Final Exam Flashcards
Zygomatic implants are ___ loading implants.
a. immediate
b. early
c. delay
d. second stage
a. immediate
What is the recommended radiographic examination for work up?
Pano = anatomy and pathology detection
PA = supplements Pano
Lateral cephalometric = sagittal relationship of jaws
CBCT = bone volume (width and height) assessment
What are contraindications of zygomatic implants?
○ Acute sinus infection
○ Maxillary or zygoma pathology
○ Underlying uncontrolled systemic disease
○ Relative contraindications: chronic infectious sinusitis, bisphosphonates, smoking
What are the indications of zygomatic implants?
○ Sufficient anterior bone + severely resorbed posterior
○ Insufficient anterior bone + severely resorbed posterior
○ Partial edentulous maxilla with unilateral or bilateral loss of posterior teeth + severe resorption
Zygomatic implants require room for at least ___ conventional implants at the anterior maxilla
2
How much can you expect to lift via intracrestal lift?
1-2 mm
What is the recommended initial maxillary residual ridge for the most predictable result for an intracrestal sinus lift?
≥ 4 mm
What is the indication for lateral window lift?
Less than 4 mm native maxillary alveolar bone
What is the pseudostratified ciliated columnar epithelium with CT and periosteum membrane that lines the maxillary sinus?
Schneiderian membrane
What is the indication for alveolar ridge splitting?
- Not enough width of alveolar bone therefore need to split and laterally reposition buccal cortex
- Simultaneous implant placement
- Reduced treatment time and cost of surgery
Barrier membrane usually not needed
What is alveolar ridge splitting?
Ridge expansion technique with longitudinal osteotomy on alveolar ridge with lateral repositioning of the buccal cortex
What is the minimum ridge width for alveolar ridge splitting?
2-4 mm (prefer more than 3 mm)
Which bone graft takes tissue from the same individual?
Autogenous
Which bone graft is the gold standard?
Autogenous
What bone graft is taken from cadavers?
Allograft
What graft takes tissue from different species?
Xenograft
What graft is composed of composite crystalline or amorphous natural or synthetic material?
Alloplast
What is type of bone is primarily compact bone? How long does it take to integrate?
Type I (oak wood), 5 months
What is type of bone is thick cortical bone and dense trabecular bone? How long does it take to integrate?
Type II (pine wood), 4 months
What is type of bone is thin cortical bone and dense trabecular bone? How long does it take to integrate?
Type III (balsa wood), 6 months
What is type of bone is thin cortical bone and low density trabecular bone? How long does it take to integrate?
Type IV (styrofoam), 8 months
What are the general properties of benzodiazepine?
○ Sedation
○ Anxiolysis
○ Muscle relaxation
○ Anterograde amnesia
○ Anticonvulsant effects
No direct analgesic effects
What are common side effects of benzodiazepines?
○ Fatigue
○ Drowsiness
○ Respiratory depression
What was the first benzodiazepine discovered?
Chlordiazepoxide (Librium)
What is the first benzodiazepine used in anesthesia?
Diazepam (Valium)
What receptor does benzodiazepine work on?
GABA receptor (inhibitory effect)
What is the reversal agent of benzodiazepine? What is the dose?
Flumazenil (Romazicon)
0.2 mg/min IV until reversal
What receptor does ketamine work on?
NMDA receptor
What are the general properties of ketamine?
○ Dissociative
○ Hallucinogenic
○ Amnesic effect
What are the disadvantages of ketamine?
○ Hallucinogenic
○ Nightmare emergence
○ Increased salivary flow
What is propofol used for? What receptor does it work on? How does it affect blood vessels?
General anesthesia induction agent
GABA channel (enhances Cl- conductance)
Arterial and venous dilation
What does the μ receptor do?
○ μ1 = analgesia
○ μ2 = respiratory depression
○ Physical dependence
○ Muscle rigidity
What does the κ receptor do?
○ Miosis
○ Sedation
What does the δ receptor do?
Behavioral response to pain
What does the σ receptor do?
○ Dysphonia
○ Hallucinations
What are the desirable effects of opioids?
○ Analgesia
○ Sedation
○ Euphoria
○ Anti-tussive (cough relief)
What are the undesirable effects of opioids?
○ Respiratory depression
○ Coma
○ Emesis
○ Constipation
○ Histamine release
○ Potential for addiction
Which is more potent: morphine or fentanyl?
How much more potent?
Fentanyl is 100x more potent
Does morphine or fentanyl result in histamine release?
Morphine
Is morphine or fentanyl contraindicated in renal patients?
Morphine
Does morphine or fentanyl have a faster onset of action? Which lasts longer?
Faster onset = fentanyl
Lasts longer = morphine
How are morphine and fentanyl eliminated?
Morphine = kidney
Fentanyl = inactive metabolite accumulates in body fat
What is the reversal agent of opioids? What is the dosage?
Naloxone (Narcan)
0.4 mg IV
Who started the ASA classification?
American Society of Anesthesiologists
What is ASA Class I?
Normal, healthy patient without systemic disease
What are examples ASA class II patients?
○ Type II or non-insulin dependent DM
○ Well-controlled epilepsy (no seizure in past year)
○ Well-controlled asthma
○ Hypothyroid/hyperthyroid patient under treatment and currently euthryoid
What are examples of ASA class III patients?
○ Type I diabetes mellitus, well controlled
○ Symptomatic thyroid disease patient
○ > 6 months without any residual complications with MI or CVA
○ BP (169-199) systolic/(95-114) diastolic
○ Epilepsy (several seizures per year)
○ Asthma
○ Angina pectoris (stable angina)
○ CHF
○ COPD
□ Emphysema
□ Chronic bronchitis
What are examples of ASA class IV patients?
○ Unstable angina
○ < 6 months without any residual complications with MI and CVA
○ BP > 200 systolic/> 115 diastolic
○ Uncontrolled dysrhythmias
○ Severe CHF or COPD
□ Wheelchair bound or need supplemental oxygen
○ Uncontrolled epilepsy
○ Uncontrolled IDDM
What is ASA class V?
Moribound patient not expected to survive 24 hours
What is ASA class VI?
Braindead patient awaiting organ harvesting
What is ASA class E?
Patient requires emergency operation (precedes number status)
Who are the qualified sedation providers according to the Missouri sedation laws?
○ Currently licensed dentist in MO with a valid permit to administer enteral, parenteral, or pediatric moderate sedation
○ Currently licensed anesthesiologist
○ Currently licensed certified registered nurse anesthetist
Regardless of intent, what type of sedation would a pediatric patient fall under?
Moderate sedation (regardless if you want only minimal sedation)
What is minimal sedation?
Minimally depressed level of consciousness produced that retains patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command
Ventilatory and cardiovascular functions are unaffected
What is moderate sedation?
conscious sedation; drug induced depression of consciousness during which patients respond purposefully to verbal commands either alone or accompanied by light tactile stimulation
No interventions required to maintain a patent airway, and spontaneous ventilation is adequate
Cardiovascular function is usually maintained
What is deep/general sedation?
drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation
Ability to independently maintain ventilatory function may be impaired
Patients may require assistance in maintaining a patent airway and spontaneous ventilation may be inadequate
Cardiovascular function is usually maintained
What are the qualifications of deep/general sedation?
Document satisfactory completion of
□ Advanced educational program accredited by ADA
□ ADA-accredited post-doctoral training program in OMFS
□ Anesthesia training program that is approved and accredited to teach postgraduate medical education by AMA
□ Diplomate of American Dental Board of Anesthesiology
Document completion of
□ Advanced Cardiac Life Support (ACLS) course of board-approved equivalent during past 5 years
□ Minimum of 15 hours of other board-approved CE pertaining to medical emergencies, anesthetic complications, or patient management while under deep sedation/general anesthesia
Undergo and successfully complete an on-site evaluation by consultants appointed by the board
Document that facility has been issued a deep sedation/general anesthesia site certificate
What is the OMS anesthesia training requirement?
5 months of anesthesia training
(Minimum 4 consecutive months + 1 month of pediatric anesthesia)
Senior resident must have at least 150+ office-based sedation cases
What are monitoring equipment used in IV sedation?
BP cuff, pulse oximeter, ECG, temperature monitor, capnography
What is capnography? How does it work?
Monitors concentration or partial pressure of CO2
Breath-to-breath ventilation; makes a graph of expiratory CO2 by expired volume
Gives real-time feedback on treatment
What does the pulse oximeter measure?
Measures oxygen saturation of arterial blood to determine percent of oxyhemoglobin in capillaries
How does the red light in a pulse oximeter work?
2 wavelengths = 650 nm and 950 nm
Red light is shined through the fingertip to calculate % oxygenated Hb vs reduced Hb
What is the most reliable airway?
Endotracheal intubation
What is the surgical airway?
Cricothyroidotomy
What are the adjunctive airways?
Nasal and oropharyngeal airways
Combitube
Laryngeal tube
Laryngeal Mask airway
King tube
Cricothyroidotomy
Who should perform patient evaluation during sedation?
The doctor/dentist
What are the different formats of the medical history questionnaire?
Short and long
What is the Mallamapti classification used for?
Airway examination prior to IV sedation
What is Mallamapti class I?
Complete visualization of soft palate
What is Mallamapti class II?
Complete visualization of the uvula
What is Mallamapti class III?
Visualization of only the base of the uvula
What is Mallamapti class IV?
Soft palate is not visible at all
How is nitrous oxide manufactured?
Made from ammonium nitrate via 240 degrees C heat
Compressed in cylinder where 30% is liquified
N2O must be 97% pure
What is the special property/characteristic of N2O gas to humans?
Only non-organic compound other than CO2 that has CNS depressant properties
What is the concentration effect of nitrous oxide?
The higher the concentration of the gas inhaled, the more rapidly arterial tension of the gas increases
What is the 2nd gas effect of nitrous oxide?
extreme update of N2O will form a vacuum at alveoli that forces other air (in this case, other inhalational agent) into the lungs
Occurs when a second inhalation anesthetic is administered along with N2O-O2
Chronic exposure of nitrous oxide is detrimental to ___? Why?
CNS
It creates transient bone marrow depression
What is the green gas cylinder? What is the size and pressure?
Oxygen
Size E
1900 Psi
What is the blue gas cylinder? What is the size and pressure?
Nitrous
Size E
745 Psi
Who was the first person to write a book on nitrous oxide?
Sir Humphrey Davy
Who were the first people to start a dental practice using nitrous?
Horace Wells and William Morton
In the 1850s and 60s, nitrous was replaced with what?
Ether and chloroform
Who re-introduced nitrous oxide to dentistry in 1863 and made it more widespread?
Gardner Colton
What did Edmund Andrews do for nitrous oxide?
Introduced 20% oxygen
What replaced nitrous oxide as the ideal drug for eliminating pain?
Lidocaine
What is the minimum O2 concentration mandated by the ADA to be delivered by inhalation sedation devices?
Atmospheric concentration (30%)
In the state of MO, what is the age that is considered a child?
≤ 12 years old
Use of what drug automatically makes a sedation procedure general anesthesia?
a. Fentanyl
b. Morphine
c. Versed
d. Ketamine
d. Ketamine
T/F: In 1845 Horace Wells demonstrated N2O at Harvard Medical School.
True
What color is the oxygen cylinder internationally (outside of the US)?
White
Where did Dr. Crawford perform the first anesthesia procedure?
Jefferson, GA
Which adjunctive airway is the most appropriate?
Nasopharyngeal airway
(patient gags if conscious with the oropharyngeal airway)
