Ortho-emergencies Flashcards
The patient has attended with a broken thermoplastic retainer
How do we treat this and why?
We make the patient a new thermoplastic retainer using an impression of their current dentition.
This is because the teeth will have moved and we want to prevent any more movement. We cannot move the teeth back to their previous position.
The patient has attended with a debonded fixed retainer.
On examination a single bond is debonded.
How do we treat this and why?
- we get a tungsten carbide bur and remove the composite to expose the wire. We then remove the composite above and below the wire.
- Check the tooth is sound (No caries)
- Check the wire (is it damaged? Passive against the tooth?)
- Etch/prime and bond the wire back to the tooth.
aftercare-Provide advice on cleaning the retainer.
We remove the existing composite so we have a larger surface area to attach the wire back on to.
We check the wire as we should not push it back into place (this would make it active rather than passive and cause tooth movement)
How do we check the bonds on a bonded retainer?
Push down on the wire with a flat plastic.
The patient has presented with a debonded fixed retainer.
On examination multiple bonds are no longer bonded.
How do we treat this and why?
- check the wire- is it active or passive.
- if it is passive you can recement the wire on
- if it is active remove the entire retainer & check the health of the teeth.
Give the patients other options for retention. If the patient refuses we get them to sign a document saying so.
If the wire is active it is significantly distorted- won’t retain the teeth.
How do we know that a wire is active?
It is active if it needs to be pushed back into place.
The patient has presented with an URA with a fractured southend clasp like so:
How do we treat this and why?
If at the start of the treatment- just make a new URA.
If in the later stages-
Cut the southend clasp at the midline .
Bend the unbroken side back on itself.
Smooth the sharp bit to make it flush with the acrylic.
Aftercare- OHI and make a new appointment.
It can’t be fixed because it is at a point of flex (the continued flexing would cause metal fatigue)
It can’t be soldered as it is too close to the baseplate (PMMA is flammable)
Half a southend clasp should provide enough retention to finish treatment.
The patient has attended with a damaged URA. There is a fracture in the midline of the south end clasp.
How do we treat this and why?
Bend both wires back on themselves.
Aftercare- OHI and make a new appointment.
We cannot solder it as it’s an area of flex.
The patient attends with a smashed URA.
How do we treat this and why?
Do not put it back in their mouth.
Find out how it happened.
Give the patient a retainer until we can get them a new appliance
(We want to know if there is a compliance problem)
The new retainer prevents the teeth moving before we can continue treatment again.
The patients attends with a broken URA.
On examination- the adam’s clasp has fractured off.
How do we treat this and why?
- Find out where the lost part is (if there is a risk that it was swallowed- A&E)
- Smooth the sharp bits and make them flush with the acrylic & check if its retentive.
- If the URA is not retentive use the study model to replace the missing part.
- If we cannot find the study model we take an impression with the broken URA in situ.
Aftercare- OHI and book an appointment for review/new URA.
The working cast has positives of saliva and air from the original impression. These are part of the URA. Another impression won’t have the same positives.
By taking an impression in situ we get the new model to take the surface of the acrylic (any imperfections get replicated on the cast)
This means there is no space in which extra PMMA could go to contaminate the fitting surface and prevent the URA sitting flush (known as acrylic creep)
The patient has attended with an adam’s clasp with a fractured arrowhead
how do we treat this and why?
If we have the souldering facilities we can solder it, .
If not-
Cut the broken part and make it flush with the baseplate.
Cut the bridge in half. Bend the unbroken side back on itself.
If we can’t modify it or it is extremely distorted cut the adam’s clasp off and smooth it. Then check for retention.
If the URA is no longer retentive:
Use the study cast to replace the URA.
If we cannot find the study cast we need to take an impression with the current URA in situ (to prevent acrylic creep)
Aftercare- OHI and book review appointment.
Soldering is an option as it is not near the baseplate and not a point of flex.
Bending the arm back still provides retention using a single arrowhead.
The baseplate alone may give enough retention.
The patient has attended with a debonded bracket on their fixed appliance.
On examination the archwire is circular.
How do we treat this and why?
If the archwire is circular we try to see if we can flip the bracket.
If the bracket can flip then we remove the ligatures and remove the debonded bracket.
Aftercare- OHI & refer patient back to their orthodontist.
We don’t stick it back on as we don’t know where the correct position is for bonding.
We don’t leave the bracket in place as we can spin it so there is a risk it could come off and be a choking hazard.
The patient has attended with a debonded bracket on their fixed appliance.
On examination the archwire is rectangular .
How do we treat this and why?
- Check if you can flip the bracket.
- check if you can move the bracket along the wire.
We ensure that the ligatures are secure and leave the bracket in the patients mouth,
Aftercare- advise the patient to move the bracket to the side for OH and refer them to their orthodontist to get the bracket put back on..
We want the ligature to be secure to prevent airway damage.
Patient has attended with a problem with their fixed orthodontic apliance.
On examination- the archwire has slid too long at the back (there is excess wire on one side and deficient on the other)
How do we treat this and why?
Excess- cut the wire where it extends at the end and bend it over itself.
On the side where there isn’t enough wire we bend it over where it is.
aftercare- OHI and refer back to their orthodontist.
We want to prevent trauma on the excess side and to prevent the archwire moving further forward on the deficient side.
Patient has attended with a problem with their fixed orthodontic apliance.
On examination- The orthodontic band has debonded.
How do we treat this and why?
We remove the orthodontic band by cutting the wire between the 6 and the 5. We then bend the archwire back on itself.
Aftercare- OH and refer the patient back to the orthodontist
To stick the orthodontic band in place we tip the band upside down before adding the RGMI. This is so any excess comes to the top.
If we just stuck it back down the excess cement would be at the bottom causing an OH problem.
Patient has attended with a problem with their fixed orthodontic apliance.
On examination- The transpalatal arch has fractured where it attaches to the orthodontic band.
How do we treat this and why?
We cut the transpalatal arch on the other side as it is no longer functional (need to prevent inhalation risk)
We use a bur for this so need to to use plenty of water (friction caused by cutting the wire will produce heat in the mouth)
Aftercare- OHI and refer back to the orthdontist.
