Managment Of Faults And Emergencies Flashcards
Process for ortho emergency assessment assessment
- Identify appliance and components
- Identify fault / emergency
- Identify if all components are present - if not, inhaled or patient has with them?
- Identify action to alleviate problem / deal with emergency - PATIENT SAFETY FIRST
- Explain procedures to tackle issue
- Aftercare instructions - also referred back to orthodontist for tx at earliest possible time
Simplified
- identify everything and issue
- SAFETY
- identify fix
- refer or not
Case 1 - How to fix southend clasp fractured at flexing point
YES
- make into single end C clasp (trim wire to acrylic on one side, fold over sharp end - trimming this would make sharper)
- if 1 week into tx = no active ortho yet so can make new URA
NO
- solder wire with lead (poisonous) or silver (too hot = acrylic on fire)
- send to lab (too long)
If C clasp not enough retention then need to remake appliance
Case 2 - Tx when adams clasp broken off URA
Why cannot use a different model for repair
- SAFETY - account for component
Early Tx
- make new URA
Later stage Tx
- trim wire to acrylic
- try in mouth (retention from other components and base plate adhesion / cohesion )
If not good enough retention =
- Send to lab
- need ORIGINAL working model (not study model) and the URA
- lab removes acrylic of clasp and places new one in self cure PMMA
If need new impression
- impression with URA
- as fitting surface will be different on new model due to positives of saliva and air bubbles being seen as negatives in impression, then being positives on cast making a space between fitting surface and model so when repair get acrylic creep (flows onto fitting surface = doesn’t fit in patients mouth)
Case 3 - action for URA that has been stood on (PMMA all broken)
SAFETY - account for all pieces (didn’t try to repair or wear it)
Need new retainer - thermoplastic
Refer back to their dentist for ortho tx
Case 4 - Action for URA fractured adams clasp
SAFETY - accounted for
- Not distorted
- can flush solder with silver as far enough away from acrylic (won’t catch fire) - Distorted
- trim broken area down to acrylic
- cut middle of bridge between arrow heads, fold arrowhead on itself to make single arrowhead - If cannot save clasp or retention it good enough then send to lab with original working casts or impression with applicable in mouth (why?)
Case 5 - action for URA Southend clasp broken in middle
Two C clasps
Case 6 - action for lower fixed appliance with debonded bracket on a round arch wire
Remove ligature and bracket
Refer to orthodontist
DON’T rebound as don’t know prescription of bracket
Case 7 - action for upper fixed with fractured transpalatal arch wire at the band of the 6
Yes
- Remove with slow speed with water, aspiration and floss around arch, smooth off to acrylic
- if can’t stand this, remove both bands and fold arch wire over to make safe, refer to specialist
NO
- solder (intraoral)
- fold over (.9mm wire and force on tooth)
Case 8 - action for debonded band on 6 of upper fixed appliance
Cut arch wire distal to 5, bend to make safe
Refer to specialist as don’t know prescription for band
Case 9 - fix for upper fixed appliance with debonded bracket on a square arch wire
Tell patient it is not attached
Make sure no risk of falling off - figure of 8 ligature
Show them how to move the bracket to clean the tooth and move it back
Tell them to see orthodontist soon / refer
Case 10 - plan when upper fixed appliance has arch wire slippage - shorter on one side and longer on one
Don’t know prescription so DONT put back
Cut long end and fold both ends to make safe then refer to orthodontist
Case 11 - Upper fixed appliance with missing brackets, debonded bracket and ligature absent (trauma caused)
SAFETY - all parts accounted for
Remove ligatures and remove arch wire (leave brackets present as takes force and teeth may be mobile from injury)
DONT CARE ABOUT ORTHO HERE - assess trauma, splint mobile teeth
Refer to ortho post acute trauma tx
Case 12 - tx for Lower fixed bonded retainer with half of the wire debonded
SAFETY - wire removed as sharp into lingual area (deformed most likely too)
Check for caries lingually
Refer or make conventional / thermoplastic retainer
If patient doesn’t want a new retainer, explain risk
Case 13 - Tx for lower bonded retainer, canine attachment lost and deformed
Cut wire and trim to the lateral incisor comp. To make safe
Warn of relapse
Case 14 - fixed bonded retainer with 11 comp. Detached but not deformed
Remove comp
Check for caries
Check wire integrity
Ensure will not act as active component
Etch, prime and bond back on
