Silicone guards (level of 77333)

1. Radiation guards Silicone guards (level of 77333) -cover metallic restoration with 5 mm thickness of silicone to prevent heating of metal crowns from radiation, which burns mucosa, or backscatter of radiation off crowns Note recent modification. Three tongue depressors are inserted while the appliance is being made to allow for some oral opening with the appliance

2. Fabrication of silicone guards • Single level scoops of base and catalyst of Reprosil polyvinylsiloxane putty • Hand-mixed, placed on trays and inserted in the patient’s mouth to close into. (also insert 3 tongue depressors between central incisors. • Once set, these are removed, trimmed to desired dimensions, and polished with Satin Wheel from E.C. Moore. • Tried in for patient and adjusted. Patient instructed in insertion and removal • Total Provider Time: Approximately 1 hour R L Engrave “L” or “R” for left or right

3. Tongue depressing stent (level of complex, 77334) • Holds mouth open, placing non-diseased tissue out of the field of radiation • Covers metallic dental restoration with 5 mm thickness to prevent radiation backscatter • Holds tongue down and out of field of radiation • Keeps oral tissue in a daily repeatable position, which is important for IMRT

4. Fabricating tongue depressing stents • Obtain alginate impressions of upper and lower dental arches and pour in stone • Obtain a wax bite registration of the patient in a mouth-open position • Mount casts on an articulator (simulates bite) • Build device out of wax on stone casts • Remove completed wax pattern, flask in stone, boil out wax, pack polyethylmethylmethacrylate into mold and allow to cure in hot water bath for 9 hours. (overnight) • Remove in the morning, trim and polish. • Total provider time, approximately 4 hours