Ortho competency

Question 1

Talk through a debonded fixed retainer - many teeth debonded

Answer 1

Check retention by using probe
check health of teeth - caries, demineralisation
is the wire passive or active?
if active - remove the loose wire, make the end safe and refer to orthodontist
do they want it all removed - thermoplastic or nothing or new one placed

Question 2

Talk through a Fixed appliance with loose bracket

Answer 2

is the wire square or round?
square - bracket safer
any caries on the tooth, or reason for debonding
make safe - cant rotate, wont be inhalation risk. make sure ligature is secure, show pt how to move it to clean
refer to ortho

Question 3

Talk through a fractured acrylic base

Answer 3

DO NOT PUT IN MOUTH OR FIX
refer to ortho
ask how and where it shattered. if intraorally then account for all parts
can offer thermoplastic retainer to fix treatment

Question 4

Talk through an adams clasp fracture close to the base

Answer 4

where did it fracture - in mouth or out
account for wire if intra or refer for x ray
make safe - smooth over
check to see retention
if not retentive
lab needs appliance and prescription and original working cast to make new. if no original cast - impression with appliance in situ

cant solder if its close to the base or an area of flex

Question 5

Talk through a fracture of the southend clasp

Answer 5

make it safe
cut in middle - bend back the wire to create a single armed clasp
smooth off the broken end
check retention

Question 6

Talk through a debonded tooth middle of fixed retainerr

Answer 6

remove the debonded composite
check health of the tooth underneath
rebond the retainer

Question 7

Talk through a debonded bracket on a fixed appliance on a round wire

Answer 7

account for all lost brackets
remove the ligature and remove the bracket. give it to the patient and refer to ortho
place ligatures on the brackets which have lost them

Question 8

Talk through a debonded fixed retainer - last tooth

Answer 8

if wire distorted then remove the wire and make safe

Question 9

Talk through a fracture of southend clasp in the middle

Answer 9

bend both clasps back to form to single arms and file down

check retention

Question 10

Talk through a fractured trans palatal arch

Answer 10

tie floss to it
cut off on other side
make safe on both sides - diamond bur and lots of irrigation
refer back to ortho

Question 11

Talk through a wire slip

Answer 11

Cut the excess of the wire end
bend to make a retentive tag
make retentive tag on deficient side
refer to ortho

Question 12

Talk through an adams clasp fractured at an arrow head

Answer 12

This area can be soldered
if cant, if there is an arrow head that engages - cut at the arrow head, squeeze it closed and make the rest safe
if distorted then remove the whole adams clasp and smooth down
make safe, check retention
if not retentive replace with in situ alginate impression

Question 13

Talk through loss of retention of molar band

Answer 13

needs removal - put a gauze behind to catch.
cut and bend wire to make safe and retentive
remove the bracket
refer to ortho

Question 14

Why do you take an impression in situ

Answer 14

fresh impression of patient will have imperfections where the saliva will be - will lead to gaps between the appliance and the new impression as the appliance fits the old clasp properly, will never fit the new one as well
so when fixing the appliance the acrylic can creep under the imperfections to fill the gaps with the new cast called acrylic creep

the appliance is sent in the alginate to the lab. can offer them a thermoplastic retainer