Orthodontic Emergencies

Question 1

how do you fix a fractured southend clasp

Answer 1

trim the baseplate so the baseplate is flush with the palate, cut southend clasp in middle to make single C clasp and then fold the end over with adams pliers so it is not sharp

Question 2

what do you do if an appliance breaks near the start of treatment

Answer 2

make a new appliance

Question 3

what do you do if an adams clasp completely fractures off but is still retentive

Answer 3

check where the component is! (ingested)
smooth down sharp areas if still retentive

Question 4

what do you do if an adams clasp completely fractures off and is unretentive

Answer 4

send to laboratory to get component replaced
need working cast
if no working cast then impression with URA in mouth
URA+impression joined sent to lab

Question 5

why can you not take completely new impressions if a component breaks from a URA

Answer 5

the impressions will be different due to air blows so URA wont seat properly and liquid from self cure PMMA will run underneath the URA and contaminate the fitting surface
ACRYLIC CREEP

Question 6

how does a baseplate offer retention

Answer 6

adhesion/cohesion

Question 7

what do you do if the URA baseplate fractured extraorally but the patient is not your patient

Answer 7

tell them not to wear it
could make thermoplastic retainer in meantime for them

Question 8

what do you do if a bracket on a fixed appliance has debonded and can rotate

Answer 8

take ligature off first
take bracket off
send to orthodontist

Question 9

what do you do if a fixed retainer debonds from 4 out of 6 teeth

Answer 9

take it all off and check for caries
seek orthodontist to reattach
offer vacuum formed retainer

Question 10

what do you do if a transpalatal arch has fractured from the metal band

Answer 10

thread floss through arch and get patient to hold floss and cut transpalatal arch at the metal band
OR
remove bands from teeth and snip arch wire
send to orthodontist

Question 11

what do you do if adams clasp fractures at the arrowhead

Answer 11

solder
OR
cut it at baseplate to remove one flyover and cut bridge so there is only one arrowhead left and fold to make safe

Question 12

what do you do if a fixed bonded retainer debonds from a tooth and is now distorted making it functional

Answer 12

remove the wire from this tooth but keep running for other teeth

Question 13

what do you do if a band on a 6 debonds

Answer 13

cut wire so the band is off and curve wire so not sharp anymore
send to orthodontist

Question 14

what do you do if a southend clasp has fractured in the middle

Answer 14

make 2 C clasps
give OHI
send to orthodontist

Question 15

what do you do if a bracket on a central has debonded but you cannot move it to the side or rotate as it is close fitting

Answer 15

tell patient it is not attached
ensure ligature is securely attaching the wire
assess inhalation risk
tell them to clean underneath and get back to orthodontist

Question 16

what do you do if an adams clasp is broken where it goes into the baseplate

Answer 16

smooth at baseplate end
cut at the bridge and arrowhead
close over arrowhead so it is not sharp
if distorted remove the whole clasp

Question 17

what do you do if someone comes in with fixed appliance and the archwire is slipped out the back

Answer 17

secure excess wire with tweezers
cut and bend into retentive tag on both sides

Question 18

what do you do if a fixed retainer debonds from 31

Answer 18

remove composite
clean tooth
check integrity of wire
rebond it

Question 19

what do you do if someone comes with missing brackets
debonded brackets
loose archwire
missing ligatures

Answer 19

ensure no ingestion
take off ligatures
take out archwire
remove loose brackets
leave remaining brackets on
do trauma stamp
splint if mobile teeth