ortho competency

Question 1

Scenario 1 - fractured Adams clasp

Answer 1

• account for the missing fragment (send to A+E for x ray if you can’t account for it)
• smooth edge of wire, try in mouth and check retention
• if start of treatment - new appliance
• if end of treatment but not retentive - new component

Question 2

Scenario 2 - fractured Southend clasp at flyover

Answer 2

• cut at midpoint and bend wire back on itself and smooth off other end of wire
• start of treatment - new appliance

Question 3

Scenario 3 - De-bond of fixed bonded retainer on lower anterior

Answer 3

• remove composite (diamond bur or flick it off)
• check wire integrity and tooth surface
• ensure wire is passive
• rebond wire to tooth using composite and light cure

Question 4

Scenario 4 - fixed appliance wire slippage at upper right 6 (insufficient wire here and excess at upper left)

Answer 4

• LHS remove excess wire and add a tag for retention
• RHS make a tag between 5 and 6
• Advise to make orthodontist appointment asap

Question 5

Scenario 5 - shattered URA

Answer 5

• make a thermoplastic retainer so teeth stay in place until patient sees orthodontist to have new URA

Question 6

Scenario 6 - Adams clasp fractured at arrowhead

Answer 6

• cut at baseplate, cut at other arrowhead and turn it into a single arrowhead

Question 7

Scenario 7 - fixed appliance with transpalatal arch (used for anchorage) and fracture at the transpalatal arch

Answer 7

• secure component with floss
• cut with a diamond bur and coolant at the point where wire meets band
• seek orthodontist appointment immediately

Question 8

Scenario 8 - fixed bonded retainer with multiple debonds and wire has now became active

Answer 8

• remove wire and composite - explain why to patient (wire became active)
• replace entire fixed bonded retainer or thermoplastic retainer
• do nothing - risk of relapse
• good notes, document conversation

Question 9

scenario 9 - fixed appliance on lower dentition - one bracket has debunked on 43 but still on round wire

Answer 9

• if round wire bracket can spin so remove bracket
• give bracket to patient, advise orthodontist appointment

Question 10

scenario 10 - fixed appliance on upper dentition, one bracket has debonded on rectangular wire

Answer 10

• leave in situ, tell patient to move to one side to clean and advise orthodontist appointment

Question 11

scenario 11 - fixed bonded retainer on lower 3-3, deboned on 3 and wire is distorted

Answer 11

cut wire distal to 2, make it safe - smooth it off and cover in composite
- advise patient on relapse and orthodontist appointment for new bonded retainer

Question 12

scenario 12 - URA fractured Adams clasp at acrylic

Answer 12

cut component at corner of bridge and squeeze arrowhead making a single arrowhead

Question 13

scenario 13 - fixed upper appliance GI cement failed on upper six and mobile band

Answer 13

cut wire between 5 and 6, lift band off and give to patient. Bend wire to make a retentive tag distal to 5

Question 14

scenario 14 - fixed appliance on lower arch with multiple missing brackets and one debunked

Answer 14

• likely fallen
• check story matches injury, do trauma stamp
• check they can account for missing pieces, if not A+E for chest x ray
• remove arch wire and loose brackets
• leave bonded in place
• check dentition for mobile teeth - splint if needed

Question 15

scenario 15 - URA fractured in midline of Southend clasp

Answer 15

create two retentive tags by bending wire back on itself and squeezing