Patient description:

● Age -10y 1m
● Sex -male
● Medical history -fit and healthy, no allergies

Procedure being carried out: Adjustment of Frankel regulator

Clinical area preparation:
- I turned on all needed equipment -PC, dental chair, mixer
- I disinfected all the clinical surfaces and contact points with isopropyl alcohol and
placed contamination barriers on surfaces to be used
- I prepared a few items to hand out to the patient at the end of the appointment -
leaflets on topics such as : a card with the practice contact details and working hours
to call in case of orthodontic emergencies and their white slip with details of the next
appointment to be filled in at the end for them to hand to reception.
- I checked the medical history, paying particular attention to allergies to nickel,
stainless steel or acrylic as these elements are present in a removable appliance
- I made available the patient’s clinical notes
- I set up: for the clinician: a treatment tray with a mouth mirror, right angle
probe,College tweezers, Adams’ pliers, spring forming pliers, ruler, straight
handpiece and acrylic trimming burs of various grittiness, patient hand mirror.
- PPE for the patient - goggles and bib
- PPE for the clinician and myself (mask, visor, gloves, plastic apron)

Assistance given to orthodontist:

- I updated the patient’s notes with a new medical history check and with details of
today’s appointment as requested by the clinician
- I invited the patient to remove the appliance and place it on the treatment tray, paying
attention to whether the appliance looks worn, and how easy is for the patient to
remove the appliance
- I handed the clinician the straight hand piece and acrylic trimming bur followed by
the Adam’s pliers..
- I held the patient mirror for the clinician to demonstrate to the patient how to apply
and remove the newly adjusted appliance

Assistance given to the patient:

- I invited and welcomed the patient and their parent in the surgery and seated them
both (I provided a chair for the parent)
- I ensured the patient is wearing their PPE and are comfortably seated in the chair,
adjusting their head rest to support their neck and adjusting the light angle to protect
their eyes
- I double checked with the patient, prior to treatment, if there are any changes in their
medical history
 - I asked the patient if there are any difficulties wearing the Frankel regulator and
when they can’t wear it - patient had no issues so far
- I reassured the patient when the appliance was tightened and I helped them to see
themselves in the mirror
- I reminded the patient the appliance is only to be removed for cleaning after meals
and during contact sports , swimming or playing mouth instruments and during this
time it is to be kept in its storage box only, not in paper tissue as they can be
discarded by mistake, also to avoid letting it within dogs’ reach as they will chew on
them.
- I advised patient and parent to consider having a mouthguard made for contact
sports
- I gave the patient a lot of positive feedback on how their profile looks and how much
progress he has made, how his profile is much better now
- I reminded the patient to wear it 4-6 hours during the day for until the next visit in 4
weeks after which he will be wearing it al night. .
- I reminded the patient when the next appointment will be in4 weeks and I briefly
explained what it will consist of ( adjustment of the pads and the wires ).
- I accompanied them into reception and said farewell after I invited them to have a sit
for a minute and indicated to them the receptionist that will book their next
appointment.

After the procedure: I ensured all the patient’s notes were saved, then I performed the
surgery turnaround and instrument reprocessing as per HTM 01-05.

Aim of procedure: The Frankel regulator is used during the growth spurt and mixed
dentition; it will correct class II division1 with prognathic maxilla and retrognathic mandible;
the benefits of the Frankel regulator are normalisation of orofacial muscle function. The
treatment can be started at an early age, the appointments are short and not too often; the
oral health routine remains unaffected and the treatment in itself is quite short. Frankel
regulator is based on the equilibrium theory which states that the dentition is maintaining
equilibrium by the muscle forces exerted by the tongue, the lips and cheeks ; when these
forces are abnormal the Frankel regulator intervenes to reestablish the equilibrium - that is to
correct the malocclusion, expand the maxilla laterally by means of periosteal pull, relax the
mentalis muscle, allow the lips to become competent and achieve seal. The adjustment
appointments aim to keep the various components active, for instance the lingual pad must
be maintained below the gingival margin, the palatal bow must stabilise the appliance
posteriorly and provide intra-maxillary anchorage while stimulating the upper molars to erupt
laterally and expand the arch; the canine loops must guide the canines and stabilise the
appliance further, etc.

Role and Reflective account:

● Strengths -I interacted very well with the patient, explaining how he needs to wear
the appliance in the following two months.
● Weaknesses - I didn't check all the records properly and I missed a note left by
reception concerning the patient's schedule and him wanting the clinician to call
back. I must check all the notes in the morning.
● Role - during this procedure my role was to assist both the clinician and the patient ,
handing instruments while ensuring the patient is at ease and comfortable at all times
while ensuring the standards of infection control are met according to regulations; it
also involved communication with members of the dental team - clinician, receptionist
and also with the patient and their parent