case 1
Say what you’ve got
A URA
Components:
2 adams clasps
Southend clasp
Palatal finger spring
Baseplate
Take off model, get hold and feel out components
Identify problem
Here southend clasp is fractured
Identified component and identified problem
If at beginning of treatment just make a new one shouldn’t be breaking,
If latter stages of treatment don’t want to lose porgress
Soft solder – has lead which is poisonous
Silver solder melting point – 950-1000 degress
Cut it off in middle and make a C clasp, turn sharp bit back on itself
Looks like southend clasp is in half
case 2
- Got a fixed lower lingual bonded retainer (say what it is and what its for
to fix diastema and rotations) - It has debonded on lower left central
- Take off composite with diamond bur, check health of tooth, check
integrity of wire and is still attached and passive - Retch and put composite on
3
- got lower fixed appliance
- Components
o Arch wire
o Brakcets
o Ligatures
o Band on 6’s - Lower right Bracket is loosen and reboned
o Take ligature off - Arch wire is round cause bracket can spin
- Take bracket off
o Take ligature off
o Take bracket off - Clean up the tooth and check health and give them ohi and refer them
back to their orthodontist
4
- Upper fixed appliance
- Components
o Arch wire
o Brackets
o Ligatures
o Band on 6’s - Sharp edge of arch wire
- Cut off sharp bit of wire with enough left to bend it round on itself and
make it safe - Bend it round between 6 and 5 so its safe and wont come round that
side - Oral hygiene and refer to orthodontist
5
- Fixed bonded retainer – for diastemas and rotations
- Canine comp debonded and wire bent
- Cut it distal to and make it smooth on composite
- You’ve made it safe but ask them to seek advice from an orthodontist
6
- Fixed upper appliance with trans palatal arch
- Components
o Arch wire
o Brackets
o Ligatures
o Transpalatal arch - To make safe remove transpalatal arch
o Using a bur
Metal dust and debris
Need loads of aspiration
Creates lots of heat
Plenty of water
o Smooth sharp edges on bands
7
- URA
- Components
o Southend calsps
o Adams clapss
o Palatal finger spring - Southend clasp fractured in middle
- If new appliance redo impressions and start again if not then bend both
edges of southend clasp into itself
8
- Ura
- Components
o Adams clasps
o southend clasps
o Palatal finger spring - Adams clasp broken bit off
- Now find out where adams clasp is if unsure then refer to a and e
- Trim edges of adams clasp
- Retention now from other adams clasp, southend clasp and baseplate
due to adhesion but if that doesn’t happen - To fix this short term trim short edges of ura
- First locate original working cast and send this with ura to lab or else
- To fix this long term give lab ura and ura if lost adams clasp take
impression with ura in situ and get them to cut out pmma part where
adams clasp was.
9
- Tell them not to glue it back together or wear in current state
- Can offer a retainer, thermoplastic to keep teeth where they are and
freeze treatment. Take impression.
10
- Upper fixed appliance
- Components
o Brackets
o Ligatures
o Band
o Archwire - Band loose
- Cut wire first and take band off
- Bend wire back to make it safe
- Refer to ortho specialist
11
- URA
- Components
o Same as before - Adams clasp fractured at arrowhead
- Solder it if got facilities
- Cut wire close twice smooth bit close to pmma so have one single
arrowhead then squeeze is close - Do same as before in regards to impression in situ
- Take impression in situ cause no impression is same have to do with
impression in so get a good flat surface finish if not it have airblows and
wont fit flush onto mouth which can cause ura to have a gap which is
called acrylic creep
12
- Lower fixed bonded retainer
- Loose on 31,32,33 debonded multipaces
- Wire is active
- Not fit for purpose
- Remove whole thing
- Check condition of teeth
- Options for patient:
o To have another bonded retainer
o To get a thermoplastic retainer
o To get a conventional retainer
o Do nothing and give risks of relapse - Get them to sign a form for doing nothing
13
- Fixed upper appliance
- One of the brackets central incisor has debonded
- Patient hasn’t noticed
- Square rectangular wire as cant rotate bracket
- Make patient aware of problem
- Need to ensure ligature is still attached and no component will fall off
- Check tooth and wire
- Get them to slide along clean tooth and slide back and make
appointment with orthodontist
14
- URA
- Components
o Buccal canine retractor
o Southend clasps
o Adams clasps - Adams clasp fractured
- Cant solder too close to pmma
- Cut wire in middle between arrowheads then make safe and close
15
- Lower fixed appliance
- 5 missing brackets a bracket debonded and a missing ligature
- Probably trauma
- Account for missing brackets
- Take it off
o First ligatures
o Take arch wire - Keep brackets on as had trauma
- Do a trauma stamp
- Make a splint
if adam clasp fracture at start middle end tx if ura unretentive
Adams clasp fracture completely
● Account for missing component: if suspicion of inhalation send for chest X ray
If it occurs at the start of treatment
● Make a new appliance
If it occurs at the middle of treatment
● Smooth the sharp edges with bur that are sticking out of baseplate
● Retention should be enough with baseplate (cohesion and adhesion), southend clasp
and other adams clasp
If URA is unretentive (does not stay in mouth)
● Send original working cast and URA to lab
● If cannot find cast or cast damaged: take an impression with URA in situ (in patients
mouth)
● The URA will come out with the impression. Send impression with URA in the impression
to lab
southend clasp fracture near baseplate
If it occurs in the start of treatment
● Make a new URA
If it occurs in the middle of treatment
● Smooth the sharp metal sticking out of baseplate
● Cut the southend clasp at the midpoint and turn it into a C-clasp
● Bend the tip of the C-clasp
● Aftercare advice: carry on treatment with OHI
Why can’t you take another impression without the URA in situ?
● No two impressions are the same
● Impression will have air blows which if poured will show as lumps and bumps on the cast
● The URA will not fully seat on the cast and this will lead to a space between the cast and
URA
● The liquid monomer will then get into the space and contaminate the fitting surface
● This is known as acrylic creep.
Fractured base plate in 3 pieces
● Account for pieces
● Instruct patient not to wear or attempt repair
● Offer a thermoplastic or conventional retainer in the meantime
● Send back to dentist who made the URA
● If patient does not want a temporary retainer made
● Outline the risks of relapse and obtain written consent
Fixed orthodontic appliance with debonded bracket that is loose
● Remove ligature
● Remove bracket
● Give it to patient and send back to dentist who installed the fixed
Lingual bonded retainer debonded, deformed, sharp
● Remove it completely
● Check integrity of teeth for caries
● Let them wear thermoplastic or conventional retainer to avoid relapse
Fixed orthodontic appliance with transpalatal arch that has fracture near metal band
● Make the transpalatal arch safe with floss
● Use slow speed bur with water and cut the transpalatal arch from the other metal band
Adams clasp fractured at arrowhead
● Solder
● Cut the defective arrowhead and smooth wire next to baseplate
● Remove the whole adams clasp and retention will be given by baseplate, southend and
other adams clasp
● If unretentive then send URA with original cast to lab
● If cast lost or damaged take impression with URA in situ
Debonded and distorted lingual bonded retainer on one of the canines
● Remove the debonded aspect and the other teeth will be enough retention
