Management of Faults & Emergencies Flashcards
How would you manage fracture of a Southend clasp close to the baseplate on an upper removable appliance?
- describe all of the components present
- inspect the appliance
- describe the fracture and its location
- if at the start of treatment, have a new appliance constructed as no risk of relapse
- if during treatment:
- risk of relapse so must have retention
- cut the clasp at the midline and bend the wire back on itself to create a C clasp
- deliver OHI and refer to orthodontist
- can remove clasp entirely and smooth wire down to baseplate but retention will be compromised
- cannot solder due to proximity to PMMA baseplate
How would you manage the debonding of a lower fixed bonded retainer from a single tooth?
- describe all of the components present and the teeth encompassed
- inspect the appliance
- explain to patient retainer is required to prevent relapse after orthodontic treatment, especially correction of rotations and diastema
to correct:
- use bur to remove debonded composite from wire and inspect tooth for caries
- ensure wire is not active
- etch, prime and bond and reattach wire with composite
How would you manage the debonding of a bracket from a fixed appliance with circular cross-section archwire?
- describe all of the components present and the teeth encompassed
- inspect the appliance
- cannot replace bracket as do not know where it should be placed
to manage:
- remove the ligature
- remove the bracket to remove inhalation risk and give it to the patient
- refer to orthodontist
How would you manage complete fracture of an Adam’s clasp close to the baseplate on an upper removable appliance?
- describe all of the components present
- inspect the appliance
- describe the fracture and its location
- determine whether the patient knows where the fractured component is, if unaccounted for they must be sent to A&E with the suspicion of inhalation
- if at the start of treatment, have a new appliance constructed as no risk of relapse
- if during treatment:
- risk of relapse so must have retention
- smooth the wire down to the baseplate and assess retention, likely due to presence of active component
- if retention is insufficient replacement clasp must be made by lab
- send original working cast and appliance
- if original working cast not available, send an impression with the appliance in situ
- cannot take a new impression as the fit surface would have different defects meaning there will be gaps present when the acrylic is applied. This allows acrylic creep to occur and the fit surface is contaminated. this means the appliance will no longer fit in the patients mouth
How would you manage wire slippage in a fixed appliance?
- describe all of the components present and the teeth encompassed
- inspect the appliance
- wire displaced from the opposing band, will likely be causing trauma
- cannot replace wire as do not know where it should be placed
- to manage:
- cut off the end of the wire which is extended beyond the band
- bend the end of the wire around itself to form a retentive tag
- cut the wire on the opposing side mesial to the most posterior bracket
- bend the end of the wire around itself to form a retentive tag
- refer to orthodontist
How would you manage the debonding of a lower fixed bonded retainer from a single tooth and distortion of the wire?
- describe all of the components present and the teeth encompassed
- inspect the appliance
- explain to patient retainer is required to prevent relapse after orthodontic treatment, especially correction of rotations and diastema
- distortion of wire prevents ability to rebond as it may be active and apply forces to the teeth
- to correct:
- remove wire distal to tooth with an intact bond
- smooth wire down to composite
- advise patient that tooth is no longer retained and there is an increased risk of relapse
- advise can revisit orthodontist for a new retainer
How would you manage the baseplate fracture of an upper removable appliance?
- describe all of the components present
- inspect the appliance
- describe the fracture and how many pieces there are
- advise patient to not try and wear the broken pieces or glue them together
- determine whether non-compliance (most common) or other reason
- if at the start of treatment, have a new appliance constructed as no risk of relapse
- if during treatment:
- risk of relapse so must have retention
- can offer thermoplastic retainer if there will be a delay to seeing an orthodontist
- would have to pay but would prevent relapse of potentially months of treatment
How would you manage fracture of an Adam’s clasp at the arrowhead on an upper removable appliance?
- describe all of the components present
- inspect the appliance
- describe the fracture and its location
- if at the start of treatment, have a new appliance constructed as no risk of relapse
- if during treatment:
- risk of relapse so must have retention
- as the arrowhead is not an area of flex and not close to the PMMA baseplate, can solder as it is neat and unobtrusive but requires the facilities
- cut the clasp at the baseplate on the side of the fracture and beside the other arrowhead to create a single arrowhead which should enjoy some retention
- entirely remove clasp and smooth wire down to baseplate then assess retention
- if retention is insufficient replacement clasp must be made by lab
- send original working cast and appliance
- if original working cast not available, send an impression with the appliance in situ
- cannot take a new impression as the fit surface would have different defects meaning there will be gaps present when the acrylic is applied. This allows acrylic creep to occur and the fit surface is contaminated. this means the appliance will no longer fit in the patients mouth
How would you manage a loose molar band in a fixed appliance?
- describe all of the components present and the teeth encompassed
- inspect the appliance
- will irritate the tongue and facilitate food packing
- cannot be replaced as do not know where bracket goes and cement would likely be deficient
- to manage:
- cut mesial to band and bend the wire to create a smooth retentive tag
- remove band
- refer to orthodontist
How would you manage the debonding of a lower fixed bonded retainer from multiple teeth and distortion of the wire?
- describe all of the components present and the teeth encompassed
- inspect the appliance
- explain to patient retainer is required to prevent relapse after orthodontic treatment, especially correction of rotations and diastema
- distortion of wire prevents ability to rebond as it may be active and apply forces to the teeth
- to correct:
- completely remove the retainer and check the teeth for decay or damage
- advise patient they can attend orthodontist for new fixed bonded retainer
- offer to construct thermoplastic retainer
- advise about risk of relapse and get a signature of consent if patient refuses treatment
How would you manage the fracture of a transpalatal arch adjacent to the molar band of an upper fixed appliance?
- describe all of the components present and the teeth encompassed
- inspect the appliance
- cannot solder as is fixed in the patient’s mouth
- cannot bend as made of 0.9mm HSSW so force required would cause significant pain
- to manage:
- cut the transpalatal arch where it is attached to the other molar band
- use bur with plenty of coolant and aspiration to smooth both bands
- refer to orthodontist
How would you manage fracture of a Southend clasp at the midline on an upper removable appliance?
describe all of the components present
- inspect the appliance
- describe the fracture and its location
- if at the start of treatment, have a new appliance constructed as no risk of relapse
- if during treatment:
- risk of relapse so must have retention
- bend the wire on each tooth back on itself to create a C clasp
- deliver OHI and refer to orthodontist
- can remove clasp entirely and smooth wire down to baseplate but retention will be compromised
- cannot solder due to proximity to frenal attachment
How would you manage the debonding of a bracket from a fixed appliance with square/rectangular cross-section archwire?
- describe all of the components present and the teeth encompassed
- inspect the appliance
- cannot replace bracket as do not know where it should be placed
- cannot remove bracket due to cross-section of wire, do not try to twist off as will bend the archwire or debond the adjacent brackets
to manage:
- ensure ligature is well attached to reduce risk of inhalation
- advise patient to move bracket to each side to clean underneath, ensure to demonstrate this
- refer to orthodontist
How would you manage fracture of an Adam’s clasp at the arrowhead on an upper removable appliance?
- describe all of the components present
- inspect the appliance
- describe the fracture and its location
- if at the start of treatment, have a new appliance constructed as no risk of relapse
- if during treatment:
- risk of relapse so must have retention
- cannot solder as close to PMMA baseplate and in area of flex
to manage:
- cut the clasp at the baseplate on the side of the fracture and beside the other arrowhead to create a single arrowhead which should enjoy some retention
- entirely remove clasp and smooth wire down to baseplate then assess retention
- if retention is insufficient replacement clasp must be made by lab
- send original working cast and appliance
- if original working cast not available, send an impression with the appliance in situ
- cannot take a new impression as the fit surface would have different defects meaning there will be gaps present when the acrylic is applied. This allows acrylic creep to occur and the fit surface is contaminated. this means the appliance will no longer fit in the patients mouth
How would you manage missing, brackets, ligatures and loose brackets on a fixed appliance?
- describe all of the components present and the teeth encompassed
- inspect the appliance
- most commonly as a result of trauma
- to manage:
- account for missing components where possible
- remove ligatures and archwire
- leave brackets and in situ as too painful to remove after trauma
- perform trauma stamp
- if teeth are mobile, place a splint, this can utilise the remaining brackets or be placed above or below
- refer to orthodontist
