This is the most important appointment to master out of any of them. This appointment and the experience the patient receives will set the tone for their whole entire treatment. Whenever doing an initial bonding, the goal is to obviously prep well and make sure everything stays isolated, but more importantly make sure the patient is at ease and feels the most comfortable they possibly can. Always over explain each step you're doing, that way the patient knows what to expect and it will calm their nerves for the most part. The child knows they are getting an appliance but they will be very nervous for the process and the after care.

Before calling patient back, make sure you have all of the necessary supplies and instruments needed or this appointment. Also be sure all of your brackets are set up and the torques are correct. Most importantly make sure the appliance is in! Once that is all done, you may begin the appointment.

1. Call the patient back and escort them to the clinic. On the way back, introduce the brushing station so they know where they can rinse out throughout the appointment today.

2. Once seated go over how the appointment will go. 9 times out of 10 the patient is very anxious and doesn’t know what to expect. OVER explaining everything will ease the patients nerves and will give them a better experience.

3. Once you are ready to start the prepping process, take a look at the schedule and make sure it is a proper time to start prepping your patients teeth. Ideally you would want to bond brackets first, before placing the telescoping herbst, but If it is closer the 30min mark of the hour, it would be time efficient to start cementing the appliance and then prep the teeth when you know that doctor will be able to bond right away. (The treatment coordinator should get the doctor on the 30 min mark every hour and will be gone on average about 10 minutes for the exam). It is better to get something done than sit and wait, even if the appliance is only half cemented before you start prepping. Cementing a telescoping herbst and tying everything in can be time consuming, so make sure you are as efficient as you can through the entire appointment.

4. When you are officially ready to start the prepping process, lean the patient back and prophy paste the upper arch to ensure any plaque or leftover breakfast is removed ;) Please be sure to take a good 2 minutes scrubbing so we have a nice clean slate to bond a bracket to. Once the teeth are all scrubbed, walk patient to the brushing station and let them rinse with water. Make sure they rinse out a few times so all the paste is gone (they should NEVER rinse with mouthwash before prepping a tooth, the alcohol base in the mouthwash can effect the prepping process)

NOW YOU ARE READY TO START PREPPING!! WITH TELESCOPING HERBST'S ONLY THE UPPER ARCH WILL BE BRACKETED!!

5. No driangles are needed since the band of the herbst will go around the 6's and in most cases the 7's are not in yet, so they will get bonded when the herbst is removed. So, start the appointment by inserting the white cheek retractors (Use the red retractors only when absolutely necessary).

6. With any other bonding you will place a cotton roll underneath the tongue to help with isolation, but since the lower arch will not be bonded at this time, no cotton roll is needed.

7. Have the patient tilt their head to the right slightly and place in the suction on the right side of their mouth.

8. Thoroughly dry all teeth you are bonding. Once dry you can start etching. Grab a micro-brush and start on the UL5. Dabbing the etch (not scrubbing), make your way up to the UR51. While you are letting the etch sit for 30 seconds, grab 3 micro brushes that are dipped in ortho solo and set that on your tray right above the patient. That will be needed in a few minutes.

9. The rinsing process is the MOST IMPORTANT PART because if you are not careful, you can easily contaminate the teeth.

10. With the small suction still on the right side, you will get the high speed suction and place it on the left side of the patients mouth near the very back molars. Start rinsing the upper left segment up until the UR5. Each tooth should be rinsed for about 3 seconds.

11. Using both suctions, make sure no saliva flies up on any of the teeth and also collect any excess water that may be in the mouth from rinsing. Using an air suyringe, take a very close look and make sure every tooth is frosty and dry. If the are completely frosty, grab a micro brush that you wet with ortho solo earlier (see step 4)

12.Assure the whole upper segment 5-5.

14. Make sure the suction is back in on the right side and re-dry everything, ensuring that no ortho solo is left on any teeth.

15. Now you are ready for the doctor to come over and bond the brackets.

***If you are every worried a tooth was contaminated, keep an L-pop near you so you can use that if needed. My philosophy is better to be safe than sorry, you would hate for a patient to come back the next day to get a bracket rebonded!

16. After every bracket is on, go back through and cure each bracket for 5 seconds.

**WHEN CURING, PLACE LIGHT INCISAL OF THE BRACKET (like you are aiming underneath the bracket)***

17. Remove cheek retractors and driangles, and let the patient rinse out.

18. Now its time to cement the herbst.