Patient description:

● Age -11.8
● Sex -male
● Medical history - clear

Procedure being carried out: bite registration 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 bite registration instruments and materials:
● mouth mirror,
● ruler,
● disinfection bath with 2% Perform solution,
● laboratory docket, paper towels, timer, plastic ziploc bag
● Bite stick to help the patient making a postured bite
● a few pieces sheets of pink wax folded 3 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 ensured that patient, clinician and myself are wearing the designated PPE
- I softened and folded two sheets of pink wax in a horseshoe shape and handed them
over to the clinician to take the normal bite ( in centric occlusion)
 - I softened and folded three sheets of pink wax in a horseshoe shape and handed
them over to the clinician to take the postured bite ( with the mandible pushed
forward)
- I rinsed and cooled off the bites then i placed in them he disinfecting bath (10
minutes by immersion in 2% Perform solution), making sure all the details of occlusal
surfaces of the teeth that were imprinted on are kept undistorted during cooling and
disinfection;
- the wax bites were 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 and drew the diagram , making sure the labwork is
due back one day before the appointment, requesting the manufacture of Medium
Open Activator
- 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

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 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 clean and they had 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 “ MOA 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: wax bite is used to create in this case an exact replica of a postured bite
next to a normal bite; it helps to manufacture a functional appliance outside surgery and in
the absence of the patient; this allows the technician to design the right twin block which will
correct a class II div 1 malocclusion during the mixed dentition and growth spurt phase and
before the fixed appliance stage; this works by means of intermaxillary traction and
mandibular growth stimulation; it is a form of interceptive orthodontic treatment.
Role and Reflective account:
● Strengths -I am interacting well with the patient, making them feel relaxed.
● Weaknesses -I confounded the impressions for twin block with those for MOA
Role - patient support and encouragement, clinician chair side support, surgery
disinfection and decontamination, liaising with reception and laboratory.