Pre-exam quick cards Flashcards
What are two different types of ankylosis?
1.With replacement resorption – bone is replacing dentine
2.Without replacement resorption - no bone replacing den
What are the steps of pathology for a transverse root fracture?
1.Facial trauma, frontal force
2.Transverse fracture – occurs if dentine, cementum and pulp involved, if enamel is also involved – it is a crown root fracture
3.Take radiograph and do all of the test
4.Reparative tissue in a form of tertiary dentine is laied down in the fracture area
5.Over time – root canal stenosis may occur – pulpal tissue will be replaced with deposited hard tissue through “buldging hard tissue” with prior joining of fracture line with fibrous connective tissue - this is done primarily by the pulp - the reparative capacity of dental hard tissue should not be underestimated
What the three different types of healing following transverse root fracture?
- Through deposition of reparative hard tissue
- Fibrous hard tissue
- Bone and periodontal ligament
- No healing and pulp necrosis of the coronal portion (trick question) - this one is pretty rare
What is apexification?
it is a method of inducing a calcified barrier at the apex of a non-vital tooth with incomplete root formation. Originally calcium hydroxide is used for coagulation necrosis of remaining pulpal tissues
What can be result of apixification?
- Formation of calcified dome in the tooth
- Formation of pulp-like tissue and formation and growth of roots
- Rejection
What are the indications for MTA?
- Vital Pulp Therapy
- Immature apices
- Perforations - lateral and furcation
- Retrograde root canal filling
What is the current flavour of the month when it comes to triggering apixification?
Biodentine from Septodont
What is apexogenesis?
A vital pulp therapy procedure performed to encourage physiological development and formation of the root.
What is guided endodontic repair?
It is the combination of stem cells, scaffold and growth factors that allows for repair of immature permanent teeth. It is not very effective so just use calcium hydroxyde.
What are the options for a tooth with replacement resorption?
- Decoronation and submergence of the tooth
- Extraction, orthodontics and implantation
- Translpalantation
What is enamel infraction? What is the treatment?
It is an incomplete fracture of the enamel, without loss of tooth structure.
Treatment: usually, no treatment but if needed etching and sealing with bonding resin should be considered.
What is an uncomplicated, enamel only crown fracture? What is the treatment?
It is a coronal fracture involving enamel only with loss of tooth structure
Treatment: if tooth fragment is available, bond back on. Alternatively smooth the edges and restore them if needed
What is an uncomplicated, enamel-dentine crown fracture? What is the treatment?
It is a coronal fracture involving enamel and dentine without pulp exposure.
Treatment: if the tooth fragment available, soak it in saline for 20 minutes, use GIC or resin to bond it. If 0.5mm away from pulp, place an indirect pulp cap with calcium hydroxide.
What is a complicated crown fracture? What are the treatments?
It is a fracture confined to enamel and dentin with pulp exposure
Treatments:
Immature roots: partial pulpotomy or pulp capping to preserve pulpal health and cause apexogenesis (vital pulp therapy)
Mature roots: partial pulpotomy and if post required to restore, root canal treatment should be considered
What is an uncomplicated crown-root fracture? What are the treatments?
It is a fracture involving enamel, dentin and cementum.
Treatment: Temporary stabilisation of the loose fragment to adjacent teeth or non-movng fragment
And after one or multipel of the following:
1. Orthodontic extrusion
2. Surgical extrusion
3. Root canal treatment and restoration if pulp becomes necrotic
4.Root submergence
5. Intentional replantation
6. Extraction
7. Autotransplantation
What is a complicated crown-root fracture? What are the treatments?
It is a fracture involving enamel, dentin, cementum and the pulp.
Treatment: temporary stabilisation to the non-mobile fragment or adjacent teeth
In immature teeth: Partial pulpotomy
In mature teeth: Pulp extirpation
Then one of the following:
1. Completion of root canal treatment
2. Orthodontic extrusion
3. Surgical extrusion
4. Root submergenbce
5. Intentional replantation
6. Extraction
7. Autotransplantation
What is a root fracture? What is the treatment?
Root fracture is a type of fracture that involves dentine, pulp and cementum.
Treatment:
- Always reposition the coronal segment ASAP and check radiographically
- Stabilise the coronal segment with a passive and flexible splint for 4 weeks. If cervical, for 4 months
- No endo immediately
- Endo might be needed for the coronal aspect with use of apexification
- In mature teeth with cervical fractures above the alveolar crest
What is alveolar fracture? What is the treatment?
It is the fracture that involves the alveolar bone and may extend to adjacent bones.
Treatment:
- Reposition any displaced segment
- Stabilise the segment by splinting the teeth with a passive and flexible splint for 4 weeks
- Suture gingival lacerations
- No root canal treatments
- Monitor the pulp contion of all teeth involved
What is a dental concussion? What is the treatment?
It is when tooth is hit and concussed. It is tender to percussion but otherwise okay
Treatment: No treatment just monitor
What is subluxation? What is the treatment?
An injury to the tooth-supporting structures with abnormal loosening, but without displacement.
Treatment:
- Usually no treatment
- A passive and flexible splint to stabilize the tooth for up to 2 wk if there is excessive mobility
What is extrusive luxation? What is the treatment?
It is the displacement of the tooth out of its socket in an incisal/axial direction.
Treatment:
1. Reposition the tooth by gently pushing it back into the socket
- Stabilise with 2 week using a passive and flexible splint
- Monitor pulp. If necrotic, start treatment appropriate for the stage of tooth maturation
What is lateral luxation? What is the treatment?
It is the displacement of the tooth in any lateral direction, usually associated with a fracture or compression of the alveolar socket wall.
Treatment:
1. Reposition the tooth digitally by disengaging it from its locked position and gently reposition it into its original location under LA
- Stabilised the tooth for 4 weeks with passive and flexible splint
- Monitor and at 2 weeks make an endodontic evaluation
- For immature teeth - might need endodontic procedure IF THE PULP IS NOT NORMAL. Similar for mature teeth
What is intrusive luxation? What is the treatment?
It is displacement of the tooth in an apical direction into the alveolar bone.
Treatment:
For immature teeth:
1. Allow re-eruption without intervention
- if no re-eruption within 4 weeks, initiate orthodontic repositioning
- Monitor pulp
- IF PULP BAD THAN TREAT
- Parents must know that follow up visits are essential
For mature teeth:
1. Allow for re-eruption without intervention if intrusion is less than 3 mm. If does not happen after 8 weeks, surgical reposition and splint for 4 weeks or reposition orthodontically before ankylosis develops
- If the tooth is intruded 3-7mm, reposition surgically (prefered) or orthodontically
- If the tooth is intruded beyond 7mm, reposition surgically
- Endo treatment will be probably needed
Your patient comes in with an avulsed tooth that has already been re-implanted. The tooth is believed to have a closed apex. What are the steps for management?
- Leave tooth in place
- Clean affected are with water, saline or 0.1% CHx
- Suture all lacerations
- Varify normal position of the replanted toothr adiographically
- Apply flexible splint for upto 2 weeks
- Immidiatley or shortly after replatation, apply corticosteroid+antibacterial dressing (e.g. odontopaste) to the tooth for atr leats 2 weeks
Your patient comes in with an avulsed tooth that has been placed in a storage medium or has been drying out for less than 60 minutes. The tooth is believed to have a closed apex. What are the steps for management?
- Clean the root surface and apical foramen with saline
- Administer LA
- Irrigate the socket with saline
- Examine the socket
- Replant the tooth slowly
- Suture lacerations
- Varify normal position with a radiograph
- Apply splint for 1-2 weeks
- Immidiatley or shortly after replatation, apply corticosteroid+antibacterial dressing (e.g. odontopaste) to the tooth for atr leats 2 weeks
Your patient comes in with an avulsed tooth that has been drying out for more than 60 minutes. The tooth is believed to have a closed apex. What are the steps for management?
The prognosis is poor
- Remove necrotic tissue attached to the root using gauze
- Treat the tooth with sodium fluoride for 20 minutes
- LA administration
- Irrigate the socket
- Examine the socket for possible fracture and reposition
- Performed root canal treatment prior or right after reimplantation
- Stabilise with a passive splint for 2 weeks
- Suture laceration
9, Verfiy normal position of the tooth
What are the guidlines for prescription of antibiotics for tooth avulsion?
First of all, ensure that the aptient had their tetnus shots.
Give doxycyclin to children aboe 8 years old for 7 day in doses
less than 26 kg - 50mg
26-35 kg - 75mg
35kg+ 100mg
If the child is less than 8 years old
amoxicillin 500mg, 3 times a day for 7 days
+ CHx mouthrinse
Your patient comes in with an avulsed tooth that has already been re-implanted. The tooth is believed to have an open apex. What are the steps for management?
- leave the tooth in place
- Clean area with saline
- Suture gingival lacerations
- Varify normal position of the replanted tooth radiographically
- Apply flexible splint for 2 weeks
Your patient comes in with an avulsed tooth that has been placed in a storage medium or has been drying out for less than 60 minutes. The tooth is believed to have an open apex. What are the steps for management?
- Clean the root and apical foramen with saline and do not touch the root
- Soak the tooth in doxycycline (1mg per 20 ml of saline) for 5 minutes if possible
- Administer local anesthesia
- Irrigate the socket with saline
- Examine for possible fractures and repositoon if necessary
- Replant the tooth slowly with digital pressure
- Verify with radiograph
- Suture gingival lacerations
- Apply flexible splint for 2 weeks
Your patient comes in with an avulsed tooth that has been drying out for more than 60 minutes. The tooth is believed to have an open apex. What are the steps for management?
he prognosis is poor
- Remove necrotic tissue attached to the root using gauze
- Treat the tooth with sodium fluoride for 20 minutes
- LA administration
- Irrigate the socket
- Examine the socket for possible fracture and reposition
- Performed root canal treatment prior or right after reimplantation
- Stabilise with a passive splint for 4 weeks
- Suture laceration
9, Verfiy normal position of the tooth
What is important to understand about ankylosis?
After the delayed reimplantation, ankylosis is essentially unavoidable and needs to be considered
What are follow up procedures for a patient who has a closed apex with extra oral dry time of less than 60 minutes?
First 7-10 days - Root canal treatment & calcium hydroxide for upto 4 weeks
Weight and height measurments
2 weeks - splint removal
4 weeks - radiographs
3 months -radiographs
6 months - radiographs
1 year - radiographs
Yearly - radiographs upto 5 years and better beyond
What are follow up procedures for a patient who has a closed apex with extra oral dry time of more than 60 minutes?
First 7-10 days - Root canal treatment & calcium hydroxide for upto 4 weeks
Weight and height measurments
2 weeks - splint removal
4 weeks - radiographs
3 months -radiographs
6 months - radiographs
1 year - radiographs
Yearly - radiographs upto 5 years and better beyond
What are follow up procedures for a patient who has an open apex regardless of extra oral dry time?
First 7-10 days - no root canal treamtnet unless clinical or radiographic signs of pulp necrosis are evidents
2-4 weeks - splint removal
4 weeks - radiographic examination
What are the types of internal resoprtion?
- Internal surface resorption
- Internal inflammatory resorption
- Internal replacement resorption
What is internal surface resorption?
It is a type of resorption that is defined as minor areas of resorption of the dentin walls of the root canal. It is believed to be transient and self-limiting.
What is internal inflammatory resorption? What is the treatment?
It is a type of resorption defined as an inflammatory process within a section of the pulp/root canal that results in loss of dentin commencing at the root canal wall and progressing towards cementum. A radiographic oval shape appearance is very common
This can be caused by traum or caries.
Treatment: Root canal treatment with corticosteroid and antibiotic + calcium hydroxide after
What is internal replacement resorption? What is the treatment?
Internal replacement resorption is a process where the pulp and dentin are replaced with bone. It usually begins within the pulp/root canal and on the root canal walls and it progresses towards the cementum. Clinical appearance may be normal or discolored.
Usually as a result of insult to the pulp.
Treatment: observation and eventual extraction. If diagnosed early, root canal treatment may be feasible.
What are the types of external tooth resorption?
- External surface resorption
- External inflammatory resorption (apical or lateral)
- External replacement resorption (transient or progressive)
- External Invasive Resorption
- External Pressure Resorption
- Orthodontic Resorption
- Physiological Resorption
- idiopathic Resorption
What is external surface resorption? What is the treatment?
External surface resorption is a self-limiting process which is usually caused by a localized to the involved part of the cementum and/or PDL.
Treatment: self-limiting so no treatment.
What is external inflammatory resorption? What is the treatment?
External inflammatory resorption occurs when the tooth has an infected root canal system and there has been damage to the external surface or communication between the pulp and external surface.
Can occur at the apex or lateral surface of the root.
Treatment: preventative approach: after external injury, utilise systemic antibiotics + corticosteroid based root canal treatment. Interceptive approach: when the resorption is already evident use corticosteroid based root canal treatment
What is external replacement resorption? What is the treatment?
External replacement resorption is the process where cementum and dentin are resorbed and replaced by bone.
Aetiology: can occur after external injuries
Treatments: lower the amount of time out of the socket after avulsion
What is external invasive resorption? What is the treatment?
It is a process that is not fully understood. It commences at the sub-gingival location and spreads through out the tooth in all directions.
According to Prof Heithersay, it can be classified as Class I-IV using a PA.
Class I-II are better treated with trichloroacetic acid (TCA) to the resorbing tissues followed by curettage of the defect and restored with glass ionomer cement. Result are usually quite good.
Class III might need adjunt treatment such as root canal treatment.
Class IV have undpredictable outcomes and patient need to be made aware of future issues and probable extraction
What is external pressure resorption? What is the treatment?
It is a resorptive process that occurs when there is pressure applied to the external surface of a tooth root.
Can be caused by impacted teeth or pathologies such as cysts.
Treatment: Removal of impacted tooth or removal of pathology or removal of resorbing tooth and extrusion of the impacted tooth with ortho
What is orthodontic resorption? What is the treatment?
Orthodontic resorption is the process by which the apical part of one or more teeth undergo resorption, resulting in a shortened root.
Treatment: when ortho stops, resorption stops. Monitor and treat when other conditions occur.
What is physiological resorption? What is the treatment?
It is the physiological resorption is the resorptive process that primary teeth undergo as they exfoliate. It is normal.
Treatment: monitoring exfoliation or extraction of primary teeth
What is idiopathic resorption? What is the treatment?
It is resorption with no apparent causes. Typically it involves multiple teeht with shorter roots.
Treatment: determining systemic causes through general health checks and after monitoring.
What is TAB?
Transient apical breakdown (TAB) is a phenomenon that indicates temporary apical periodontal destruction and root resorption after tooth luxation injuries, followed by the healing process of the dental pulp.
This is why in luxation injuries, root canal treatment is usually needed in mature teeth but not always. WATCH FOR SYMPTOMS.
What is improtant to understand in injuries to orthodontically resorbed roots?
Technically, because of the apical resorption, the teeth have an open apex thus can heal better. They are considered premature.
What are the problems with Cone beam CT?
1.Movement artifact – shown as multiple lines– patient need to be very still
2.No soft tissue resolution – use convetional CT
How much of the radiation does CBCT produce?
75 uSv (microSieverts)
What is another machine that can be used to observe soft tissues as well?
MDCT – multi detector computer tomography – 200 microSieverts
Do you need a radiologist?
Yes because:
1.It provides a provider number to allow Medicare rebates
2.Review of all areas of the scan
3.Removes much of the legal responsibility
What are the medicolegal responsibilities of dentist in terms of radiology?
Dentists who record OPG radiographs must take responsibility for all non-dental diagnosis from such images or alternatively have them assessed on referral by an oral radiologist or medical radiologist and include this cost in their estimate of fees to the patient.
What are the two different groups of unwanted effect after CBCT?
1.Deterministic – result of cell killing
2.Stochastic – result from cell modification
What is the DOT DAM principle of radiology?
Don’t Order Tests that Don’t Affect Management
What is the common appearance of the radicular cyst?
Lesion consists of a lucent centre and a thin, well-defined sclerotic rim. Cortical bone destruction may occur if cyst becomes too big.
What is the common appearance of the dentigerous cyst?
Lesion uniformly lucent with a thin, well-defined sclerotic rim attached to the cemento-enamel junction.
What is a common appearance of a odontogenic keratocyst?
Odontogenic keratocyst is a well-defined sclerotic which causes less jaw expansion and grows along the jaw bone.
What is a common appearance of an ameloblastoma?
Has aggressive growth characteristics. Typically well-defined and radiolucent. Cause root resorption, tooth displacement and bone expansion. Floating tooth appearance.
What is a common appearance of an adenomatoid odontogenic tumour?
Anterior mandible, well defined with corticaed border. Tooth displacement is common, root resorption is uncommon.
What is a common appearance of cemento-ossifying fibroma?
Mandible, fibrous capsule gives a thin raiolucent halo. Rapid expansion and tooth displacement. May contain abnormal bone and cementum like tissue.
What is a common appearance of cementoblastoma?
Slow growing lesion full of cementum like tissue. Attached to root apex. Well-defined with cortical border.
What are giant cell lesions?
Anterior to first molar. Slow growing with well-defined margin. Some cortical expansion can occur.
What is nasopalatine cyst?
A defined radiolucency that occurs in the palate
What is a Stafni’s bone defect?
It is a salivary inclusion cyst. A well-defined oval lucencies anterior to angle of mandible.
What is the common appearance of eosinophilic granuloma?
Solitary lesion, well-defined bu non-corticated with irregular margins. DESTROYS BONE AND LEAVES THE FLOATING TOOTH APPEARANCE. Periosteal new bone formation is common.
What is common appearance of periapical cemental dysplasia?
At apex bone is replaced with fibrous material. Lesion persistent after extraction.
What is a common radiographical appearance of squamous cell carcinoma?
Smoking adults. Ill-defined, permeative lesion. Spread localy and lymph nodes. Destroys bone.
What is a common appearance of mucoepidermoid carcinoma?
Well-defined border in posterior body or angle of mandible.
What is a common appearance of osteogenic sarcoma?
Posterior mandible. Painless swelling. Ill-defined borderd\s. “Sun-ray” spiculation appearance. Breaks bone.
What is the common appearance of metastases to the jaw?
Usually from renal, breast, lung, colon and prostate. Affect posterior mandible. Ill-defined, lytic lesions with clear bone destruction.
What is the common appearance of osteomyelitis?
PAIn _ subtle changes in bone density. Bone destruction with sequestration formation.
What is the common appearance of MRONJ?
Pains, swelling and draining sinuses. Bone destruction. Periosteal reaction is common.
What are the 7 signs of IAN involvement?
1.Darkening of the roots
2.Interruption of the white line
3.Diversion of the mandibular canal
4.Deflection of the roots
5.Narrowing of the roots
6.Dark and bifid roots
7.Narrowing of mandibular canal
What is the common appearance of fibrous dysplasia?
Genetic disorder resultin in replacing of bone with fibrous tissue. Ill-defined margin and grounnd-glass appearance. Only condition that can displace the mandibular canal superiorly.
What is the common appearance of the radicular cyst?
Lesion consists of a lucent centre and a thin, well-defined sclerotic rim. Cortical bone destruction may occur if cyst becomes too big.
What is the common appearance of the dentigerous cyst?
Lesion uniformly lucent with a thin, well-defined sclerotic rim attached to the cemento-enamel junction.
What is a common appearance of a odontogenic keratocyst?
Odontogenic keratocyst is a well-defined sclerotic which causes less jaw expansion and grows along the jaw bone.
What is a common appearance of an ameloblastoma?
Has aggressive growth characteristics. Typically well-defined and radiolucent. Cause root resorption, tooth displacement and bone expansion. Floating tooth appearance.
What is a common appearance of an adenomatoid odontogenic tumour?
Anterior mandible, well defined with corticaed border. Tooth displacement is common, root resorption is uncommon.
What is a common appearance of cemento-ossifying fibroma?
Mandible, fibrous capsule gives a thin raiolucent halo. Rapid expansion and tooth displacement. May contain abnormal bone and cementum like tissue.
What is a common appearance of cementoblastoma?
Slow growing lesion full of cementum like tissue. Attached to root apex. Well-defined with cortical border.
What are giant cell lesions?
Anterior to first molar. Slow growing with well-defined margin. Some cortical expansion can occur.
What is nasopalatine cyst?
A defined radiolucency that occurs in the palate
What is a Stafni’s bone defect?
It is a salivary inclusion cyst. A well-defined oval lucencies anterior to angle of mandible.
What is the common appearance of eosinophilic granuloma?
Solitary lesion, well-defined bu non-corticated with irregular margins. DESTROYS BONE AND LEAVES THE FLOATING TOOTH APPEARANCE. Periosteal new bone formation is common.
What is common appearance of periapical cemental dysplasia?
At apex bone is replaced with fibrous material. Lesion persistent after extraction.
What is a common radiographical appearance of squamous cell carcinoma?
Smoking adults. Ill-defined, permeative lesion. Spread localy and lymph nodes. Destroys bone.
What is a common appearance of mucoepidermoid carcinoma?
Well-defined border in posterior body or angle of mandible.
What is a common appearance of osteogenic sarcoma?
Posterior mandible. Painless swelling. Ill-defined borderd\s. “Sun-ray” spiculation appearance. Breaks bone.
What is the common appearance of metastases to the jaw?
Usually from renal, breast, lung, colon and prostate. Affect posterior mandible. Ill-defined, lytic lesions with clear bone destruction.
What is the common appearance of osteomyelitis?
PAIn _ subtle changes in bone density. Bone destruction with sequestration formation.
What is the common appearance of MRONJ?
Pains, swelling and draining sinuses. Bone destruction. Periosteal reaction is common.
What are the 7 signs of IAN involvement?
1.Darkening of the roots
2.Interruption of the white line
3.Diversion of the mandibular canal
4.Deflection of the roots
5.Narrowing of the roots
6.Dark and bifid roots
7.Narrowing of mandibular canal
What is the common appearance of fibrous dysplasia?
Genetic disorder resultin in replacing of bone with fibrous tissue. Ill-defined margin and grounnd-glass appearance. Only condition that can displace the mandibular canal superiorly.
What is internal replacement resorption? What is the treatment?
Internal replacement resorption is a process where the pulp and dentin are replaced with bone. It usually begins within the pulp/root canal and on the root canal walls and it progresses towards the cementum. Clinical appearance may be normal or discolored.
Usually as a result of insult to the pulp.
Treatment: observation and eventual extraction. If diagnosed early, root canal treatment may be feasible.
What is pressure resorption and orthodontic resorption?
Type of traumatic resorption that occurs due to impacted teeth or orthodontic treatment
What is internal inflammatory root resorption?
Resorption that occurs internally
What is external inflammatory root resorption?
Resorption due to periapicla infection
What is communication internal-external inflammatory resorption?
Both internala nd external resorptions
What is surface resorption?
Type of trauma-induced tooth resorption. Involves cementum and small amount of dentine.
What is Transient apical internal resorption?
This process can follow luxation injuries and may be associated with TAB
What is replacement resorption?
Can follow trauma. Tooth structure is replaced.
