Middy Flashcards
What are the characteristics of an ideal alveolar ridge?
- Proper jaw relationships
- Proper configuration of alveolar process (board U shape)
- No bony or soft tissue protuberances or undercuts
- Adequate attached keratinized mucosa in the primary denture bearing area
- Adequate vestibular depth (BL)
- Adequate bone height & width
- Fixed tissue under dentures
- No obstructing arena or scar bands
- No displacing muscle attachments
When a tooth is no longer situated in alveolar bone, what happens to the alveolar bone?
- Immediate change starts following tooth loss due to lack of function stress from the PDL (PRIMARY CAUSE)
-the bone atrophies but muscle attachments remain in the same place leading to:
1. lack of floor of mouth on lingual side
2. lack of vestibular depth on buccal side
What is the primary cause of Immediate change of alveolar bone following tooth loss?
Lack of functional stress from PDL
Describe bone resorption from one person to another-
unpredictable- in some it is stabilized and in others you can have total loss of alveolar and underlying basal bone
Which arch resorbs more quickly following extraction?
mandible
What component of the maxilla resorbs most quickly following extractions?
hamular notch
Increasing the quantity or quality of bone or soft tissues in the edentulous areas of the oral cavity:
vestibuloplasty
The purpose of a vestibuloplasty is to reposition the alveolar mucosa and muscle insertions more ____ to gain ____.
apically; vestibular depth
Another name for vestibuloplasty:
relative ridge augmentaiton
Vestibuloplasty increases:
- surface area of fixed tissue for denture support
- depth of vestibules for denture flange extension
- depth of sulcus for healthy, firm soft tissue coverage of the ridge, and adequate bony support for the denture
Indications for performing a RELATIVE alveolar ridge augmentation:
- flat ridge with MODERATE resorption of alveolar bone
- 2 cm or MORE of bone present at the mid-body of the mandible
Where will height be increased for a RELATIVE alveolar ridge augmentation?
symphysis and mid-body regions
Indications for performing an ABSOLUTE alveolar ridge augmentation:
- flat ridge with EXTREME resorption of alveolar bone
- BONE GRAFTING is done to increase the bone height
- LESS THAN 2CM of bone at mid-body of mandible
If we have LESS THAN 2 cm of bone at mid-body of mandible, this indicates:
ABSOLUTE alveolar ridge augmentation
Where can you procure bone for the AUTOLOGOUS bone graft to maxilla/ mandible?
Iliac crest
Describe bone resorption in the maxilla:
Buccal-palatal resorption (width)
Maxillary resorption = width
(also tend to get hyper mobile soft tissue)
Describe bone resorption in the mandible:
SUPI
Superior-inferior resorption (height)
More bone resorption in mandible
Bone resorption is enhanced by:
- surgery
- denture wearing
- low mandibular plane angle
What deficiency may accelerate bone resorption?
Vitamin D and calcium deficiency
What systemic diseases may accelerate bone resorption?
- osteoporosis
- endocrine dysfunction
- other conditions
List the possible causes of tooth impactions:
- inadequate arch lenght
- prolonged deciduous tooth retention
- malposition of impacted tooth
- excessive bone or soft tissue
- malposition of adjacent tooth/teeth
- associated pathology (3rd molars)
What is the most common cause of tooth impaction?
malposition of impacted tooth
Which teeth are most likely to become impacted (in order)
- mandibular 3rd molars
- maxillary 3rd molars
- maxillary canines
- mandibular premolars
- mandibular canines
- maxillary incisors
- supernumeraries
If a MAXILLARY TOOTH is impacted, what position/orientation is it typically located in?
Vertical impaction
If a MANDIBULAR TOOTH is impacted, what position/orientation is it typically located in?
mesioangular impaction
What is the most difficult position of an impacted tooth for removal?
distoangular
What classification system is used for 3rd molar impaction?
Pell and Gregory
In Pell and Gregory classification of impacted 3rd molars, what does class 1,2,3 describe?
relation of mandibular 3rd molar to anterior border of the ramus
In Pell and Gregory classification of impacted 3rd molars, what does class A,B, and C describe?
The depth of impaction of maxillary or mandibular 3rd molars in bone relative to adjacent tooth
Determine the Pell and Gregory classification of the following:
- sufficient amount of space between the anterior border of ramus and the distal of the 2nd molar for accommodation of the entire crown of 3rd molar
- situated ANTERIOR to the anterior border of the ramus and there is ADEQUATE room to erupt
Class 1
Determine the Pell and Gregory classification of the following:
- space between the anterior border of the ramus and the distal of the second molar LESS THAN the MD diameter of the crown of the 3rd molar
- crown is 1/2 covered by anterior border of the ramus
class 2
Determine the Pell and Gregory classification of the following:
- the ENTIRE 3rd molar is within the ramus
Class 3
Determine the Pell and Gregory classification of the following:
- the occlusal plane of the impacted tooth is at the SAME LEVEL of the adjacent tooth
Class A
Determine the Pell and Gregory classification of the following:
- the occlusal plane of the impacted tooth is BETWEEN the occlusal plane and CEJ of the adjacent tooth
Class B
Determine the Pell and Gregory classification of the following:
- the occlusal plane of the impacted tooth is apical to the cervical line of the adjacent tooth
Class C
What are the radiographic predictors determining the proximity of the inferior alveolar nerve to an impacted mandibular 3rd molar?
- darkening of the root
- interruption of the white line cortication (lamina dura) of the canal
- deflection or narrowing of root
- diversion or narrowing of canal
- PA radiolucent area
Why and where do you perform buccal hockey stick incision?
- triangular flap for a full bony impacted 3rd molar
- must be on the buccal to avoid damage to the lingual nerve
for a buccal hockey stick incision, you are trying to avoid damage to the:
lingual nerve
What are the various treatments to remove impacted teeth?
- flap and surgical removal
- section the tooth
- surgical exposure and orthodontic guided eruption
What are the potential complications for performing impacted teeth surgery?
- hemmorhage
- fracture root or damage to adjacent tooth or tooth displacement
- oro-antral or oro-nasal communication
- fracture to mandible/maxillary tuberosity
- nerve injury (paresthesia)
- infection
Note maxillary sinus anatomy, what is in the bony box?
- should be empty and only filled with air
- largest para-nasal sinus is located in the maxilla
- pyramidal in shape
- lateral nasal bone forms the base
- ostium drains from maxillary sinus to middle meatus
- capacity is 15 cc
Lining of the maxillary sinus cavity:
schneiderian membrane
What is the schneiderian membrane made of?
mucous secreting pseudo stratified ciliated columnar epithelial cells on the internal side
(fewer mucus glands on the lateral wall compared to the medial wall)
Gold standard for sinus imaging
water’s radiograph (sinus should appear radiolucent)
About 10% of inflammatory episodes (sinusitis) are extensions of:
dental infections
Time period for acute sinusitis:
less than 2 weeks
signs and symptoms of acute sinusitis:
- headache
- pain
- nasal obstuction
- nasal discharge
- toxic manifestations
- heavy feeling with bending
- congestions
treatment for acute sinusitis:
antibiotics: augmentin
nasal decongestion: afrin
steam inhalation: restores function of cilia
analgesics: NSAIDS and antihistamine
Timeline for chronic sinusitis:
greater than 3 months
Complications of maxillary sinusitis:
- orbital abscess and orbital cellulitis
- intracranial abscess/ meningitis
- cavernous sinus thrombosis
- spread of infection to neighboring sinuses, structures and organs
- osteomyelitis
Leforte type 1,2 and 3 fracture patterns:
- Horizontal alveolar ridge
- Pyramidal nasofrontal structure
- Horizontal cranofacial dislocation
Access for sinus lift:
lateral
How can you visualize inside of maxillary sinus?
Caldwell Luc approach
Do you need surgery with less than 2 mm of OAC?
no
2-6mm OAC =
figure 8 suture
greater than 7mm OAC=
surgical treatment (buccal flap)
T/F: You can use buccal fat pad to close OAC
true
2 different type of flaps to close OAF?
- buccal advancement flap
- palatal rotation flap
Best way on radiograph to tell IAN involvement:
darkening of roots
Buccal hockey stick, what is purpose of shape?
avoid damage to lingual nerve
T/F: Purpose of valsalva maneuver is to check for sinus involvement in the mandible:
false- maxilla
How long should Afrin be used?
2-3 puffs daily for 3-4 days
Can you prescribe afrin for moderate OAF?
yes
What treatments for chronic sinusitis:
- nasal decongestant
- analgesic
- antibiotic
