Orthopedo Flashcards
what is MDA used for?
to predict the size of the unerupted 3, 4, 5
uses ratio/proportion of Md and Mx tooth size to estimate overbite and overjet
Bolton’s analysis
determines if crowding is due to inadequate apical bases based on measurement of apical base width at premolar
Howe’s analysis
suggests ideal maxillary 4, 5, 6 arch form based on Mesiodistal diameter of 22/12
Pont’s index
if FL > MD = broader contact areas which will result in more stable and resistant crowding
Peck and Peck
Classified teeth into small, medium, and large
Sanim-Savarra
father of modern orthodontics
Edward Angle
Angle’s Class I Malocclusion
Class I/Neutrocclusion
MB cusp of Mx 1st molar lines up with buccal groove of Md 1st molar
Mx canine lies between the Md canine and 1st PM
Dewey’s modification of class I malocclusion
Class I type 1 = anterior crowding
type 2 = labioversion
type 3 = anterior crossbite
type 4 = posterior crossbite
type 5 = mesial drifting
Angle’s Class II malocclusion
Distoclussion/Retrognathism
Mb cusp of the Mx 1st molars falls between the Md 1st molar and 2nd PM
Mx canine is mesial to Md canine
Class II division 1: Mx CI in extreme labioversion (Sunday bite)
Class II division 2: MX CI tipped palatally and in retruded position; Mx LI are typically tipped labially or mesially
*SUBDIVISION = unilateral
Angle’s Class III Malocclusion
Mesiocclusion/Prognathism
MB cusp of the MX 1st molars falls between the Md 1st molar and 2nd molar
Mx canine is distal to Md canine
Dewey’s modification of class III
Class III Type 1: Edge to edge
type 2: anterior crowding
type 3: anterior crossbite
*SUBDIVISION = unilateral
most common malocclusion
Class I malocclusion
signs of incipient malocclusion
- lack of interdental spacing in the primary dentition
- crowding of permanent incisors in mixed dentition
- premature loss of primary Md canine
premature loss of primary Md canine, what is the space maintainer to be used?
Lingual holding arch with spurs
(prevent distalization of incisors)
Normal eruption sequence of Mx teeth? of Md teeth?
Mx: 61245378
Md: 61234578
Which surface of the deciduous anterior teeth resorbs first when permanent teeth erupts
linguo-apical
what is the “poor-man’s cephalometrics”
facial profile analysis
facial profile analysis reference points
glabella
subnasale
tip of chin (pogonion)
straight - class I
convex - class II
concave - class III
facial type
mesofacial, dolichofacial (long face), brachyfacial (broad face)
(soft tissue nasion to tip of chin) / bizygomatic width = facial type
the highest point in the concavity behind the occipital condyle
Bolton (Bo)
most forward and highest point of the anterior margin of foramen magnum
Basion (Ba)
point of intersection of the contour of the posterior cranial base and the posterior contour of the condylar process
Articulare (Ar)
junction of frontal bone and nasal bone
Nasion
most superior margin of the external auditory canal
Porion (Po)
midpoint of sella turcica
Sella (S) - most stable landmark in cephalometric radiograph
most inferior portion of the orbit
Orbitale
innermost point on contour of premaxilla between incisor and ANS
Point A (subspinale)
innermost point on contour of premaxilla between incisor and bony chin
Point B (supramentale)
most anterior point of the contour of the chin
Pogonion (Pog)
Most inferior part of the mandibular symphysis
Menton (Me)
lowest most posterior point on the mandible with teeth in occlusion
Gonion (Go)
point between Pogonion and menton
Gnathion
Porion to orbitale forms what plane?
Frankfurt-Horizontal Plane
Nasion to sella forms what plane?
Sella-nasion plane -represents anterior cranial base together with frankfurt horizontal plane
nasion to pogonion forms what plane?
facial plane
menton to gonion forms what plane?
mandibular plane
Frankfurt mandibular plane angle
mandibular plane and frankfurt-horizontal plane
normal: 22.3 - 34.5
steep mandibular plane angle: long vertical dimension, open bite, class II
flat FMA: short anterior facial vertical dimension, deep bite, class III
ANB
A to nasion and nasion to B
normal: 0-5
higher: skeletal class II
lower/negative: skeletal class III
*Remember mas anterior ang A kesa B
SNB
mandible to cranial base
SNB > normal = prognathic
SNB < normal = retrognathic
normal 77-79
SNA
determine relationship of maxilla to cranial base
SNA > normal = prognathic
SNA < normal = retrognathic
normal: 78-82
Tweed’s triangle is formed by what cephalometric angles
FMA - frankfurt-Md plane angle
FMIA frankfurt-Md incisor angle
IMPA - incisor Md plane angle
Indication of removable appliance
Tipping movements
Retention after comprehensive movements (retainers)
Growth modification during the mixed dentition (headgears)
Major components of Removable appliance
retentive component (adam’s clasp, ball clasp, c clasp, arrow clasp)
framework or baseplate
active component
anchorage component
headgears are usually used in?
developing skeletal class II
1. high pull (distal and intrusive)
2. cervical pull (distal and extrusive)
3. straight-pull (DISTAL ONLY)
developing skeletal class III
1. reverse-pull
2. chin cup
extra-oral headgear used to treat scoliosis
Milwaukee Brace
designed to modify growth during mixed dentition both dental and skeletal effects
functional appliance -primarily skeletal class II
MOA of functional appliance and types
advances the Md forward and allows condyle to move superiorly and posteriorly towards the fossa
A. TOOTH-BORNE APPLIANCE
1. activator -advances the Md to edge-to-edge
2. bionator - trimmed down activator
3. herbst - Mx and Md framework splinted together via PIN AND TUBE to hold Md forward
4. twin block - two-piece acrylic appliance
B. TISSUE-BORNE
1. Frankel functional appliance - alters both Md posture and contour of facial soft tissue
Order of wirebending
first order: in and out bends (facial/lingual/rotational)
second order: tip bends (mesially/distally)
third order: torque
Method by which a rectangular archwire is inserted into the bracket
edgewise method (invented by Edward Angle)
Device that projects horizontally to support auxillaries and is open on one side usually in the vertical or horizontal axis (HISTORY)
Bracket
Pin and tube - 1910
Ribbon arch / Begg appliance - 1915
Edgewise Appliance (1925)
Slot size of edgewise bracket
0.022 - 0.025
Conventional edgewise - order bends are needed
Pre-adjusted edgewise appliance (PEA) - order bends are incorporated
Most commonly used orthodontic appliance
edgewise appliance (BAND-FREE APPLIANCE)
Four basic components of fixed appliances
band, brackets, archwires, and auxillaries
BOND-free appliance
Crozat
bonding for brackets
resin cement; etch with 35 - 50% unbuffered phosphoric acid
Archwire properties
high strength, low stiffness, high range, and high formability
Archwire alloys
Stainless steel wires (18% Cr - 8% Ni)
Cobalt-chromium (40% Co - 20% Cr)
Ni-Ti (55 Ni - 45 Ti)
Beta-Ti wires (79 Ti - 11 Molybdenum)
Gives corrosion resistant properties
Chromium
Gives properties for ductility
Nickel
Gives properties for rigidity
Cobalt
Elastics (classes and used for??)
Class I (Horizontal) - IntRA-arch - for space closure, can open the bite (canine to molars)
Class II - Inter-arch - tx of class II (Mx 3 to Md 6)
Class III - inter-arch - tx of class III (Mx 6 to Md 3)
discrepancies in the faciolingual relationship of Mx and Md arch
Crossbite
-buccal crossbite
-lingual crossbite
-posterior crossbite
-anterior crossbite
Tx for posterior crossbites
A. Pre-adolescent
Slow
Expansion Lingual Arch (W-arch, Quad-helix)
Split removable plates with jackscrews/springs (Schwarz expander, Coffin spring)
slow/rapid
Fixed palatal expanders with jackscrews
B. Adolescent
Rapid palatal expanders (Hyrax, Haas)
Slow palatal expanders
Implant-supported expansion
Surgery
Tx for dental anterior crossbite (reverse overjet)
Tongue blade
inclined plane or composite inclines or catlan’s appliance
Hawley appliance with springs
jackscrew devices
Common cause: lack of space or over retained primary teeth
Tx for skeletal anterior crossbite
headgear, bilateral sagittal split osteotomy (BSSO)
Tx for functional anterior crossbite
Occlusal equilibration
common cause: malocclusion –> comfy bite
best way to prevent relapse after treating anterior crossbite
establish overbite
slow vs rapid expansion
0.5mm - 1mm /week
0.5mm - 1mm /day
*both can expand 5mm
one turn of expander
0.20 - 0.25mm of movement
Triads of thumbsucking
Duration (4-6hrs)
Frequency (am and pm)
Intensity (measured by sound)
Tx for thumbsucking
Less than 3 1/2 - observe
3 1/2 to 6 y/o - habit must cease for malocclusion to be self limiting
Palatal crib
**Correct habit prior to eruption of 6s!!
Consequences of thumbsucking habit
Functional posterior crossbite
Anterior open bite -> tongue thrusting
Most common malocclusion during early MDP
Anterior openbite
Most common cause of anterior openbite
Thumbsucking
Tx of anterior open bite in early MDP
No habit - no tx
With habit - break habit
Tx for tongue thrusting habit
*normal with developmental period (infantile swallowing)
Developmental period - no tx
Associated with thumbsucking - remove habit
Appliance: tongue crib
Appliance of choice to correct swallowing
Blue grass
Infantile vs adult swallowing
Infantile: 0-18mos (CN VII); tongue between gum pads
Adult: 4-5 y/o (CN V); tognue palatal to the maxillary central incisors
Mandibular space maintainers
Band and loop - unilateral single tooth loss
Lingual holding arch -bilateral single/multiple tooth loss, unilateral multiple tooth loss
Distal shoe
Partial denture
Maxillary space maintainers
Band and loop - unilateral single tooth loss
Transpalatal arch - unilateral multiple tooth loss
Nance - bilateral single/multiple
Distal shoe
Partial denture
Most common space maintainer
Band and loop
Appliance for hyperactive mentalis (4 names)
Lip bumper/ plumber / Mayne / Denholtz
Appliance for mouth breathing
Oral vestibular screen / shield
Primary determinant of diastema
Canine
Detemines future antero-posterior position of permanent 1st molar (types?)
Primary molar relationship
Flush terminal plane - cusp to cusp to class I*
Distal step - class II
Mesial step class I to class III*
*Due to mesial shift by occupying primate spaces (EARLY, interdental spaces) OR nance leeway space (LATE, eruped 3 4 5)
Difference between MD width of CDE and 345 (values??)
Nance leeway space always positive
Asian mx: 1.8mm (0.9mm each side)
Asian md: 3.4mm
Location of primate spaces
Maxillary: mesial of primary canine / distal of primary lateral incisors or bet B and C
Mandibular: distal of primary canine / mesial of primary first molars or bet C and D
Causes of diastema
Normal part of development
Tooth size discrepancy
Mesiodents
Crestal frenal attachment
*<2mm - Usually closes after canine erupts
*>2mm -unlikely to close and usually caused by supernumerary
Tx of diastema
Due to supernumerary: Remove mesiodens but do not close yet until canine erupts
During MDP and less than 2: observe
Always wait for canine before tx of diastema
Ortho, resto
Conditions associated with supernumerary teeth
Gardner’s syndrome (familial colorectal polyposis)
Down’s syndrome
Cleidocranial dysostosis/ dysplasia
Sturge-weber syndrome (encephalotrigeminal angiomatosis)
What stage of development does supernumerary occur
Initiation - determine # of teeth
How many teeth are present in a panoramic radiograph of a newly born child?
24
20 primary
4 6s
Growth and development (growth curve)
Cephalocaudal growth curve (farther from the brain grows more but grows later)
Lymphoid growth curve (increase in size until puberty then decrease in size)
Timing of growth spurt
3 times
the earlier the growth spurt, the earlier it will stop
1 F (3y/o) M (3y/o)
2 F (6-7) M (7-9)
3 F (11-12) M (14-15)
Explain enlow’s principle
most of the facial bones are V-shaped and follows:
deposition: inner
resorption : outer
Explain cortical drift
combined deposition and resorption results to a gradual growth movement towards the deposition surface. (Deposition faces the direction of growth)
Explain piezoelectric theory
aka bioelectric theory
deposition: negative ions (anions)
resorption: positive ions (cations)
Reason for increase in length of the body of mandible?
resorption process of the anterior border of ramus
at the age of 6, the greatest increase in size of the mandible occurs distal to the first molar
growth center of maxilla, cortical drift direction and growth displacement
nasal septum
cortical drift direction: superior-posterior
growth displacement: downward-forward
growth center of mandible, cortical drift direction and growth displacement
condylar cartilage
cortical drift direction: superior-posterior
growth displacement: downward-forward
craniofacial growth theory: growth is controlled by genetic influence
genetic theory
craniofacial growth theory: sutural growth is the proliferation of the connective tissue between two bones
Sicher’s theory
craniofacial growth theory: growth depends on cartilage and periosteum
Scott’s theory cartilagenous theory
growth center
craniofacial growth theory: functional matrices; mostly accepted
Moss’ theory
form follows function
Bone yields to soft tissue
craniofacial growth theory: supports all theories
Van Limborg’s theory
craniofacial growth theory: servosystem theory
Petrovic’s theory
when does crowns of primary teeth begin to calcify?
14 weeks - 24 weeks IU or
2nd trimester
3.5 - 6 months IU
enamel of primary central incisor is completed at what age?
1.5 to 2.5 months after birth
enamel of primary molars is completed at what age
1st molar 6 months mx, 5.5months md
2nd molar 11 months mx, 10months md
enamel of primary canines are completed at?
9 months
natal teeth vs neonatal teeth
natal teeth - present at birth
neonatal teeth - present within 30days after birth
*both hypocalcified
*both possess high risk of aspiration
tetracycline staining can affect a child’s teeth until what age?
8 y/o
if 5 y/o, teeth affected would be canine, premolar, 2nd molar
Nolla’s stages of development
Stage 0 - absence of crypt
stage 1 - presence of crypt
stage 2 - initial calcification
stage 3 - 1/3 of crown completed
stage 4 - 2/3 of crown completed
stage 5 - crown almost completed
stage 6 - crown completed; root formation begins, ERUPTION STARTS
stage 7 - 1/3 root completed
stage 8 - 2/3 root completed, TOOTH CLINICALLY EVIDENT
stage 9 - root almost complete, open apex
stage 10 - root completed, closed apex
tooth that does not resemble any permanent tooth?
primary mandibular first molars
POT BELLY appearance
No central fossa
big MB cervical ridge
rounded and short DISTAL surface
flat and long MESIAL surface
molar teeth that resembles permanent teeth
primary md 1st molar -> WALA
Primary md 2nd molar -> md 1st molar
primary mx 1st molar -> mx 1st premolar
primary mx 2nd molar -> mx 1st molar
only anterior teeth that have greater width than height
primary maxillary central incisors
Teeth developmental lobes
all anterior teeth - 4 lobes
all pms - 4 lobes except md 2nd PM - 5 lobes
mandi first molars - 5 lobes
maxi 1st molars 4 lobes or 5
2nd molars - 4 lobes
3rd molars - at least 4 lobes
peg shaped - 2 lobes
first dental visit should be
as soon as first tooth erupts or within 6 months
classification of behavior
COOPERATIVE
LACKING COOPERATIVE ABILITY
POTENTIALLY COOPERATIVE
1. uncontrolled - temper tantrums
2. defiant - i dont want to attitude
3. timid
4. tense cooperative - white knuckler
5. whining
6. incorrigible
7. fearful
orientation of enamel rods in gingival 3rd
primary - slopes occlusally
permanent - slopes gingivally
permanent vs primary canine
longer mesial slope for primary
longer distal slope for permanent
phases of seizure disorder
aura - alteration in senses
ictus - seizure
postictal - recovery
status epilepticus
repeated grand mal
or seizure lasting more than 5mins
sedation drugs for pediatric
oral
1. chloral hydrate - most common, no reversal agent, long acting
2. midazolam
inhalation
1. nitrous oxide oxygen inhalation - most common
administering concentration and maintaining concentration of nitrous oxide oxygen inhalation? combined volume of gas delivered?
admin: 70% N2O2, 30% O2
maintaining: 30% n2o2, 70% o2
combined volume of gas delivered: 3-5L or 4-6L
what to do during termination of n2o2?
100% O2 inhaled not less than 3-5 mins to prevent diffusion hypoxia
minerals removed during demineralization? remineralization?
carbonate, calcium, phosphate
re- fluoride, calcium, phosphate
carbonate is first tooth mineral affected first when there is active caries
pH of saliva? critical enamel pH?
6.2 - 7.6
critical- 5.5 - 5.7
fluoridation vs fluoridization
fluoridation - incorporate F to forming tooth structure - systemic
fluoridization - F to tooth present on mouth -topical
caution: dental fluorosis, skeletal fluorosis
fluoride can inhibit what enzymes?
phosphatase and enulase
dose and onset for chloral hydrate
dose: 50-75mg/kg max 1g
onset: 30-60mins
fluoride MOA
converts hydroxyapatite crystals into fluoroapatite
optimal fluoride concentration for public water?
0.7 - 1.2 ppm F
*toothpaste contains 1,100ppm of fluoride
lethal dose of Fluoride
adult: 4-5g
child: 15mg/kg
supplemental fluoride recommendation
No F for
F level more than 0.6ppm
px less than 6months
px more than 16 yrs old
*check table
types of fluoride, concentration, pH?
2-5% NaF pH 9.2
1.23% APF pH 3-3.5
8% SnF pH 2.1-2.3 (with brown discoloration)
long acting anes contraindicated to pediatric patients
Bupivacaine
tx for fluoride toxicity
syrup of ipecac
milk of magnesia
Management of crowding
observation (> 6mm of excess space = no crowding)
disking of primary teeth –> apply fluoride kasi mangingilo
exo and serial extraction (CD4)
corrective orthodontics
Intraoccipital synchondroses closes at?
3-5 years old
spheno-occipital synchondroses closes at?
until 20 years old (15-25 years old)
spheno-ethmoidal synchondroses closes at?
6-7 years old
intersphenoidal synchondroses closes at?
during birth
key to success of serial extraction
extract 1st premolar before eruption of permanent canine
reason why mandibular arch commonly fails (61234578)
indication of serial extraction
Class I
space deficiency (5-10mm - borderline, >10mm)
most difficult orthodontic tooth movement to achieve
intrusion, translation/bodily movement
orthodontic tooth movements
tipping (simplest)
extrusion
intrusion
rotation - ex. coupling force
translation or bodily movement
best example of rotation orthodontic movement
coupling force
when a tooth is moved, the first thing that happens is?
bone bending
what is the best force in orthodontics?
light continuous force
*heavy forces – delays tooth movement –> instead of bone deposition and resorption, hyalinization happens or necrosis
what and when to extract during serial exo?
C - primary canine - 8 yrs old
D - primary 1st molar - 9 yrs old
4 - 1st PM (as soon as it erupts!)
Scammon growth curve
Lymphoid is a SCAM
Lymphoid - double at age of 12 then decreases
Neural - completed 6-7 years old
General - direct line to age 20
Genital - sexual maturation is accompanied by a spurt in growth begins at puberty
Intercanine dimension of mandible and maxilla is completed at what age
Maxi - 12 yrs girls, 18yrs boys
Mandi - 9yrs girls, 10yrs boys
Location of dental arches based on cranial landmarks
Simon system
Contraction - nearer to sagittal plane
Distraction - farther SP
Attraction - nearer FH plane
Abstraction - farther FH plane
Protraction - anterior to orbital plane
Retraction - posterior to OP
Represents five major characteristics of malocclusion through a venn diagram
Ackermann proffitt system
Scissor bite
Buccal crossbite
Palatal cusp of maxi posteriors occlude with the buccal cusp of mandi
What do you look for in hand-wrist radiograph
Adductor sesamoid -indicates growth spurt
Modification of space saddle used to regain space by pushing the 6 posteriorly
Split saddle appliance
18-8 Austenitic wire
Stainless steel
18% chromium
8% nickel
signs, symptoms, and types of amelogenesis imperfecta
yellow teeth, hypersensitivity
types:
enamel hypoplasia - #(deficiency in A, C, D, calcium, phosphorus)
enamel hypocalcification -quality
signs and types of dentinogenesis imperfecta
Gray-brown teeth, opalescent hue, weak enamel, obliterated pulp chamber
type 1 - assoc osteogenesis
type 2 - most common, hereditary opalescent dentin
type 3 - multiple pulpal exposures and PA lesions (shell like apperance - Brandywine type)
pattern of ECC?
cervical of mx incisor > maxi posteriors > mandi posteriors > mandibular incisors
painful hyperemic gingival punched out erosions covered by gray pseudomembrane/ fetid odor
Necrotizing Ulcerative gingivitis
Fusobacterium, prevotella intermedia, spirochetes (TREPONEMA)
tx of NUG
hydrogen peroxide rinses, debridement, Abx
oral manifestations of achondroplasia, gigantism, acromegaly?
achondroplasia - class III maxi deficiency
gigantism - enlarged tongue, longer root, skeletal class III
acromegaly - skeletal class III
cluster of ulcers are also known as
recurrent herpetiform
*frequent recurrence of ulcers should be screened for DM and Behcet’s syndrome
when does cleft palate, cleft lip occur?
lip - 5th - 6th week IU
palate - 6th-8th week IU/8th -10th
syndromes associated with cleft lip and palate
stickler syndrome
van der woude syndrome
Di george syndrome
other term for:
cleft lip?
cleft on hard palate?
cleft on soft palate?
cleft lip - cheiloschisis
hard palate - uranoschisis
soft palate - staphyloschisis
rule for cheiloplasty
rule of 10
10 weeks
10 lbs
10 gm/dl of hemoglobin
cleft palate repair rule
delayed up to 9 to 18 months after birth
BEFORE 2yrs old patient!
treat soft palate followed by hard palate
oral manifestation of trisomy 21
absent nasal bone, associated with supernumerary
periodontal disease»_space; dental caries
delayed eruption
4 classes of cleft lip
Class I - vermillion border, microform cleft, unilateral notching
Class II - extending to lip not extending to nose
Class III - unilateral
Class IV - bilateral
4 class of cleft palate (Veau classification)
Class I (incomplete)- soft palate
Class II (incomplete)- soft and hard palate
class III (complete)- unilateral involvement of alveolus
Class IV (complete)- bilateral involvement of alveolus
hypopituitarism: delayed or hastened eruption?
hypothyroidism: delayed or hastened eruption?
delayed eruption
Dental: clinical sign and radiographic sign of cleidocranial dysplasia
clinical sign: few teeth
radiographic sign: numerous supernumerary teeth
gingival fibromatosis: delayed or hasted eruption?
delayed eruption
hypodontia, anodontia, oligodontia vs pseudodontia
hypodontia - missing 1-5 teeth
anodontia - total absence
oligodontia - missing > 6 teeth
pseudoanodontia - missing due to extraction/impaction
hypohidrosis, hypodontia, hypotrichosis
anhidrotic ectodermal dysplasia
formocresol/Buckley’s solution
19% formaldehyde
35% cresol
15% glycerin
31% water
dilution 1/5 20%
contraindication of formocresol? alternative?
young permanent with open apex -can cause cessation of root formation
use MTA (mineral trioxide aggregate) instead
why is CaOH contraindicated in primary teeth?
it can cause internal resorption
indication for pulpotomy
1.8mm of dentin thickness between pulp and carious lesion
vital tooth with provoked pain
root resorbed less than or equal to 2/3
medicament for pulpotomy
formocresol (not for young permanent)
calcium hydroxide (NOT for deciduous)
indication for pulpectomy
infected pulp with spontaneous pain/nocturnal pain
nonvital with periradicular lesion
root resorbed less than or equal to 2/3
medicament for pulpectomy
ZOE
Vitapex (CaOH with iodoform) - ideal
iodoform paste (KRI paste)
contraindication of pulpectomy
large bifurcation lesion, bone loss, mobility, nonrestorable, root resorption > 2/3 (at least 4mm root length)
pulpectomy and pulpotomy procedure
pulpo: remove caries, access, remove coronal pulp, pulp stumps, medicament (formo: 5mins), ZOE, SSC
pulpec: remove caries, access, remove entire pulp, cleaning of canal without enlarging (WL: 2mm short), irrigation (NaOCl/Chx) , obturation (using cotton pellet and pliers, push down ZOE)
why prep canal 2mm short of working length during pulpectomy
due to resorption, radiographic apex of primary tooth may may not correspond to the anatomical apex. apical foramen may be 3mm short of the radiographic apex and may be at the lateral surface of root
problems of primary tooth that had undergone pulpectomy
delayed/ectopic eruption - large ZOE in chamber –> prolonged retention of crown –> needs exo
apexogenesis vs apexification
apexogenesis (vital young permanent tooth -open apex)
apexification (NON vital young permanent tooth -open apex)
apexogenesis: direct pulp capping, indirect pulp capping, partial pulpotomy procedures
direct pulp capping: CaOH –> GI –> resto (controllable bleeding, exposure should not be due to inflammation/bacterial infection)
indirect: liner -> GI –> resto
partial pulpotomy/ cvek pulpotomy: remove only inflamed pulp (traumatic exposure, big exposure) –> MTA -> GI –> resto
apexification procedure
Canal filled with CaOH or MTA (CaOH 2 to 4 weeks, MTA apical barrier)
after apical closure, proceed to RCT
anterior strip off crown prep
featheredge finish line
1-1.5mm incisal
1mm labial and proximal
0.5mm lingual
*make vents on SOC for the escape of excess material before curing
*cement with GI/composite
*passive fit
SSC prep
snap fit
1mm subgingival featheredge finish line
1.5mm overall reduction size??? (UP: 1mm lang tas interproximal lang)
GI cement
most common error for ssc prep
interproximal ledges
tooth trauma primary teeth tx:
pain, mobility, intrusion, lateral luxation, extrusion, avulsion
spontaneous pain: pulpectomy
provoked pain: pulpo/no pulpal tx
slight mobility - observe
moderate mobility - passive repositioning or active repositioning then stabilize
intrusion, lateral luxation - passive repositioning or active repositioning the stabilize
extrusion - active repositioning then stabilize
avulsion - do not replant
tooth trauma permanent teeth tx: pain, mobility, intrusion, lateral luxation, extrusion, avulsion
spontaneous pain: RCT
provoked: no pulpal tx
mobility: active repositioning then stabilize
intrusion, lateral luxation, extrusion: active repositioning then stabilize
avulsion: store tooth in Hank’s solution, milk, saliva, reimplant –> stabilize for 2 weeks
Elli’s classification of tooth trauma
I - enamel
II - dentin
III - exposed pulp
IV - non vital with or without loss of crown
V - tooth loss as a result of trauma
VI - root fracture
VII - displacement
VIII - loss of crown
IX - deciduous teeth
which is more common in primary anterior teeth: fracture or displacement?
which is more common in permanent anterior teeth?
primary teeth: displacement mainly intrusion
permanent: fracture *specially for class II div I
most common ankylosed primary tooth?
primary mandibular 1st molar (incomplete eruption) / submerged tooth
Ugly duckling stage is also known as
Broadbent’s phenomenon
First molar first evidence of calcification
At birth
Enamel completed 3-4yrs
Syndromes associated with natal or neonatal teeth
hallermann-streiff
Ellis-van creveld
Pierre robin
most atypical primary molar
maxi 1st molar
largest primary tooth
primary mandi 2nd molar
largest permanent tooth: MAXI 1st molar
