Ortho Emergencies Flashcards
How should I go about assessing an orthodontic emergency?
Patient safety paramount with ideally no compromise to orthodontic treatment
- Identify type of therapy and its indications
- Identify the fault and its emergency
- Account for any components
- Describe satisfactory option
- Explain procedure and implements to alleviate issue
- Provide appropriate aftercare
How manage
URA
2 Adam’s clasps and a Southend clasp
Fracture of Southend clasp where wire is emanating from aryclic edge to make them flush with baseplate
Cut southend clasp in middle, turn it back on itself to create a single C clasp and smooth off rough edges to make it flush with baseplate
- if not retentive - refer to orthodontist
- dont solder as too close to the acrylic
Fixed bonded retainer
- composite debonded in two teeth
Remove as much composite as possible
- check tooth health
- Check wire integrity
- rebond
Fixed - bonded appliance with molar bands
- loose bracket LR3
- arch wire is round in CC
Round wire = bracket rotating is an issue as can come off, be ingested or inhaled
- never reattach bracket
- remove bracket by removing ligature
- check health of tooth
- hand to pt and refer to ortho
URA
- 2 Adam’s clasps
- Southend clasp
- palatal finger spring
Middle fracture of Southend clasp
Bend both back to make two C clasps
- if it not retentive then refer
- dont solder as in area of flex
fixed bonded retainer
- deboned UR3, UL3, UL2 and fracture in middle and no longer passive (not against teeth)
Take it all off as not fit for purpose
- check health of teeth
- not necessarily competent to place FBR, offer thermoplastic or refer for FBR elsewhere
- inform need to get retainer and the risks of not having one
Fixed bonded appliance with traspalatal arch
- fracture where TPA meets band on UR6
Trauma risk
- 0.9mm SS wire so cannot bend back on itself
- don’t re-solder as not removable
- no longer fit for purpose, use diamond bur and irrigation to remove the TPA from bands
- attach floss and get pt to hold it so don’t aspirate it
- refer to orthodontist
URA
- 2 Adam’s clasps
- Southend clasp
- palatal finger spring
Fracture on left Adam’s clasp on both sides where wire emanating from baseplate
Account for missing component
- if pt doesn’t know, send for chest x-ray
- smooth edges
- if retentive, its ok
If not
- refer or
- take impression with appliance in situ, send to lab with appliance in the impression and ask for new clasp to be made
FB appliance with molar bands
- bracket come off of 21
- square or rectangular wire used
Bracket can’t be rotated to be removed
- show them how to move bracket to the side and clean underneath
- refer to orthodontist to rebond
URA, shattered in pocket / accident
Tell pt not to self repair or try and put it in
- fractured extra orally so parts missing not issue
- would be intra orally
- offer thermoplastic retainer in meantime to freeze treatment
- wearing nothing = relapse of tx
FBA with molar bands
- arch wire slippage as retentive tag as failed leading to arch wire excess on one side
Cut excess wire
Create retentive tag
On deficient side, create a new retentive tag
Refer back to orthodontist
URA
- 2 Adam’s
- Southend
- PFS
Fractured Adam’s clasp through arrowhead mesially
Can solder arrowhead if correct facilities as it is not an area of flex
If not
- cut the arrowhead mesial to the distal arrowhead as it is still engaging, and squeeze together to minimise trauma
- remove rest of clasp and smooth at baseplate
- if cannot do any of the above, remove entire component
- take new imps with appliance in situ
Fixed bonded appliance with molar bands
- one band loose as GIC failed
Don’t cement it back on!
- cut arch wire mesially, make retentive tag
- remove band, give to pt and refer to orthodontist
Fixed bonded appliance
- brackets debonded off of LL1, LL2, LL5
- ligatures missing LL4, LR3
Account for missing brackets if any - chest x-ray
If all accounted for
- no longer fit for purpose, remove arch wire and all ligatures
- refer to orthodontist
- trauma stamp / investigations if need be
- wax over brackets if traumatic
Fixed bonded retainer 3-3
- debonded composite 33 and wire distorted away from tooth
Don’t rebond as wire not passive anymore
- cut off and leave on remaining teeth
- refer to ortho if pt wishes for new one
