The Pract ice Bui lding BULLETIN

The Appliance Therapy WorksheetA Design for Success

VOL. II, NUMBER 5

IN THIS ISSUE:• Common Problems

• Treatment Procedures

• Income Potential

• Sample Worksheet

Could you successfully

design this appliance?

See the Appliance Design

Worksheet inside.

A MEMBER OF THE APPLIANCE THERAPY GROUP

PRACTICE POTENTIALIn the past, “appliance therapy” only referred tothe use of simple orthodontic appliances like aspace maintainer or a Hawley retainer. Today,this term encompassed a wide variety of appli-ances which are used through every phase ofa patient’s treatment. Whether you are placingimplants, performing periodontal surgery, orsimply doing interceptive orthodontics, youwill need to use appliances to help control anddirect your patient’s treatment.

The Principles of Appliance Therapy for Adultsand Children textbook was introduced to helpyou integrate the use of appliances into yourpractice. Although there are over 200 appli-ances illustrated, it is rare to find an appliancethat is exactly what you need for a patient. Infact, the book’s main purpose is just to giveyou ideas. It is up to you to design a specificappliance to fit your patient’s needs.

There is nothing worse than receiving anappliance back from the lab only to find outthat it just won’t do what you intended it todo. Unfortunately, this problem usually occursbecause of a breakdown in communicationbetween the laboratory and the doctor. Hereare three typical prescriptions which led tofailure. Do any of them look familiar?

“Please make an upper Hawley retainer”

A simple Hawley retainer (Appliance #1161)was fabricated with full acrylic palatal cover-age, Adams clasps on the first molars, and astandard labial bow running from the distal ofboth cuspids. Unfortunately, the patient wouldnot wear the appliance because her lowerteeth kept making contact with the Adamsclasps during function. To avoid this type ofproblem, the doctor should have checked thepatient’s occlusion, sent an opposing cast, andrequested a design with no occlusal interfer-ences (Appliance #1165).

“Design and fabricate an upper bruxism splint”

Although over 80% of the splints made todayare maxillary splints, this is not enough infor-mation to properly fabricate one that will

work. It is essential to always send thoroughinstructions describing the splint’s occlusalscheme. For example, a proper prescriptionmay say the following: “An upper horseshoesplint (Appliance #6193) with point contact onall posterior teeth, slight cuspid rise and brushcontact in the anteriors during protrusive”.

“I would like to correct the crowding in theupper anterior region. Please design anexpansion appliance to make room for theblocked-out cuspids.”

The term “expansion appliance” usually refersto a group of appliances that are used for archdevelopment. Depending on the type of appli-ance, you can develop an arch in ananterior/posterior direction, a lateral direction,or limit its lateral development to the anterioror posterior region. As you can see, it is essen-tial to diagnose the cause of the crowdingbefore selecting an appliance to treat it. Then,and only then, will you be able to give the labthe specific instruction it needs to make youan appliance that will work.

TREATMENTSimply put, if you don’t fill out your prescrip-tions carefully, you will get what you ask for butnot what you really need. To solve this problem,I have developed the Appliance Design Worksheet(see sample attached) to help you better inte-grate appliance therapy into your practice.

Following these simple steps will help insureyour success with appliance therapy:

1) Read the textbook, The Principles ofAppliance Therapy for Adults and Children.Doing so will give you an excellent overviewof the hundreds of appliance designs thatare available to treat your patients.

2) Read carefully the section called the"Anatomy of an Appliance." Every compo-nent that goes into designing an appliance isdescribed in this chapter. This informationwill allow you to modify any appliance inthis book to meet your needs.

3) Turn to the section in the book which bestdescribes the problem you are trying tosolve. The quick reference format makesthis an easy task. Select an appliance bynumber but then be sure to modify thisdesign to meet your specific needs.

THE PRACTICE BUILDING BULLETIN

4) Fill out the design worksheet com-pletely. DO NOT skip any section.Although certain parts of theWorksheet may not seem applicable,reading each part will ensure nothingis left out of your design. This slip ismeant to be a teaching tool as well asa design sheet. Every time you fill itout completely, you will becomemore proficient in the art of appli-ance design.

5) There is no such thing as giving thelab too much information. We haveleft plenty of room on the work sheetfor you to write a narrative. Do nothesitate to use it.

DESCRIPTIONOn this page is a completed example ofour new Appliance Design Worksheet. Weare confident that if you take the time tocomplete every step you will not onlylearn how to design appliances, but youwill also receive an appliance that will dowhat you want it to do.

STEP I. Doctor’s InformationThis first section contains the basicinformation we need to properlyprocess your lab work. Although as anactive account, this information isalready in our computer. However enter-ing it here will allow the lab managersto contact you quickly if we have anyquestions. Please do not forget to giveus your patient’s name and age.

STEP II. Special ServicesDuplicate and return models- We doreturn working models. However somedoctors like to have their appliance sentback with their original cast untouched. Ifthis is a service you prefer, please checkoff the box in this section.

Fabricate Study Models - Today’s standardof care requires you to keep excellentrecords. When doing appliance therapy,keeping study models of your treatmentis recommended.

Emergency Service - There are times whenyou need to have an appliance made andreturned to you faster than can beaccomplished by regular mail service.When this is the case, you can requestspecial handling. A list of these optionscan be found in the section of the bookcalled “Guide to Services”.

Complete Consultation Service - If youneed help completing your records, or

you simply want another diagnosticopinion, our consultation service may befor you. For a complete description ofthis service, just give us a call.

STEP III. Diagnostic InformationThis step is essential if you want to besuccessful. Filling in this informationreminds you to take the time to do acomplete diagnosis. It also gives ourtechnicians the information they need tounderstand your treatment objectivesand properly fabricate your appliance.Only so much can be ascertained from aset of study models alone. There is plen-ty of room on the back side of the worksheet for you to write a narrative. Pleasedon’t hesitate to use it.

STEP IV. Appliance DesignA. Type of Treatment - After you havecompleted your diagnosis, the next stepis to select the section in the Principles ofAppliance Therapy that contains the typeof treatment that you want. Mark thissection on the worksheet.

B. Appliance type - Make sure to indicatewhether you are designing an appliancefor the UPPER or LOWER arch. REMEM-BER TO ALWAYS USE A SEPARATE WORKSHEET FOR EACH APPLIANCE.

Think about whether you want to use aREMOVABLE or a FIXED appliance.

APPLIANCE THERAPY DESIGN WORKSHEET - The 7 Steps To SuccessI. Dr’s Name_________________________________________________

Address ___________________________________________________

City ___________________________ State_______ Zip____________

Office Phone Number: ( ) _______________________________

Patient: ____________________________________________________

SML Account Number: _____________________________________

II. Special Services:

❑ Duplicate & Return Models

❑ Fabricate Consultation Study Models*

❑ Fabricate Board Quality Study Models*

❑ Emergency Services - Same Day Processing (extra charge)** For information see guide to services or call client services

Please refer to the SML “The Principles of Appliance Therapy” when completing this Form

III.Diagnostic InformationPatient age:________Birthdate________________________________Dental Classification: _______________________________________Skeletal Classification: ❑ Class I ❑ Class II ❑ Class IIITreatment objective: Please write narrative on back side.

IV. Appliance Design - Please use separate sheet for each appliance

A. Treatment Type: (please check type)❑ Space maintenance ❑ Finishing/Maintaining❑ Habits ❑ Mouthguard❑ Regain lost space ❑ Splint❑ Close space ❑ Restorative enhancement❑ Individual tooth movement ❑ Interim partial/bridge❑ Crossbite correction ❑ Implant❑ Arch development ❑ Peridontal❑ Functional orthopedics ❑ Obstructive sleep apnea❑ Orthodontics

B. Appliance Type: ❑ Fixed or ❑ Removable & ❑ Upper or ❑ LowerNumber from textbook if applicable_____________________**Caution-if modifications are not listed the appliance will befabricated exactly as described in the textbook.

C. Expansion Screws:❑ Midpalatal screw for lateral development❑ Swing lock for anterior/posterior lateral development❑ Sagittal screw for AP development❑ Unilateral ( ❑ right ❑ left )❑ Bilateral ❑ Three-way ❑ RPE (Haas) ❑ RPE (Hyrax)❑ Micro screw ❑ Mini screw Tooth #___________See pgs 1.14-1.17 for expansion screw selection and section 8

D. Springs: (list tooth # next to spring type)Recurved ________Lap________Direct Pressure (“T”)_________Mesial kick spring (labial or lingual)_______________________Distal kick spring (labial or lingual) _______________________See pgs 1.11-1.13 for best spring selection

E. Bonded Buttons or Hooks:Indicate tooth #/position/direction _______________________

F. Labial Archwires:❑ Standard Hawley ❑ Quad Loop ❑ Apron❑ Wrap-Around ❑ Flat ❑ Sliding ❑ ContouredPlacement (see Textbook pg 1.5-1.8)

G. Clasps: (list tooth # next to clasp type)Adams __________Ball______________“C” Finger_____________Crozat_____________Delta____________Sage________________band and bar______half clasp_______Truax claspless _______See pgs. 1.1-1.4 for best clasp selection and contraindications

H. Acrylic:❑ Full Palate ❑ Horseshoe ❑ Open Palate ❑ Color_______❑ Strengthening wire ❑ Kevlar ❑ Special design❑ Specific finish line (ie. anterior relief)see page 1.9-1.10

I. Bite Planes: (construction bite essential at desired vertical and APrelationship)❑ Lingual anterior bite plane❑ Posterior coverage ❑ Complete coverageType of finish:

❑ Flat ❑ Intercuspated ❑ Point contact ❑ Cuspid rise❑ Anterior incline ❑ Anterior brush ❑ Contact in protrusive❑ Special design (see special instructions)see page 1.20 for selection

J. Habit Control Devices: - opposing model essential❑ Loops ❑ Fence ❑ Rake ❑ Spinner ❑ Lip Shield❑ Check Shield ❑ Anterior ❑ Lateral ❑ PosteriorNote: Indicate position and height on model: see pgs. 3.1-3.5

K. Rest Seats:Indicate tooth # and position ____________________________

L. Bands:Teeth to be banded______________________________________❑ Preformed band provided by doctor.❑ Provide custom band.see pg 1.21 for information on band selection.

M.Lingual Archwires:❑ Ideal ❑ Contoured❑ Removable – ❑ Vertical ❑ Horizontal❑ Stops – location ______________________________________see pgs 1.23-1.25

N. TeethTooth Shade______________ ❑ Biotone ❑ Other _____

Tooth/Teeth to be replaced____________________________Tooth Placement:

❑ Socketed Adjust model in lab _______________mm.❑ Flange/saddle ❑ Butted❑ Please see written special instruction.

O. Positioners: request Positioner Design Form.

V. Construction Bite❑ Maximum intercuspation bite.❑ Repositioned (with precise vertical and AP)

❑ Checked on models for accuracy.❑ Carefully and separately wrapped for shipping.

VI.Models❑ Models checked for accuracy (bubble free, no distortion)

and individually wrapped.❑ Opposing model enclosed❑ Models trimmed to avoid extra shipping charges.❑ Teeth to be extracted are checked on cast.

VII.THIS LAB SLIP HAS BEEN COMPLETED AND APPROVED BY DOCTOR

Doctor’s Signature _________________________________________

License Number ___________________________________________❑ See back for diagram and written instructions

© 2003 Space Maintainers Laboratory

ROB VEIS D.D.S.

9129 LURLINE AVE.

CHATSWORTH CA 9131 1

818 998-7460

FRANK LAGERS

0012345

31 6-10-72IX

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X X1084

3X

#10

X

#14 #4,5 #12,13 #2

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Some of the factors which will help youmake a decision are found in the sectionof the book called “The Anatomy of anAppliance.” Once you have made a deci-sion, indicate your choice on the sheet.

Note - If you only give us a specificappliance number or name, the lab willmake the appliance exactly as it isdescribed in the book unless you take thetime to modify the design by completingthis Worksheet.

C. Expansion Screws - One of the activecomponents of an appliance, thesescrews come in many sizes and designs.Please review pages 1.14-1.18 and Section8 in your book to help you select theproper screw and placement. When usingmicro and mini screws, don’t forget toindicate the tooth number and position.

D. Springs - There are many types ofsprings which can be utilized to moveyour patients’ teeth. Please review pages1.11-1.13 in your textbook. There youwill find help in making the proper selec-tion. Then, list the tooth number you aretrying to move next to the spring youhave chosen. For mesial and distal kick-ers springs, make sure to indicatewhether you want them coming fromthe labial bow or from the lingual aspectof the appliance.

E. Bonded Buttons or Hooks - When usinga bonded button or hook to move atooth, it is essential to tell the lab thetooth number, the intended position ofthe bonded component, and the direc-tion you want to move the tooth.Fixed/Removable appliances must becarefully designed so that the bondedcomponents do not interfere with theseating of the removable appliance.

F. Labial Arch Wires - An arch wire can beused for appliance retention, to passivelyretain teeth, or to actively move teeth.Both design selection and placement affectits usage. Please review pages 1.5-1.8 in thebook to help you select a design to meetyour needs.

G. Clasps - Being the main method ofretention, the correct selection and prop-er placement of clasps is essential for theappliance to be successful. Please look onpage 1.1-1.4 in the textbook to help youwith clasp selection. Remember, it isimportant to place some form of reten-tion as close as possible to the active part

of your appliance. To fill out the designsheet, simply list the tooth number nextto the clasp type.

H. Acrylic - Stability, strength, comfort,and the possible affect on speech arejust a few of the factors that can affectthe acrylic component of an appliance.Today, we even have the ability to havecolors and designs added for betterpatient motivation. Page 1.9-1.10 in yourtextbook will help you further modifyyour design. Please make sure to indicateon the model where you want the acrylicfinish line.

I. Bite Planes - Jumping anterior and pos-terior crossbites, increasing applianceretention, and repositioning the mandibleare just a few of the reasons to use a biteplane. Whatever the use, it is essential toalways provide the lab with an accurateconstruction bite.

J. Habit Control Devices - Thumb sucking,tongue thrusting, cheek biting, and brux-ism often occur in both adults and chil-dren. To select the best device to controlthese habits, please review chapter 3 inthe textbook. Regardless of the design, itis always essential to indicate the exactposition and height of the habit device onthe model. Please don’t forget to includean opposing model.

K. Rest Seats - When you need a restadded to an appliance, you must indicatethe tooth number and the position (i.e.mesial fossa, lingual groove) where youwant the rest to be placed. Always takean opposing cast so you and the lab canmake sure that there is enough clearanceto place the rest.

L. Bands - Make sure to indicate whichteeth are to be banded by entering thetooth number. When using your ownbands, don’t forget to indicate whichband is for which tooth. PLEASE DO NOTPOUR UP YOUR MODEL WITH THEBANDS IN PLACE - just tape your bandsto the lab slip.

M. Lingual Arch Wires - These wires,which are usually used to maintain space,can also have a number of active compo-nents attached to them. When this is thecase, you will need to be able to removethe arch wire to make adjustments. Whendesigning this wire please review pages 1.11 and 1.12.

N. Teeth - Are you designing an activetooth movement partial? Maybe youneed a partial to handle an immediateextraction case. Because every type ofpartial has specific demands for toothplacement, it is up to you to tell us howyou want us to place the teeth. DON’TMAKE THE LAB GUESS. Use thisWorksheet to indicate shade, mold, tissuecontouring, placement, and any otherpertinent information.

O. Positioners - Designing a positioner fororthodontic finishing can be quite com-plex. To accommodate everyone’s individ-ual needs, Space Maintainers has aseparate lab slip for designing a position-er. Just give us a call and we will be hap-py to supply you with them.

STEP V. Construction BiteBe sure to supply the laboratory with aconstruction bite that gives us thedesired vertical and anterior/posteriorrelationship.

STEP VI. Models (working casts)Excellent stone casts are essential tomaking a proper diagnosis and to proper-ly construct an appliance. If your casts aredistorted in any way, you can be assuredthat your appliance will not fit. Pleasetake the time to closely inspect your castsbefore you send them to the lab. Takingthis small step will save you time andmoney. There is nothing more frustratingthan having to re-appoint a patient totake new impressions. If your staff is hav-ing problems with their impression tech-nique, you may find it useful to havethem review the Practice Building Bulletinon alginate impressions.

STEP VII. Doctor ApprovalAs a practicing dentist, I know how busyyou can get during a typical day.However, delegating the responsibility offilling out this Worksheet to your assis-tant or depending on the lab to designyour appliance by writing PLEASE CALL isa mistake. In most states, you areresponsible for any prescription that yousend to a lab. Although SpaceMaintainers’ staff are experts in appliancedesign and will assist you in any waythey can, ultimately, correct appliancedesign is your responsibility.

APPLIANCE THERAPY DESIGN WORKSHEET - The 7 Steps To Success

I. Dr’s Name_________________________________________________

Address ___________________________________________________

City ___________________________ State_______ Zip____________

Office Phone Number: ( ) _______________________________

Patient: ____________________________________________________

SML Account Number: _____________________________________

Please refer to the SML “The Principles of Appliance Therapy” when completing this Form

III.Diagnostic InformationPatient age:________Birthdate________________________________Dental Classification: _______________________________________Skeletal Classification: ❑ Class I ❑ Class II ❑ Class IIITreatment objective: Please write narrative on back side.

IV. Appliance Design - Please use separate sheet for each appliance

A. Treatment Type: (please check type)❑ Space maintenance ❑ Finishing/Maintaining❑ Habits ❑ Mouthguard❑ Regain lost space ❑ Splint❑ Close space ❑ Restorative enhancement❑ Individual tooth movement ❑ Interim partial/bridge❑ Crossbite correction ❑ Implant❑ Arch development ❑ Peridontal❑ Functional orthopedics ❑ Obstructive sleep apnea❑ Orthodontics

B. Appliance Type: ❑ Fixed or ❑ Removable & ❑ Upper or ❑ LowerNumber from textbook if applicable_____________________**Caution-if modifications are not listed the appliance will befabricated exactly as described in the textbook.

C. Expansion Screws:❑ Midpalatal screw for lateral development❑ Swing lock for anterior/posterior lateral development❑ Sagittal screw for AP development❑ Unilateral ( ❑ right ❑ left )❑ Bilateral ❑ Three-way ❑ RPE (Haas) ❑ RPE (Hyrax)❑ Micro screw ❑ Mini screw Tooth #___________See pgs 1.14-1.17 for expansion screw selection and section 8

D. Springs: (list tooth # next to spring type)Recurved ________Lap________Direct Pressure (“T”)_________Mesial kick spring (labial or lingual)_______________________Distal kick spring (labial or lingual) _______________________See pgs 1.11-1.13 for best spring selection

E. Bonded Buttons or Hooks:Indicate tooth #/position/direction _______________________

F. Labial Archwires:❑ Standard Hawley ❑ Quad Loop ❑ Apron❑ Wrap-Around ❑ Flat ❑ Sliding ❑ ContouredPlacement (see Textbook pg 1.5-1.8)

G. Clasps: (list tooth # next to clasp type)Adams __________Ball______________“C” Finger_____________Crozat_____________Delta____________Sage________________band and bar______half clasp_______Truax claspless _______See pgs. 1.1-1.4 for best clasp selection and contraindications

H. Acrylic:❑ Full Palate ❑ Horseshoe ❑ Open Palate ❑ Color_______❑ Strengthening wire ❑ Kevlar ❑ Special design❑ Specific finish line (ie. anterior relief)see page 1.9-1.10

I. Bite Planes: (construction bite essential at desired vertical and APrelationship)❑ Lingual anterior bite plane❑ Posterior coverage ❑ Complete coverageType of finish:

❑ Flat ❑ Intercuspated ❑ Point contact ❑ Cuspid rise❑ Anterior incline ❑ Anterior brush ❑ Contact in protrusive❑ Special design (see special instructions)see page 1.20 for selection

J. Habit Control Devices: - opposing model essential❑ Loops ❑ Fence ❑ Rake ❑ Spinner ❑ Lip Shield❑ Check Shield ❑ Anterior ❑ Lateral ❑ PosteriorNote: Indicate position and height on model: see pgs. 3.1-3.5

K. Rest Seats:Indicate tooth # and position ____________________________

L. Bands:Teeth to be banded______________________________________❑ Preformed band provided by doctor.❑ Provide custom band.see pg 1.21 for information on band selection.

M.Lingual Archwires:❑ Ideal ❑ Contoured❑ Removable – ❑ Vertical ❑ Horizontal❑ Stops – location ______________________________________see pgs 1.23-1.25

N. TeethTooth Shade______________ ❑ Biotone ❑ Other _____

Tooth/Teeth to be replaced____________________________Tooth Placement:

❑ Socketed Adjust model in lab _______________mm.❑ Flange/saddle ❑ Butted❑ Please see written special instruction.

O. Positioners: request Positioner Design Form.

V. Construction Bite❑ Maximum intercuspation bite.❑ Repositioned (with precise vertical and AP)

❑ Checked on models for accuracy.❑ Carefully and separately wrapped for shipping.

VI.Models❑ Models checked for accuracy (bubble free, no distortion)

and individually wrapped.❑ Opposing model enclosed❑ Models trimmed to avoid extra shipping charges.❑ Teeth to be extracted are checked on cast.

VII.THIS LAB SLIP HAS BEEN COMPLETED AND APPROVED BY DOCTOR

Doctor’s Signature _________________________________________

License Number ___________________________________________❑ See back for diagram and written instructions

© 2003 Space Maintainers Laboratory

II. Special Services:

❑ Duplicate & Return Models

❑ Fabricate Consultation Study Models*

❑ Fabricate Board Quality Study Models*

❑ Emergency Services - Same Day Processing (extra charge)** For information see guide to services or call client services

RIGHT LEFT

UPPER

LEFT RIGHT

LOWER

RIGHT LEFT

UPPER

LEFT RIGHT

LOWER

ADULT PEDO

SPECIAL INSTRUCTIONS

The Practice Building Bulletin is a special service of Space Maintainers Laboratoryproduced solely for the private use of our clients. It is designed to help expand andenhance your ability to provide comprehensive patient care. As an active client, youwill continue to receive all future editions at no charge. Subscriptions are available for$98.50 for 10 bulletins and includes a free three-ring binder with all back issues todate. Information included is the opinion of the author and may not be reproduced inany form without written consent.

UNITED STATESAppliance Therapy Group Headquarters:

Space Maintainers LaboratoryP.O. Box 4184, Van Nuys, CA 91409-4184

800-423-3270Copyright © 2003www.smldent.com

Regional Labs:Northwest: 800-423-6509

Midwest: 800-325-8921CANADA 800-661-1169

AUSTRALIA (03) 9521-0299MALAYSIA (03) 621-8599TAIWAN: 886-7-235-5612

CONTRA-INDICATIONS AND CONCERNS - COMMON PROBLEMS1) Prior to beginning any appliance

therapy, always collect excellentrecords. These should include acomplete medical and dental his-tory, periodontal screening, com-plete dental charting, all necessaryx-rays (FMX, Panorex, LateralCeph, Tomograms), photographs,study models, and working casts.

2) Diagnose and treatment plan thecase— Take the time to closely eval-uate your records. Next, sequenceout your treatment step by step.

3) Evaluate your ability to treat —(Case selection)— It is essential tounderstand your own limitations.Not everyone feels comfortableperforming endodontic therapyon second molars. The same canbe said about appliance therapy. Ifyou are uncomfortable treating aproblem don’t hesitate to refer itto a specialist.

4) Every appliance in the textbookhas been given an appliancenumber. It will always be tempt-ing to simply write this numberdown and leave the rest of thework sheet blank. DO NOT DOTHIS. It is very rare to be able toselect an appliance out of thebook without having to do somesmall modification in its design.At bare minimum, you will needto indicate which teeth need tobe clasped or banded. ThereforePLEASE FILL OUT THE WORK-SHEET COMPLETELY.

5) Check your models very carefullyfor accuracy and completeness.Large air holes and stone bub-bles are not acceptable. Themodels should articulate proper-ly and not rock due to stonebubbles on the occlusal surfacesof the posterior teeth.

6) When sending a construction bite,check to see that the models fitinto the bite completely and accu-rately prior to shipping. Do notship the models in occlusion orwith the construction bitebetween the teeth.

7) Often, when in maximum inter-cuspation, the lower incisors aretoo tightly coupled with the lin-gual of the upper incisors to allowneeded tooth movement. Checkto see that adequate overbite andoverjet are present prior todesigning an appliance to alignlower anteriors.

8) Carefully consider the age andresponsibility level of youryounger patients. Are they respon-sible enough to properly care fora removable appliance?...or willthey be losing it constantly?Consider a fixed approach inthese situations.

9) Always design active componentsfirst and retention second. Thiswill help ensure retention is ade-quate and in the proper location.Note...the design sheet has beenorganized so the active componentswill be designed first.

10) It is best to always try to designan appliance with no occlusalinterference. Sometimes thepatient’s free-way space will beenough to allow for comfortableappliance wear. However, occlusalinterference from clasping maynot always be avoidable. Whenclasp interference is a problem, athin, balanced, occlusal bite planemay be required.

11)Proper treatment sequencingusually entails: 1st - correct anycrowding (lateral and anterior/posterior). 2nd - correct the jawrelationship (anterior/posteriorand vertical). 3rd - align the

teeth. A common problem is try-ing to accomplish too muchwith one appliance. More thanone appliance is often needed tocomplete treatment.

12)Be sure that a tooth to be claspedor banded is erupted sufficientlyfor proper retention. If a tooth isnot fully erupted you may con-sider creating retention by placinga buccal undercut with a com-posite ledge. A "C" Clasp can thenbe used to engage the undercut.

INCOME POTENTIALCommon sense tells you that thekey to being successful is doingthings right the first time. This isespecially true when doing appliancetherapy. Conservatively speaking,adding appliance therapy to yourpractice can allow you to increaseyour gross production $50,000 ayear. However, this figure can bemarkedly reduced if you don’t takethe time to properly design yourappliances.

Have you ever sat down and figuredout what your time is worth? If itcosts you $300 an hour to run youroffice, what does it cost you everytime you have to repeat a procedureunnecessarily?

Take the time to properly design an appliance by completely filling outthis work sheet. It will save youtime, money, and a lot of unneces-sary grief.

By Rob Veis D.D.S.Director of Practice Development