midterm Flashcards
What is the characterisc of an Ideal alveolar ridge?
- Adequate FOM,
- Deep vestibule
- adequate bone height and width,
- kertinized/fixed tissue under dentures,
- absence of redundant tissues,
- no obstructing scars/frena,
- no displacemed mm attachments,
- proper jaw relation,
- proper shape (U),
- no protuberneces/undercuts,
When a tooth is no longer situated in the alveolar bone, what happen to the alveolar bone?
Unpredictable bone resorption, atrophy of ridge
What’s the purpose of vesbuloplasty?
relative ridge augmentation, increase vestibular depth and SA for denture by repositioning alveolar mucosa and mm attachments apically.
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).
Indications for performing alveolar ridge augmentaon
- Absolute augmentation indications: In man: severe resorb and less than 2cm bone in mid-body
- Relative indications: Indicated for a flat ridge with moderate resorption of the alveolar bone. IN MAN: 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
Where can you procure bone for the autologous bone graft to maxilla / mandible? Please know the characteristics of bone resorption.
Iliac crest
Know the possible causes of tooth impactions
- Inadequate arch length
- Prolonged deciduous tooth retention
- Malposition of Impacted tooth
- Malposition of adjacent tooth/teeth
- Excessive bone and/or soft tissue
- Associated pathology
Indications for 3rd molar extractions?
* resorption of?
* Facilitate?
* orhto?
* 2nd molar?
* Pathology?
* Tooth interfering with?
* trauma/tumor?
* Prophylactic removal in patients with?
* Facilitate the management of or limit progression of?
* caries?
* pulp?
* Acute or chronic?
* position?
- 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
- 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
- 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
Which tooth/teeth are most likely getting impacted? (in order)
- Mandibular third molars
- Maxillary third molars
- Maxillary canines
- Mandibular premolars
- Mandibular canines
- Maxillary incisors
- Supernumeraries
If a tooth (maxillary / mandibular) is impacted, what position (orientation) does it usually located?
Maxilla: vertical
Mandible: mesioangular
classes for third molar impaction
- angulations
- Pell and Gregory (1,2,3 and A,B,C)
classes 1,2,3 Pell and Greg
Relation of the Mandibular third molar to the anterior border of the ramus
1. Enough space for crown between ramus and 2nd molar
1. 3rd molar crown ½ covered by ramus
1. 3rd molar crown entirely in ramus
classes ABC Pell and Greg
Relation of crown to adjacent occlusal plane (both arches)
A: crown occlusal plane adjacent to 2nd molar occ plane
B: Occ plane impacted tooth between occlusal plane and cervical line of adjcent
C: Occlusal plane apical to adjacent cervical line
Radiographic predictors about proximity of Inferior alveolar nerve to impacted mandibular 3rd molars?
- Darkening of root
- Deflection/curving of root
- Narrowing of root
- Interruption of the white line of the canal
- Diversion of the canal
- Narrowing of the canal
- PA lucency
Why and where do you perform buccal hockey stick incision?
Mandibular posterior to avoid the lingual nerve
Please know the various “treatments” to impacted tooth /teeth
- Removal/ prevention of pathology
- Repositioning
- Monitoring
- Exposure
Potential complications for performing impacted teeth surgery… Please know all of them.
- Hemorrhage
- Fractured root
- Damage to adjacent tooth, tooth displacement
- Oro-antral or Oro-nasal communication
- Fracture mandible / Maxillary tuberosity
- Nerve injury(Paresthesia)
- Infection
Please know about maxillary sinus anatomy. Example, what’s in the bony box?
* The largest?
* Located in?
* Bony box?
* shape?
* what forms its base?
* Ostium?
* histo?
- The largest para-nasal sinuses.
- Located in the maxilla.
- Bony box: Inferior orbital floor, lateral nasal bone, maxillary, zygomatic
- Is pyramidal in shape.
- The Lateral nasal bone forms its base
- Ostium: drains into nasal cavity
- Schniderian/Bilaminar membrane (mucus secreting pseudostratified ciliated columnar epithelium + periosteum on osseous side)
Sinusitis
suppurative or non-suppurative inflammation of mucosal sinus lining
acute sinusitis
<2wks, secondary to allergies, hay fever, cold and URT infection, bac infection from dental, foreign body in sinus
acute sinusitis signs and symptoms
Headache, Pain and tenderness., Nasal obstruction, Nasal discharge, Toxic manifestations, Heavy filling with bending, Nasal congestion.
acute sinusitis tx
- Rest and fluid and oral hygiene
- Antibiotics, (Augmentin) after C&S is done; pneumococci and streptococci are the most causative organisms.
- Analgesics and NSAIDS
- 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
both acute and chronic use this
nasal decongestant regimen
Afrin Sinus decongestant, 2 to 3 Nasal puffs 2 times daily for 3 to 4 days, Steam inhalation
chronic sinusitis
> 3months, can be due to polyps, nonresolved acute sinusitis, dental abscesses, virulent organism with low resistance, foreign body
chronic sinusitis signs and symptoms
Headache, Nasal obstruction, Nasal discharge, Fatigue, Hyposmia/ Anosmia
chronic sinusitis tx
- Surgical: sinus washout,
- Rest and fluid and oral hygiene,
- Antibiotics, (Augmentin) after C&S is done; pneumococci and streptococci are the most causative organisms.
- Analgesics and NSAIDS
- 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
diagnostic tools for sinusitis
- clinical examination (examine nasal cavity, palpate maxilla, rule out odontogenic cause),
- radiographic exam
What are LeFort 1,2,3 fracture paterns?
1: maxilla only
2: maxilla and nasal
3: maxilla, nasal and zygoma
If you were to have odontogenic infection, Incision and drainage procedure is made. What do you do with the drain? (management)
- non-resorbable Suture drain in place at incision site to keep patent
- Abx
- 24h post op irrigation
- monitor drainage,
- removal (2-7 days)
What’s is a Valsalva maneuver?
Pinch nose and blow, bubble forms= positive
where do oroantral fistulas occur
post. maxilla
small oroantral fistula management (<2mm)
- no additional sx tx,
- sinus precautions: no blowing nose, sneezing, smoking (or small puffs if they cant stop), no straws
moderate oroantral fistula management (2-6mm)
ensure clot with figure 8 suture, augmentin 7 days, nasal decongestant to keep osteium patent
large oroantral fistula management (>6mm)
closure with buccal flap procedure (refferal to OS)
general oroantral fistula post op care
Augmentin
Pain meds (NSAIDs)
Nasal decongestant
Saline nasal decongestant
Steam inhalation
Various Surgical management of Oroantral fistula.
* dif flaps?
* success rate?
* Flap needs?
* Handing flap?
* No what on flap?
* Achieve proper?
- Buccal advancement flap - can cause loss of vestibular depth
- Palatal rotation flap- keratinized tissue for coverage, no loss of vestibular depth
- No guaranteed success
- Flap needs good blood supply
- Handle flap gently
- No tension on flap
- Achieve proper hemostasis
What exactly is a fistula? I mean anatomy wise and what is it made of?
- Biological tract connecting one anatomical cavity to another or the exterior
- Always lined with stratified squamous epithelium, remains patent until these cells are scrapped off
Common sign and symptom of oroantral fistula.
* Bubbling?
* what attatched to roots of extracted teeth?
* Fracture of?
* Radiographic?
* Patient may complain of:
- Bubbling of blood in socket or nostril
- Antral floor attatched to roots of extracted teeth
- Fracture of alveolar process/ tuberosity
- Radiographic evidence
- Patient may complain of: nasal regurg of liquid/drinks, altered nasal resonance, episodes of pain/tenderness, foul tasting discharge, bad taste while speaking or whistling
