Dr. Brewster Procedures Updated 11/3/09 (Go to Table of Contents) Contents of Dr. Brewster’s Procedure Manual



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Dr. Brewster

Procedures
Updated 11/3/09

(Go to Table of Contents)

Contents of Dr. Brewster’s Procedure Manual



Crown and Bridge

  • Crown Preps and Bridges

  • Crown and Bridge Delivery

Dentures

  • Partial Denture Start

  • Full Denture Start

  • Denture Bite Register

  • Denture Wax Try-in

  • Denture Insert

Extraction

  • Extractions

Fillings & Restorative

  • Sealants

  • C- Seal

  • Composites

  • Amalgam

  • Zeza Splint

  • Post Build Ups

Root Canals (Endodontics)

  • O and D

  • Root Canal

Snap On Smile

  • Snap On Smile

  • Snap On Smile Insert




Orthodontics

  • Ortho Workup

  • Ortho Case Presentation

  • Bracket Start (insignia)

  • Bracket Adjustment (Damon)

  • Bracket Removal

  • Invisalign Workup

  • Invisalign Case Presentation

  • Invisalign Start

  • Invisalign Adjustment

  • Invisalign IPR




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Composites


2 surfaces

Needed: Basic set up, amalgam set up, syringe, plastic, Septocaine, Auto Mate, wedge, blue etch, Prime and Bond, Dyract flow, Esthetx, LED light, High speed hand piece, burs; 330, 33 ½, tapered two striper diamond, white stone, Cotton rolls and gauze, articulating paper.

Procedure: Update HH, take BP.

Anesthesia (by doctor or hygienist)

Prep tooth w/ 330 then 33 ½

Place automate and wedge

Etch for 10 secs,

Rinse and dry

Prime and Bond

Dyractflow and esthetx

Light cure 20 secs

Remove matrix

Polish w/ diamond and white stone

Check occlusion



3+ surfaces

Needed: Basic set up, amalgam set up, syringe, plastic, Septocaine, Auto Mate, wedge, blue etch, Green etch, Amalgabond, Esthetx, LED light, High speed hand piece, burs; 330, 33 ½, tapered two striper diamond, white stone, Cotton rolls and gauze, articulating paper.

Procedure: Update HH, take BP.

Anesthesia (by doctor or hygienist)

Prep tooth w/ 330 then 33 ½

Place automate and wedge

Blue and green Etch for 10 secs,

Rinse and dry

Amalgabond wetting agent and bond

Dyractflow and esthetx

Light cure 20 secs

Remove matrix

Polish w/ diamond and white stone

Check occlusion



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C-Seal

Needed: : Basic set up, plastic, blue etch, Prime and Bond, Dyract flow, Esthetx, LED light, Paper Pad, High speed hand piece, burs; 330, 33 ½, tapered two striper diamond, white stone, Cotton rolls and gauze, articulating paper.

Procedure: Update HH, take BP.

Prep tooth w/ 330 then 33 ½

Etch for 10 secs,

Rinse and dry

Prime and Bond

Dyractflow and esthetx

Light cure 20 secs

Polish white stone

Check occlusion


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Amalgam


-2 Surfaces

Needed: : Basic set up, amalgam set up, syringe, plastic, Amalgam Carrier, Septocaine, Auto Mate, wedge, Copalite, Amalgam, High speed hand piece, burs; 330, 33 ½, Cotton rolls and gauze, articulating paper.

Procedure: Update HH, Take BP

Anesthesia (given by Doctor or hygienist)

Prep tooth w/ 330 and 33 ½

Place Auto Mate and wedge

Copalite and Amalgam

Pack w/ plugger

Trim w/ plastic and explorer

Remove matrix and finish trimming

Check Occlusion


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3+ Surfaces

Needed: : Basic set up, amalgam set up, syringe, plastic, Amalgam Carrier, Septocaine, Auto Mate, wedge, Amalgambond, Amalgam, High speed hand piece, burs; 330, 33 ½, Cotton rolls and gauze, articulating paper.

Procedure: Update HH, Take BP

Anesthesia (given by Doctor or hygienist)

Prep tooth w/ 330 and 33 ½

Place Auto Mate and wedge

Amalgambond and Amalgam

Pack w/ plugger

Trim w/ plastic and explorer

Remove matrix and finish trimming

Check Occlusion.


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Crown Preps and Bridges



Needed: Basic set up, plastic or cord packer, syringe, Septocaine, blue mousse, Aquasil high and low, three triple trays, hemodent, ultrapak cord #0, dapen dish, mixing tips, small tips, Vita shade guide, Protemp garant, Cavitec, High seed, crown prep burs.

Procedure: Update HH, Take BP

Anesthesia (given by Doctor or hygienist)

Template w/ triple tray and blue mousse

Prep teeth or tooth

Place hemodent and cord.

Remove cord and take two final impressions w/ aquasil.

Make temp with blue mousse template and protemp

Trim temp crown

Seat with cavitec

Check occlusion

Send to cooks


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Crown and Bridge delivery



Needed: Basic set up, syringe, Septocaine, flecks or metabond, Crown removing pliers, spatula, glass slab, high speed,330, football diamond, articulating paper

Procedure: Update HH, Take BP

Anesthesia (given by Doctor or hygienist

Remove temp crown

Try in final crown for adj if needed

Used high speed 330, football for adj

Seat with flecks or metabond

Check bite final time.

Clean around crown


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Post and Build up



Needed: Basic set up, amalgam set up, syringe, plastic, Septocaine, Auto Mate, wedge, blue etch, Green etch, Amalgabond, Esthetx , LED light, High speed hand piece, burs; 330, 33 ½, tapered two striper diamond, white stone, Cotton rolls and gauze, articulating paper, slow speed, contra angle, post, post drills, metabond,

Procedure: Update HH, Take BP

Anesthesia (given by Doctor or hygienist

Prep tooth w/ 330 then 33 ½

Prep w/ slow speed and post drills

Micro etch post

Blue and green Etch for 10 secs,

Rinse and dry

Seat post w/ metabond

Trim excesses metabond

Place automate and wedge

Blue and green Etch for 10 secs,

Rinse and dry

Amalgabond wetting agent and bond

Dyractflow and esthetx

Light cure 20 secs

Remove matrix

Polish w/ diamond and white stone

Check occlusion

And possibly prep for crown
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O and D



Needed: Endo set up, syringe, septocaine, glass slab, PD4, slow speed, contra angle, high speed, 330, long endo diamond, O and D packet (#10-#20 file, broach, lenchalo), plastic, IRM for temp.

Procedure: Update HH, Take BP

Anesthesia (given by Doctor or hygienist

Prep tooth w/ 330 then long diamond

Use O and D packet to clean canal (note how many canals)

Mix ambrotose (1 scoop) and tetra liquid (1-2 drops)

Place mixture in canal with slow speed and lenchalo

Mix pulp dent powder( 2 scoops) and liquid(3 drops)

Mix with remaining ambrotose mixture

Place mixture in canal with slow speed and lenchalo

Seal with IRM for temp



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(Back to contents)
Root Canal

Needed: Endo set up, syringe, septocaine, slow speed, contra angle, high speed, 330, long endo diamond, Dr.B endo cart (set up motor and hand piece, files, smear clear, taper points, real seal primer and RC sealer, absorbent points, x fine and medium, apex locater) burn out instrument, torch, x-ray set up.

Procedure: Update HH, Take BP

Anesthesia (given by Doctor or hygienist

Prep tooth w/ 330 then long diamond

Endo motor and endo files from 45-25

Apex locater with #10 file

Irrigate with smear clear

Dry with absorbent points

Place real seal primer with absorbent point

Select taper point

Place real seal sealer with slow speed and lenchalo

Place taper point to length

Burn off excesses with burn out instrument and torch

Place extra rc sealer or IRM for temp

Take final pa



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Zeza splint

Needed: Basic set up, amalgam set up, syringe, plastic, Septocaine, wedge, blue etch, Green etch, Amalgabond, Esthetx, LED light, High speed hand piece, burs; 330, 33 ½, tapered two striper diamond, white stone, Cotton rolls and gauze, articulating paper, metabond, nickel titanium bar, epic or esthetx,

Procedure: Update HH, Take BP

Anesthesia (given by Doctor or hygienist)

Prep tooth w/ 330 then 33 ½

Micro etch zeza splint

Place wedge

Blue and green Etch for 10 secs,

Rinse and dry

Seat splint w/ metabond

Amalgabond wetting agent and bond (if needed) Dyractflow and esthetx or epic

Light cure 20 secs

Remove wedges

Polish w/ diamond and white stone

Check occlusion.
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Work up (traditional)

Needed: Basic set up, panoramic, ceph, metal trays, impression material, digital camera, lip retractors and Occlusal mirror

Procedure: Take measurements

Take oral/facial photos w/ digital camera

Take panoramic and ceph

Take lower and upper impressions

Re-appt for case presentation (4 weeks)

Pour up impressions in white stone

Download photos from digital camera on pt chart


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Invisalign work up

Needed: Basic set up, digital camera, panoramic, blue and yellow putty, blue plastic trays, exafast (impression material), exabite ( bite registration),

Procedure: Take measurements

Take oral/ facial photos w/ digital camera

Take panoramic

Take bite registration w/ exabite (time for 1min)

Try in blue trays

Mix 1 scoop of blue and 1 scoop yellow putty together

Place in blue plastic tray

Use gun to squirt impression material onto putty

Take impression and hold in place (time for 2min)

Re-appt for case presentation (4 weeks)

Download photos from digital camera on template for invis
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Invisalign Adj.

Needed: Ortho adj set up, clincheck pulled up of pt. floss, box of aligners, next aligner

Procedure: Check with pt about which aligner they are in to confirm notes

Check clincheck and pt teeth see how they are tracking

Check pt interproxaml w/ floss see if floss is getting stuck at all

Get red, blue, yellow invis strip

Give pt new aligner to put in

Dispense 1-2 other aligners with date on the when to insert

Re-appt pt


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Ortho Adj



Needed: Ortho adj set up, optical pliers, speed howe pliers, damon opening instrument, Tweed, color elastic ( if teeth are clean), wires

Procedure: Inform Dr.B of what wire they are in and how long

Get new wire if needed (Dr.B will inform you of what one)

Cut wire to size

Place colors if teeth are clean or chain elastic if needed

Re-appt pt
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Invisalign Startup



Needed: Ortho adj. set up, esthetx universal, plastic, blue etch, Dyractflow, prime and bond, high speed, tapered two striper diamond, white stone, invis box (template)

Procedure: Pull up clincheck

Try in template

Etch for 10 secs,

Rinse and dry

Prime and Bond

Esthetx and Dyractflow in template

Light cure 20 secs

Polish w/ diamond and white stone

Insert first aligner

Go over how to insert and remove aligner

Give box of aligner cases

Go over care instruction of aligners with pt

Re-appt

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Bracket Startup (Insignia)



Needed: Ortho adj set up, Damon opening instrument, Insignia box, pumice polish (not prophy paste), Blue etch, Solo ortho bond, Enlight, Speed howe pliers, distal end cutter pliers, tweed pliers, Curing light, high speed, diamond

Procedure: Pumice polish( just buccals)

Try in gigs

Blue etch 10 sec

Rinse and dry

Solo ortho bond

Add small amount of enlight to bracket

Place gig on teeth

Remove excesses enlight

Light cure for 10 sec a bracket

Remove gig and light cure 10 sec a bracket once more

Polish around brackets w high speed(diamond)

Place wire

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Invisalign IPR

Needed: Basic set up, high speed, floss, blue, yellow or red invisalign strip, IPR diamond bur, clinchek up, incremental thickness gauges, floss

Procedure: Pull clinchek up

Double check what teeth you are working on

Slenderize each tooth that needs to be done according to clincheck

Check with incremental thickness gauges

Use invis strips if needed also with floss

Re- appt pt


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Bracket removal

Needed: Ortho adj set up, high speed, tapered two striper diamond, white stone, pin cutter pliers or Damon bracket remover instrument , speed howe pliers, Damon opening instrument, retainer

Procedure: Remove wire(s)

Snip off brackets with pin cutter pliers or Damon bracket removers

Polish w/ diamond and white stone

Place retainer(s) in

Adj retainer(s) if needed

Instructed to wear 24/7 except eating and drinking

Re-appt

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Case Presentation (traditional)



Needed: Folder from lab, study models, break down on payments.

Procedure: Bring pt and parent back

Go over treatment plane

Go over any questions and break down

Bring to Deb for any insurance question

Bring STM, folder from lab and box to send to EDS (if have)

Re-appt if ready (not EDS pt we will call)



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Case Presentation (invis)



Needed: Clincheck up in consult room, break down of payments.

Procedure: Bring pt and parent into room

Go over composite attachments

Let both parent and pt watch video

Go over IPR if needed

Inform how many aligners and how long

Go over payment break down

Bring to Deb if any insurance questions

Re-appt if ready (not EDS pt we will call)




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Denture -Partial



Needed: Basic set up, panoramic, alginate, metal trays, high speed, round diamond

Procedure: Take panoramic

Review pan and do visual exam

High speed and round diamond (to make partial seats)

Take impression of both upper and lower arch

Pour up in yellow stone

Send to H and O


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Denture - Full
Needed: Basic set up, panoramic, alginate, metal trays, accutray materials, accutray trays

Procedure: Take panoramic

Review pan and do visual exam

Take impression of edentulous with accutray

Take impression of opposing arch with alginate

Pour up in yellow stone

Send to H and O
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Bite registration



Needed: basic set up, denture wax kit(in sterilizing area), torch

Procedure: Have pt try in bite registration

Used denture wax kit as needed for adj

When done send back to H&O for wax try in

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Wax try in

Needed: basic set up, denture wax kit(in sterilizing area), torch, denture adj bur

Procedure: Have pt try in wax up

Used denture wax kit as needed for adj

When done send back to H&O for final denture

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Denture insert
Needed: Mirror, pip paste, brush, denture adj bur,

Procedure: Paint denture with pip paste

Try in denture

Adj as needed

Re-appt for adj




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Extractions



Needed: Basic set up, syringe, septocaine, sterilized gaze, PDL, 34S, 301, 150, 151

Procedure: Update HH, Take BP

Anesthesia (given by Doctor or hygienist)

PDL if needed

34s or 301

150 or 151

Place sterilized gaze in ext site

Give care instructions and extra sterilized gaze


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Sealants



Needed: Basic set up, Cotton rolls, Dry angles, Blue etch, Clinpro, Curing light

Procedure: Update HH

Visual exam

Place cotton rolls or dry angles

Dry teeth and etch 10 secs a tooth

Rinse and Dry

Place Clinpro on etched surfaces

Light cure each tooth 10 sec

Repeat for each quadrant



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Snap on Smile

Needed: Basic Set up, Alginate, metal trays, Exafast impression material, Exabite, Blue and Yellow Putty, blue invisalign trays

Procedure: Visual exam

Take alginate impressions upper and lower

Take bite registration w/ exabite (time for 1min)

Try in blue trays

Mix 1 scoop of blue and 1 scoop yellow putty together

Place in blue plastic tray

Use gun to squirt impression material onto putty

Take impression and hold in place (time for 2min)

Pour up alginate impressions w/ White stone

Re appt for insert (5 weeks)

Send to lab


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Insert Snap on Smile


Needed: Basic set up, Articulating paper, Dent adj bur

Procedure: Insert Snap on Smile

Check Bite

Adj as needed

Go over care instructions w/ pt, given from the Lab



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