Midterm

Question 1

What is the characteristic of an Ideal alveolar ridge?
(12)

Answer 1

Adequate vestibular depth
Deep FOM
- Proper Jaw Relationship.
- Proper Configuration of the Alveolar Process (broad U-shaped ridge with Vertical components as Parallel as possible).
- No Bony or Soft tissue protuberances or undercuts.
- Adequately attached Keratinized mucosa in the primary denture bearing area.
- Adequate Vestibular Depth (Buccal and Lingual sulcus)
- Adequate bone height and width
- “Fixed Tissue” under dentures
- Absence of redundant tissue
- No obstructing frena or scar bands
- No displacing muscle attachments

Question 2

When a tooth is no longer situated in the alveolar bone, what happen to the alveolar bone?

Answer 2

With loss of teeth, there is significant resorption leading to bone atrophy in the jaws. However, the muscle attachments still remain in the same place

Question 3

What’s the purpose of vestibuloplasty?

Answer 3

Vestibuloplasty is a soft tissue surgical procedure designed to increase:
- Surface area of fixed tissue for denture support
- Depth of vestibules for denture flange extension
- Used to prepare for either complete or partial dentures
Purpose
To provide better anatomic condition for denture construction by deepening the sulcus to provide healthy, firm soft tissue coverage of ridge thereby help in the denture flange extension.
To provide adequate bony support for denture (decreasing dislodging forces by muscles and soft tissues in denture bearing areas)

Question 4

Indications for performing alveolar ridge augmentation.

Answer 4

Relative Ridge Augmentation
Indicated for a flat ridge with moderate resorption of the alveolar bone.
Indication for Relative Ridge Augmentation in the Mandible
If there is 2 cm or more bone present at the mid-body of the mandible. Height will be increased in the symphysis and the mid- body regions.

Absolute Ridge Augmentation
Indicated for a flat ridge with extreme resorption of the alveolar bone.
Indication for Absolute Ridge Augmentation in the Mandible:
Indicated when there is extreme resorption of the body of the mandible.
There is less than 2 cm bone at the mid-body of the mandible

Question 5

Where can you procure bone for the autologous bone graft to maxilla / mandible?

Answer 5

Iliac crest

Question 6

Please know the characteristics of bone resorption.

a. — is the primary cause of resorption; however, the muscle attachments still remain in the same place!
b. Accelerated by —
c. Affects the — more severely because of (2)
d. Factors responsible can be systemic like (2), or local like (3)
e. In the maxilla, resorption is more –; in the mandible it is more —

Answer 6

Maxilla = B/L (width); Mandible = vertical (height)

Lack of functional stress from teeth and PDL following extraction
denture wearing
mandible, decreased surface area and less favorable distribution of forces
nutritional abnormality or systemic bone disease
surgery, denture wearing, low mandibular plane angle
anterior to posterior, superior to inferior

Question 7

Know the possible causes of tooth impactions
(6)

Answer 7

Inadequate arch length
Prolonged deciduous tooth retention
Malposition of Impacted tooth
Malposition of adjacent tooth/teeth
Excessive bone and/or soft tissue
Associated pathology

Question 8

Indications for 3rd molar extractions?
(14)

Answer 8

Facilitate the management of or limit progression of periodontal disease
Non-restorable caries
Non-treatable pulpal lesions
Acute or chronic infection (e.g., cellulitis, abscess, pericoronitis)
Preventive or prophylactic removal
Ectopic position Indications For Removal of Impacted Teeth
Internal or external resorption of tooth of adjacent teeth
Facilitate prosthetic rehabilitation
Facilitate orthodontic movement and promote dental stability
Orthodontic abnormalities (e.g., arch length/tooth size discrepancies, malposed/impacted second molars Indications For Removal of Impacted Teeth
Pathology associated with tooth follicle (e.g., cysts, tumors)
Tooth interfering with orthognathic, reconstructive surgery, trauma or tumor surgery
Prophylactic removal in patients with certain medical or surgical conditions or treatments (e.g. organ transplant, alloplastic implants, chemotherapy, radiation therapy)

Question 9

Which tooth/teeth are most likely getting impacted?
Order of frequency:
(7)

Answer 9

Mandibular third molars
Maxillary third molars
Maxillary canines
Mandibular premolars
Mandibular canines
Maxillary incisors
Supernumeraries

Question 10

If a tooth (maxillary / mandibular) is impacted, what position (orientation) does it usually located?

Answer 10

Vertical – Most common in the maxilla
Mesioangular – Most common in the mandible

Question 11

Know the classification of 3rd molar impaction

Answer 11

Degree of impaction (Depth in Bone)
Position of tooth (Long axis of tooth in Bone)
Pell and Gregory

a. Degree of impaction (depth in bone)
i. Erupted
ii. Soft tissue impaction
iii. Partial bone impaction
iv. Complete bone impaction

b. Position of tooth (long axis of tooth in bone)
i. Vertical, horizontal, mesioangular, distoangular, inverted, buccal/palatal, lingual

c. Pell and Gregory (“helpful in predicting surgical difficulty”)
i. Class 1, 2, and 3 is the relation of the mandibular third molar to the anterior border of the ramus
1. Class 1: sufficient amount of space between the anterior border of the ramus and the distal of the second molar for the accommodation of the entire crown (medio-distal diameter) of the third molar. Situated anterior to the anterior border of the ramus and there is adequate room to erupt
2. Class 2: space between the anterior border of the ramus and distal of the second molar is less than the mesio-distal diameter of the crown of the third molar. Crown is ½ covered by the anterior border of the ramus
3. Class 3: all of the third molar is within the ramus. Crown is fully covered
ii. Class A, B, and C refers to the depth of the impaction of max or mandibular 3rd molars in bone relative to the adjacent tooth
1. Class A: occlusal plane of the impacted tooth is at the same level as the adjacent tooth
2. Class B: the occlusal plane of the impacted tooth is between the occlusal plane and the cervical line of the adjacent tooth
3. Class C: the occlusal plane of the impacted tooth is apical to the cervical line of the adjacent tooth

Question 12

Radiographic predictor about proximity of Inferior alveolar nerve to impacted mandibular 3rd molars
(6)

Answer 12

Radiographic predictors of nerve injury
– Darkening of root
– Deflection of root
– Narrowing of root
– Interruption of the white line of the canal
– Diversion of the canal
– Narrowing of the canal
`

Question 13

Why and where do you perform buccal hockey stick incision?

Answer 13

Used for 2nd and 3rd molars
Distobuccal release at a 30-90 degree angle
2 teeth anterior, 1 tooth posterior
Along the anterior ramus
Done for better access and visualization

Question 14

Please know the various “treatments” to impacted tooth /teeth
(3)

Answer 14

• Surgical removal of the Impacted tooth(Third Molars).
• Surgical exposure and orthodontic assisted eruption (canines and 2nd molars)
• Surgical repositioning and transplantation

Question 15

Potential complications for performing impacted teeth surgery… Please know all of them.
(6)

Answer 15

Hemorrhage
Fractured root
Damage to adjacent tooth, tooth displacement
Oro-antral or Oro-nasal communication
Fracture mandible / Maxillary tuberosity
Nerve injury(Paresthesia) Infection

Question 16

Please know about maxillary sinus anatomy. Example, what’s in the bony box?

Answer 16

The largest para-nasal sinuses.
Located in the maxilla.
Is pyramidal in shape.
The Lateral nasal bone forms its base

Question 17

acute sinusitis

Answer 17

Acute Maxillary Sinusitis There is suppurative or non -suppurative inflammation of the mucosal lining of the maxillary sinus. Acute sinusitis (<2 weeks), It involves one or both of the Maxillary sinuses

Question 18

chronic sinusitis

Answer 18

Chronic sinusitis It is a chronic type of infection that affects the mucosal lining of one or both sinuses, resulting inmucous or pus collection. Chronic sinusitis (>3 months).

Question 19

how to dx

Answer 19

Acute Maxillary Sinusitis - Clinical Exam Examine the nasal cavity: discharge–pus–blood -polyps…. Palpate the anterior wall of the maxilla (Intra and extra-oral approach) Rule out odontogenic cause (through clinical and radiographic exam)

Question 20

what to look for

Answer 20

Acute Maxillary Sinusitis - Signs and Symptoms
Headache.
Pain and tenderness.
Nasal obstruction.
Nasal discharge.
Toxic manifestations.
Heavy filling with bending.
Nasal congestion

Chronic Maxillary Sinusitis - Signs and symptoms
Headache.
Nasal obstruction
Nasal discharge.
Fatigue.
Hyposmia/ Anosmia.

Question 21

how to tx

Answer 21

Rest and fluid and oral hygiene.
Antibiotics (Augmentin) after C&S is done; pneumococci and streptococci are the most causative organisms.
Analgesics and NSAIDS (Acetoaminophen, Ibuprofen)
Antihistamines

Local treatment
Nasal Decongestant e.g. Afrin Sinus decongestant, 2 to 3 Nasal puffs 2 times daily for 3 to 4 days
Steam inhalation

Question 22

What is the complication of sinusitis?
(5)

Answer 22

Orbital abscess and orbital cellulitis.
Intracranial abscesses / Meningitis.
Cavernous sinus thrombosis.
Spread of infection to neighboring sinuses, structures and organs.
Osteomyelitis.

Question 23

What are LeFort 1,2,3 fracture patterns?

Answer 23

Trauma to the Maxillary Sinus - Le Fort I Fracture Horizontal fracture through the maxilla above the level of the nasal floor and alveolar process Piriform rims Anterior maxilla Zygomatic buttresses Pterygoid plates

Question 24

If you were to have odontogenic infection, Incision and drainage procedure is made. What do you do with the drain? (management)

Answer 24

First, you secure the drain with a non-resorbable suture, and suture the drain at the incision site to keep it patent.
The purpose of the drain is to keep the surgical site open so the mucosa won’t close immediately where multiple minor infection “pus” sites with pus will have an opportunity to exit the human body
Place drain and once the condition improves (2-7 days) with antibiotic support, then remove

Question 25

What’s is a Valsalva maneuver?

Answer 25

– To confirm the presence of a communication, the best technique is to use the “Nose-blowing test” (Valsalva Maneuver).
– The patient is asked to pinch their nostrils together to occlude the nose. The patient blows gently to see if air escapes into the oral cavity via the maxillary sinus opening.
– Presence of OAF appears as bubbling of blood in the extraction socket

Question 26

Oroantral fistula: please know everything about it. Where it happen, the size ( yes! The size DOES matter in this situation, as it pertains to the proper management of the opening). How to tell patient about sinus precaution, and post-op regimen including pharmacological management.

Answer 26

Small Size - (2 mm in diameter or less)
• Small (2 mm in diameter or less), no additional surgical treatment is necessary
• Sinus precautions
– avoid blowing the nose, violent sneezing, sucking on straws, and smoking
– Patients who smoke and who cannot stop (even temporarily) should be advised to smoke in small puffs, not in deep drags, to avoid pressure changes.
• Surgeon must not probe through the socket into the sinus with a periapical curette or a root tip pick
Moderate Size O.A.C (2 to 6 mm)
• Ensure the maintenance of the blood clot in the area, a figure-of-eight suture should be placed over the tooth socket .
• Antibiotics, usually Augmentin, should be prescribed for 7 days
• A nasal decongestant spray should be prescribed to shrink the nasal mucosa to keep the ostium of the sinus patent.
Large size O.A.C (7 mm or larger)
• Dentist should consider closing the sinus communication with a flap procedure.
• Usually requires that the patient be referred to an oral and maxillofacial surgeon.
• Flap development and closure of a sinus opening are somewhat complex procedures that require skill and experience. – most commonly used flap is a buccal flap
• This technique mobilizes buccal soft tissue to cover the opening and provide for a primary closure

Question 27

Various Surgical management of Oroantral fistula.
(5)

Answer 27

• Success of operation is not always guaranteed.
• Flap should have good blood supply.
• Flap tissue must be handled gently.
• Flap should lie in its new position without tension.
• Good hemostasis must be achieved before discharging the patients.

Question 28

What exactly is a fistula? I mean anatomy wise and what is it made of?
(2)

Answer 28

• Is a biological tract that connects an anatomical cavity with the external surfaces or another anatomical cavity (unlike sinus tract).
• It is always lined with a stratified squamous epithelium and the patency of the tract is preserved until epithelial cells scraped off.

Question 29

Common sign and symptom of oroantral fistula.
Patient usually complains of
(5)

Answer 29

• Nasal regurgitation of liquid and reflux of food and drinks.
• Altered nasal resonance,
• Intermittent episode of pain and local tenderness.
• Foul-tasting discharge.
• Bad taste in the mouth and whistling sound while speaking