Page 102 - REMOVABLE ORTHODONTIC APPLIANCES

94 Removable Orthodontic Appliances
General practitioners should try to set aside Changes in the occlusion since the
some 'protected lime' by reserving a particular last visit
session for orthodontic work. It is when the
'quick orthodontic adjustment' is sandwiched It is good practice to measure and record
between time-consuming restorative or surgical changes in tooth position at each visit rather
procedures that inadequate thought and atten- than simply entering a verbal comment. A
tion are so often given. simple measurement is often sufficient, for
example during retraction of upper canines a
pair of dividers may be used to measure the
distance from the highest part of the buccal
Preliminary discussion with the fissure of the first molar to the tip of the canine
patient
(Figure 10.11). The distance between the points
• Enquire whether the patient has experi- of the dividers can then be measured and
enced any problems with the appliance since recorded in the patient's folder.
the previous visit. Avoid leading questions Measurements are usually possible for any
such as 'Have you been wearing the appli- tooth movement. When distal movement of
ance?' This merely encourages an affirma- upper molars is being carried out, a measure-
tive answer, even if the patient has not been ment from the buccal fissure of the first molar
cooperating. The operator should be alert to the mesial corner of the central incisor will
for any signs of poor cooperation. For exam- be of use and during lateral arch expansion
ple, it is generally a bad sign if the appliance measurement across specified cusps will serve.
is not actually in the mouth, even if the Overjet reduction can be measured by means of
patient claims that it had been removed for a ruler with a millimetre scale, with the zero
cleaning before entering the surgery. Poor point at the extreme end. It should be pointed
speech is also often a symptom of poor wear out that overjet measurement is an arbitrary,
(but do check that this is not the patient's rather than a defined, parameter and repre-
normal voice before making accusations). sents the horizontal distance between the labial
• Look into the mouth before the appliance is surface of the lower incisor and the incisal edge
removed. The fit of the appliance is then of the uppers. Some variation is bound to occur
easily assessed. Similarly, it is easy to see as a result of different inclinations of the ruler
whether it is being correctly worn and but in practice this is small and the overjet
whether all springs are correctly positioned. measurement is reproducible. The operator
Excessive looseness may lead the operator should get into the habit of using the same
to suspect that the patient has developed the points of reference as a routine, for example
habit of moving the appliance up and down overjet measurements might be taken from the
with the tongue. This is a sure method of
producing multiple fractures of wire during
treatment and must be firmly discouraged.
• If you conclude that the appliance has not
been worn as directed, raise the matter
directly: 'Why have you been leaving your
brace out?'
The operator should then remove the appliance
noting any degree of activation remaining in
the springs. The fitting surface of the appliance
will give some clue to oral hygiene but in addi-
tion the teeth, gingivae and oral mucosa, partic-
ularly the area covered by the appliance, should
be inspected. Generalized palatal inflammation
may reflect the need for more thorough oral
hygiene. Heaping up of the gingivae around the Figure 10.11 Measurement to assess canine
teeth being moved indicates that the appliance retraction. This must be combined with a record of
has not been trimmed away adequately. overjet to ensure that anchorage loss is not
occurring.