Removing the Appliance:

1. Remove all wires, wire-ties, and un-screw the herbst arms and take them out. Once all of that is out and the arms are removed you are ready for the doctor.

2. Things you will need before the doctor comes to the chair to remove the appliance:

• 557 Bur (new)

• High speed suctions - large and small

• 2 small mirrors - one for the doctor and one for the assistant incase the tongue needs to be retracted.

• Herbst band remover

• Instrument cassette

2. Have the patient ready to go by placing protective eye wear on (from metal particles) and explain to the patient how the appointment is going to go. Let them know that the doctor will be coming over to slit the bands so the herbst comes off nice and easy and wont hurt. Explain to the patient that the bur may sound loud and screechy, but the doctor is only cutting the band and it is not harmful to them or their teeth.

3. When the doctor comes to the chair, hand him the high speed with the new 557 bur. Stand on the other side of the patient (opposite of the doctor) with the large suction. The assistants job is to follow closely catching as many of the metal shavings as you can. while the doctor is slitting the bands.

** Make sure to not get in the visual way of the doctor with the suction**

Once all bands are slit, you are the Dr will finish removing the rest of the bands with the band remover.

4. Clean off all of the adhesive from the bands around the molar teeth to make sure they are ready to be prepped and bracketed. Use the prophy paste and clean the molars and all lower teeth that will be bracketed. Let the patient go rinse and brush, making sure the metal particles and all paste is removed.

5. Before you start to prep the the molars (6's and 7's) and all lower teeth, take all photos and an x-ray. Upload them (or have the records assistant upload them) and set up your brackets. Be sure to confirm bracket torque with the Dr before setting up brackets.

6. Make sure to get all other instruments that will be needed to bond.

Once that is all done you are ready to prep and bond!!

After Bonding:

7. Place an .018 CuNiTi (no wire tie) in the upper 7-7 (or 6-6 if upper 7's are not in) and .014 CuNiti in the lower only placing it 5-5. You will start a shorty Cl II elastic, even though pt is in an underbite, to ensure their lower jaw does not relapse.

**Make sure to explain the importance of rubber bands now that the appliance is out to both patient and parents. Explain how the jaw will naturally want to go back to where it started and if rubber bands are not worn properly there could be a chance of putting the appliance back on or not finishing with ideal bite**

8. Make sure all questions and concerns are answered and schedule patient to come back in 6-8 weeks for their next adjustment (follow standard wire sequencing).