ortho emergencies scenarios

Question 1

Southend clasp fracture just near acrylic - at v start of tx (no active tx yet)

Answer 1

take fresh impression and replace

OHI

Question 2

Southend clasp fracture just near acrylic - later stages of tx

Answer 2

bur to smooth wire flush to acrylic baseplate
cut wire in middle and bend back on itself to make it safe
OHI and refer to orthodontist

Question 3

debonded fixed retainer - fixable

Answer 3

smooth down and remove excess composite, check other bonds
check tooth integrity and wire integrity (passive and not damaged)
if both fine - reapply composite (etch, prime, bond)

Question 4

debonded fixed retainer - multiple debonds/fractures and not fit for purpose

Answer 4

remove entire appliance, smooth down and remove composite and check integrity of teeth
options
1- replace bonded retainer
2- thermoplastic retainer
3- Hawley retainer

advise of relapse risk if they decline, document it and get signature

Question 5

debonded fixed retainer - fit for purpose but wire not passive

Answer 5

wire springing where debonded on last tooth
smooth down and remove excess composite, check other bonds
check tooth integrity and wire integrity
cut wire distal to next tooth and smooth flush with composite
options
1- leave - advise of possible relapse
2- thermoplastic retainer on top
3- new bonded retainer from orthodontist

Question 6

bracket debonded - round wire

Answer 6

clean tooth
remove ligatures
remove bracket and give to pt
OHI and refer to orthodontist 
don't rebond as you don't know the prescription

Question 7

bracket debonded - rectangular CS wire

Answer 7

don’t rebond as you don’t know the prescription
cant remove as doesn’t rotate
check not an inhalation risk and ensure there is a ligature securely placed
tell pt it has debonded and you cant replace it
move to side and clean underneath
orthodontist ASAP

Question 8

URA baseplate fractured into multiple segments

Answer 8

DON’t wear it as it is or superglue it back together
if fractured intraorally account for all fragments
offer a thermoplastic retainer
- advise pt there will be a cost - document if patient doesn’t want it
- can get it made quickly to “freeze” tx, prevent relapse and prevent lengthening of tx
often non-compliant pt who doesn’t want it anymore
- don’t assume this though

Question 9

wire slippage on fixed appliance

Answer 9

cut then bend retentive tag on both sides
refer to orthodontist
don’t pull arch wire round - might distort it or put it in wrong starting position

Question 10

Adams clasp snapped off

Answer 10

account for component - if unsure (risk of inhaled/ingested) refer to A and E
smooth off wire flush with baseplate
- check if enough retention with remaining clasps and cohesion-adhesion

Question 11

Adams clasp snapped off and not enough retention

Answer 11

1 - have original working cast

• send to lab with script and URA
• remove area, make new clasp and add acrylic which will bind

2 - can’t locate original cast

• take impression with URA in
• URA wouldn’t fit on the cast and be flush with palate due to imperfections, so when you put new acrylic on it would run down - acrylic creep
• new model will take surface of existing baseplate

Question 12

molar band detached on fixed appliance

Answer 12

cut wire between 5 and 6 and bend retentive tag
remove band and give to pt
refer to orthodontist
don’t recement

Question 13

Adams clasp fractured at arrowhead

Answer 13

not area of flex and far from acrylic so if have facilities solder it flush
if not remove mesial aspect - cut at top of other arrowhead and squeeze it closed to make it safe. smooth fractured edge flush with acrylic
if can’t modify remove entire clasp and assess whether enough retention
if not enough retention get a new clasp made
- locate original working cast
- or take imp with URA in situ (prevent acrylic creep)

Question 14

Southend clasp fractured in midline

Answer 14

can’t solder as area of flex and near soft tissues

make 2 C-clasps - bend wire back for retentive tags

Question 15

fixed appliance - brackets missing/debonded, missing ligatures

Answer 15

likely due to trauma
not fit for purpose
account for missing components (ingested/inhaled) and check no other injuries if trauma (refer to A and E if necessary)
remove arch wire (will also remove any loose brackets)
leave firm brackets in situ - put wax on if sore (if had trauma avoid force to teeth)
may need to splint - utilise brackets/above or below/palatal
refer to orthodontist

Question 16

fixed appliance with TPA fractured by molar band

Answer 16

remove TPA - tie floss and ask pt to hold it to avoid dropping down back of throat. don’t use cutters as large and can be painful. use bur to cut - need water coolant and aspiration. smooth edges
refer to orthodontist

Question 17

Adams clasp fractured near acrylic

Answer 17

can’t sold as area of flex
1 - cut to other arrowhead (otherwise too much strain) and squeeze to make safe - check if retentive enough
2 - if not get Adams clasp replaced - find working cast or take new impression with URA in