Orthodontic Emergency Assessment

Question 1

what is the first thing you always address when looking at the appliance that a patient has presented to you with in an emergency

Answer 1

are all components still intact
state what type of orthodontic therapy being used

Question 2

what would you do if a patient presented to you with a URA that had adams clasps and southend clasp and palatal finger springs but the southend clasp has fractured

Answer 2

account for components
trim any fractures flush with the baseplate - cut the southend clasp in the middle to create a C clasp
fold sharp edges of the C clasp down

Question 3

why can you not solder the wire together on a fractured southend clasp

Answer 3

lead is used to solder the wire which cannot be used in the mouth as it is poisonous and carcinogenic

Question 4

why can you not just get the patient to take the appliance that has broken out

Answer 4

compromising the orthodontic treatment

Question 5

a patient attends your practice with a URA (adams clasps, southend clasp and palatal finger spring) which has had one of the Adams clasps fractured off - what would you do

Answer 5

account for the components
trim adams clasp down to baseplate - if you try the URA and it is not retentive you need to replace the adams clasp
send to lab the original working cast and the URA

Question 6

why does it need to be the original working cast that gets sent to the lab to replace a clasp on the URA, why can you not just take new impressions

Answer 6

the air traps due to saliva causes voids when poured
the baseplate wont fit properly on the palate - there will be a space so the URA will not be flush against the palate
since it is not flush against the palate, when adding the acrylic the liquid will contaminate the fitting surface of the URA by running down

Question 7

what is acrylic creep

Answer 7

when acrylic contaminates the fitting surface of the URA

Question 8

what will you do if a patient attends your practice with a broken baseplate that occurred by fracturing outside of the mouth

Answer 8

do not need to account for missing pieces as happened extxraorally
make thermoplastic retainer and then get patient to see their orthodontist ASAP

Question 9

what would you do if a patient attended your practice and the 43 bracket of their fixed ortho has fallen off

Answer 9

remove ligature around bracket
remove bracket
send patient to their orthodontist

Question 10

what would you do if a patient attended your practice with a fixed bonded retainer on the lower anteriors but 4 out of the 6 teeth have debonded

Answer 10

take the whole retainer off
check lingual sides of the teeth for any caries
make a thermoplastic retainer
send to patient’s orthodontist

Question 11

what should you do if a patient refuses a treatment option you have suggested

Answer 11

explain risks of not following the proposed treatment plan and if patient still refuses get them to sign treatment plan that says the patient is going against the dentist’s advice

Question 12

what should you do if a patient attends your practice with a fixed appliance with a transpalatal arch that has fractured off the metal band on one side

Answer 12

remove the transpalatal arch by using a slowspeed to cut it where it is still attached to the metal band
use water as heat will be produced and use an aspirator for the debris

Question 13

why should you not attempt to bend a transpalatal arch that has fractured off of one of the metal bands

Answer 13

the pressure will go to the other side of the arch where the band is still attached to the transpalatal arch and to the tooth

Question 14

what should you do if a patient presents with a URA with adams clasps, palatal finger springs and southend clasp but the adams clasp has fractured at the arrow head

Answer 14

as long as it is far enough away from the acrylic you can solder it as it is not an area of flex
if it is so distorted that you cannot solder it - you can smooth off the fractured arrowhead so you are left with only one arrowhead
if distorted so much that modifying isn’t an option - remove the whole adams clas (retention from other clasp and southend)
if you dont have good enough retention - send an impression to the lab with the URA in the patient’s mouth for it to be repaired there

Question 15

you have a patient that presents with a fixed bonded retainer where the wire has debonded at 43 - what do you do

Answer 15

check no caries have occurred on the lingual surface
do not apply the wire and composite
cut wire and send patient away to be seen by their orthodontist

Question 16

why would you not rebond a wire that has debonded from a fixed retainer

Answer 16

the wire has distorted and would now exert force on the tooth

Question 17

what would you do if a patient attended your practice and the upper band for their fixed ortho has debonded on the 26

Answer 17

cut the wire mesial to the band and sent patient to their orthodontist

Question 18

why would you not bond a band back on a molar if it has debonded

Answer 18

a lot of the band would not be able to be covered in GIC as you cannot get it fully of the teeth so it would allow caries to ingress

Question 19

what would you do if a patient came in with a URA where the southend clasp has fractured in the middle

Answer 19

if new appliance - make new one
if been wearing for a while - bend the wires to make 2 C clasps and give OHI

Question 20

what would be the treatment for a patient who has fixed ortho and their bracket has debonded but it is not rotating on the archwire

Answer 20

not rotating = rectangular cross section instead of circular
make sure bracket is secured to archwire with ligature so no inhalation risk and send pt to their orthodontist

Question 21

what is your treatment if your patient appears with fixed orthodontics but the archwire has slipped out of one side

Answer 21

bend the archwire to a tag on one end of it and cut distal to nearest bracket it has slipped out of
send pt to their orthodontist

Question 22

what would you do if a patient presents with a fixed bonded retainer that has debonded from 31 only

Answer 22

if the wire is not distorted - remove composite, check health of tooth on lingual side and then etch prime and bond composite onto tooth again

Question 23

what are two indications for fixed bonded retainers

Answer 23

rotations
diastemas

Question 24

what would you do if a patient attends following trauma where there are multiple missing brackets and some debonded brackets and a loose archwire

Answer 24

account for components
take off ligatures
remove archwire
leave brakets that are securely bonded
carry out trauma stamp if need be