Orthodontic Emergencies Flashcards
URA with a fractured southend clasp where it eminates over the lateral central on the RHS
a) Identify and describe ortho therapy being used and explain general uses;
b) Identify the fault(s) of emergency
c) Account for all the components of the appliance and demonstrate the importance of each component
d) Demonstrate the treatment options for the emergency and what option is best to treat the problem – always ensuring patient safety and ideally not compromising the orthodontics
e) Provide the appropriate advice to a patient regarding aftercare
A) URA - tip and tilt teeth, habit breaker, correct overbite, space maintainer, expand upper arch.
B) southend fractured where it emanates over the lateral and central on the RHS
C) Southend clasp - retention, Adams clasps - retention,
retention = resistance to vertical displacement forces
SC PMMA baseplate - unites components on one side of the arch to the other, provides a seal and can provide anchorage.
active component = The component that is moving the teeth with the application of force
* palatal Finger springs - used to retract teeth in the line of arch
* Z- spring – push tooth forward into the arch (ant crossbites)
* Flapper spring – push tooth forward into the arch
* T spring
* midpalatal screw = expand the upper arch
0.5mm Sheathing placed over the wire to prevent distortion
* Roberts retractor - reduce an overjet
* Buccal canine retractor - retract buccally placed canines
D) NO = Composite to fix the fracture = No as fracture in is an area of flex
NO = Soldering the wire to– high temps will melt acrylic and wire won’t be able to flex afterwards
YES = Cut the SE clasp in the middle so that it engages one tooth and bend it back on itself and then smooth the wire still embedded in the acrylic so that its flush
E) If still retentive then no need to visit orthodontist, continue tx and provide OHI
Fixed bonded retainer - debonded from one of the teeth
a) Identify and describe ortho therapy being used and explain general uses;
b) Identify the fault(s) of emergency
c) Account for all the components of the appliance and demonstrate the importance of each component
d) Demonstrate the treatment options for the emergency and what option is best to treat the problem – always ensuring patient safety and ideally not compromising the orthodontics
e) Provide the appropriate advice to a patient regarding aftercare
A) FBR on teeth X - used after orthodontics on the incisors/canines to retain the position of the teeth and prevent relapse (especially rotated teeth/diastemas)
Adv - good compliance, aesthetic
Disadv - hard to clean (plaque/calucus build up), if debonded can cause caries, no posterior retention
B) wire debonded from teeth X and is still passive and not distorted
C) passive Stainless steel wire ??mm held on to each tooth with composite
D) Go round and inspect all the bonds (bouncing = not bonded)
Identify where its deboned and on what tooth
Make patient aware
TX:
1. Remove comp until it’s flush with the wire and flick it off the remaining
2. Inspect the tooth beneath for caries
3. Tooth fine – assess wire intact and no distortion to the wire - ENSURE its still PASSIVE
4. All adequate – etch, prime and bone and rebond composite
E) Don’t need to send back to orthodontist and provide OHI
URA with a fracture at the midline of the southend clasp
a) Identify and describe ortho therapy being used and explain general uses;
b) Identify the fault(s) of emergency
c) Account for all the components of the appliance and demonstrate the importance of each component
d) Demonstrate the treatment options for the emergency and what option is best to treat the problem – always ensuring patient safety and ideally not compromising the orthodontics
e) Provide the appropriate advice to a patient regarding aftercare
A) URA - tip and tilt teeth, habit breaker, correct overbite, space maintainer, expand upper arch.
B) southend fractured at the midline
C) Southend clasp - retention, Adams clasps - retention, SC PMMA baseplate - unites components on one side of the arch to the other, provides a seal and can provide anchorage. + active component
D) NO = Soldering the wire – high temps will melt acrylic and wire won’t be able to flex afterwards
YES = half the southend so it’s retentive on both sides and then bend the wire back on its self on EACH side
E) If still retentive then no need to visit orthodontist, provide OHI and continue tx
Active fixed appliances with a bracket debonded on tooth X.
The bracket is still attached to the wire and can be easily rotated.
a) Identify and describe ortho therapy being used and explain general uses;
b) Identify the fault(s) of emergency
c) Account for all the components of the appliance and demonstrate the importance of each component
d) Demonstrate the treatment options for the emergency and what option is best to treat the problem – always ensuring patient safety and ideally not compromising the orthodontics
e) Provide the appropriate advice to a patient regarding aftercare
A) Active fixed appliances
Used for precision to tooth movements in three dimensions.
B) Bracket debonded on tooth X, still attached to the archwire and can be easily rotated
C)
1. brackets - Have prescription incorporated into them and based on what position/movements are required from the teeth.
2. orthodontic bands - provides a stopping point for the appliance and useful for bonding to teeth that don’t have sufficient enamel.
3. arch wire - used to slide teeth
4. ligatures - held keep wire and bracket together
5. anchorage components - resist unwanted tooth movement
6. force generating components e.g. intra-oral elastics - move by using the force stored in the elastic or the spring
7. Auxillaries -
D)check for caries below
2. check wire integrity and no distortion
3. if bracket can be easily rotated = remove the ligature and bracket
(cant rebond since you don’t know the prescription of the individual brackets)
E) Give px the bracket, provide OHI and tell them to see orthodontist at earliest to rebond to prevent disruption of the teeth.
Active fixed appliances with hyperexteded/overextended archwire
visually: wire extends out the back of the band on one side and wire slippage on the otherside (not visible)
a) Identify and describe ortho therapy being used and explain general uses;
b) Identify the fault(s) of emergency
c) Account for all the components of the appliance and demonstrate the importance of each component
d) Demonstrate the treatment options for the emergency and what option is best to treat the problem – always ensuring patient safety and ideally not compromising the orthodontics
e) Provide the appropriate advice to a patient regarding aftercare
A) Active fixed appliances
Used for precision to tooth movements in three dimensions.
B) Active fixed appliances still bonded to each tooth with hyperexteded/overextended archwire
C)
1. brackets - Have prescription incorporated into them and based on what position/movements are required from the teeth.
2. orthodontic bands - provides a stopping point for the appliance and useful for bonding to teeth that don’t have sufficient enamel.
3. arch wire - used to slide teeth
4. ligatures - held keep wire and bracket together
5. anchorage components - resist unwanted tooth movement
6. force generating components e.g. intra-oral elastics - move by using the force stored in the elastic or the spring
7. Auxillaries -
D)can’t push it through as we won’t know the correct position and can cause movement of the arch
TX for overextended side:
- Grip extension
- cut to reduce length
- place retentive tag
Tx for slipped side:
- place a retentive tag in the side still attached (bin the excess bit of wire from the 6)
= Tags on both sides
E) provide OHI and tell them to see orthodontist at earliest to prevent disruption of the teeth.
URA shattered into multiple fragments (brought in a bag)
a) Identify and describe ortho therapy being used and explain general uses;
b) Identify the fault(s) of emergency
c) Account for all the components of the appliance and demonstrate the importance of each component
d) Demonstrate the treatment options for the emergency and what option is best to treat the problem – always ensuring patient safety and ideally not compromising the orthodontics
e) Provide the appropriate advice to a patient regarding aftercare
A) URA - tip and tilt teeth, habit breaker, correct overbite, space maintainer, expand upper arch.
B) URA shattered into multiple fragments (brought in a bag)
C) Southend clasp - retention, Adams clasps - retention, SC PMMA baseplate - unites components on one side of the arch to the other, provides a seal and can provide anchorage. + active component
D) Tell them not to: repair/glue back together or wear (aspiration/ingestion risk)
TX = take impressions and provide a new thermoplastic retainer
= prevent teeth from relapsing (freezes tx)
E) Advise px: charge for retainer, provide OHI and advise them to see orthodontist asap to get a new one made.
Active fixed appliances with a transpalatal arch
Transpalatal arch fractured at the junction between the palatal archwire and the ortho band on one side
a) Identify and describe ortho therapy being used and explain general uses;
b) Identify the fault(s) of emergency
c) Account for all the components of the appliance and demonstrate the importance of each component
d) Demonstrate the treatment options for the emergency and what option is best to treat the problem – always ensuring patient safety and ideally not compromising the orthodontics
e) Provide the appropriate advice to a patient regarding aftercare
A) Active fixed appliances
Used for precision to tooth movements in three dimensions.
transpalatal arch = anchorage
B) Transpalatal arch fractured at the junction between the palatal archwire and the ortho band on one side
C)
1. brackets - Have prescription incorporated into them and based on what position/movements are required from the teeth.
2. orthodontic bands - provides a stopping point for the appliance and useful for bonding to teeth that don’t have sufficient enamel.
3. arch wire - used to slide teeth
4. ligatures - held keep wire and bracket together
5. anchorage components e.g. transpalatal arch - resist unwanted tooth movement
6. force generating components e.g. intra-oral elastics - move by using the force stored in the elastic or the spring
7. Auxillaries -
D) 1. Loop and tie dental floss around the bar and get px to hold = prevent aspiration risk
2. Cut the bar at the other ortho band union - ensure coolant and aspiration to prevent it heating up
3. Cut and smooth each side to make it flush with the ortho bands
E) provide OHI and tell them to see orthodontist at earliest to prevent disruption of the teeth.
URA with adams clasp fractured off on RHS
a) Identify and describe ortho therapy being used and explain general uses;
b) Identify the fault(s) of emergency
c) Account for all the components of the appliance and demonstrate the importance of each component
d) Demonstrate the treatment options for the emergency and what option is best to treat the problem – always ensuring patient safety and ideally not compromising the orthodontics
e) Provide the appropriate advice to a patient regarding aftercare
A) URA
B) adams clasp fractured off on RHS
C) Southend clasp - retention, Adams clasps - retention, SC PMMA baseplate - unites components on one side of the arch to the other, provides a seal and can provide anchorage. + active component
D) 1. find out where the adams clasp is (is it inhaled/ingested – A&E for an x-ray) did it happen extra-orally and can it be accounted for
2. smooth off the wire where adams clasp was and ensure it’s flush with the baseplate
3. try back in px mouth and assess if retention still present from the other retentive features
What can offer retention even although the adams clasp has fractured?
- adhesion/cohesion from baseplate
- Other adams clasp
- southend clasp
- If adequately retentive = cont. with treatment
or - If dropping down/unretentive = get the original working casts that the appliance was made from
(If can’t get this cast/cast is broken take an alginate impression with the appliance in situ and the impression should have the appliance in the alginate, impression poured up in stone with the URA on the model
= creates a perfect seal and minimises acrylic creep** know this as you will be asked
E) provide OHI and continue with treatment
Fixed bonded retainer - debonded from multiple teeth and the wire is no longer passive
a) Identify and describe ortho therapy being used and explain general uses;
b) Identify the fault(s) of emergency
c) Account for all the components of the appliance and demonstrate the importance of each component
d) Demonstrate the treatment options for the emergency and what option is best to treat the problem – always ensuring patient safety and ideally not compromising the orthodontics
e) Provide the appropriate advice to a patient regarding aftercare
A) FBR on teeth X - used after orthodontics on the incisors/canines to retain the position of the teeth and prevent relapse (especially rotated teeth/diastemas)
Adv - good compliance, aesthetic
Disadv - hard to clean (plaque/calucus build up), if debonded can cause caries, no posterior retention
B) debonded from teeth X and wire not passive any more (no longer fir for purpose)
if more than half debonded = no longer serving the purpose and remove
C) passive Stainless steel wire ??mm held on to each tooth with composite
D) remove it entirely
If px wishes - Take impressions to replace with a thermoplastic retainer
E) If the px wants another fixed retainer = see your orthodontist
If you remove it and px doesn’t want you to replace it with anything = have to document and get px to sign to confirm
and Don’t need to send back to orthodontist
Active fixed appliance ligatures fallen off, bracket debonded from tooth and can be pushed from side to side - cant be rotated just bends and displaces the arch wire = risk for debonding other brackets
a) Identify and describe ortho therapy being used and explain general uses;
b) Identify the fault(s) of emergency
c) Account for all the components of the appliance and demonstrate the importance of each component
d) Demonstrate the treatment options for the emergency and what option is best to treat the problem – always ensuring patient safety and ideally not compromising the orthodontics
e) Provide the appropriate advice to a patient regarding aftercare
A) Active fixed appliances
Used for precision to tooth movements in three dimensions.
B) active appliances withbligatures fallen off, bracket debonded from tooth and can be pushed from side to side - cant be rotated just bends and displaces the arch wire = risk for debonding other brackets
C)
1. brackets - Have prescription incorporated into them and based on what position/movements are required from the teeth.
2. orthodontic bands - provides a stopping point for the appliance and useful for bonding to teeth that don’t have sufficient enamel.
3. arch wire - used to slide teeth
4. ligatures - held keep wire and bracket together
5. anchorage components e.g. transpalatal arch - resist unwanted tooth movement
6. force generating components e.g. intra-oral elastics - move by using the force stored in the elastic or the spring
7. Auxillaries -
D) 1. Put a ligature on the attached brackets/debonded brackets to secure them and make the px aware – don’t try to twist it off as you could cause more damage and debond more brackets
E) Advise px to Move it to the side and clean during brushing
Refer to orthodontist asap
URA with fractured Adams clasp at the arrowhead (not an area of flex – don’t adjust it here)
a) Identify and describe ortho therapy being used and explain general uses;
b) Identify the fault(s) of emergency
c) Account for all the components of the appliance and demonstrate the importance of each component
d) Demonstrate the treatment options for the emergency and what option is best to treat the problem – always ensuring patient safety and ideally not compromising the orthodontics
e) Provide the appropriate advice to a patient regarding aftercare
A) URA - tip and tilt teeth, habit breaker, correct overbite, space maintainer, expand upper arch.
B) fractured Adams clasp at the arrowhead (not an area of flex – don’t adjust it here)
C) Southend clasp - retention, Adams clasps - retention, SC PMMA baseplate - unites components on one side of the arch to the other, provides a seal and can provide anchorage. + active component
D) Can repair if you have the app facilities/lab nearby = can solder since far enough away from the acrylic and can carry on with tx
Or
If clasp too distorted and can’t adjust/solder = cut the leg on the fractured side and adjust at the arrowhead on the other side and squeeze shut with plyers = single arrowhead and retention still present.
Or
Remove the whole component, trim until its flush with the baseplate and see if retention still present with the other components
To Replace the component;
Get the OG working casts that the appliance was made from
or
If can’t get this cast/cast is broken;
- take an alginate impression with the appliance in situ in the mouth and when you take the impression out it should have the appliance in the alginate
- impression poured up in stone with the URA on the model
= perfect seal and minimises acrylic creep
E) provide OHI and continue with treatment
Fixed bonded retainer - debonded from tooth/teeth at the end and the wire is no longer passive
a) Identify and describe ortho therapy being used and explain general uses;
b) Identify the fault(s) of emergency
c) Account for all the components of the appliance and demonstrate the importance of each component
d) Demonstrate the treatment options for the emergency and what option is best to treat the problem – always ensuring patient safety and ideally not compromising the orthodontics
e) Provide the appropriate advice to a patient regarding aftercare
A) FBR on teeth X - used after orthodontics on the incisors/canines to retain the position of the teeth and prevent relapse (especially rotated teeth/diastemas)
Adv - good compliance, aesthetic
Disadv - hard to clean (plaque/calucus build up), if debonded can cause caries, no posterior retention
B) debonded from teeth X and wire not passive any more (no longer fir for purpose)
C) passive Stainless steel wire ??mm held on to each tooth with composite
D) 1. Cut distal to the tooth still bonded and make it flush with the composite, smooth it off, leave the retainer untouched on the other teeth if it is still bonded.
E) Inform px where its debonded and that this tooth may relapse
advise px that if they want another and don’t want tooth to relapse to see the orthodontist asap
Active fixed appliance - GIC failed on an orthodontic band and it has come loose
a) Identify and describe ortho therapy being used and explain general uses;
b) Identify the fault(s) of emergency
c) Account for all the components of the appliance and demonstrate the importance of each component
d) Demonstrate the treatment options for the emergency and what option is best to treat the problem – always ensuring patient safety and ideally not compromising the orthodontics
e) Provide the appropriate advice to a patient regarding aftercare
A) Active fixed appliances
Used for precision to tooth movements in three dimensions.
B) Active fixed appliance - GIC failed on an orthodontic band and it has come loose
C)
1. brackets - Have prescription incorporated into them and based on what position/movements are required from the teeth.
2. orthodontic bands - provides a stopping point for the appliance and useful for bonding to teeth that don’t have sufficient enamel.
3. arch wire - used to slide teeth
4. ligatures - held keep wire and bracket together
5. anchorage components e.g. transpalatal arch - resist unwanted tooth movement
6. force generating components e.g. intra-oral elastics - move by using the force stored in the elastic or the spring
7. Auxillaries -
D) Don’t rebond as the band has a prescription too (we are not qualified to manage ortho prescriptions)
- also if you replace the band with GIC it won’t have a perfect seal around the band
TX = Cut the wire and place a retentive tag, remove the ortho band and give to the px
Advise px sees orthodontist asap
E) Advise px to see orthodontist asap
Active fixed appliance ligatures fallen off, bracket debonded from tooth and can be moved
a) Identify and describe ortho therapy being used and explain general uses;
b) Identify the fault(s) of emergency
c) Account for all the components of the appliance and demonstrate the importance of each component
d) Demonstrate the treatment options for the emergency and what option is best to treat the problem – always ensuring patient safety and ideally not compromising the orthodontics
e) Provide the appropriate advice to a patient regarding aftercare
A) Active fixed appliances
Used for precision to tooth movements in three dimensions.
B) Active fixed appliance ligatures fallen off, bracket debonded from tooth and can be moved
C)
1. brackets - Have prescription incorporated into them and based on what position/movements are required from the teeth.
2. orthodontic bands - provides a stopping point for the appliance and useful for bonding to teeth that don’t have sufficient enamel.
3. arch wire - used to slide teeth
4. ligatures - held keep wire and bracket together
5. anchorage components e.g. transpalatal arch - resist unwanted tooth movement
6. force generating components e.g. intra-oral elastics - move by using the force stored in the elastic or the spring
7. Auxillaries -
D) Discuss why the brackets could have debonded:
* Trauma (and soft tissue trauma)
- If this is the case we are not mainly concerned with the ortho tx but the other injuries (trauma to teeth/ST tissues)
TX: prioritise patient safety/health
1. Complete trauma stamp
2. Remove arch wire and any loose brackets
3. Account for the missing brackets (ensure not inhaled/ingested)
4. Mobile teeth splinted
What do you do with the existing brackets/bands?
Don’t take them off as it requires force and teeth sore/mobile = leave these
E) Advise px to see orthodontist asap
URA with a space maintainer with a fractured adams clasp where wirework eminates from the acrylic
a) Identify and describe ortho therapy being used and explain general uses;
b) Identify the fault(s) of emergency
c) Account for all the components of the appliance and demonstrate the importance of each component
d) Demonstrate the treatment options for the emergency and what option is best to treat the problem – always ensuring patient safety and ideally not compromising the orthodontics
e) Provide the appropriate advice to a patient regarding aftercare
A) URA - tip and tilt teeth, habit breaker, correct overbite, space maintainer, expand upper arch.
B) URA with a space maintainer with a fractured adams clasp where wirework eminates from the acrylic
C) Southend clasp - retention, Adams clasps - retention, SC PMMA baseplate - unites components on one side of the arch to the other, provides a seal and can provide anchorage. + active component
D) cant solder as it’s too close to acrylic
TX = utilise single arrow head approach
or
If wire is too distorted = completely remove and assess retention without the adams clasp
In this case there is only one other retentive component = poor retention = have to completely replace the clasp
To Replace the component;
Get the OG working casts that the appliance was made from
or
If can’t get this cast/cast is broken;
- take an alginate impression with the appliance in situ in the mouth and when you take the impression out it should have the appliance in the alginate
- impression poured up in stone with the URA on the model
= perfect seal and minimises acrylic creep
E) provide OHI and continue with treatment
