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OS 3 > midterm guide > Flashcards

midterm guide Flashcards

1
Q

Is Zygomatic Implant immediate, early, delay, or second stage loading?

A

immediate

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2
Q

What’s the recommended radiographic examination for work up of a zygo implant?

A

Recommended Radiograph
Panorex: Anatomic structure and pathology detection
 Intraoral PA: supplement Panorex
 Lateral Cephalometric: Sagittal relationship of jaws
 **CT: **Bone volume (width and height) assessment

all 4

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3
Q

Classic Treatment planning requirement for Zygomatic implant placement is

A

Traditional use of zygoma implants dictates room for
at least TWO conventional implants at anterior
maxilla

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4
Q

Intracrestal lift
* How much can you expect to lift?

A

1-2mm

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5
Q

Intracrestal lift
Recommended initial Maxillary residual ridge for the most predictable result is ?

A

bone height 4-6mm

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6
Q

Lateral window lift
* What’s the indication?

A

Less than 4 mm native maxillary alveolar bone

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7
Q

What’s Schneiderian Membrane?

A

pseudostratified columnar epithelium of the maxillary sinus overlying connective tissue and periosteum

Membrane can support elevation in the sinus cavity of 4-8mm

limiting factor of sinus lift

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8
Q

Alveolar Ridge Splitting
* What’s the indication and minimum ridge width?
* implant placement?
 tx time?
 cost?
 Barrier membrane?
 dif in arches?

A

Simultaneous implant placement for horizontal bone def
 Reduced treatment time
 Reduced cost of surgery
 Barrier membrane usually not needed minimum width: 2-4mm (pref more than or equal to 3mm)
 Maxilla is more applicable: Due to bone type (3 or 4), especially for immeadiate
delayed works well for mandible

used when graft fails/pt doesnt want graft

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9
Q

how much bone should surround implant in ridge splitting

A

1mm at B/P regions

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10
Q

disadvantages of ridge splitting

A

Bone loss
 Difficult on single tooth site
 Cannot Correct Vertical defect
 Only ↑alveolar width
 Implant placed tends to situated facially due to remodeling and resportion of buccal plate

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11
Q

Various types of bone graft materials

A

autograft
allograft
xenograft
alloplast

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12
Q

bone types based on hardness

A
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13
Q

integration times based on bone type

A
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14
Q

properties of bone grafts

A

osteogenesis, osteoinduction, osteoconduction

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15
Q

osteogenesis

A
  • viable cells contribute to new bone formation
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16
Q

osteoinduction

A
  • proteins, factors, hormones modulate host cells
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17
Q

osteoconduction

A
  • matrix/scaffold onto which new bone can form
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18
Q

autogenous bone graft

  • from?
  • preffered? properties?
  • donor sites
  • forms?
  • Cortical vs. Cancellous?
A
  • Same individual
  • Gold standard : Osteogenic, osteoinductive, & osteoconductive
  • Extra-oral vs. intra-oral donor sites
  • Intra-membraneous vs. cartilaginous
  • Block vs. particulate forms
  • Cortical vs. Cancellous
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19
Q

cons of autogenous

A
  • Need for second operative site
  • Insufficient amount of bone
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20
Q

cortical autogenous graft advantages

A

more bone morphogenic proteins (BMPs) & better structural support

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21
Q

cancellous autogenous graft advantage

A

more osteoblast precursor cells for greater osteogenic potential

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22
Q

healing time of autogenous graft

A

Healing time 3~7months

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23
Q

extra oral autogenous donor sites

A

skull, ribs, illiac crest, tibia

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24
Q

intra oral autogenous sites

A

man symphasis
ramus

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25
Q

allogratft

  • From?
    *properties
  • Types of Allografts?
A
  • From other individuals of the same species
  • Cadavers
  • Tissue bank
    * Osteoinduction & osteoconduction
  • Types of Allografts
  • Freeze-dried bone allograft (FDBA): 6-15 months
  • Demineralized freeze-dried (DFDBA) 6 months
  • Irradiated bone (2.5 million rads)
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26
Q

allograft advantages

  • available?
  • Eliminates?
  • Reduced?
  • Decreases?.
  • Fewer?
A
  • Ready availability
  • Eliminate second surgery
  • Reduced anesthesis & surgical time
  • Decrease blood loss
  • Fewer complication
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27
Q

allograft disadvantages

A
  • Associated with the use of
    tissues from another person
  • Immune responses
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28
Q

xenograft

  • from?
  • what is it?
  • Highly?
  • Rapid revitalized through?
  • resorbtion?
A
  • Different species
  • Anorganic bone treated to remove its organic component
  • Highly osteoconductive
  • Rapid revitalized through new blood vessels
  • Slowly resorbing matrix structure (6 months ~)
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29
Q

alloplasts properties
* Natural or Synthetic?
* Mostlywhat property?
* Variety of?
* Crystalline or amorphous?
* Granular or molded?
* take longer to?

A
  • Natural or Synthetic
  • Mostly osteoconductive
  • Variety of textures, sizes, and shapes
  • Crystalline or amorphous
  • Granular or molded
  • take longer to absorb
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30
Q

Type of Alloplastic Bone Graft material

A

I. Ceramic : HA, TCP
II. Calcium Carbonate : Bio Coral
III. Biocompatible composite polymer
IV. Bioactive glass ceramic : Bio-glass

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31
Q

barrier membrane characteristics
 Biocompatible?
 Stability for?
 Manipulable?
 closure form?

A

 Biocompatible
 Stability for space maintenance
 Manipulability
 Primary closure throughout healing period is essential to GBR outcome

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32
Q

non-resorb barrier membranes
GOldstandard for?
 Optimal?

A

 Polytetrafluoroethylene (e-PTFE, TR e-PTFE), or titanium mesh
* Titanium Reinforced PTFE Membranes (TR e-PTFE), Ti-Enforced microporous (ePTFE)
 Gold standard for GBR
 Optimal graft containment

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33
Q

nonresorb barrier mem cons

A

flap management
- 2nd surgical procedure to remove membrane

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34
Q

natural resorb barrier membranes
made of?
- degrades?
- Limited ability to?
- retention time frame?

A

Natural: collagen of animal origin
- Enzymatic degradation
- Limited ability to maintain space
- 4 to 6 months of retention

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35
Q

types of resorb barrier mem and resorb time frames

A
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36
Q

synthetic resorb barrier mem, made of?
- Degradation by?
- rate of membrane resorption?

A

 Synthetic: poly(lactic) and poly(glycolic) acid copolymers
- Degradation by hydrolysis
- Highly variable rate of membrane resorption (pH & material composition)

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37
Q

available bone augmentation procedures

A
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38
Q

what is GBR

A

ingrowth of
osteogenic cells
while preventing
migration of
unwanted cells

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39
Q

Benzodiazepines General properties
 Benzodiazepines cause

A

 Sedation
 Anxiolysis
 Muscle relaxation
 Anterograde amnesia
 Anticonvulsant effects

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40
Q

Benzodiazepines General properties

 Common Side Effects

A

 Fatigue
 Drowsiness
 Respiratory depression !
 No direct analgesic Effect

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41
Q

benzos

What receptor does it work on?

A

 Enhances inhibitory effect of neurotransmitters
 Facilitates GABA receptor binding
 ↑membrane conductance of Chloride ions

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42
Q

benzo

reversal agent

A

Flumazenil (Romazicon)
 Competitive antagonist of benzodiazepine receptors (GABA)

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43
Q

Propofol / Diprivan
 Mechanism of action, results in?

A

 Enhance GABA inhibitory function = ↑Cl channel = hyperpolarization of cell membrane
 Results Rapid onset of unconsciousness

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44
Q

Propofol / Diprivan additional effect?

largely replacing?

A

 Arterial and venous dilatation
 Largely replacing Thiopental (Barbiturates)

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45
Q

Ketamine
moa

A

 General Anesthesia Medicine
 Selective NMDA receptor blocker

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46
Q

ketamine effects

A

 Dissociative, Hallucinogenic and Amnesic Effect
 Sympathomimetic medicine

47
Q

ketamine disadvantages

A

 Hallucinogenic, Nightmare emergence, Increase Salivary flow

48
Q

opioid receptros effected

A

mu
kappa
delta
sigma

49
Q

opioids effect at kappa

A

Kappa (κ)
 Miosis
 Sedation

50
Q

opioids effect at mu

A

Mu (μ)
 μ1 : Analgesia
 μ2 : Respiratory Depression
 Physical dependence
 Muscle rigidity

51
Q

opioids effect at delta

A

Delta (δ)
 Behavioral response to pain

52
Q

opioids effect at sigma

A

Sigma (σ)
 Dysphonia
 Hallucinations

53
Q

desiresable effects of opioids

A

 Analgesia
 Sedation
 Euphoria
 Anti-tussive

54
Q

undesireable effects of opioids

A

 Respiratory Depression
 Coma
 Emesis
 Constipation
 Histamine release
 Potential for addiction

55
Q

opioids occular effect

A

 Miosis
 Mechanism of action
○ Edinger-Westphal nucleus of Oculomotor nerve
○ Enhanced parasympathetic stimulation
 Significance?
○ Most other causes of coma and respiratory depression produce mydriasis (dilation of pupil)
 All Addicts demonstrate pin-point pupils

56
Q

morphine vs fent potentcy

A
  • Fentanyl=100X potency of morphine
    *
57
Q

morphine vs fent metabolism

A

Morphine: Conjugate with glucuronic acid
○ Morphine-6-glucuronide (potent analgesic)
○ Morphine-3-glucuronide (inactive)

Fent: Inactive metabolite
○ Remember the “end “ of the effect is due to redistribution!!
○ Fentanyl will accumulate in body fat with repeated injections

58
Q

what additional route of entry can fent use

A

transdermal along with IV and IM like morphine

59
Q

fent vs morphine onset and duration

A

morphine: Onset 5-10mins, peak within 30mins, T ½ 1.5 – 2 hours, Duration of action : 4-6 hours
fent: Onset of action < 60 sec with peak effect in 2 – 5 mins, Duration 30 – 60 mins

fent is much more lipid soluble, morphine less BBB penetration

60
Q

morphine vs fent elimination

A

Morphine Elimination:
 End product eliminated by kidney
 Renal failure patient may have narcosis and vent failure for days !

Fent Elim
 Little effect on renal patient
 Clearance dependent on hepatic blood flow

61
Q

morphine vs fent ADRs

A

Morphine Adverse Effects
 Nausea and Vomiting: Stimulate medullary chemoreceptor trigger zone
 Severe respiratory depression: Rigid chest syndrome
 Histamine Release: May lead to profound drop in BP and systemic vascular resistance

Fent ADRs
 No histamine release
 Rigid Chest Syndrome: After large drug bolus !!

62
Q

opioid reversal agent

A

naloxone/narcan

63
Q

naloxone moa

A

 Competitive antagonist at opioid receptors
 Greater affinity for μ receptors than κ or δ receptors

64
Q

noloxone dosing

A

IV administration of 0.4mg IV (Titrate to effect !!!)

65
Q

naloxone side effects

A

 Abrupt reversal = Excessive catecholamine release
○ tachycardia, hypertension, ventricular irritability
 May antagonize Clonidine
 Nausea/Vomiting may be observed

66
Q

naloxone time frames

A

 Rapid antagonizing (1-2 min)
 Brief duration of action (30-45 mins) IV
○ Rapid redistribution from CNS
 T ½ is only 30–80 mins
○ Respiratory depression may linger despite “alert/awake” appearance

67
Q
A
68
Q

ASA system

A

 System to estimate medical risk
 Originally designed for general anesthesia patient
 Commonly known as ASA Classification

69
Q

ASA classes

A

1,2,3,4,5,6,E

70
Q

ASA 1

A

Normal, Healthy patient without systemic disease

71
Q

ASA 2

A

Mild systemic disease

72
Q

asa 3

A

Severe systemic disease, limits activity but no
incapacitating

73
Q

asa 4

A

incapacitating systemic disease that is constant threat to life

74
Q

asa 5

A

Not to survive 24 hours with/without operation

75
Q

asa 6

A

Brain-dead patient awaits for organ donation

76
Q

asa e

A

Emergency operation
 Precedes number status ( i.e. ASA E-II)

77
Q

ASA Classification, Definition
 Normal or Usual:
 Distress:

A

 Normal or Usual: Ability to climb one flight of stairs or walk 2 level city blocks
 Distress: Undue fatigue, shortness of breath, or chest pain

78
Q

asa 2 examples

A

 Type II or Non insulin dependent diabetes
 Well controlled epilepsy ( no seizure in the past year)
 Well controlled asthma
 Hypothyroid / Hyperthyroid patient under treatment and currently euthyroid
 Healthy pregnant female
 > 60 y/o patient
 Extreme phobic patient
 Drug allergy or multiple allergies patient
 Systolic 140/159mmHg and diastolic 90-94mmHg
may proceed with tx

79
Q

asa 3 examples

A

 Type I DM, well controlled patient
 Symptomatic thyroid disease patient
 >6 months without any residual complication
 Myocardial infarction
 CVA
 BP (169-199) systolic / (95-114) diastolic
 Epilepsy: Several seizures per year
 Asthma,: Stress / exercise induced / hospitalization
 Angina Pectoris (stable angina)
 CHF with
 orthopnea ( > 2 pillow)
 Ankle edema
 COPD

80
Q

ASA III
 No S/S of distress at rest, BUT?
 tx mod
 tx?

A

 No S/S of distress at rest, BUT not under stressful situation
 Serious treatment modification is needed
 Yellow light for treatment ( proceed with caution

81
Q

ASA IV
 S/S of their medical problem when?
 Their medical problem has greater significance than?
 OK for ?
 If invasive dental treatment is needed?
 go ahead?

A

 S/S of their medical problem at REST
 Their medical problem has greater significance than
elective dental treatment
 OK for non invasive dental emergency treatment
 If invasive dental treatment is needed  hospital
 Red light for treatment ( DON’T Proceed)

82
Q

asa 4 examples

A

Unstable Angina
 <6 months without any residual complication
 Myocardial infarction
 CVA
 BP >200 systolic / >115 diastolic
 Uncontrolled dysrhythmias
 Severe CHF or COPD
 Wheel chair bound or need supplemental oxygen
 Uncontrolled epilepsy
 Uncontrolled IDD

83
Q

ASA V
 def
 Hospitalized patient with?
 dental care?

A

ASA V
 Moribound patient not to expect to survive 24 hours\
 Hospitalized patient with end-stage disease
 Palliative dental care

84
Q

Examples of ASA V Patients

A

 Hospital heart valve surgery patients in need of dental
extractions
 Hospital patients with end-stage organ disease in need
of palliative dental care

85
Q

Patient Demographic in asa classes

A

Patient Demographic
 ASA I or II = 85% dental patients
 ASA III or IV = 14% dental patients

86
Q

who started ASA classification

A

American Society of Anesthesiologists (ASA)
 Started in** 1962**
 System to estimate medical risk
 Originally designed for general anesthesia patient
 Commonly known as ASA Classification

87
Q

Sedation
 Definition

A

 Reduction of irritability or agitation by administration of
sedative drugs, generally to facilitate a medical procedure

88
Q

MO Dental Board sedation types

A

 Moderate Sedation: Enteral, Parenteral, Pediatric
 Deep Sedation / General
 Site Certificate for each type

89
Q

Pediatric Patient Definition and sedation allowed

A

 A patient aged twelve (12) or under. The use of preoperative sedatives for children (aged twelve (12) and under) except in extraordinary situations must be avoided due to the risk of unobserved respiratory obstruction during transport by untrained individuals.

 Children (aged twelve (12) and under) can become moderately sedated despite the intended level of minimal sedation; should this occur, the guidelines for moderate sedation apply

90
Q

Minimal Sedation (Anxiolysis)

A

 Minimal sedation (Anxiolysis)—A minimally depressed level of consciousness produced by a pharmacological method, which retains the patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although **cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected. **Note: In accord with this particular definition, the drug(s) and/or techniques used should carry a margin of safety wide enough never to render unintended loss of consciousness. Further, patients whose only response is reflex withdrawal from repeated painful stimuli would not be considered to be in a state of minimal sedation. When the intent is minimal sedation for adults, the appropriate initial dosing of a single enteral drug is no more than the maximum recommended dose (MRD) of a drug that can be prescribed for unmonitored home use

91
Q

NO used with Rx for minimal sedation

A

Nitrous oxide/oxygen may be used in combination with a single enteral drug in minimal sedation. Nitrous oxide/oxygen when used in combination with sedative agent(s) may produce minimal, moderate, or deep sedation or general anesthesia.

92
Q

Moderate Sedation (Conscious Sedation)

A

 A drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation.
 Generally, no interventions are required to maintain a patent airway, and spontaneous ventilation is adequate.
Cardiovascular function is usually maintained.

93
Q

Deep Sedation

A

 A drug-induced depression of consciousness during which patients** cannot be easily aroused but respond purposefully following repeated or painful stimulation.
 The 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.**

94
Q

Qualified Sedation Provider

A

 Qualified sedation provider—Any of the following who have satisfied the provisions of this rule:
 1. A currently licensed dentist in Missouri with a valid permit to administer enteral, parenteral, or pediatric moderate sedation
 2. A currently licensed anesthesiologist
 3. A currently licensed certified registered nurse anesthetist.

95
Q

OMS Resident Anesthesia Training

A

Five months of Anesthesia training
 Minimum of consecutive 4 months, OMS must function as an anesthesia resident with commensurate level of responsibility.
 One month of pediatric anesthesia
 Senior resident must have at least 150+ office based sedation cases

96
Q

Monitoring Equipment for IV sedation

A

 Device to measure blood pressure and heart rate with multiple size cuffs
 To auscultate the heart and lungs
 Pulse oximetry with appropriate probes
 Electrocardiogram
 Temperature monitor
 Ideal that monitor can print

97
Q

stethocpose and BP cuff use

A

can be used to determine BP/HR in monitoring

98
Q

Capnography

A

 Monitoring of concentration or partial pressure of CO2
 Graph of expiratory CO2 by expired volume
 Advantage of capnography
 Breath to breath ventilation data
 Respiratory effort
 Real-time feedback on treatment ( i.e. IV med administration)

99
Q

Pulse Oximeter

A

 Measures oxygen saturation of arterial blood
 Determine percentage of oxyhemoglobin in capillaries
 Operates on 650nm and 950nm wave length: oxygenated
(absorbs more infrared light) and deoxy Hb (absorbs more red light) absorb different wavelenghts and the ratio of this is used to determine O2 saturation

100
Q

What’s the most reliable airway?

A

endotracheal intubation

101
Q

Adjunctive airways
* IN IV sedation, what’s the most appropriate adjunctive airways?

A
102
Q

Patient Evaluation should be done by….

A

Should be conducted by the person planning and administering the anesthetic

103
Q

Medical history questionnaire has different formats?

A

 A tool to gather written information about the patient’s health
 Completed by the patient or the patient’s guardian
 Simple format which is easy to understand
 Two standard formats: short and long

104
Q

Airway examination prior to IV sedation is ….
* What are the different class?

A

everything, based on Mallampati Classification
1: soft palate, fauces uvula, ant/post tonsillar pillars
2: soft palate, fauces uvula
3: soft palate, base of uvula
4: only soft palate

105
Q

Nitrous oxide…… how was it manufactured?

A
  • Nitrous oxide is made from ammonium nitrate via 240oC heat
  • NH4NO3 = N2O + 2H2O
  • Compressed in cylinder where 30% is liquefied
  • N2O must be 97% pure
106
Q

What’s the special property or characteristic of Nitrous oxide gas to human?

A
  • cns depressant
  • second gas effect
  • concentration effect
  • rapid onset/recovery (insoluble)
  • not flammable/explosive but can support this in other agents
  • Oxygen of N2O not used by body (not broken down)
  • least potent anaesthetic gas
107
Q

N2O concentrations

A
  • Optimum concentration of N 2O for production of analgesia while maintaining patient cooperation is 35%
  • 20%:80% mixture N2O-O 2  10-15mg of morphine
    max is 70% N2O
108
Q

special properties of n2o

A

concentration effect and second gas effect

CNS depressant

109
Q

Concentration Effect

A
  • The higher the concentration of the gas inhaled, the more rapidly arterial tension of the gas increases
  • Fresh gas will be pushed into the lungs from the anesthesia machine= increase arterial N 2 O arterial tension
  • So its important to start the Nitrous slowly and not blast it high in the beginning
110
Q

2nd Gas Effect

A
  • Occurs when a second inhalation anesthetic is administered along with N 2O-O 2
  • Extreme uptake of N 2O will form a vacuum at alveoli that forces other air ( in this case, other inhalational agent) into the lungs
111
Q

Chronic exposure of nitrous oxide is detrimental to…?

A
  • Inhibits methionine synthetase impair B12 metabolism = decreased Bone Marrow function =Pernicious anemia (Vitamin B12 anemia)
  • Long term exposure ( > 24 hr exposure) = transient bone marrow depression
  • also causes neurological deficiencies and perihperal neuropathy
112
Q

ONLY nonorganic compound other than CO2 that has CNS depressant
properties

A

N2O

113
Q

size, pressure and color of N2O/O2 cylinder

A

Full E cylinder has gaseous 750 psi and liquid states
* 750 psi will stay there until the moment of empty tank
blue color

Full E Cylinder is about 1900 psi in gaseous state only, green color
* Psi will decrease as O2 is being used

OS 3 (6 decks)

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