Preparation For Appliance Removal The Final Adjustment Appointment

Before making arrangements for appliance removal, it is necessary to ensure that treatment has been completed. All the recommended checks in finishing and detailing (Ch. 10, p. 279) should be carried out at the final adjustment appointment.

Spaces can sometimes appear late in the treatment. Tie wires or very light elastic chain (p. 286) should be placed at the final adjustment appointment to maintain tight tooth contacts. This will avoid patient disappointment, and ensure that the long appointment can be used for appliance removal, as planned. If ligature wires, instead of elastomeric modules, are used to attach the archwires at this final adjustment visit, bracket removal may be easier at the next appointment (p. 309).

The patient should be informed and reassured about procedures at the forthcoming appliance removal appointment. Because it will be a long procedure, with laboratory time involved, they should be asked to try not to re-schedule it. The patient should also be asked to arrange to see the family dentist for a routine check-up, but not until at least 4 to 6 weeks after removal of the fixed appliance. This will allow settling and gingival improvement.

It is necessary to take an impression of the lower anterior teeth at this appointment, to allow laboratory preparation of the multistrand wire. If there are deposits on the lingual aspects of the lower incisors, it is correct to carry out thorough cleaning and polishing at this appointment. This gives a more accurate laboratory model. Also, at the subsequent appliance removal appointment, this will reduce the amount of cleaning needed, and hence the amount of oozing.

In a few cases, for a variety of reasons, the orthodontist may agree to removal of appliances before completion of tooth movements. Such cases may have a greater tendency for relapse, and many orthodontists ask the patient to sign a release statement, acknowledging early appliance removal. This confirms that the patient has been informed that the treatment has not been completed, and that further improvement could be achieved.

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