Ortho Competency Scenarios Flashcards
(21 cards)
What are the steps in presenting the case in ortho competency?
Steps in presenting:
Identify device and components
Inspect- Identify and describe fault
Discuss options
Give answer
Say that you would give OHI and get patient to contact orthodontist
How is a southend clasp fractured at the fly over area fixed/
If in first few weeks- complete remake as patient has paid money and barely any orthodontics has occurred
If later:
Cut at midpoint to bend back on itself create single C clasp (bend sharp end away, as trying to smooth off would actually make it sharper)
Smooth bit of wire that is emanating from acrylic so that it is flush
Give OHI, recommend attending orthodontist
What its the use of a fixed retainer?
Prevents relapse of rotations and diastemas
How is a broken fixed retainer fixed?
Inspect all bits of composite for debonding
Remove composite with tungsten carbide/diamond bur
Check for caries
Check integrity of wire and ensure it is passive
Apply bond and use composite to re-bond wire
Give OHI
How is fracture at middle of south end managed?
Create 2 single c clasps
OHI and recommend seeing orthodontist
How is debonded bracket which has moved fixed?
Do not re-bond as you are not aware where the bracket was meant to be bonded in the first place (makes situation worse as patient won’t know until they see orthodontist)
If you can flip bracket- archwire is round in cross section
Rotate bracket, take off ligature and give bracket to patient
Give OHI and get patient to go to orthodontist
How is fractured Adam’s clasp with missing flyover and arrowhead fixed?
Remake URA
Smooth down edges and just leave without - as other Adam’s clasp, baseplate (adhesion/cohesion) and south end clasps (check retention)
Account for components- ask what happened and where it is (is it in bin or inhaled/ingested)
If suspicious of inhalation or ingestion- refer to get chest X-ray at A&E
What can be done if URA is unretentive after leaving without Adam’s clasp?
Replace adam’s clasp:
Send appliance with original working cast if it can be located and it’s not damaged
If you cannot locate clasp:
Take impression with alginate with appliance in situ
Dental stone will be poured over fitting surface of the appliance to produce cast (uses baseplate as part of the impression- will share imperfections with appliance fitting surface and be perfect replica)
The appliance will be sealed perfectly against model- then repair can be done
Why must appliance be in situ for impression with alginate if broken Adams clasp?
Cannot use alginate impression to make new clasp as voids will be present due to air bubbles/saliva as appliance will not fit on another model and there will be gaps (this means that monomer will contaminate underneath and appliance won’t fit- acrylic creep)
What should be done following fix of fractured Adam’s clasp?
OHI and send them back to orthodontist
How is wire slippage and excess wire which is creating trauma and deficient on other side fixed?
Fix for excess wire:
Trim wire- get nurse to hold excess and give snip with cutter/bur
Bend sharp end of wire to give mechanical retention and make it safe
Fix for wire slippage:
Don’t attempt to move wire as you do not know where it is meant to be and it changes forces applied on teeth
Bend arch wire at sharp edge
OHI and Refer to orthodontist
How is a baseplate fractured on holiday fixed?
Account for fractured components- ask patient what happened
If suspicious of inhalation or ingestion- chest x-ray
Tell patient not to attempt to repair it or wear in current state
If its not your patient- do not remake appliance
In mean time- offer thermoplastic retainer to prevent relapse and lengthening of treatment time (at a cost)
*if not on holiday- complete remake
What is the fix for debonded SS band due t failure in GIC?
Cut wire to distal of 5, put retentive tag in and remove band
Don’t re-bond band- as it can intrude tooth or interfere with occlusion or impart rotational movement
How is debonded bracket on stiff square wire that cannot be rotated fixed?
Rotating will cause flexing and bend arch wire out of shape and can debond other brackets
-> Ensure ligature is in position
-> Make patient aware that it has debonded- get them to move to side when cleaning and put back
-> Get them to go to orthodontist at next convenience
How is fixed retainer debonded on multiple teeth and wire bent lingually fixed?
Explain that it is no longer fit for purpose and should be removed (ask if they want a new bonded retainer- refer to orthodontist)
Suggest thermoplastic clear retainer- can be offered as stop gap or alternative by GDP
If they do not want new retainer
-> Ensure there is no caries
-> Give OHI, warn of relapse, document in notes and get patient to sign
How is an Adam’s clasp fractured at the mesial arrowhead managed?
If facilities available:
Solder this together if not distorted- as arrowhead is not an area of flex and will not be adjusted
If facilities not available- modify:
Cut mesial leg of fracture to make it flush with acrylic
Leave other arrowhead and bend it back on itself to create retention
If you cannot modify:
Cut component off and see if there is retention from adam’s clasp, south end and baseplate
If unretentive- replace component in same way as before
How is debonded retainer on 43 which is no longer passive fixed?
Cut distal to 2, smooth sharp edge so that it is flush with composite on 2
-> Inform patient that relapse is unlikely
If they want a new retainer then they can seek help from orthodontist
What is the function of Trans-palatal archwire?
used for anchorage- through spreading load
How is a fractured transpalatal arch wire fixed?
Remove trans-palatal arch by using a bur to cut it off flush with SS bands (as wire cutters can apply fore to teeth)- to secure it use floss around omega loop
Use suction to pick up fragments
Use water and do in short bursts as friction will produce heat and can burn tongue
Sharp edge on other side- cut again with bur
What is done when trauma has resulted in multiple breakages on fixed appliance?
No longer fit for purpose:
Remove arch wire- takes off loose brackets with it
Account for all components
Follow protocol for trauma stamp
If mobile teeth- splint (maybe using existing brackets)
How is Adams clasp fractured at point where it emanates from acrylic mesially fixed?
Cut so flush mesially- go for single arrow head
If distorted:
Check and see if retentive with other components
If not retentive:
Same as before
