Exam 1 (Lectures 1-6) Flashcards
average formation of 3rd molar formation is ____
20-24 years
pathognomic indicating md fracture
sublingual hematoma
cleft lip with or without cleft palate is the failure of fusion between the
median nasal process and the maxillary process
osteomyelitis results in
ischemia and bone necrosis
skeletal defiency secondary to oligodontia
ectodermal dysplasia
option for intrusion
allow passive eruption (deciduous teeth) orthodontic traction stabilize 2-3 months
Name six indications for orthognathic surgery
skeletal discrepancy with masticatory difficulty impingement on palatal tissue speech difficulty OSA psychosocial problems esthetics
what procedure has low morbidity
Lefort 1
limited correction is possible for this type of movement
growth redirection
open apex of avulsed teeth (<2 hours) (7) steps KNOW FOR CLINIC
- reimplant immediately 2. transport in Hanks soln or milk 3. Doxycycline 4. LA, socket irrigation, Tetanus 5. Replant 6. Splint for 7-10 days 7. Apexification (Ca(OH)
why do we close in layers
to eliminate dead space
position of 3rd molars does not change substantially after _____
25 years
non-surgical treatment of fractures is indicated in which situations
fractures without malocclusion and a compliant patient
are vertical impacted md 3rds easy or hard according to winter’s classification?
generally easy
which type of healing has a little bit of movmenets
secondary healing
closed reduction requirements
good teeth
favorable fracture
min-mod displacement
palatal repair of cleft palate patients should be done when
12 months
velopharyngeal flap helps eliminate _____
nasal speech
the role of age in third molar surgery
Surgery less complicated § Healing process quicker
if pt has a fractured mandible they will have
malocclusion
attaches part of soft palate to posterior wall of pharynx
velopharyngeal flap
periodontal compromise
orthodontic camouflage
in orthognathic surgery what does the stent determine
AP and transverse
how long can an avulsed tooth last in milk
six hours
incidence of cleft lip with or without palate in african-american
1:2000
full bony impaction of 3rd molar
D7240
area between the mental foramina
symphysis
what winter’s classification is this
mesioangular
vertical maxillary deficiency
class 3
posterior to canine and anterior to mental foramen
parasymphysis
<2 hours closed apex tx of avulsed teeth
- Store in hank’s solution 2. Replant 3. Splint for 7-10 days 4. Perform endodontic cleansing and shaping of canal 5. fill canal with Ca(OH)2 (6-12 months) 6. perform gutta percha obturation (6-12 months)
fusion of facial structures occur at what week
week 7
how often do vertical impacted md 3rds occur (winter’s classification)
38%
disadvantages of extraoral approach for surgical
external scar
potential for facial n. damage
surgical procedures for mx
maxilla anterior segment, posterior segment, Lefort 1, high lefort 2 and 3
Principles of Management for Fractures
- Reduction
- Stabilization
- Immobilization
- Prevent Infection
why does osteomyelitis occur
Smokers
End-stage process of long wound healing
Immunocompromised
dentition used as the handle to reduce the fracture
closed reduction
orthognathic movements on cleft palate patients have to use what
distraction
big advantage of a BSSO (Saggital Split Ramus Osteotomy)
can advance the jaw without doing a bone graft
pt’s occlusion and teeth then wired together
maxillo-mandibular fixation
in closed reduction
fracture of the cheekbone
zygomaticomaxillary complex ZMC
most commonly selected time for alveolar bone graft for cleft lip/palate
mixed dentition grafting
what winter’s classification is this
easy or difficult?
horizontal
difficult
TMJ considerations for this type of movement
growth redirection
Class 2 bites have what percent occurrence
10%
what winter’s classification is this
vertical
which type of healing has no movements
primary healing
lacerations tx
return tissue to proper orientation
Class 2 bites need surgery what % of times
2%
Subperiosteal Abscess
occurs when
2 – 3 weeks post op
metallic sound upon percussion
intrusion
AAOMS / OMSF
• 7 year study
• Advised that even most 3rds that are asymptomatic
and free of disease are at
Advised that even most 3rds that are asymptomatic
and free of disease are at risk for chronic oral infections
tooth decay and should be considered for removal in young adulthood
impacted/unerupted. FIll in blank Not all __________ teeth are ______
unerupted/impacted
high mortality rate and brain trauma resulting from this fracture
LeFort 3
extraction technique for mx third molars
Flap design
• Approach
Name four advantages of orthognathic surgery
decreased treatment time improved esthetics improved occlusion increased esthetics
Based on inclination of impacted tooth to long axis of 2nd molar
Winter’s Classification
what is the easiest winter’s classification
mesioangular
Bleeding:
Intraopeatively from 3rd molar extractions
give local, bone wax, Gelfoam, Surgicel, pressure pack if needed
velopharyngeal flap complications
mouth breathing, OSA, complicates intubation for surgery
incidence of isolated cleft palate
1:2000
reimplanted tooth (mature) stabilization periods
7-10 days
tx of abrasions
DEBRIDEMENT 1) scrub with mild soapy water/irrigate with saline 2) cover with thin antibiotic ointment
advancement of set back of mandible
BSSO bilateral saggital split osteotomy
in orthognathic surgery the vertical position is determined by what
k-wire placed in the nasion
fratures involving upper, middle, and lower face
panfacial trauma
Treatment options for facial fractures
No treatment
Closed Reduction
Open Reduction with rigid internal fixation
Combination
what % of time does distoangular classifications occur for md molars
6%
general facial form is defined by what
Na-A-pg form
convex profile is usually what
skeletal and dental class 2
complex, full bony impaction of 3rd molar
D7241
fractures of medial orbital walls
ethmoid fractures
class 3 bites have what percent occurrence
2.5%
crown formation of thirds
14 years
frontal sinus fractures can lead to
brain abscess
continuous bleeding may lead to
hematoma
in cleft lip with or w/out cleft palate the lip/alveolous is contiguous without any
vestible
theories behind impacted thirds
Differential root growth between mesial & distal • Inadequate arch space • Dental development lags skeletal development • Obstruction secondary to cyst, tumor, supernumerary teeth
mesioangular impacted md 3rds occur what % of time
43%
how to manage thirds in pt >40 yrs
Monitor with panoramic x-ray every 1-2 years
• Surgical intervention for clinical symptoms or
radiographic signs
secondary to ____________, _______ remains open during speech and ______
velopharyngeal incompetence, nasal airway remains open during speech and air escpaes
treatment for extrusion and lateral displacement
reposition tooth fully at socket splint tooth for 1-3 weeks
move maxilla in all planes
Lefort 1
classify this
distoangular impaction of mx third molar
INTRAOPERATIVE COMPLICATIONS
• Sinus Perforation what to do?
- Sinus Perforation
- Antibiotic
- Decongestants
- Afrin nasal spray
- Written & verbal instructions
• Suture tight
• Follow-up
(ADAWSF)
tooth not having perforated the oral muocsa
unerupted tooth
what has shown to remove 100% of the cpap in patients
maxillo mandibular advancements
recovery period of 3rd molar extractions
3-4 days
how long can an avulsed tooth last in Hanks solution
24 hours
chief complaint of pts who have md fracture
malocclusion
may not be stable when used for anterior open bite
BSSO (bilateral saggital split osteotomy) BSSO
fracture common in fights
ZMC complex
what makes the cleft palate patient different?
large maxillary AP defiencies scar tissue VP incompetence vascular compromise palatal and nasolabial fistulas
stable treatment of anterior open bite
Lefort 1
incidence of cleft lip with or without palate in whites
1:1000
Alveolar fractures treatment
stabilization, reduction, RCT
residual _______ at _______ and in _______ is common in palate repair
residual fistula at anterior of palate and in vestible is common
what bacteria are we considered about in animal bites
pasteurella multocida (gram-negative rod)
root fracture stabilization periods
2-4 months
compression fracture of alveolus to accomodate new position
intrusion
opposite movement of pre-surgical orthodontics
orthodontic camouflage
what symptoms are associated with osteomyelitis
imflammation and edema
pt has grossly displaced md fracture what tx to use?
open reduction with internal fixation (ORIF)
lacerations management
cleaning/debridement/hemostasis/closure
what winter’s classification is this
distoangular
failure to fully erupt within the expected developmental time period
impacted tooth
painful, owing to exposed nerve endings
abrasions
classify this
mesioangular impaction of maxillary third molar
Ideal Patient Selection for 3rd molar removal (5)
_____ root formation
______age
+ 3 others
2/3RD root formation
- 18-25 year old
- Healthy
- No psychological contraindications
- No job restrictions to “numb lip”
dentition is used as a handle to reduce the fracture
closed reduction
between sigmoid notch and the top of the condylar head
condyle
what type of movement has a possible periodontal compromise
orthodontic camouflage
T or F
Most healthy 3rd molar patients benefit IVSA / GA
true
for minimal discrepancy
orthodontic camouflage
Nerve Injury
- Nerve Injury
- Follow
- Document, document, document
- Steroid dose pack
- Neurosensory testing
- When to refer?
- Malpractice
results in multiple fractured segments
comminuted fracture
extraoral approach for surgical approach
excellent access for reduction/fixation
pt has facial fracture and has lung disease
open reduction with internal fixation (ORIF)
Midface Fractures
LeFort 1,2,3
ZMC, ZOE
partial bony 3rd molar impaction
D7320
intraoral surgical approach disadvantages
oral contamination
fracture reduction can be difficult to reduce
what is noticed with chronic osteomyelitis
> 1 month
Dull discomfort
Paresthesia
Moth eaten appearance of bone on film
how common are mesioangular mx 3rd winter’s classifications
12%
how common are horizontal mx 3rd winter’s classifications
1% -rarely seen
most frequently used md procedure
BSSO (bilateral saggital split osteotomy)
removes papillary dermis and epithelial layer
abrasions
how common are distoangular mx 3rd winter’s classifications
25%
when should lip repair be done in cleft palate/lip patients
Rule of ten
pt is 10lbs
WBC<10
HG>10
10 weeks
what percentage of BSSO patients have IAN nerve damage
50%
classification of soft tissue 3rd molar impaction
D7220
between sigmoid notch and angle
ramus
how often does horziontal md molar 3rd impactions occur
3%
possible esthetic compromises
orthodontic camouflage
allows segmentalization of maxilla
Lefort 1
whole part of midface is fractured, most severe
LeFort 3
what to do for bleeding vessels
clamp/tie/cauterize
how long does post-surgical orthodontics take
6 months
in mixed dentition graft in cleft lip/palate patients and lateral incisor is absent or pt is small or cleft is large, ___
delay until later
what tooth is functionally missing in cleft lip/palate patients and what %
80% lateral incisor
expose fractures and use direct visualization and dentition to manipulate segments into place then fixate with plates and screws
open reduction with internal fixation (ORIF)
POSTOPERATIVE COMPLICATIONS
• Secondary bleeding
Suction oral cavity
• Examine site
- Apply pressure for 5 minutes
- Local
- Curettage
- Identify and control source of bleeding
- Monitor for 15 minutes before discharge
bone healing in the wrong position
malunion
stabilization periods for displaced tooth
3-4 weeks
Contraindications to removal of 3rd molars
Extremes of age:
Yo u n g a g e : mandible may grow to accommodate 3rd molars Old age: most common contraindications for removal
tx for pasteruella multocida
augmentin po for 7 days
what is problem in speech evaluation of cleft lip/palate patients
nasal speech
rarely need for intermaxillary fixation (wiring of the teeth together)
orthognathic surgery
class 3 bites need surgery what percentage of time
40%
pt has facial fracture and has seizures what treatment to use
open reduction with internal fixation
direction of the fracture line is different then the muscle line
favorable
classify this
vertical impaction of maxillary third molar
how long is maxillo-mandibular fixation needed for in closed reduction
4-8 weeks
layers of the lip
1) muocsa 2)orbicularis oris-muscle 3) skin
incidence of cleft lip with or without cleft palate with male and females
male: female 2:1
regions involved in panfacial trauma
frontal bone
ZMC
NOE region
maxilla and mandible
how long does pre-surgical orthodontics take
12-18 months
mandibular intraoperative complications of 3rd molar removal
- Root tip out lingual plate
- Submandibular, lingual
- Nerve injury
- Fracture
indications for 3rd molar removal
Indications for 3rd molar removal
Therapeutic
To treat a currently active process/disease
Prophylactic
To prevent future disease or other problems
what type of movement has a possible esthetic compromise
orthodontic camouflage
incomplete fracture
greenstick
how common are vertical mx 3rd winter’s classifications
63%
possibly less stable
orthodontic camouflage
name the maxilary winter’s classification
vertical
distoangular
mesioangular
horizontal
must have remaining growth to work
growth redirection
what may improve speech evaluation/therapy in cleft palate/lip patients
velopharyngeal flap
stable rigid fixation possible
BSSO (bilateral saggital split osteotomy) BSSO Lefort 1
a callous/cartilage involves which phase of healing
secondary phase
which trauma to tooth has the worst prognosis
intrusions
maxilary intraoperative complications of oral surgery
Infratemporal fossa
• Tuberosity “tuberectomy”
• Oroantral communication
what is used for large AP discrepancies
distraction
fracture line is allowing the bones to be displaced
unfavorable
where are incisions made for orthognathic surgery
intraoral
what to expect after 3rd molar surgery as far as pain/swelling
Expected mild-moderate pain
• Expected mild-moderate swelling to peak at day 3 and
decrease after
• Expected to feel lousy – dental surgery – makes talking,
eating, and social situations hard for a few days
tx of subperiosteal abscess
Flap and irrigate • Antibiotics
has potential for iAN nerve damage
bilateral saggital split osteotomy (BSSO)
reimplanted tooth (immature)
3-4 weeks
combined orthodontics and surgery are used to manage a skeletal malocclusion
orthognathic surgery
incidence of isolated cleft palate in females: males
2:1
single fracture line
simple fracture
vertical maxillary hyperplasia
class 2
stabilization periods for mobile tooth
3-4 weeks
accentuate dental compensations
orthodontic camouflage
bleeding under the skin
contusion
what is the critical driving force in cleft palate repair
speech
odontogenic bacteria invade bone marrow describes what process
osteomyelitis
communication with the external environment
compound fracture (open)
what percentage of patients are happy with BSSO even with IAN numbness
90%
concave profile is usually what
skeletal and dental class 3
advances the anterior pharyngeal palate and enlarges the mandible
maxillo-mandibular advancement
◦ ____moved the envelope of discrepancy further out for the dental movements
TAD
pyramidal fracture bc of shape
involving orbit
LeFort 2
how long can an avulsed tooth last in ViaSPan
a week
abrasions leaves what exposed
raw bleeding reticular dermis
lacerations are a tear in what
epithelial and subcutaneous tissue
just the fracture of the maxilla
LeFort 1 fracture
patients occlusion established and teeth are then wired together
maxillo-mandibular fixation
Three ways to treat skeletal malocclusion
- Growth Redirection 2. Orthodontic Camouflage 3. Orthognathic Surgery
first treatment of avulsed tooth
put it back
straight profile is usually what
skeletal and dental class 1
indicating of a fractured mandible
floor of mouth hematoma
what systemic problems are seen in cleft lip/palate patients
middle ear disease
cardiac disease
Collection of purulence between periosteum of flap and
bone
Subperiosteal Abscess
intraoral surgical approaches benefits
no external scar
no f. nerve damage
what three signs are noticed with acute OM
Duration < 1 month
Pain
Minimal to no radiographic
changes
root formation is approximately ____ by _____ years
Root Formation approximately 50% by 16 years
compliance and burnout are possible for this type of movement
growth redirection
pt has a condylar fracture
open reduction with internal fixation (ORIF)
not healing, bone segments are still moving
nonunion
in mixed dentition grafting if lateral incisor is present, consider grafting ____
early
name the 4 winter’s classification
• 1. Mesioangular • 2. Distoangular • 3. Horizontal • 4. Vertical
purpose of stannous fluoride in a RCT
prevents root resorption
purpose of citric acid in a root canal
disinfects dentinal tubules
stabilization period for mobile tooth
3-4 weeks
stabilization periods for displaced tooth
3-4 weeks
stabilization periods for roor fracture
2-4 months
stabilization periods for reimplanted tooth (mature)
7-10 days
stabilization periods for reimplanted tooth immature
3-4 weeks
blunt trauma can cause this type of injury
contusion
subcutaneous or submucosal hemorrhage wihtout breakage of the soft tissue
contusions
treatment of contusions
surgical exploration if arterial involvement is involved
antiobiotic if contaminated
removes epithelial layer and papillary dermis
abrasions
soaps which enter a wound can cause
cellular damage and necrosis
