Ortho emergency faults

Question 1

Lower fixed bonded retainer uses

Answer 1

post ortho treatment to prevent relapse and rotations or diastemas

Question 2

Composite debonded on lower retainer and bounces

Answer 2

remove original composite and thin down with bur and remove above and below the wire
check no caries present and health of tooth
check integrity of wirework and still passive not active

Question 3

Tx for composite debonded from fixed retainer

Answer 3

rebond the retainer with bond and composite and give OHI

Question 4

Debonded composite on 43 and wire distored away from tooth

Answer 4

would not want to rebond as retainer not in passive state and distorted from tooth
Tx - cut wire at 42 and leave it bonded to remaining teeth
refer to ortho for new fixed retainer
OHI

Question 5

Fixed bonded retainer debonded from 41, 31,32,33 and no longer in passive state as no longer against teeth

Answer 5

take the retainer off and check for caries and tooth health
Wait for new fixed retainer for new fixed then provide a thermoplastic retainer to prevent relpase
OHI

Question 6

What to say if pt does not want new retainer

Answer 6

Document in pt notes and get them to sign it as evidence

Question 7

URA - 2 adams clasp, palaltal finger spring and guard, southend clasp
Fracture of southend clasp in the middle

Answer 7

Don’t solder the wire as area of flex and will not work
Bend both wires back to make safe and create 2 c shapes
check in pt’s mouth and give OHI
refer back to ortho

Question 8

URA - fractue of southend clasp at the flyover between 11 and 12 where wire is coming out of acrylic

Answer 8

If recently given - supply new URA
Later stages - don’t solder as close to acrylic and is area of lfex and acrylic is flammable, cut the southend at mid point to produce a single clasp and create C shape and smooth off rough edges to make them flush to baseplate, check still retentive
Give OHI
Refer back to ortho

Question 9

URA broken into 4 bits

Answer 9

tell pt not to attemp to put back in mouth or superglue together
ensure all pieces have been accounted for and establish how it happend
Offer thermoplastic retainer till can see ortho to prevent relaspe but would be a cost
call ortho for new URA

Question 10

URA - fractured adams clasp at arrowhead

Answer 10

if still engaging and retentive - cut infront of the arrowhead leaving a single distal arrowhead and squeeze closed to make safe, remove rest of clasp, smooth mesia lpart of baseplae
if distorted - cut the entire component, smooth down and check retention
if not retentive, need component replaced - need appliace, prescription and working cast
Give OHI and refer back to ortho

Question 11

What happens if can’t locate working cast

Answer 11

take a new impression with appliacne in situ, the cast will therefore have the surface of the acrylic baseplate
it will create a cast with a perfect seal between the appliance and model minimising risk of acrylic creep on fitting surface

Question 12

Why can’t you just take impression without applaince in situ

Answer 12

every impression has imprefections, discrpeancies, voids etc due to saliva/air bubbles and therefore the appliance would not seat correctly leading to acrylic creep

Question 13

URA - ul6 broken adams clasp - fracutred on both sides where the wire is coming out of acrylic, missing flyover and arrowhead

Answer 13

account for the missing components - if think inhaled or ingested then send to hospital for chest xray
Cant solder as too close to acrylic
smooth down and see if retention
if not retentive the component will need replaced - need appliance, prescription and working cast
Give OHI
refer back to ortho

Question 14

URA - fracture of adams clasp mesially where wire is coming from the acrylic

Answer 14

cut the adams clasp leaving a distal arrowhead and smooth wire at baseplate and check retention
Poor retention - need to replace component
OHI
Refer to ortho

Question 15

Fixed bonded appliance with arch wire, ligautres, brackets, molar bands
archwire slippage causing excess wire onLHS which could create trauma

Answer 15

remove sharp edge with cutters and bend to create retentive tag
on defienent side put new retentive tag in place
refer to ortho

Question 16

Fxed boned applaiance - bracket loose on LR3

Answer 16

arch wire is round due to being able to rotate and flip over the bracket and this is risk for ingestion of pt
never reattach bracket as GDP
check tooth health and give OHI
refer to ortho for rebond of bracket

Question 17

Fixed bonded appliance - molar band is loose, GIC failed

Answer 17

don’t cement the molar band back on as interfering with ortho work
Cut the archiwre mesially, make retetentive tag
give band to pt and refer to ortho

Question 18

Fixed bonded appliance - bracked debonded on 21

Answer 18

as it does not rotate unlikly for pt to ingest, ensure ligature is attached to bracket
tell them bracket has debonded
show them how to clean underneath by moving bracket to side
refer to ortho

Question 19

Fixed bonded appliance with transpaltal arch - fracture where TPA meet the band on UR6 and risk of truama

Answer 19

0.9mm HSSW so can’t bend back on itself
Remove the rest of TPA with a stone/diamond bur - losts of water and aspiration to disappate heat and smooth with disks
refer to ortho

Question 20

Fixed bonded appliance - brackets debonded and ligautres off on LL1,2,3

MOST COMMON CAUSE IS TRAUMA

Answer 20

account for missing brackets and if can’t refer to hosp for chest xray
arch wire is not fit for purpose
take ligaures off archwire and leave bonded brackets
apply trauma stamp to teeth and supervise any trauma
refer to ortho