Orthodontic emergency competencies Flashcards
For all orthodontic emergy cases how should your answer always be present. 5 parts.
- Identify and describe the type of ortho therapy
- Identify the emergency/fault
- What should you check for prior to correcting the faults?
- What options you have to correct this problem
- What Advice can you give the patient
Type, Emergency, Check, Options, Advice
TECOA
What is the orthodontic emergency here and what would you do?
**TECOA **
**Type of URA. ARAB.
A - Palatal finger spring with guard in 0.5mm HSSW on X tooth
R - Adams clasps on 16 and 26 0.7mm HSSW and southend clasp on 11 and 21 0.7mm HSSW
A - yes
B - self cure PMMA
** Explain the fault or emergency. So there is a midline fracture of the southend clasp.
-Check. What should you check for before fixing? Check what stage of the treatment the patient is at.
**Options **what are the patients treatment options.
a) If just started tx then refer back to orthodontist to remake URA.
b) If far into treatment then use adams pliers to create 2 c-clasps
c) cut off completely and smooth edges ensure retention is adequate ** is an area of flex so not suitable for soldering
**Advice **
- Advise the patient to continue wearing even though aesthetics arnt good to avoid relapse
What is wrong here and how would you treat this situation
TECOA
Type of appliance is a URA. ARAB.
A - Palatal finger spring with guard in 0.5mm HSSW on X tooth
R - Adams clasps on 16 and 26 0.7mm HSSW and southend clasp on 11 and 21 0.7mm HSSW
A - yes
B - self cure PMMA
Explain the fault
- Broken southend clasp on the 11 side
Checks. What should you check prior to correcting fault?
- What stage of treatment are they at
Options for tx
a) Just started then refer back to ortho to re-make URA
b) If well into tx then trim back one side and reshape otherside into a C clasp. Make sure other send is mooth and flush against the base plate
Advise
Advise the patient to continue to wear their URA to prevent relapse
What is fault here and how will you deal with it?
TECOA
Type of appliance ARAB.
A - Palatal finger spring with guard in 0.5mm HSSW on X tooth
R - Adams clasps on 16 and 26 0.7mm HSSW and southend clasp on 11 and 21 0.7mm HSSW
A - yes
B - self cure PMMA
Explain the fault
- Broken UR adams clasp
Check anything before carry out treatment?
- Check for all fragments and account for them. refer to A&E if cant account for some.
- Check what stage of teatment they are
Options
a) If they have just started tx then refer back to orthodontist and remake
b) If well into treatment, trim and smooth ends so that its flush against base plate, ensuring retention is adequate.
c) if retention not adequate, check for pt’s previous working cast and send appliance back to lab for the damaged clasp to be removed and replaced.
c(i) If working cast not present, take impression with URA in place and send to lab. Lab can block out active component with wax then pour impression so that cast can be replicated to the fitting surface of the baseplate
c(ii) If impression taken without URA, acrlic creep may occur to blebs on the acrylic baseplate and new cast resulting in URA not sitting flush against the platal surface of the cast
Advise
- ??
What is the orthodontic emergency here and how will you treat it?
TECOA
Type of appliance ARAB.
A - Palatal finger spring with guard in 0.5mm HSSW on X tooth
R - Adams clasps on 16 and 26 0.7mm HSSW and southend clasp on 11 and 21 0.7mm HSSW
A - yes
B - self cure PMMA
Explain the fault
- Small fracture of the UR adams clasp at arrowhead region
Check. Any checks you should do before treatment carried out?
- Check for any missing pieces of wire. Patient hasnt inhaled any.
- Check what stage of tx the patient is at
Options. What are the treatment options?
a) If early in tx then refer to ortho to remake
b) if far along tx and fracture isnt at any area of flex then can solder back together
c) If retention is adequate then trim distal arrowhead which is no longer functioning up to the baseplate. Trim remaining if the clasp to mesial arrowhead and squeeze it inwards with pliers to make a single arrowhead/retentive tag.
d) If retention is NOT adequate check for the patients previous working cast and send appliance back to lab for the damage clasp to replaced.
- However if you dont have the previous working casts. Then take impression with URA in place and send to lab for new URA. Lab can block out active component with wax and pour up impression so the cast can be replicated to the fitting surface of the baseplate. N.B if the impression is taken without URA then acrylic creep can take place and URA wont be flush with palate.
Advise
- Continue tx once URA is fixed
- Can make thermoplastic retainer in the mean time to prevent relapse
What is the orthodontic emergency here and how will you treat it?
TECOA
Type of appliance
ARAB.
A - Palatal finger spring with guard in 0.5mm HSSW on X tooth
R - Adams clasps on 16 and 26 0.7mm HSSW and southend clasp on 11 and 21 0.7mm HSSW
A - yes
B - self cure PMMA
Explain what the fault is.
- Fracture of UR adams clasp at an area of flex at the flyover
Check what before continue tx
- Check for fragments
- Check stage of treatment
Options - Tx options
a) If at start of tx then refer to ortho for new URA
b) if far into treatment then think retention. If it is still retentive then trim at the distal end which is no longer functioning up to the baseplate. Trim remaining part of the clasp to mesial arrowhead and squeeze it inwards with pliers to make a single arrowhead/retentive tag.
c) if URA is no longer retentive then send to lab with previous working casts. If these casts ar unavailable then take an impression with URA in place and send to the lab.
Cant solder as this is an area of flex
Advise patient to wear URA if still fits to prevent relapse
if the adams clasp breaks at an area of flex like the flyover. Can you repair it by soldering it back together?
No as it is an area of flex
If working casts are not present and you have to replase a URA. Why do you need to take impressions with the URA in place?
- To prevent acylic creep
- This means that the URA will fit more flush against the palatal surface
What is the orthodontic emergency here and how would you tx it?
TECOA
Type of appliance
ARAB.
A - Palatal finger spring with guard in 0.5mm HSSW on X tooth
R - Adams clasps on 16 and 26 0.7mm HSSW and southend clasp on 11 and 21 0.7mm HSSW
A - yes
B - self cure PMMA
Explain the fault/emergency
- Shattered baseplate
Check. What should you check for before carrying out treatment?
- Check for fragements. None were inhaled
- Check how it happened. If they smashed it could be a sign of non-compliance.
- Check stage of tx
Options.
- Do not put back into the patients mouth. refer to orthodontist to remake
- Can offer to make a thermoplastic retainer in the mean time to avoid relapse. Explain risk of relapse if the patient delcines and document in the notes.
Advise
- Advise the patient to see there orthodontist as soon as possible
- Wear retainer to prevent relapse
What orthodontic emergency is this and what would you do to treat it?
TECOA
Type of appliance
- Lower fixed braces
Explain the fault
- Loose bracket on 31
Check. What should you check prior to correcting the fault.
- Check for any missing brackets or ligatures
- Check the health of the tooth by removing the remaining composite
Options
- If wire has round cross section then remove the bracket and ligature and refer to ortho
- If wire has square cross section. Secure the bracket with a ligature and show the patient how to move the bracket to the side to allow them to celan properly underneath. Refer to ortho
- Do not attempt to re-bond bracket
Advise
- Advise the patient to see an orthodontist and to continue to keep area clean
What type of wire cross section would you
a) Remove the bracket and ligature
b) Stabilise the bracket with a ligature
a) Round
b) Square
What orthodontic emergency is this and what would you do to treat it?
TECOA
Type of orthodontic appliance
- Upper and lower fixed applaince
Explain the fault/emergency
- Arch wire slippage. Excess wire poking into tissues on LL
Check. What should you check before giving treatment
- Check for missing parts
- Stage of tx the patinet is at
Options
- Cut the excess wire distal to the 36 and bend into a retentive tag.
- Cut the shortened end mesial to 45 and bend into retentive tag
- Refer to ortho to replace the arch wire. Do not attmept to replace yourself
Advise
- Advise the patient to see orthodontist asap
What orthodontic emergency is this and what would you do to treat it?
TECOA
Type of appliance
- Upper fixed appliance with molar bands on the 6’s and a transpalatal arch
Explain the fault
- UR molar band has seperated from the transpalatal arch.
Check
- Check for missing wire
- Check the stage of tx
Options
- Appliance is no longer fit for purpose. Remove the TPA by using a high speed bur. Tie floss to the TPA and ask patient to hold when removing (protect airway). Smooth off any rough edges
- Refer to ortho
- cant fix it as wire too thick 0.9mm HSSW and cant solder as I/O
Advise
- See orthodontist asap
What orthodontic emergency is this and what would you do to treat it?
TECOA
Type of appliance
- LR molar band with lower fixed appliance
Explain the faults
- Debonded molar band 46
Checks. What should you check for before carrying out tx.
- Check for any missing components
Options
- Cut arch wire distal to the 45 and bend into retentive tag. Remvoe molar band and check health of tooth.
- refer to ortho
- Dont rebond it as dont know the correct postiion of the band
- Dont pack GI cement in
Advise patient
- See orthodontist asap
What orthodontic emergency is this and what would you do to treat it?
TECOA
Type of appliance
- Upper and lower fixed appliances
Explain the fault
- Upper fixed appliance brackets has de-bonded. Multiple debonded brackets and missing ligatures from 11 to 24
Check?
- Check for missing componets. Ligatures, brackets and wire.
- Check how this happened. trauma?
Options
- Remove ligatures, arch wire and loose brackets. Do not remove bonded brackets as teeth may be mobile from trauma. Assess teeth using tauma stamp and manage accordingly.
- refer to ortho asap
Advise
- Inform patinet that teeth movement is possible if significant time has lapsed between initial visit and orthodontic appointment
What orthodontic emergency is this and what would you do to treat it?
TECOA
Type of appliance
- Upper bonded retainer. On palatal surface 13-23
Explain the faults
- Debonded Composite on 13 (passive wire)
Check?
- Check composite is still attached on other teeth
- Check that the wire is passive still and not active
- Remove composite from tooth surface and check health of tooth 13. Restore if appropriate
- Check integrity of wrie framework
Options
- Ensure wire is passive and rebond with etch prime bond and composite
Advise
What orthodontic emergency is this and what would you do to treat it?
TECOA
Type of appliance
- Fixed bonded retainer 13-23
Explain the fault
- Debonded composite on 13 (active wire)
Check
- Check if the composite is still attached to the other teeth
- Check if the wire is active or passive
- Check tooth is healthy underneath composite. So remove composite on 13 and restore tooth is needed
Options
- Trim wire to distal of the 12. Use soft flex disc to smooth
Advise
- Inform the patinet that teh 13 may move. Ask patient to return to orthdontist asap to have retainer replaced
- Encourage use of thermoplastic retainer if they have.
What orthodontic emergency is this and what would you do to treat it?
TECOA
Type of appliance
- Upper fixed bonded retainer 13-23
Explain the fault
- Wire has debonded from 13 to 21
Check
- check for any decay around tooth
Options
- Remove composite and the entire fixed retiner as no longer functioning. Check health around the teeth
- Inform the patient that anterior teeth can move and offer options for replacement
- Thermoplastic retainer
- hawley retianer
- Another fixed bonded retainer, refer to ortho
Advise
If patient declines, ensure patient understands the risk of relapse and document this in the notes
