Orthodontic Competency Flashcards
What is the main indication of use for a URA?
- tipping of teeth
- space maintainer
What is the main indication of use for a fixed bonded retainer?
prevent relapse of malocclusion (especially rotations and diastemas)
What is the main indication of use for fixed bonded appliances?
- alignment
- movement
- space maintenence
A patient attends your practise with an orthodontic emergency, how might you tackle this?
Go through case systematically:
- ask how it happened
- account for any missing components
- deal with problem
- account for retention
- refer to orthodontist
A patient attends your practise with an orthodontic emergency, they are wearing the following appliance: URA, 2 adams clasps, southend clasp, palatal finger spring.
There is a fracture of the Southend clasp at the gingival margin between 11 and 12 where the wire eminates from the acrylic.
What is your management?
- Cut Southend in the middle
- Turn back on itself to create a single C clasp and smooth off rough edge to make flush with baseplate
- Check if still retentive, if not refer to orthodontist
- Cannot solder as too close to acrylic (it will melt/go on fire)
A patient attends your practise with an orthodontic emergency, they have a fixed bonded retainer.
There is debonded composite on 2 teeth.
What is your management?
- Remove overlying composite as much as possible
- Check tooth health (caries)
- Check integrity of the wire
- Ensure wire is still passive
- Replace composite over wire
A patient attends your practise with an orthodontic emergency, they have a fixed bonded appliance with molar bands.
A bracket has come loose on LR3.
What is your management?
- Archwire is round in cross section so the bracket can rotate (health risk as the bracket may come off and be aspirated)
- DO NOT REATTACH BRACKET, you will move tooth in wrong position if re-attached in wrong position
- Remove bracket by removing ligatures, give to pt and refer to orthodontist
- Check tooth health, give OHI
A patient attends your practise with an orthodontic emergency, they are wearing the following appliance: URA, 2 adams clasps, southend clasp, palatal finger spring.
There is a fracture of the Southend clasp in the middle.
What is your management?
- Take appliance off
- Bend both parts back to make 2 C clasps
- Wouldn’t solder as this is an area of flex so will just break again
A patient attends your practise with an orthodontic emergency, they have a fixed bonded retainer.
There is a debond on UR3, UL3 and UL2 and a fracture in the middle so retainer no longer passive.
What is your management?
- No longer fit for purpose/passive, will move teeth
- Cut component off and refer back to orthodontist asap
- Check tooth health!
- Let patient know alternative is a thermoplastic/pressure formed retainer, warn them that relapse likely to occur if no retainer
A patient attends your practise with an orthodontic emergency, they have a fixed bonded appliance with a transpalatal arch.
There is a fracture where the TPA meets the band on UR6.
What is your management?
TPA used predominantly for anchorage. This emergency is a trauma risk:
- Not removable so cannot solder
- Cannot bend tag in it as 0.9mm HSSW (too strong)
- Not fit for purpose so must remove TPA, cut at level of orthodontic bands with a diamond bur and LOTS of irrigation to dissipate heat and aspiration to remove debris. Sharp areas smoothed down.
- Short sharp bursts & tie floss to ensure pt doesn’t inhale it
- Refer back to orthodontist
A patient attends your practise with an orthodontic emergency, they are wearing the following appliance: URA, 2 adams clasps, southend clasp, palatal finger spring.
There is a fracture of the Left Adam’s claps at both sides, wire left eminating from acrylic.
What is your management?
- ACCOUNT FOR MISSING COMPONENT (if pt doesn’t know send them for X-ray)
- Smooth off edges
- Still retentive (due to remaining southend, adams and adhesions/cohesion from palate) = then no tx
- Not retentive = component needs to be replaced
To replace component the lab needs:
- The appliance
- The prescription
- The original working cast
Cannot locate original working cast/damaged:
- Can’t take new impression without appliance in as imperfections/discrepancies due to saliva/air bubbles means that appliance won’t seat properly on new cast [this leads to acrylic creep when appliance is attempted to be repaired]
- Take an impression with the appliance in situ, send impression to lab with appliance still in alginate [cast will have the surface of the acrylic baseplate]
- This will create a cast with the perfect seal between appliance and model, risk of contamination and acrylic creep is minimised
A patient attends your practise with an orthodontic emergency, they have a fixed bonded appliance with molar bands.
There is a debonded bracket on the 21 and square/rectangular wire has been used.
What is your management?
You cannot rotate bracket to take it off because of square wire
- Not likely to be an inhalation risk
- Ensure ligature is maintained well
- Move to side and check integrity of tooth underneath and show pt how to clean area
- Refer back to orthodontist
A patient attends your practise with an orthodontic emergency, they are wearing the following appliance: URA, 2 adams clasps, southend clasp, palatal finger spring.
The URA has shattered in their pocket.
What is your management?
- tell pt to NOT attempt to put appliance back in mouth (inhalation risk)
- account for lost parts (not as much of a risk as broke in pocket)
- take impression and provide pt with thermoplastic retainer in meantime until they get replacement
- if no replacement retainer they are at risk of relapse
A patient attends your practise with an orthodontic emergency, they have a fixed bonded appliance with molar bands.
There is archwire slippage due to failure of the retentive tag on one side leading to excess wire on other side.
What is your management?
- If not too bad give them orthodontic wax
- Cut excess wire and create retentive tags
- Also put retentive tag on deficient side to ensure it doesn’t happen further
- Refer back to orthodontist
- Can also just take archwire off and refer back to orthdontist
A patient attends your practise with an orthodontic emergency, they are wearing the following appliance: URA, 2 adams clasps, southend clasp, palatal finger spring.
There is a fracture of the Adams clasp through the arrowhead .
What is your management?
- Arrowhead not an area of flex so generally CAN be soldered back together if facilities present
- If not, cut in front of the arrow head so just leaving one distal arrowhead, squeeze arrowhead closed to make it safe
- Smooth at baseplate
- If this also isn’t possible remove entire Adam’s clasp and smooth off
- If retentive then okay
- If not then lab will require:
- Appliance
- Prescription
- Original working case OR new impression with appliance in situ to create cast with ideal palate to avoid acrylic creep due to appliance not seating properly
