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OMFS > Dentoalveolar > Flashcards

Dentoalveolar Flashcards

1
Q

Gelatin sponge AKA “…” disrupts platelets and causes a clot to form.
How long does the gelatin sponge take to resorb?

A

Gel foam

Two weeks

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2
Q

Oxidized regenerated cellulose AKA “…” is (more/less) efficient than gelatin sponge.
Oxidized regenerated cellulose has what effect on the duration of healing?
In what period of time does this product resorb

A
  • Surgicel
  • More efficient than gel foam
  • Delays healing
  • 7 -14 days
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3
Q

When metabolized, what type of environment does surgicel create in the extraction socket?

A

Surgicel creates an acidic environment and has been associated with nerve dysfunction

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4
Q

Type I bovine collagen plug AKA “…”

A

Collaplug

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5
Q

Inferior Alveolar Likelihood of injury study

Authors and Year and Number of criteria

A

Rood and Shebab 1990

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6
Q

Rood and Shebab, 1990, determined three specific radiographic signs that signify increased risk of injury to the IAN

A

1- Diversion of the canal
2- Darkening of roots
3- Loss of cortical border

Other risk factors for injury to the IAN include
Age >25; F>M; Socket curettage; intra-socket medications

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7
Q

Imaging to obtain after aspiration of object

A

PA and lateral chest x-ray; abdominal x-ray determines respiratory vs. GI tract

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8
Q

If tooth is in respiratory tract, how should it be retrieved?

A

Bronchoscopy

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9
Q

If tooth is in GI tract, is intervention warranted?

A

No, request patient to evaluate stool and assess for passage

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10
Q

Presenting signs of Ludwig’s Angina

A

Pain, drooling, dysphonia, brawny neck edema, tongue protrusion, dyspnea

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11
Q

What are the three bacteria most commonly associated with pericoronitis?

A
  1. Peptostreptococcus
  2. Fusobacterium
  3. Porphyromonas
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12
Q

What is the most common reason for removal of mandibular third molars after the age of 20?

A

Pericoronitis

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13
Q

What is the percentage of neoplastic change of the third molar follicular sac generally noted as?

A

Roughly 3 percent

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14
Q

What are three general contraindications for removal of impacted teeth?

A
  1. Advanced patient age
  2. Poor health
  3. Surgical damage to adjacent structures
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15
Q

What is the most common type of tooth impaction following third molar impactions?

A

A palatally positioned maxillary canine

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16
Q

When performing an expose and bond, should the CEJ be exposed?

A

No, exposure of the CEJ has been shown to increase root resorption, increase ankylosis, and increase periodontal inflammation

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17
Q

When is the appropriate timing in root development for surgically uprighting the mandibular second molar?

A

When the apex is open and 2/3 of the roots are developed

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18
Q 
Place the following in the correct order of difficulty of extraction (least to most difficult) 
Distoangular 
Vertical
Horizontal
Mesioangular
A

Mesioangular
Vertical and horizontal (intermediate)
Distoangular

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19
Q

According to Miloro, what percentage of lingual nerves are intimately associated with the lingual cortical plate in the third molar region?

A

25%

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20
Q

According to Miloro, what percentage of lingual nerves are above the lingual crest?

A

10%

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21
Q

What is the optimal amount, in ml, of sterile saline or water to thoroughly irrigate an extraction socket?

A

30-50ml

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22
Q

Generally, what category of contamination does the removal of impacted third molars fall into?

A

Clean-contaminated

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23
Q

Does the application of ice packs following extraction of dentition have any effect on the magnitude of edema?

A

No, ice packs are for patient comfort only

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24
Q

What are two categories of patients that have a higher likelihood of developing alveolar osteitis?

A

Smokers and women taking oral contraceptives

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25
Q

A gelatin sponge soaked with which antimicrobial may reduce the incidence of dry sockets?

A

Tetracycline

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26
Q

Define alveolar osteitis

A

A disturbance in healing that occurs after the formation of a mature blood clot but before the blood clot is replaced by granulation tissue, with a primary etiology of excess fibrinolysis which begins to occur on the third to fourth day post-operatively

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27
Q

Dodson has studied the utilization of bone grafting the third molar extraction socket extensively. In what population has he identified as benefitting from this grafting procedure?

A

Patients older than 25, have pre-existing periodontal defects such as probing >4mm, and horizontal or mesioangular impactions

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28
Q

Why are cortical grafts not ideal for subsequent implant placement?

A

Cortical grafts revascularize slowly and have minimal yo no cell survival

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29
Q

Which type of graft, cortical or cancellous, has more mesenchynal stem cells, which can be induced to form osteoblasts

A

Cancellous grafts have a higher concentration of mesenchymal cells

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30
Q

What type of stem cell will differentiate into an osteoblasts?

A

A mesenchymal stem cell differentiates into osteoblasts, which then form osteoid.
In bone grafts, the formation of osteoid takes place in phase one of of the two phases of graft healing. It is usually an active phase for the first two to four weeks.

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31
Q

Initiation of osteoclastic activity is a sign of which of phase of bone graft healing?

A

Osteoclastic activity is a sign of the initiation of phase two of bone graft healing, which usually occurs two weeks into the healing process.

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32
Q

Why does allogenic bone not have BMP?

What is the downside of this?

A

Allogenic bone has to be irradiated with gamma rays. This destroys BMP
Therefore, the allogenic bone grafts are not osteoinductive

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33
Q

What is rhBMP/ACS?

What is the ideal dosing?

A

This is a clinical combination of BMP with an absorbable collagen sponge carrier.
The dose is 1.5mg/mL

34
Q

When performing pterygoid plate separation, what direction should the leading edge of the curved osteotome be going?

A

Inferior, anterior, and medial

35
Q

Which tooth is most likely going to have a root fracture during extraction?

a. maxillary first premolar
b. Maxillary second premolar
c. Mandibular first premolar
d. Maxillary second premolar

A

A. The maxillary first premolar is the most likely to have a bifurcated root

Maxillary second premolars and mandibular premolars usually have single roots

36
Q

Which factor is most important in deciding to remove a 2mm fractured root tip of a maxillary molar?

a. Close proximity of root tip to floor of maxillary sinus
b. Patient’s age is less than 50
c. Operator skill
d. Periapical pathology

A

D. Periapical pathology

37
Q

Which condition is most likely associated with an asymptomatic erupted mandibular third molar?

a. resorption of the distal root of the adjacent tooth
b. dental caries
c. loss of periodontal support
d. dentigerous cyst

A

C. loss of periodontal support

38
Q

Which is an indication to perform a sulcular incision instead of a scalloped mucogingival incision when perform periapical surgery on a maxillary incisor

a. Presence of a short root
b. Preserving anterior gingival esthetics
c. Avoidance of releasing incisions
d. Eliminate the need for suturing

A

A. A short root, periodontal breakdown and a large periapical lesion are all reasons to perform a sulcular incision

39
Q

Which of the following factors are associated with a favorable outcome when uprighting a second molar?

a. Uprighting involving an arc of rotation of greater than 90 degrees
b. Incomplete vertical growth of the mandible
c. The need to correct the bucco-lingual position of the tooth
d. Second molar root formation of 2/3

A

D.

All other factors would increase the difficulty

40
Q

The most frequent location for an impacted supernumerary tooth

a. Maxillary central incisor
b. maxillary canine region
c. Maxillary third molar
d. Mandibular premolar

A

A.
Maxillary central incisor region (most common)
Maxillary lateral incisor region
Maxillary canine region (least common)

41
Q

Which tooth orientation is the most difficult mandibular third molar impaction to remove?

a. mesioangular
b. distoangular
c. horizontal
d. vertical

A

B. Distoangular

42
Q

Coronectomy is an alternative technique for the management of an impacted third molar when

a. there is an infection
b. the tooth is mobile
c. the root is intimately associated with the IAN
d. the tooth is horizontally impacted along the course of the IAN

A

C

43
Q

The technique for a partial odontectomy (corornectomy) is

a. the level of 3mm above the level of the IAM and healing by secondary intention
b. to the level of 3mm below the crestal bone followed by secondary intention
c. to the level of 3mm below the crestal bone with primary closure
d. to the level of 3mm above the IAN with primary closure

A

C. 3mm below the crestal bone with primary closure

The 3mm rule has been confirmed in animal studies which allows for bone formation over the retained roots.

44
Q

IV antibiotics should be delivered how much time prior to the removal of impacted third molars associated with pericoronal infection?

a. immediately prior to surgery
b. 30 minutes to 2 hours prior
c. 3-4 hours prior
d. 6 hours prior

A

B. IV anx should be delivered 30 minutes to 2 hours prior.

45
Q

A third molar which is displaced into the infratemporal fossae will likely cause bleeding from the

a. pteryoid venous plexus
b. sphenopalatine artery
c. descending palatine
d. massteeric artery

A

a. pterygoid venous plexus

46
Q

The best approach for surgical exposure of an impacted tooth for orthodontic bracketing

a. complete CEJ exposure
b. partial exposure of the crown and avoiding CEJ exposure
c. complete exposure of the CEJ and 1 mm of surround alveolar bone
d. exposure of the crown until its greatest diameter is revealed, regardless of the CEJ

A

B. Partial exposure of the crown and avoiding CEJ exposure

47
Q

Why is the incision designed for removal of impacted mandibular third molars extended laterally

a. places the incision in keratinized tissue
b. avoids injury to the buccal artery
c. avoids injury to the lingual nerve
d. reduces post-operative trismus

A

C. Lateral extension avoids injury to the CEJ. The lingual nerve extends above the crest 10% of the time

48
Q

What is the most frequent postoperative complications mandibular third molar extractions

a. localized alveolar osteitis
b. subperiosteal abscess
c. IAN injury
d. Lingual nerve injury

A

A. Localized alveola osteitis

49
Q

What is the frequency with which the lingual nerve runs superior to the lingual crest

a. <5%
b. 10%
c. 30%
d. 50%

A

On average, the lingual nerve is found to 2.8mm below the crest and 2.5mm medial to the lingual plate
10% of the time, lingual nerve is above the crest
25% of the time, the lingual nerve is in direct contact with the lingual plate

50
Q 
Place teeth in order of frequency of impaction
Third molars
Maxillary canines
Mandibular premolars
Maxillary premolars
Second molars
A 
Third molars
Maxillary canines
Mandibular premolars
Maxillary premolars
Second molars
51
Q

According to the “Clarke’s” SLOB rule, if the tooth moves in the same direction as the x-ray head, the tooth is positioned palatal/buccal?

A

Palatal

52
Q

The shape of the medical grade CT scanner bean is

a) fan-shaped
b) cone shaped

A

A) Conventional CT is fan-shaped

53
Q

What is the amount of background radiation, in uSv, that humans are exposed in one year?

a) 3000
b) 30
c) 3
d) 30000

A

A) 3000

54
Q

How many uSVs does a CT head expose the patient to?

a) 40
b) 700
c) 4000
d) 2000

A

D) 2000

55
Q 
A single intra-oral PA image is equivalent to how many uSvs?
A) 10
B) 20
C) 40
d) 5
A

D) 5

56
Q

When surgically up-righting a second molar, how much root formation is ideal?

A

2/3 root formation

57
Q

At what age does there appear to be radiographic evidence of the mandibular third molar tooth germ?

A

9 years of age

58
Q

At what age does the mandibular third molar have crown formation, but minimal root development?

A

14

59
Q

The mesial root of an impacted mandibular third molar is underdeveloped, what is the orientation of the mandibular third molar?

A

Mesioangular - the opposite is then true if the mesial root is overdeveloped. With a severally overdeveloped distal root, the tooth will be horizontal in angulation

60
Q

How many stages of pericoronitis are there?

A

3
I: only in peri-coronal area
II: Spread to contiguous submucosa
III: Spread to adjacent spaces/fascial planes and stimulates systemic response

61
Q

What is the percentage of neoplastic change seen in third molar follicles?

A

3%

62
Q

What is the increase risk of angle fracture when the third molar is present?

a) 1.2
b) 1.6
c) 2.8
d) 3.8

A

2.8

63
Q

Which root is most commonly displaced into the maxillary sinus

a) Maxillary first molar palatal root
b) Maxillary second molar palatal root
c) Palatal root of maxillary second premolar

A

Maxillary first molar palatal root

64
Q

If there is profuse bleeding secondary due a displaced maxillary third molar, where is the bleeding most likely from?

a) MSA
b) PSA
c) Sphenopalatine

A

PSA

65
Q

Gel foam is

a) resorbable porcine skin gelatin sponge
b) oxidized cellulose plant polymer
c) Type I bovine collagen plug

A

a) resorbable porcine skin gelatin sponge

a) resorbable porcine skin gelatin sponge (Gel foam)
b) oxidized cellulose plant polymer (Surgicel)
c) Type I bovine collagen plug (Collaplug)

66
Q

A tongue flap should be ___mm thick and ___% wider than oro-antral defect

A

5-7mm and 20% wider than defect

67
Q

Which of the bacterial species below are commonly fund in acute sinusitis?

a) S. pneumonia
b) H. influenzae
c) M. catarrhalis
d) S. pneumo

A

a) S. pneumonia
b) H. influenzae
c) M. catarrhalis

68
Q

This nerve structure surrounds a group of fascicles

a) epineurium
b) endoneurium
c) perineurium

A

Perineurium surrounds a group of fascicles

69
Q

Which of the below nerve fibers are unmyelinated?

a) C fibers
b) A-delta
c) A-beta
d) A-alpha

A

C fibers

70
Q

What is the average diameter of the sural and greater auricular nerves?

A

Sural - 2.1 mm (up to cm)

Greater auricular -1.5mm (1-2 cm)

71
Q

What is the average incidence of alveolar osteitis following extraction of third molars?

a) 1%-2%
b) 6-8%
c) <1%
d) 3-5%

A

D) 3-5%

72
Q

A submarginal flap requires at least __mm of attached gingiva

a) 2mm
b) 3mm
c) 4mm
d) 5mm

A

4mm

73
Q

Edentulous anterior maxilla undergoes excessive resorption from opposing forces of anterior mandibular dentition

a) Anterior resorption syndrome
b) Collateral syndrome
c) Combination syndrome
d) Soft tissue adaption consequence

A

C) Combination syndrome

74
Q

Stages of odontogenic infections
A) induration, abscess, cellulitis
b) induration, cellulitis abscess
c) abscess, cellulitis, induration

A

B) induration, cellulitis, abscess

75
Q

Of the below bacteria, which is known to cause a foul smell

a) S. viridians
b) Bacteroides
c) S. pneumo

A

B) Bacteroides causes a foul smell

76
Q

At the level of C2 and C6, what is the average distance from the anterior surface of the vertebrae to the posterior border of the airway

a) 7, 18
b) 4, 20
c) 7, 22

A

C) 7mm and 22mm

If patient is <15 years, the distance from C6 should be 14mm or less

77
Q

Ciprofloxacin, levofloxacin, and moxifloxacin are all __inhibitors. Why are they contraindicated for pediatric populations?

a. DNA gyrase inhibitor, headaches
b. RNA polymerase inhibitor, tendon rupture
c. Beta-lactamase, head ache
d. DNA gyrase inhibitor, tendon rupture

A

D. DNA gyrase inhibitor and spontaneous tendon rupture

78
Q

Which of the following is not in the cavernous sinus?

a. CNIII (oculomotor nerve)
b. CN IV (trochlear nerve)
c. V1 and V2
d. VI (abducens nerve)
e. CN X (vagus nerve)
f. Internal carotid artery

A

E

79
Q

Which of the following types of nec fasc are associated with soft tissue crepitation?

a. Type I (mixed aerobic and anaerobic)
b. Type II (S. pyogenes and S. aureus)

A

Type II only

80
Q

What are the two types of Zycomycosis (mucormycosis)

A

Rhino-orbital-cerebral form and rhinomaxillary form

81
Q

What will the hyphae of zycomycosis (mucor) look like?

a. acute angle with septate hyphae
b. Acute angle with non-septate hyphae
c. right angle with non-septate hyphae
d. right angle with septate hyphae

A

C. Right angle with septate hyphae

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