Orthodontic emergencies competency

Question 1

Fractured Southend clasp at baseplate

Answer 1

1. Cut wire at the baseplate and smooth
2. Cut wire and create C clasp on adjacent tooth by curling sharp end
3. Could not solder due to proximity to the baseplate
4. OHI and refer to dentist who supplied appliance

Question 2

Debonded fixed retainer, wire not distorted

Answer 2

1. Remove composite with bur
2. Check tooth
3. Check wire
4. Apply etch, prime and bond
5. Apply fresh composite ensuring wire is passive
6. OHI

Question 3

Debonded bracket on fixed appliacne

Answer 3

If bracket can rotate (circular wire)
1. Remove ligatures and bracket
2. Check tooth
3. OHI and refer to dentist who supplied appliance

If bracket cannot rotate (square wire)
1. Secure bracket with ligature
2. OHI and refer to dentist who supplied appliance

Question 4

Fractured Adam’s clasp

Answer 4

Identify where missing component is
- if patient has it then continue with treatment
- if patient doesn’t know where it is, refer to A+E

1. Smooth wire and check retention
2. If component requires replacing, send the working cast and appliance to lab
3. If no working cast, take imp over appliance to obtain same fitting surface and prevent acrylic creep

Question 5

Define acrylic creep.

Answer 5

Device contaminated due to defects between plate and model

Question 6

Wire slippage

Answer 6

1. Cut wire at end that is over extended and curl to create retentive tag
2. Cut shorter wire mesial to molar band to create retentive tag
3. OHI and refer to dentist who supplied appliance

Question 7

Debonded fixed retainer (1 bracket), wire distorted

Answer 7

1. Inform patient that retention may be lost
2. Cut wire distal to last bonded tooth
3. Smooth wire
4. OHI and refer to dentist who supplied appliance

Question 8

Fractured URA in pieces

Answer 8

1. Inform patient they should not attempt to wear
2. Offer to make patient thermoplastic retainer to prevent relapse
3. Inform and document risks of not using retention, get patient to sign
4. OHI and refer to dentist who supplied appliance

Question 9

Fractured Adam’s clasp at arrowhead

Answer 9

1. Solder
   If unavailable:
2. Cut wire to create single arrowhead and curl wire to make safe
3. If not possible, remove entire clasp and check retention
4. If unretentive, new component required (working cast and appliance to lab)

Question 10

Loose molar band

Answer 10

1. Cut wire mesial to band and curl to make safe
2. Remove band and give to patient
3. OHI and refer to dentist who supplied appliance

Question 11

Debonded fixed retainer (multiple brackets), wire severely distorted

Answer 11

1. Inform patient it is not fit for purpose
2. Remove wire completely
3. Check teeth
4. Inform patient they still require retention, either thermoplastic (GDP) or wire (orthodontist)
5. Inform of risks of relapse, if patient refuses ask for signature

Question 12

13

Fractured transpalatal arch

Answer 12

1. Cut wire with handpiece to remove
2. Smooth bands
3. OHI and refer to dentist who supplied appliance

Question 13

6

Fractured Southend clasp at midline

Answer 13

Curl both ends of wire to make safe, and create two C clasps

Question 14

14

Fixed appliance with missing brackets, missing ligatures and loose brackets

Answer 14

Likely reason is trauma - REFER TO A+E IF PIECES MISSING
1. Orthodontics have been compromised
2. Remove ligatures and archwire
3. Leave brackets in place
4. Trauma stamp
5. +/- splint
6. OHI and refer to dentist who supplied appliance