try in and delivery of orthodontic applicances presentation seminar

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Try in and delivery of Orthodontic Appliances

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Outline

• Introduction• Definition• Objectives• Removable appliances• Fixed appliances• Functional appliances

Delivery + Instructions

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Introduction

• There are many factors that should be looked into when delivering an orthodontic appliance.

• If these factors are not considered, problems can occur that can be costly and damaging, both to the patient and the doctor.

• The above outcomes are also anticipated if the patient is not instructed well.

• When these factors looked into, the patient has good outcome in treatment leaving both the doctor and patient satisfied.

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Definitions• To deliver -–produce or achieve what is desired or expect

ed; make good– To surrender (someone or something) to ano

ther; hand over

• Try-in The temporary placement of a dental restoration or device to determine its fit and comfortableness. http://medical-dictionary.thefreedictionary.com/try-in

http://www.thefreedictionary.com/deliver

http://medical-dictionary.thefreedictionary.com/try-in


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Objective• To be able to describe what happens during

Try in and Delivery of Orthodontic appliances

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Try in and Delivery of Removable Appliances

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• Tissue surface of appliance – no sharp areas or nodules

• Baseplate may need trimming to help in easy insertion and removal

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• Clasps examined for adequate retention – if not then they should be adjusted to engage the undercut

• The active components should rest at desired location - should not impinge on gingiva, sulcus or frenum

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Instructions on Removable appliances

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• The pt should be educated on how to insert and remove appliance.

• Show the appliance to them and demonstrate to them the action of the various components.

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• They should be instructed not to distort the various active components of the appliance.

• The active components can be activated after a few days once the pt gets used to the appliance

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• Number of hours of wear – most appliances both day and night (24hrs). Recommended to be removed during strenuous physical activities, sports and mealtimes.

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• Talking and eating are difficult at first, but will return to normal after 2 or 3 days.

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• Salivating is a totally normal occurrence and should subside within a week

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Avoid sticky or hard foods

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• Otherwise dilemma…

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• Appliance and teeth cleaned after every meal and before going to sleep at night

• Clean appliance using detergent solution and brush – careful not to bend or dislodge any of the components of the appliance

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• If screws present – instruct on how to activate

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• Instruct to report immediately to clinic if appliance damages or any other problem while wearing them

• Instruct to not leave appliance out of mouth for long time as it increases the risk of loss and damage

• The appliance should be stored safely in a container when not in use (during mealtimes, strenuous physical activities or sports)

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Delivery of fixed appliances

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• In most cases the teeth banded and then brackets added.

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• Adhesive applied on teeth to be braced to help the cement bond to the surface of the tooth.

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• A bracket applied on each tooth, and light cured until hardened.

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• If required, orthodontic spacers may be inserted between the molars to make room for molar bands to be placed at a later date.

• Molar bands are required to ensure brackets will stick.

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• An archwire will be threaded between the brackets and affixed with elastic or metal ligatures.

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• Ligatures are available in a wide variety of colors and shapes, and the patient can choose.

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• Brackets with hooks can be placed, or hooks can be created and affixed to the archwire to affix rubber bands to.

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• Rubber bands –Different diameters, sizes, and strengths. –Colored or clear/opaque.

• Their placement and configuration will depend on the course of treatment and the individual patient.

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• Accurate bracket placement crucial to achieving successful treatment outcome.

• The 'correct' position of the bracket on the facial surface will depend upon the bracket system used.

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• Bracket placement is particularly important with these pre-adjusted systems as the values for tip and torque are calculated for the midpoint of the facial surface of the tooth.

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Incorrect bracket positioning

Incorrect tooth position

Affected function and aesthetics

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Instructions for fixed appliances

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• Cut food up into small pieces • Avoid fizzy drinks in-between meal times

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• Brush twice a day removing food/plaque form the braces

• Use a fluoride mouthwash during the day • There may be need to replace toothbrush

more often as it will wear out faster.

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• Instruct pt that teeth will be uncomfortable for the first couple of days so to take painkillers

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• If the brace rubs on their gums or lips, use the wax that they are given.

• They are to take a small piece and place it onto the bit brace that is rubbing.

• Dry the tooth beforehand or the wax will not stick.

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If they play a musical instrument with a mouthpiece, it will take them one to two weeks before they become as skillful as before.

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Functional appliance

• For patients with a large overjet protruding the patient's mandible more than 75 per cent of their maximum protrusion can make the appliance difficult to tolerate.

• It is possible to reactivate some functional appliances during treatment if further protrusion is required.

• Incremental advancement of the mandible during treatment may make it easier for the patient to tolerate, but claims that this may improve the skeletal response have not been prove

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Fitting the functional appliance

• The patient should be made aware that although the functional appliance will not be painful, it can be difficult to get used to initially.

• Good motivation is important in all aspects of orthodontics, but this is particularly true with functional appliances.

• They can be demanding appliances to wear at first, but children will adapt to them very quickly provided they are worn sufficiently.

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• The amount of hours the appliance needs to be worn each day depends on the type of appliance.

• remove during sports• Functional appliances such as the twin-block

and Herbst that can be worn full-time often allow the patient to adapt more quickly.

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Reviewing the functional appliance

• It is advisable to see the patient 2-3 weeks after fitting.

• At every review appointment motivation of the patient is vital, as well as checking the fit of the appliance and treatment progress.

• Once the clinician is confident that the patient is wearing the appliance as instructed the review appointments can be made at 6-10-week intervals.

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• If there is no progress this could be due to a number of factors:– Poor compliance– Lack of growth or an unfavourable growth

rotation– Problems with the design or fit of the appliance

• Compliance tends to be better with the younger patients.

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References

• Removable Orthodontic Appliance instructions – Chapel Road Orthodontics.

• An introduction to Orthodontics – Laura Mitchell, pgs 185, 197, 214.

• https://en.wikipedia.org/wiki/Dental_braces#Fitting_procedure

• http://www.pontcannadental.co.uk/treatments/all-our-treatments/14/fixed-appliance-braces.html

• http://lowtondental.co.uk/patients/Leaflets/Fixed%20Appliance%20Instructions.pdf

• http://medical-dictionary.thefreedictionary.com/try-in

• http://www.thefreedictionary.com/deliver

https://en.wikipedia.org/wiki/Dental_braces

https://en.wikipedia.org/wiki/Dental_braces

http://www.pontcannadental.co.uk/treatments/all-our-treatments/14/fixed-appliance-braces.html

http://www.pontcannadental.co.uk/treatments/all-our-treatments/14/fixed-appliance-braces.html

http://lowtondental.co.uk/patients/Leaflets/Fixed%20Appliance%20Instructions.pdf

http://lowtondental.co.uk/patients/Leaflets/Fixed%20Appliance%20Instructions.pdf




try in and delivery of orthodontic applicances presentation seminar

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