This patient just got his braces put on along with an expansion device in the roof of his mouth

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Noel Mitchell
6 years ago
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1 Czajka 1 Dr. Cline Date: 3/16/2015 Time at Office: 9:30 11:30 Number of Patients: 5 Patient 1 (images 1 3): This patient just got his braces put on along with an expansion device in the roof of his mouth before I arrived. The expansion device is being used to expand his upper teeth so that they overlap the lower. The DA uses a Hollowback Mathieu Needle Holder (image 4) to place thin wires, steel tall wires (image 5), that tightly attach the bracket and the micah wires; the overarching wire, that covers all brackets. Next, rubber o bands (image 6) are placed on each bracket and over the micah wire, to hold the micah wire to the brackets. The o bands aid in moving the teeth by attaching the micah wires to the brackets. Now, the patient is holding the mirror, looking at his teeth as the DA explains information about his braces. The DA places o bands over the brackets, even though there is no micah wire over the brackets due to the expansion appliance; the brackets might feel rough without the rubber o bands. Also, the DA explains to the patients mother that she will need to turn the expansion appliance once a day. Next, she explains how to floss between the teeth and under the micah wires by using a special thread floss. At the end of the patients visit, the patient is given wax to place over the brackets so that they will not cut the gums. During this visit, I was not able to observe what Dr. Cline s role was in putting the braces and expansion appliance in. However, I was able to watch the DA when she was placing the steel

2 Czajka 2 tall wires, micah wires, and o bands on the brackets. With the unfamiliarity I had with the expansion appliance, I asked the DA what the use of it was and was told it helped achieve Dr. Cline s goal; expand the upper teeth, while aligning the lower. The o bands that were placed on the brackets with no steel tall wires were to insure that the patient was comfortable and had no protruding sharp edges that could puncture his cheek. Patient 2: The DA begins to pop some of the lower brackets off and after the molar bands are removed, the micah wire is taken out with the attached brackets. Next, she removes all of the brackets from the top and when the molar bands are removed, she again removes the micah wire with the attached brackets (image 1). Bottom Teeth 3 3 (image 2) still have their brackets on them while all other teeth have them off. The patient will come back tomorrow to have these brackets taken off and a permanent retainer put in behind the teeth. Dr. Cline doesn t like to take the brackets off if the retainer isn t ready. The DA scrapes the patient s teeth free of any plaque or glue build up using the adhesive removing pliers (image 3) and then the patient goes to brush. When the patient returns, Dr. Cline sits in the chair and uses an explorer to remove extra plaque in between the teeth that could have popped out from under the brackets. Now he uses the fast drill to smooth the fronts of the teeth. During this process, the drill on bone smells very dry and the patient bleeds a little bit when Dr. Cline knicks the gum. The last thing done is a upper impression by the DA and takes approximately seconds. The DA had to use the adhesive removing pliers to add enough force to remove the brackets from the patient s teeth. After all brackets on the top were removed, the arching micah wire was removed, bringing along all of its attached brackets. I am interested in seeing how the

3 Czajka 3 permanent retainer gets put in and who is in charge of what steps during the procedure. Dr. Cline used a fast drill that was similar to the one that Dr. Czarsty and Dr. Meyer used, however, he was not drilling, but smoothing off the fronts of the teeth. The DA took an upper impression at the end for a plastic retainer the patient will receive tomorrow. Patient 3: The DA removes the spacers (image 1) that were in between four of the patient s bottom teeth. The spacers were put in to create a space in between the teeth and to keep that space, Dr. Cline places a lower lingual arch (image 2). To place the molar rings around the patient s molars, Dr. Cline has the patient bite down on a Molar Band Seater (image 3), a plastic tool with one side that has a metal piece. When the force that is applied from the patients bite pushes on the plastic end of the tool, it in turn relays the force onto the metal side which then pushes the molar band down around the molar. Dr. Cline removes the lower lingual arch and bends it using a tweed arch forming plier (image 4) to fit it better to the patient s mouth. After placing it back around the molars, it still does not fit correctly, so he removes it and bends it once more. Using the Molar Band Seater, Dr. Cline places the piece back inside the patient s mouth and it fits properly. After getting it to fit correctly, he removes it and air dries the two molars in preparation for the permanently placing the lower lingual arch with glue. Once more, Dr. Cline uses the Molar Band Seater to place the arch and uses a cotton gauze to wipe away any excess glue from around the molar rings. Dr. Cline hardens the glue using a blue curing light (image 5) that looks very similar to the ultraviolet rays that Dr. Meyer used. Dr. Cline tells the patient to push up on the wire every few days to insure that it hasn t become loose. The DA then explains how to use wax for the rough, metal edges on the outsides of the molar

4 Czajka 4 bands. The wax will help prevent the molar bands in getting caught on the patient s cheek. The patient is scheduled to come back in 3 months. The orthodontic process of getting a patient s teeth in order and straight can be a long process. Every patient will require different mechanisms to be used over different periods of time, all depending on how fast their teeth align. This patient needed space for the molar bands so Dr. Cline had previously placed rubber spacers on the mesial side of the molars. He utilizes another unique piece of equipment today, lower lingual arch, to keep creating space in preparation for braces. Unlike general and pediatric dental procedures, orthodontics utilized the patient when using the molar band seater. Patient 4: The patient is given a plastic retainer and a case. This patient recently got their braces off and came to get their plastic top retainer that will keep the teeth from moving out of place. Patient 5: The patient currently has a retainer but has been grinding through the previous ones. Appointment was scheduled today to see if the grinding has decreased or if she will need a new retainer. The patient s year old retainer has held up with old minor grinding points. Dr. Cline suggests making a rubber one that will be thicker, lasting longer but the patient does not want to change. She tells Dr. Cline that she has been focusing on reducing her grinding. She also never wanted a lower permanent retainer, so she has both a top and bottom retainer. Dr.

5 Czajka 5 Cline tells the patient to continue using the current retainers and that he will see her back at Christmas to see if the retainers are still usable. Dr. Cline s job is to prepare the teeth for braces and put the braces on, making adjustments every now and then. Here we have the follow up to his job as an orthodontist, making sure the teeth stay straight. With the help of retainers, whether plastic or permanent, Dr. Cline is able to keep his patients teeth straight. He sees these patients once a year normally unless the patient has an issue such as grinding that might prevent the retainer from serving it s purpose.

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