KFO Questions & Answers
Here you will find answers to general questions from everyday orthodontic practice and laboratory life.
Selected and answered by RealKFO, Specialist Laboratory for Orthodontics.
The texts contained serve as general initial information for those interested in orthodontics, e.g. prospective orthodontists and specialist assistants. We have compiled and answered the questions and answers from over 30 years of experience to the best of our knowledge and belief. The information does not have the right to be complete, but merely offers the reader the possibility of food for thought and further study or self-study.
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1. "What does a model analysis tell us?"
The model analysis provides decisive information for the treatment procedure and a possible treatment result. The analysis is used to observe the transversal and sagittal symmetry, the midline position, the space available in the dental arches, the deviation of individual teeth and tooth material, the apical base, the Spey curve and the palatal height. Values are determined via fixed measuring points and compared with target values for the eugnathe primary or mixed dentition.
2. "What does a orthodontic planning model look like?"
The basis for meaningful planning models are exact impressions of the anatomical conditions of the maxillary/ mandibular dentition. The models must be free of bubbles and usually cast with white hard stone. Trimming or socketing is performed in the three planes (occlusal-tuber-aphe-median plane). The models are labeled with the patient’s name and/or number, date of fabrication and the corresponding time of treatment.
3. "What does an FRS (cephalometric lateral radiograph) evaluation say?"
The FRS is used to make a statement about which values are present in the facial skull portion: Values are determined via specified measuring points and compared with target values eignete dentition development. These data, like those of the model analysis, are the basis for the course of treatment and the treatment objective. Values to be considered are: the growth tendency, the axial position of the incisors, the occlusion of the teeth, the positional relationship of the upper and lower jaws, the soft tissues, differentiation between skeletal and dentoalveolar deviation.
4. "What is the significance of a carpal evaluation and is it necessary in every patient?"
The carpal evaluation provides information about the actual physical developmental status of the patient. By means of a hand x-ray, the state of ossification of the hand skeleton can be detected. These values are needed above all: to calculate the remaining growth and the associated consequences after orthodontic treatment, to use the remaining growth for functional orthodontic treatment, to plan forced palatal expansion.
5. "What is an intermediate orthodontic analysis?"
An interim analysis involves the evaluation of diagnostic records. Between the start and expected completion of the treatment case. For those with statutory health insurance, this includes a three-dimensional assignment of the current upper and lower jaw model and the associated model analysis, and an OPG/orthopantomogram if necessary. For patients with private health insurance, a three-dimensional assignment of the current upper and lower jaw model as well as the associated analysis are possible approx. twice per treatment case. A current OPG, FRS/ teleradiograph and its analysis is possible. However, care must be taken to ensure that the X-ray measures are in proportion to the medical necessity in order to avoid unnecessary radiation exposure.
6. "What is KIG in orthodontics?"
KIG stands for Kassenindikationsgruppe (health insurance indication group). The respective KIG classification determines the treatment eligibility to a contractual dental care. The respective KIG must have at least a classification of 3. A distinction is made between KIG for the early mixed dentition/ after eruption of the first molar and the permanent dentition/ from eruption of the first premolar. It is important that the KIG is determined before treatment begins, i.e. already in the dental chair. Treatment-worthy cases in the mixed dentition/early treatment early treatment are classifications 3,4,5 for contract dental treatment: KIG D5, K3, M O Treatment-worthy cases in the permanent dentition are for statutory health insurance: from E3, D4, K3, K4;T3,P3. For patients with private health insurance, it is recommended that a KIG classification be made at the beginning of treatment in order to facilitate a possible change of the treatment case from private to health insurance.
7. "What documents are sent to the assessor?"
In the case of an appraisal procedure ordered by the substitute health insurance company or the insurance company of the beneficiary/patient, all diagnostic documents must be sent to the assigned orthodontist/appraiser. Three-dimensional oriented models, OPG, FRS and model and FRS analysis.
8. "How often are screws activated in active plates?"
Generally, expansion and sector screws are activated “Sunday-after-church” one ¼ turn in the direction of the arrow. In some cases, activation is additionally recommended “Wednesdays” by a ¼ turn. The treating physician will decide when and how to activate the screw, depending on the degree of treatment. By turning the screw, using an adjusting key, the gap between the screw parts is opened by approx.0, 2 mm. The activation of the screws is very well transferable to the patient/ if necessary the guardian. If the patient cooperates well, the function of the screw should be exhausted after 4-5 months and the desired result should have been achieved.
9. "Can a fixed space maintainer be billed for an SHI patient?"
No, a fixed space maintainer is a purely private service according to GOZ and BEB.
10. "How is a space maintainer with denture (pediatric denture) requested?"
For space maintainers with dentures/ ZE, caused by carious destruction of the anterior and/or posterior region and/or multiple non-attachments, An interim restoration is requested via ZE. Laboratory billing is carried out via BEL II according to positions relevant for ZE. This also applies to repairs/ adjustments. Placeholder with denture over a construction supported by ligaments is not a contractual dental service. This is a GOZ and BEB to be billed.
11. "What is meant by functional orthodontics, or FKO for short?"
FKO has the basic task of developing the mouth-jaw-facial area by the body’s own forces. For this purpose, one uses an appropriate aid, be it in the form of a ready-made molded part or an individually manufactured appliance. In the case of customized appliances, the bite position to be aimed at is recorded by the orthodontist by means of a construction bite. This information is transferred to the removable FKO appliance during fabrication, e.g. bionator according to Balters, function regulator according to Fränkel, standard activator. With insertion of the appliance into the patient’s mouth, it is now possible to train the musculature by sucking swallowing, speaking etc.. The “reprogramming” of the musculature makes an accompanying bone and temporomandibular joint remodeling possible.
12. "What does a orthodontic planning model look like correctly?"
Planning models reflect the actual situation of the dentition and the mucosa-related jaw portion. Planning models are necessary before the start of treatment to ensure documentation of the initial, intermediate and final situation. They are a valuable component in forensic questions. As a standard, they are made of white hard plaster. The models must not only be free of bubbles, but must also reproduce all anatomical features of the jaws, i.e. teeth, folds, tuberosities, alveolar processes as well as palatal and lingual mucosal parts of the jaws. An exact occlusal setting is achieved in ambiguous situations by means of a situation bite. With a situation bite, a correct upper jaw to lower jaw or occlusion assignment of the models is possible. There are two options for fabricating the planning models, either 3 dimensional trimmed or socketed. Important: – Occlusal plane is parallel to the top and bottom of the model – Raphe median plane is perpendicular to the model or base back surface – When setting up the models, the final bite is possible in any position of the models – Reproduce the anatomical features of the jaw and tooth rows – The models must be marked with the patient’s name and increase, patient number, date of impression taking.
13. "Why is my basal base blistered after scattering?"
The model was too dry. By absorbing the water into the plaster model-the remaining air escapes. This is later visible basally as a bubble. Tip: Water the model for 15 minutes before sprinkling. If you are in a hurry, place the model and water in the beaker of the vacuum mixing unit. Please remove the stirrer. Close the lid and insert the closed beaker into the holder of the mixing device and press the corresponding button. The vacuum, approx. 30s draws the air out of the model.
14. "How do I reduce the remaining monomer content before inserting a plate apparatus/scattering technique?"
Monomer can cause allergic reactions in the patient. To reduce the risk from the outset, we recommend storing the finished appliance in a water bath for at least 15 hours (preferably overnight), at maximum lukewarm. The volatile monomer is thus well flushed out. It is also recommended to store the orthodontic appliance in a water bath at maximum hand temperature after the first insertion date, during breaks in wear.
15. "What angle should the guide planes of a Twin Block appliance have?"
According to the inventor, orthodontist Dr. William J. Clark from Scotland, the guide planes of the bite blocks or the intermaxillary connecting elements have an angle of 70 º in case of class II malocclusion. In extreme class II, the angle is 45 º is indicated. Tip: Twin Block Tool Invented and patented by RealKFO Exact 70° or 45° angle according to Dr. W. Clark Parallel angle of the right and left posterior bite block Saves time in the spreading and finishing process Individually adjustable, durable, economical, easy to clean Applicable for TB Class II and Class III.
16. "What is particularly important when fabricating a removable retention appliance?"
Retention appliances have the task of stabilizing the targeted tooth-jaw positions and preventing recurrence. Therefore, an exactly contoured tooth counter-bearing of the palatal or lingual portions is necessary when working out the acrylic. Required retaining elements must be guided exactly interdentally over the occlusal plane to avoid extensive interference. A labial bow is guided along the horizontal center of the tooth and represents the labial or buccal counter bearing. Retention splints must fit exactly after fabrication and end at least 1 mm in front of the gingival margin. The margins must not be sharp-edged so as not to irritate the tongue.
17. "What is particularly important when fabricating an adhesive retainer?"
An individually bent lingual retainer usually of 3-3, e.g. made of Twistflex wire 0.0175″ must be passed exactly along the horizontal center of the teeth and the interdental portions. The ends of the wire are screwed in once. An individually curved maxillary retainer made of wire, must be guided exactly along the palatal tooth surfaces and the interdental portions. Undisturbed occlusion must also be taken into account during fabrication. The ends of the wire are screwed in once. Prefabricated retainers with adhesive bases must be adapted to the tooth position situation before insertion.
18. "The plastic bracket does not hold on the tooth, the adhesive is on the bracket - Why?"
This is due to unfavorable mechanical forces acting on the bracket/tooth and/or a processing error. E.g. the tooth was fluoridated promptly, insufficient mechanical tooth cleaning was performed on the chair, the etching gel was not processed properly.
19. "The plastic bracket is not holding on the tooth, the adhesive is on the tooth - Why?"
This is usually a processing error. Insufficient or missing bonding. Bonding is the basis for a chemical bond of the surface structure between bracket adhesive and the bracket resin. Such detachments can also be observed in ceramic brackets. In the case of ceramic brackets with an applied silane layer, care must be taken not to touch the bracket base with bare fingers. The body fat immediately provides a dispersion layer. Newer ceramic brackets are provided with a retention base. Care must be taken to ensure that the product provides an optimum undercut for the adhesive.
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