Presentation Summary Use polishing discs with a slow speed to polish the teeth, if need be. Be an ortho-dentist. Don't be afraid to restore incisal edges with composite. Phase 2 non-extraction: Hawleys Phase 2 extraction: Wraparound with loop distal to the extraction spaces Troubleshooting: You have to know where the trouble spots are and remove them. For the lower Hawley, it is on the lingual (inside of posterior region). 3-D printing changes protocol: Have retainers ready prior to debonding. Give the printed model to the patient; parents will be very appreciative. Essix retainers to second molars: critical in Class III camouflage. You have to incorporate second molars or you will have super-eruption of second molars and bite opening. Bonded Retainers Stainless steel Ortho-FlexTech Two-step double-etch: 1. Etch the lingual / palatal and then have the patient get up and rinse his/her mouth. 2. Have the patient sit back in the chair and dry the teeth. This prevents the patient from tasting the etch and salivating too much. 3. Measure the retainer on the outside: measure to the embrasure between lateral and canine. 4. Use L-pop under and then over the retainer, because it etches the teeth again. 5. Use flowable to bond the retainer. 6. Use a thin diamond burn going behind the retainer to make sure the patient can floss in between the teeth. Measuring the retainer on the outside from the embrasure of the canine-lateral incisor on one side to the other will give you the size you need on the lingual. Use the flat bur to shave the marginal ridges in order to better adapt the fixed retainers. Winter 2017 PCSO Bulletin Clinical Staff Use double-bonded lingual retainers for teeth that had severe rotation: two stands of OrthoFlexTech with an overlay Essix retainer. MEMOTAIN retainers: CAD / CAM memory nickel-titanium retainer. Give the patient a little bit more overbite and it is very precise. AOA makes them for about a $100 per retainer. Also used for holding extraction spaces in adults. NiTi-active bonded retainer: Used for relapsed patients. Bond it and take it off after correction of relapse, and bond a permanent retainer. Typically works in seven days. Submerged deciduous molar: Bond composite on the occlusal / buccal of the lower second premolar and create a second premolar cusp. Retainer Protocol Debond and Essix: Full-time wear for three months (final records). First prophylaxis after three months (to allow gingival inflammation to go down). Virtually everyone gets bonded retainers. No charge for replacement Essix. Extraction space retention protocol: Fixed retention on both sides of the edentulous space. For multiple missing teeth, use a banded retainer with pontics; then, bond fixed retainers as well. In-office flipper: Use temporary bridge material (Structure II by VOCO) for the temporary pontic to stay in the Essix retainer and cure it on the mouth. Fixed pontic retainer: Bond your pontic and then place a permanent fixed retainer that covers the pontic as well (takes about 10 minutes). Have fun! If a kid does not like his/her retainers, give him/her another retainer. Dr. Kravitz says to remember we are treating patients, not teeth. 55