plan. Make sure you know if the tooth is palatal, lingual, facial, etc.
2. Prepare your station for everything that you might need
Laser Checklist
Place new laser tip and make sure it is scored correctly
Have foot pedal in ideal place for the Doctors accessibility
Protective eye wear
Articulating paper
Station Checklist
Instruments - Door opener, Weingart, Mathieu, Distal End Cutter
Cheek retractors
Numbing Gel
Lidocaine in Syringe (Just in case/set aside)
Cotton tip applicators
Surgical Suction
Large/Small mirrors x2 (one for Doctor one for Assistant to retract if needed)
Bite block - If the tooth being exposed is on the lower arch
Small Cup with 2-4 mm of water in the bottom and 10 micro-brushes. Place them on the tray so they are easily accessible for you as an assistant.
Bonding Supplies - L-pop, air/water syringe, both suctions, bracket position/holder. Make sure you are prepared for multiple scenarios. Prier to the procedure, discussing it with the doctor can help you better prepare if you will be bracketing the tooth, Kaplan hook, button, etc.
If you have all of these things you are ready to ROCK AND ROLL! It is better to be over prepared than unprepared.
3. Going to get your patient. Approach the patient by name and greet them. Walk them back to the clinic and get them seated. Make sure they are comfortable, blanket, etc. Ease as much stress or concern as you can, and explain the process so there are no surprises.
4. Lay the patient back and remove any Arch wires, wire ties, power-chain, etc.
5. Place cheek retractors (no driangles are needed). Have the pt bite on the small suction during this process. Before placing the gel make sure that it is ideal timing to start your procedure with Dr. time and the schedule.
6. Use air syringe to dry the tissue and apply numbing gel in designated area. Let the topical gel sit for five minutes. While it is sitting, make sure the gel is staying in designated area and not traveling to other parts of the mouth (tongue, throat, etc. It will make the patient uncomfortable). After it has been five minutes, using the surgical suction, remove the topical gel.
**If the tooth is palatal, use the numbing gel where the injection will be given so it eases the discomfort of the injection.
7. Once the topical gel is removed you may remove the cheek retractors and make the patient comfortable. Continue to let the gel absorb for 5-10 minutes. During this time make sure the patient does not drink any water or rinse unless it is absolutely necessary.
8. After it has been 5-10 minutes since the gel was removed you are now ready for the doctor to come over. Make sure you have gloves and a mask ready for the doctor. The doctor will sit at the head of the chair and the you (the assistant) will have the surgical suction at hand on the left side of the patient, or wherever the doctor specifies for convenience (If more anesthetic is going to be given have it ready for him at this time).
9. Before the procedure begins, make sure the pt has protective eye wear and any others within the area. Let the pt know that they should not feel anything, but if they start to feel something past tolerance to raise their hand and the procedure will stop and more anesthetic can be given (have the lidocaine syringe ready).
10. When the procedure begins, the assistant will follow behind the laser with the surgical suction. Lightly hover the gum tissue, catching any smoke, smells, etc. THIS IS YOUR NUMBER ONE JOB!! Also be aware of the area and use the wet micro-brushes as needed to clean up or be ready to hand the doctor one when asked for.
11. Once the tooth is exposed be ready to bond. Have the L-pop, air water syringe, bracket (or whatever will be attached at this time) ready for the doctor. Once the bracket is in position make sure it gets a full 10 seconds of curing. The doctor and assistant will bond the tooth together, but the tooth will be dried, then L-pop for 8 seconds, dried one final time and then the bracket will be placed.
12. Place .014 wire on the upper 6-6 or lower 5-5, unless specified otherwise by the Doctor, engaging the exposed tooth. Ensure that the end of the wire is secure and not going to cause discomfort. Add glue stop distal to the end of both sides or make sure the wire is cinched so there is no chance of it poking with the movement of the new teeth coming into position (there can be a lot of movement).
13. When the patient is tied in, make sure to take after photos and go over all oral hygiene care and instructions. Instruct the patient to keep the area clean and give Chlorhexidine mouth rinse if needed. It will take up to 5-7 days for the tissue discoloration, pain, etc. to go away but some patients it can be up to 14 days. Since the tooth is coming into place, let the patient and patients parents know that as the tooth comes down there can be excess wire.
14. Schedule the patient to come back for there next adjustment in 6-8 weeks. At that next appointment we will be repositioning the exposed tooth to continue to bring it into the correct position.
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