Exposing & Bonding of Brackets to Teeth

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  • #10038
    drsushant
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    Registered On: 14/05/2011
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    The objective of exposing ± bonding a bracket on to
    an unerupted tooth is to move the tooth into a good
    functional & aesthetic position.

    Exposure of a tooth at its simplest, consists of removing the
    gum overlying the crown of the unerupted tooth under Local
    Anæsthetic. Most unerupted teeth are deeper within the
    jaw and require the removal of bone as well as the gum to
    expose and disimpact them; as a consequence, this may be
    done under General Anæsthetic.

    The application of traction (using the chains attached to
    braces) to stimulate and guide the eruption of buried teeth
    is necessary as the teeth are unfavourably angled (and
    spontaneous eruption is inhibited), where buried teeth are
    obstructed from eruption by other teeth & where teeth are
    exposed long after their root development is complete.

    Teeth most likely to be exposed and bonded are the upper
    canines / eye teeth, upper central incisors, molars and the
    occasional premolars.

    #14698
    Anonymous

    This list of warnings might seem excessive to some however the legal ruling
    in the case of Chester vs Afshar (2004) would suggest that it is quite
    prudent / necessary to list them. Others might say that there isn’t enough
    information but where do you stop?

    The following list of warnings regarding tooth exposure & bonding is neither
    exhaustive nor is it predictive. The most pertinent warnings have been
    included here.

    You are to have a tooth exposed ± bracketed. You can expect the
    following:

    Exposing ± Bracketing of Tooth Specific Warnings:

    Stitches. The extraction site will often be closed with stitches. These are
    dissolvable and ‘fall out’ within 10 – 14 days. If a pack has been sewn in or
    the chain is ‘parked’ high up in the sulcus, non-dissolving stitches are used,
    that will need to be removed at some point.

    Brackets. These are small golden plaques with chains attached. These are
    stuck onto the teeth that need to be moved. Sometimes, the cement
    sticking the chain onto the tooth can break after traction is applied to the
    tooth; if this happens, the bracket will need to be re-cemented on.
    Occasionally, the chain itself breaks and this will mean that the chain and
    bracket have to be replaced.

    Gauze Pack. Sometimes, it is not possible to stick the chains onto the
    teeth. If this is the case, a gauze pack impregnated with an antiseptic
    (BIPP) is placed over the exposed tooth and sewn into place. The pack is
    removed after approximately a week and the chain will be stuck on at this
    point.

    Ankylosis of Tooth. Occasionally, even if the tooth has traction applied to
    it, it still refuses to move. If this happens, it is sometimes necessary to
    explore the area – there may be a lip of bone preventing the tooth from
    moving or the tooth has fused with the surrounding bone (ankylosis).

    Repeated Operation. The gum can easily grow back over the exposed
    tooth. If this is the case and the tooth doesn’t have a bracket stuck on it,
    the tooth will need to be re-exposed, hence another operation.

    General Surgical Warnings:

    Pain. As it is a surgical procedure, there will be soreness after the
    procedure. This can last for several days. Painkillers such as ibuprofen,
    paracetamol, Solpadeine or Nurofen Plus are very effective. Obviously,
    the painkiller you use is dependent on your medical history & the ease with
    which the tooth was exposed.

    Swelling. There will be swelling afterwards. This can last up to a week.
    Use of an icepack or a bag of frozen peas pressed against the cheek
    adjacent to the tooth removed will help to decrease the swelling. Avoidance
    in the first few hours post-op, of alcohol, exercise or hot foods / drinks will
    decrease the degree of swelling that may develop.

    Bruising. Some people are prone to bruise. The bruising can look quite
    florid; this will resolve but can take several weeks (in the worst cases).

    Limited Mouth Opening. Often, the chewing muscles and the jaw joints are
    sore after the procedure so that mouth opening can be limited for the next
    few days.

    #14697
    drsushant
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    Registered On: 14/05/2011
    Topics: 253
    Replies: 277
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    Been thanked: 0 times
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