Patient description:

● Age -10.3
● Sex -female
● Medical history - clear

Procedure being carried out: IMPRESSIONS AND BITE REGISTRATION FOR

FUNCTIONAL APPLIANCE (CLARK TWIN BLOCK)

Clinical area preparation:

- I turned on all needed equipment -PC, dental chair
- I disinfected all the clinical surfaces and contact points with isopropyl alcohol and
placed contamination barriers on surfaces to be used
- I checked any updates in the medical history
- I made available the patient’s clinical notes and radiographs (panoramic and
cephalometric) ;also camera, lip and cheek retractors, photographic mirror
- I set up the impression and bite registration instruments and materials for the twin
block:
● mouth mirror,
● ruler,
● upper and lower impression trays,
● orthodontic alginate,
● bowl, scoop and spatula,
● Water,
● adhesive spray,
● disinfection bath with 2% Perform solution,
● laboratory docket, wrapping gauze and paper towels, timer,
● 2-3 pieces sheets of pink wax folded 2 times ,
● bowl with hot water to soften it
● bowl with cold water to harden it after use,
● kidney dish, paper towels and tissues for the patient’s face, hand mirror.
● googles, bib, mouthwash for the patient, PPE for clinician and myself (mask, visor,
gloves, apron)
- BOS “Functional Appliances” to be given to the patient to have a read before the fit
appointment
- Forms for patient/parent to sign: Consent to Orthodontic Treatment, Consent to
Clinical Photographs, FP17O
- White slip for reception with the next appointment date within approx. 2 weeks - “twin
block fit”
Assistance given to orthodontist:
- I ensures that patient, clinician and myself are wearing the designated PPE
- I softened the first sheet of wax and folded it a few times getting it ready for the
normal centric occlusion bite registration
- I rinsed and cooled off the fist bite then i placed it in the disinfecting bath
- I repeated the process for the second bite to be registered in the postured position,
making sure all the details of occlusal surfaces of upper teeth that were imprinted on
are kept undistorted during cooling;
- I rinsed, cooled, handed over the bite a few times, while the clinician re-tried the bite
on to check for accuracy
- I retrieved the bite registrations, dipped them in cold water to preserve the shape and
rinsed them to remove any bioburden then I disinfected them for 10 minutes by
immersion in 2% Perform solution
- I handed over to the clinician a selection of sizes of orthodontic dentate impressions
trays and sprayed the selected ones with adhesive spray
- I shook the alginate box once to even it out and break any compacted powder
- By dipping the scoop once and overloading it, then cutting the excess off with the
spatula, i measured 3 scoops for the upper tray and 2 scoops for the lower tray
- I measured the same amount of room temperature water
- I mixed the alginate by incorporating the powder in the water then spatulating it to
obtain a bubble free mix within 1 minute
- I loaded the impression trays one by one, starting with the upper and I handed them
to the clinician, waiting for the best moment to start mixing the second impression
- I rinsed them gently in tap water to remove any bioburden and I disinfected them for
10 minutes by immersion in 2% Perform solution
- I wrapped the alginate impressions in wet gauze and paper towels, the wax bite was
dried and wrapped in a dry paper towel
- I placed them in a ziploc bag
- I attached a disinfection seal label, with my initials, practice name and date of
disinfection
- I filled in the laboratory docket, making sure the labwork is due back one day before
the appointment, requesting the manufacture Clark twin blocks and pre-treatment
study models
- I logged the labwork in the reception despatch folder and stored it in the clinical fridge
ready for collection
- I added a note in the patient records with the lab name and date due back
- I filled in the white slip for reception with an appointment date one day after the
labwork due back date, within one week from debond.

Assistance given to the patient:

- I welcomed the patient and his parent in the surgery and I made sure they are seated
comfortably
- I encouraged the patient by stating this procedure will not take very long
- I supported and encouraged the patient during the impression and bite taking, having
a kidney dish ready and encouraging them to breathe through their nose and relax
- I offered the patient a rinse after each impression taking
 - I made sure their face is also free from alginate and allowing time for them to clean
their face and have extra rinses at the end.
- I explained to the patient what to expect from the next appointment and what to do
with the appliance after that, I reminded them to read the leaflet before the next
appointment so we can have a reference point for more detailed oral health
instructions and appliance wear.
- I filled in the white slip for them to hand to the receptionist, with their name, clinicians
name, next appointment in 14 working days as “twin block fit”
- I said farewell and directed them into reception..

After the procedure:I segregated the clinical waste, I decontaminated the surgery and
reprocessed the instruments as per HTM 01-05, I refreshed the disinfection bath solution,
and I saved the patient notes.

Aim of procedure: alginate impressions and wax bite are used to create in this case,
functional appliances and study models outside surgery and in the absence of the patient;
sending to the lab two sets of wax bites - current bite and desired bite allows the technician
to design the right twin block which will apply intermaxillary traction to correct class II - a
form of interceptive orthodontic treatment.

Role and Reflective account:

● Strengths -I am managing the patient well during the impression taking, watching
their body language for stress and gag reflex.
● Weaknesses - I shaped the wax like a horseshoe, as for retainers bite, which
rendered it useless and I had to provide a new batch
● Role - patient support and encouragement, clinician chair side support, surgery
disinfection and decontamination, liaising with reception and laboratory.