Emergency

Question 1

Paitent presents with a fractured Southend clasp between the central and lateral what do u do?

Answer 1

• if new treatment and appliance ; new impression new appliance
• mid treatment ; cut in the middle of the centrals and create two C clasps to smooth the edges

Cannot smooth with a bur as will just make it sharper - 0.7mm wire

General OHI and refferal

Question 2

Patient presents with a de- bonded lower lingual retainer, on inspection the composite is debonded on the lower left - the wire is passive

Answer 2

Remove the composite
Check the health of the tooth
Check the integrity of the wire - should be passive
Re etch the tooth
Bond composite

Refferal and OHI

Question 3

Patient presents with de bonded bracket - bracket can rotate around the wire - what do u do

Answer 3

Move bracket
Remove ligature
Remove bracket
Check health of the tooth
General OHI and refferal

Question 4

Why would we not rebond a bracket

Answer 4

Because each bracket has a prescription and this needs to be done by the orthodontist

Question 5

Patient presents with arch wire slippage

Answer 5

Secure wire with locking tweezers
Cut wire at end
Bend wire to make retentive tag
Bend wire back on itself at other end
General OHI and refferal

Question 6

Patient presents with composite debonded on lower lingual retainer and wire is bent at the canine

Answer 6

Cut wire distal to the 2
Inform the patient that the wire is still attached to 5 of the teeth so chances of it relapsing are unlikely
Referral made if patient would like a new one
General OHI

Question 7

Patient presents with transpalatal arch fracture at the band

Answer 7

Using a high speed hand piece cut at both sides next to the band
Can get patient to hold floss around omega loop
Smooth with bur at bands
Referral
OHI

Question 8

What options would you not consider for transpalatal arch fracture and why

Answer 8

Soldering is not an option as is intra oral
Cannot bend the wire as it is 0.9mm
Cutting with pliers would exert a massive force on the teeth

Question 9

Patient presents with a south end clasp fracture in the middle

Answer 9

If new tx - new impression new appliance
If middle of tx - bend clasps in on each other to make smooth
General OHI
Referral to orthodontic

Question 10

Patient presents with a broken Adam’s clasp

Answer 10

• Locate the missing piece ; if you cannot patient must go to A and E
• smooth sharp edges and hope that there is retention from remaining components
• if unretentive needs to be sent to the lab to get a new clasp
• send original working casts to the lab
• if the casts are damaged or cannot be found
• new impressions must be taken with the appliance - IN THE MOUTH
• this is because no two impressions are the same due to saliva and air bubbles which can lead to acrylic creep
• cast them up
• ask them to cut out area with the broken 6 and replace it

General OHI and refgferal

Question 11

Patient presents to holiday having stood on thier appliance and it is now in 4 pieces

Answer 11

• tell patient not to wear it

Delay between seeing GDP and ortho
- Can offer the patient a thermoplastic retainer to freeze mid treatment and prevent Relaspe
- would take an impression and make retainer

General OHI

One other reason for this could be non compliance or bullying

Question 12

Patient presents and thier molar band GI cement has failed what do u do

Answer 12

• Cut wire distal to the 5
• remove the band and hand it to the patient
• make a retentive tag on the wire

Referral and OHI

Question 13

Patient presents to you and their Adam’s clasp has fractured at the arrowhead

Answer 13

First thing to do is solder - if you have an on site lab
No on site lab

• modify ; remove it to acrylic at bridge and then use pliers to squeeze arrowhead to create a rententive tag
• if cannot modify remove it , smooth the edges and get retention elsewhere
• in adequate rentention
• send original working casts to lab to get another made
• no working cast ; take impression with appliance in the mouth preventing creep

General OHI and refferal to ortho

Question 14

Patient presents with lower lingual de bonded in multiple areas

Answer 14

Remove the whole thing
Check the condition of the teeth
Give patient options
- replace bonded - says no
- thermoplastic - says no

Patient doesn’t want anything - make sure to write it in the notes and get him to sign it

Question 15

Patient presents to u and you notice that their bracket has debonded but the patient hasn’t noticed
Cannot rotate the bracket

Answer 15

Since it cannot rotate unlikely to fall off
Tell the patient what has happed - inhalation risk
Make sure the ligature is firmly attached

OHI - tell patient to move the bracket for cleaning

Refferal

Question 16

Patient presents with an Adam’s clasp fracture close to the acrylic

Answer 16

This cannot be soldered as close to the acrylic
Cut at the bridge and squeeze to make a retentive tag
If cannot do this -send original working casts to the lab to make a new one
- if don’t have casts
- take impression with appliance in to prevent acrylic creep

General OHI
Refferal

Question 17

Patient presents with multiple missing ligatures and debonded brackets

Answer 17

• account for all missing brackets
• remove all ligature
• remove arch wire
• leave remaining brackets
• do a trauma stamp
• if any teeth mobile they can be splinted

Referral and OHI

Question 18

What is a lingual bonded retainer used for

Answer 18

Post orthodontic treatment retention
Rotations and diastema’s

Question 19

What is a URA used for

Answer 19

Tipping teeth
Space maintained

Question 20

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