O contact your indemnity insurance company o child

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o Contact your indemnity / insurance company. o Child protection advisor. o Speak to the GP. o Document in the note. o Not police unless a huge risk. What are NOT the duties of the therapist? o Modify prescribed archwires. o Re-cement crowns. o Treatment planning. o Should be supervised every third visit. The duty of candour: o Inform the patient about what has happened, possibilities, options, risks and treatments.
  Miscellaneous notes and evidence   Implied consent is consent with agreement mutually.   Informed consent CIA: o The patient is Competent. o Informed explanation. o Autonomy to decide and think. Removable appliances Advantages and Disadvantages Components of removable appliances   Retentive components Adams clasp 0.7mm SS Southend clasp 0.7mm SS Ball end clasp Plint clasp 0.7mm SS Labial bow 0.7 SS   Active component Springs 0.5mm SS for 3 mm activation or 0.7mm SS (less common) for 1mm activation.
o  Palatal finger spring 0.5-0.6mm SS. o  Buccal canine retractor 0.7mm SS because they are long and have loops, can be reduced to 0.5mm SS if sheathed. o  Z-Spring 0.5mm SS o  T-spring 0.5mm SS o  Coffin spring 1.25mm SS o  Active labial bow e.g reobert’s retractor 0.5mm SS Screws Elastics Different appliances
  Miscellaneous notes and evidence   F depends on DR4/L3.   For Twin Block wear, according to latest randomized controlled trial, part-time wear is as effective as full-time wear (Parkeh, 2019) AJODO. But there was more girls in the FT group, as girls are more compliant than boys, this causes attrition bias. And underpowering of the study where the acquired sample size was 56 patient (28 per group) and there was a loss to follow up 6 patients in FT group and 1 patient in PT group.   Incremental VS single advancement, there is no difference (Banks, 2004) Ajo. Incremental can be more comfortable for the patient. Fixed appliances Methods to accelerate tooth movement Non-surgical low energy laser radiation. Intermittent vibration. Pulsed electromagnetic waves. Muscle exercise. N.B at the present time, there is no high quality evidence to support the claims of these approaches.
Surgical approaches o Alveolar decortication, a series of small holes are drilled into the bone. o Corticision, the cortices are divided transmucosally without the need to raise a flap. o Surgical procedures to the interceptal bone. N.B, all the surgical methods depend on reducing the bone density, and increasing the body’s inflammatory response. Pharmaceutical interventions Demineralization, how to reduce?   Careful patient selection.   Fluoride mouth rinses for the duration of treatment.   Local fluoride release from fluoride containing cement and bonding adhesive.   Dietary advice.

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