Lesson 1Final intraoral checks and occlusal verification: ensuring no sharp edges, patient bite check, articulating paper if indicatedFocus on final intraoral inspection after ligation. Include checking for sharp edges, verifying archwire seating, assessing occlusion wid bite checks, and using articulating paper when indicated.
Inspect brackets and tubes visuallyCheck for exposed or sharp wire endsVerify full archwire seatingAssess patient bite and comfortUse articulating paper if neededLesson 2Temporary management of loose brackets during sequence: isolation, placement of bracket on a gauze, protecting soft tissues and deciding whether to postpone bondingDescribe how to handle loose brackets discovered during di sequence. Include isolation, safe storage, soft tissue protection, documentation, and when to postpone rebonding or proceed after consultation.
Recognize signs of loose bracketsIsolate bracket with gauze or cottonRemove bracket from archwire safelyStore bracket on labeled gauzeInform and consult orthodontistLesson 3Placing new ligatures (elastic): selecting size and color, single vs figure-of-eight technique, placement technique to avoid tissue impingementCover selection and placement of elastic ligatures, including size and color choices. Compare single versus figure-eight techniques and emphasize avoiding tissue impingement and excessive force on brackets.
Select correct ligature size and typeColor selection and patient inputSingle tie versus figure-eight useStepwise placement around bracketsCheck for tissue impingementLesson 4Initial patient interaction and verification: identity confirmation, medical/dental history update, explain planned sequence in simple languageCover confirming patient identity, reviewing medical and dental history, and explaining di archwire and ligature change sequence in clear, reassuring language to support safety, consent, and patient cooperation.
Confirm identity with two identifiersReview medical alerts and medicationsUpdate dental and orthodontic historyExplain procedure in simple languageObtain and document informed consentLesson 5Placing metallic ligatures: twisting technique, appropriate tension, protecting gingiva and avoiding over-tighteningDetail placement of metallic ligatures, including threading, twisting, and tucking techniques. Emphasize correct tension, avoiding over-tightening, and protecting gingiva and lips from sharp wire ends.
Select appropriate ligature gaugeThread ligature through tie wingsTwisting technique and tension controlCut and tuck pigtails safelyCheck for sharp or exposed endsLesson 6Identifying and managing debris and plaque before wire removal: plaque clearing, use of gauze, retraction for visibilityFocus on identifying plaque, food debris, and calculus before wire removal. Emphasize retraction, suction, and gauze use to improve visibility, reduce contamination, and prepare teeth for accurate archwire placement.
Visual inspection for plaque and debrisUse of air, water, and suctionGauze use for wiping and isolationRetraction for visibility and accessPatient education on oral hygieneLesson 7Placing new archwires: selecting appropriate wire, pre-bending and trial fitting, insertion sequence for upper and lower archesOutline selection, pre-bending, and trial fitting of new archwires. Detail insertion order for upper and lower arches, managing crowding, and ensuring smooth engagement without excessive force or tissue trauma.
Confirm prescribed wire size and alloyPre-bend and contour arch formTrial fit and adjust before full seatingInsertion sequence by quadrantManage crowding and rotated teethLesson 8Securing archwires and verifying fit: torque/engagement checks, trimming distal ends, using distal end cutters and overlaysExplain how to secure archwires and verify fit. Include torque and engagement checks, trimming distal ends, using distal end cutters, and adding overlays when indicated to prevent irritation or slippage.
Check full bracket engagementAssess torque and rotational controlTrim distal ends safelyUse distal end cutters correctlyAdd overlays or stops if neededLesson 9Removing archwires safely: steps for upper and lower wire removal, stabilizing brackets, controlling spring-back, minimizing patient discomfortExplain stepwise removal of upper and lower archwires, including cutting, stabilizing brackets, and controlling spring-back. Emphasize minimizing patient discomfort and preventing soft tissue injury or wire aspiration.
Check wire type and attachmentsCut wire in safe strategic segmentsControl spring-back with cotton rollsStabilize brackets and tubesRetrieve and secure removed wireLesson 10Handling unexpected resistance or tissue entrapment during wire removal: stepwise maneuvers to release wire, instruments to use, when to call orthodontistGuide management of resistance or tissue entrapment during wire removal. Cover systematic maneuvers, instrument choices, soft tissue protection, and clear criteria for stopping and calling di orthodontist.
Identify source of resistanceUse mirror and retraction for viewGentle back-and-forth wire mobilizationUse hemostats or Weingart pliersIndications to stop and call orthodontistLesson 11Removing elastic ligatures: instrument selection, technique for safe removal, handling and disposal of used elasticsDetail instrument selection and safe technique for removing elastic ligatures. Include controlled removal sequence, avoiding bracket damage, preventing tissue trauma, and proper handling and disposal of contaminated elastics.
Select appropriate ligature removerSequence for quadrant by quadrant removalStabilize brackets during removalAvoid snapping toward soft tissuesDispose of used elastics as biohazardLesson 12Sequence overview and roles: clear division of tasks between assistant and orthodontist for each stageProvide a structured overview of di entire sequence and clarify task division between hygienist, assistant, and orthodontist. Highlight communication, timing, and safety checks at each stage of di procedure.
Outline full archwire change workflowDefine hygienist and assistant dutiesIdentify orthodontist-only proceduresHandoff communication checkpointsTime management and chairside flow
