Expansion And Quad Helix Flashcards
1
Q
Method of expansions?
A
- Upper removable appliance with midline screw
- Expanded stainless steel arch wire
- Cross elastics
- Expansion arch
- Rapid Maxillary Expansion (RME)
- Quadhelix
2
Q
Upper removable appliance with midline screw
A
- Patient or parent turns screw once/ week (0.25mm expansion)
- Not suitable if maxillary Teeth are buccally tipped.
- Problem - compliance , should be avoided poorly controlled epileptic patients ( Risk to airway from displacement during seizure)
3
Q
Expanded Stainless steel archwire
A
- Ideally large dimension 0.019x 0.025ss
- Expanded extra orally and tied into brackets.
- Useful - Co ordinate upper and lower arch
- only possible once in stainless steel wire.
4
Q
Cross elastics
A
- Patient places elastics daily
- From Upper palatal button to buccal hook
- Careful monitoring needed - can cause molar extrusion which can be reduced with rigid SS archwire.
5
Q
Expansion arch
A
- Large dimension auxiliary archwire 1mm around SS.
-Placed in HG Tubes, cinched and ligated anteriorly. - Bulky/ patient discomfort (rarely used)
6
Q
Rapid Maxillary Expansion (RME)
A
- Dental and skeletal expansion 2:1 (sk 40% expansion)
- Patient less than 15yrs old
- Screw turned -Hyrax once a day (0.2-0.5/day) for 1-3 weeks (midline diastema develops quickly).
- Evidence that mid- palatal suture does split producing maxillary expansion.
7
Q
What is Quadhelix?
A
- Fixed expansion appliance
- 4 x helices
8
Q
Quadhelix - why used in ortho tx?
A
- Anterior posterior expansion
- Does not rely on compliance
9
Q
Quadhelix appliance- Mode of action:
A
- Expansion primarily buccal tipping of maxillary posterior teeth
- Some skeletal expansion may be achieved depending on age of patient but mainly dental.
- Prepubertal childer 6:1 ratio of molar tipping : Skeletal expansion .
10
Q
Advantages of Quadhelix
A
- Provide some differential expansion
- Can derotate molars
- No need of pt compliance like URA
- Good retention
- Can be used with Fixed appliance
- More cost effective than URA
11
Q
Disadvantage of Quadhelix
A
- Molar tipping and buccal flaring of molars
- Limited skeletal change
- Patient discomfort
12
Q
Indications for Quadhelix
A
- Posterior crossbite correction
- Expansion for upper narrow arch
- improvment of upper arch crowding
- Habit breaker
13
Q
Contraindications for Quadhelix
A
- Active periodontal disease
- Patient non- compliance or lack of co-operation
14
Q
Types of Quadhelix
A
- Fixed & removable
15
Q
Removable Quadhelix advantages .
A
- Easily removed and reinserted , avoiding debanding & recementation
- Extra oral activation is simple and precise
-Can be left in place during tx or it can be removed without the need for new molar bands
16
Q
Removable Quadhelix - Disadvantages
A
- During fitting, important to avoid distortion of retention loops.
- Retention loops sometimes require adaption before they lie passively in the sheaths.
17
Q
Types of Quadhelix- Different designs
A
- Bilateral expansion of molars only
- Bilateral rotation of molars
- Unilateral rotation of molar
- Asymmetrical expansion.
18
Q
Appointment steps and constructing Quadhelix
A
Visit 1 - Place separators upper 6sā
Visit 2- Band upper 6sā / Upper impression with bands in situ for Quadhelix construction. Replace seps/ bands to maintain space for Quadhelix fit.
Visit 3- Fit Quadhelix with GIC
19
Q
Quadhelix insertion and activation step 1
A
- Clean and sterilise appliance
- Ensure all necessary component are present.
20
Q
Quadhelix insertion and activation
Step 2
A
- insertion process and pre expansion measurment
- Position the Quadhelix at the desired location in the mouth
- Gently guide it into place
- Ensure proper fit and comfort for patient
- Record pre- expansion measurements (ruler and caliper )
21
Q
Quadhelix insertion and activation
Step 3
A
- Activation by orthodontist and activated measurement
22
Q
Quadhelix insertion and activation
step 4
Insertion of activated appliance
A
- Place GIC on inner surface of bands to cement Quadhelix
- Compress the appliance to fit bands onto upper molars
- Remove excess GIC.
23
Q
Aftercare instructions
A
- OHI cleaning
- Speech
- Eating
- Discomfort and pain relief
- Wax
24
Q
Monitoring Expansion
A
- 6 weeks review appointments
-Record measurement of inter molar width and compare to pre- treatment measurements and expansion measurement
- We are expecting 2mm expansion / month (1mm each side).
- Record buccal segment relationship: x-bite /edge-edge/ Scissorbite
- Intra-oral photos are urself
25
Re- Activation of the Quadhelix
- Re- activation Methods:
- Removal of appliance and replacement with increased expansion
- Quadhelix in situ with triple beak pliers
26
Cases Can be
- Unlateral x bite and mandibular displacement correction
- Quadhelix use in orthodontic with fixed appliance
- Quadhelix use for therapeutic diagnose w/o fixed appliance
27
Complications and challenges
- Tissues irritation
- Breakages of appliance
- Unwanted tooth movement e.g overexpansion = scissor bite
- Reduction in overbite
- Communication with orthodontist for complex issues.
28
Removal of Quadhelix and maintenance of expansion
- Aim to over expand to reduce relapse potential.
- Maintenance of expansion with stainless steel.
29
Summary of OT responsibilities
1- Appliance Maintenance
2- Monitoring progress
3- Communication within orthdontic team
30
1- Appliance Maintenance
- Instructing patient on proper oral hygiene practices while wearing the appliance
- Emphasising the importance of regular check ups and follow up appointments
31
2-Monitoring progress
- Regualr evaluation of patient's dental changes during treatment
- Documenting any adjustments made to the Quadhelix appliance
- Tracking patient compliance and addressing any issue may arise.
32
3- Communication within orthodontic team
- Effective collaboration with orthodontists , dentist, and other healthcare professionals involved in patient care
- Sharing relevant information regarding treatment progress , challenges, or modifications needed.
