MOS Flashcards
Incidence of ID nerve injury after mos
1-5% but <1% has paraesthesia persist >6mo
What are radiogaphic signs of increased risk of IAN injury
- Loss of cortical white line
- Darkening of the root
- Narrowing of ID canal
- Diversion of ID canal
- Dilaceration of roots
- Bifid root apex
What is tx alternative for wisdom tooth removal with high risk of ID nerve injury
Coronectomy. Partial removal of the crown of tooth leaving the roots retention.
Indications of coronectomy
No pathology
Not interfering with future prostheric rehab. Or orthodontic tx
What is ALARA
Radiation principle - As Low As Reasonably Achievable
Indications of apical repositioning of flap (open exposure)
When impacted teeth are more buccal
Why do we use flap with parallel mesial and distal relieving incisions?
To prevent deficiencies between the margins of flap and adjacent tissue when repositioning is made
Allows tooth to erupt into attached mucosa
Reduce periodontal pocket/defecr
Tx options for impacted second molar
- Extraction (esp for maxilla, as it allows third molar to drift into occlusion! Not suitable for mandible, as third molar will tilt instead of drift and risk perio issues or interproximal caries)
- Surgical uprighting (ideally when 2/3rd of root formed)
- too late will lead to pulpal necrosis
What are options of impacted canine tx
Observation - retaining deciduous and leave impacted canine in situ
Surgical removal of impacted canine
+ retaining c
+ exo c and close space/implants
Exo C and surgically expose impacted canine for ortho traction
Autotransplantation
How do u decide on which tx options for impacted canine
Depends on dental age
Development of impacted canine - root length
Condition of c - carious/root resorption
Arch discrepancy - malocclusion/crowding/space
Pathology
Investigations to assess position of impacted canine
History - perceived bulging/swelling/hx of extraction/ pain / nasal symptoms
Examination - buccal or palatal bulging/ condition of arch
Imaging - parallax technique using 2 PAs or 1 PA 1 OPG or 1 OPG 1 occlusal
Cbct
Median diastema causes
Ugly duckling stage
Mesiodens
Low attachment of labial frenum
What imagings do you request when pt request for frenectomy to close median diastema
PA to assess presence of impacted teeth in the region of median diastema thats causing the central incisors to be separated
Parallex technique - to locate the impacted tooth
Cbct - to assess exact location of the impacted tooth
Consequences/sequalae of leaving mesiodens
Malocclusion with persistent spacing between central incisors - median diastema
Impacted central incisors due to impeding path of central incisor eruption
Persistent median diastema and failure of space closure despite ortho tx
Cystic changes
Infection
Root resorption of adj teeth
