Small Animal Surgery Ear Flashcards
Blood supply for most of the ear
Caudal auricular artery. Runs towards apex
Collection of blood within the cartilage plate of the ear. Usually accumulates in the concave surface of the ear.
Predisposing factors:
Otodectes-cats
Bacteria- dogs
Capillary fragility from Cushings disease
Aural Hematoma
Goals of aural hematoma correction
Remove blood or clot
Prevent reoccurrence
Retain ear appearance
When is non surgical correction of aural hematomas used
For recent and fluctuated hematomas, and smaller hematomas
When is surgical correction of aural hematomas recommended
Chronic hematomas, harder to remove clots through aspiration, larger hematomas
Non surgical management for aural hematomas
Usually done in first 24 hours.
Use 18g needle and drain. Combine aspiration with IV or local Dexamethasone or methylprednisolone infusion for better outcome.
In ears that stand up make hole closer to skull to allow for drainage, in flopped ears make hole near tip of pinna.
Should repeat procedure for better success rates
Surgical treatment for aural hematoma.
Uses Penrose drain (for 5 days) or Teat cannula (for 3-5 days)
Passive drainage
Surgical treatment for aural hematoma
Uses butterfly catheter secured into the end of the ear and suction can be applied when needed. Promotes adhesion
Active drainage
Surgical treatment for aural hematoma.
Incision types
S shaped gap: 2mm space heals by second intention
Dermal punch: use punch, place multiple mattress sutures to close
Laser: 1mm spaces made throughout pinna, allows for adhesions
When suturing the pinna, this is the most appropriate pattern used
Vertical mattress.
Runs same direction of blood supply to prevent occlusion accidentally.
Plate secured to ear for surgical treatment of aural hematoma. Used after drainage or aspiration of hematoma. Decreases dead space and creates adhesions. Usually left on for 2 weeks
Practice hematoma repair system
If laceration on one skin surface of the pinna…
Heals by second intention of suture. Pinna usually maintains normal position
If laceration of two skin surfaces or cartilage of pinna….
Must do primary closure (vertical mattress usually)
Deep bites used to align cartilage, and superficially bite aligns skin.
Locally invasive tumor. Caused bleeding and cracked non healing wounds on ear margins. Low metastatic rate.
Squamous cell carcinoma
Indication for subtotal or total pinnectomy
Neoplasia, trauma, SCC
Procedure specifics for subtotal or total pinnectomy
Take 1-2cm margins from lesions. Pull skin from convex over cartilage. Close with monofilament suture
Which bulla osteotomy is more common in dogs
Lateral
Which bulla osteotomy is more common in cats
Ventral
Primary causes of otitis externa
Parasites FB Hypersensitivities Keratinization disorders Autoimmune
Indication for lateral ear canal resection
Tumor involving tragus or lateral wall
Disease involving VERTICAL canal only
Improves ventilation, decreased moisture, better access for medicating
When performing a lateral ear canal resection why do you leave the ventral 1/3 of the flap created during surgery?
Decreases suture near stoma
Decreases strictures
Shifts hair bearing skin
Closure of a lateral ear canal resection
Suture epithelium and cartilage to skin, do deepest area first
Single layer closure using 3/0 monofilament
Complications with lateral ear canal resection
Inadequate drainage
Continued otitis externa (underlying disease or concurrent middle ear infection)
DONT DO THIS PROCEDURES IN COCKERS
Indications for a vertical ear canal resection
Hyperplastic otitis involving the vertical canal only.
Neoplasia
Trauma
Procedure is rarely done
What separates the vertical and horizontal ear canal?
This is the level at which you transect for a vertical ear canal resection
Annular ligament
Indications for a TECA with Lateral Bulla Osteotomy
Cercuminous gland adenocarcinoma
Extensive otitis
Failed lateral resection
Middle ear disease
You are a cocker spaniel….
How is a TECA done
T-shaped incision
Dissect around cartilage until you reach the bulla
Avoid the facial nerve
Amputate canal close to auditory meatus
How to perform a lateral bulla osteotomy (dog)
Remove soft tissue from lateral bulla
Avoid stray dissection (This shit is there: Retroglenoid vein, carotid artery, maxillary artery, facial nerve)
Create keyhole with Rongeurs at osseus prominence
Curettage bulla floor for retained epithelium
Irrigate and close
Submit cytology and C/S
Why do you avoid the rostral aspect inside the tympanic bulla during osteotomy?
Sympathetic nerves lie and can initiate horners syndrome
Post op care for TECA Lat. Bulla Osteotomy
Ice pack wound
Multimodal analgesia (local, CRI, opioids)
Antibiotics (7-10 days)
Drains and bandages
(No drain if you remove all epithelium, bandage inhibits ability to clean so might not use)
Damage to the post ganglionic sympathetic fibers
Horners syndrome
Enopthalmos, miosis, ptosis, 3rd eyelid up
Why cant animals hear after TECA BO
Most already have bad hearing from disease
Fibrous tissue fills the bull further diminishing sound transmission through skin
How to correct damage to retroglenoid vein (hemorrhage) during TECA BO
Pack bone with bone wax, vein usually retracts when severed and cant be found.
Life threatening issue
How to treat infection or draining tract after TECA BO
Long term antibiotics, consider tubes
Draining tracts develop due to incomplete removal of affected epithelium
Destructive keratin in the middle ear
Cholesteatoma
How to diagnose otitis media
Examine for other derm diseases
Palpate Lymphnodes
TMJ joint palpation
Neuro exam (facial paralysis, Horners)
Diagnostic method for otitis media, Use general anesthesia. Examine tympanic membrane and malleus. Consider cytology and C/S sample by myringotomy if membrane is intact
Otoscopy
Radiologic findings of otitis media
Loss of air density and thickening of wall
Most sensitive test for detecting otitis media
MRI, detects early disease
Medical management for otitis media
Myringotomy
Irrigating with saline
Topical and systemic non ototoxic antibiotics for 4-6 weeks
Indications for surgical treatment of otitis media
Severe canal stenosis
Tympanic bone infection
Failure of medical management
Significant neurological signs
Surgical management of otitis media in cats
Ventral Bulla Osteotomy (when disease confined to middle ear) and inflammatory polyps
Lateral Bulla Osteotomy: combined with TECA, rare in cats
Non neoplasia, made of inflammatory and epithelial cells. Occur in young cats. Signs based on location
Middle ear polyps
Sites of origin for middle ear polyps in cats
Tympanic bulla, Auditory tube, Nasopharynx
Management of polyps that must be seen through the tympanic membrane. Reoccurrence in 50%
Traction extraction
Commonly done to correct polyps in cats. Done in dorsal recumbancy
Ventral bulla osteotomy
Why are cats more likely to develop horners syndrome
Nerves run superficial in ventromedial area
Usually occurs in the lower lip. can affect either. Caused by shearing trauma.
Labial avulsion.
Avulses along mucogingival line
When correcting lip avulsion, remove this to prevent saliva leaking causing pyoderma
Lip frenulum
Suture reconstruction is effective for these lip avulsions
Maxillary
Mandibular are usually too heavy.
How to correct mandibular lip avulsions
Use needle below gingival margin to pass wire through tissue and through lip. Place button outside mouth to reduce tension. Suture the mucogingival junction closed.
Do not place anything around teeth.
Moist dermatitis just caudal to canine teeth. Causes pain and foul odor.
Occurs in pendulous lipped breeds
Lip fold pyoderma
Treatment for lip fold pyoderma
Wedge resection and tissue moved forward.
Surgical consideration based on breed, lesion size and location (proximity to mucocutaneous junction)
Avoid mucosal inversion. Start suturing at lip margin to avoid step deformity. Figure 8 of suture apposed lip margin well at mucocutaneous junction
Reconstruction option for lip
Labial advancement flap: Come up at fornex and make incision through lip and advance lip comminsure forward
When to use labial rotation flap for reconstruction
When you need to include a lot of oral mucosa and reconstruct inside and outside of lip
Most common location of salivary mucocele in the dog
Sublingual - Monostomatic portion
Salivary glands that share a capsule
Sublingual Monostomatic portion and Mandibular gland
Which salivary gland has two portions
Sublingual : Monostomatic, and Polystomatic (more rostral)
Additional salivary gland in the cat
Molar gland
During physical exam you see fluctuated swelling suspect
Mucocele
During physical exam you see swollen/enlarged salivary gland suspect
Primary gland disorder
Subcutaneous (submucosal) accumulation of saliva within a nonepithelial, nonsecretory lining.
Most common disease of the salivary system in dogs and cats
Soft and non painful
Salivary mucocele
Why would a salivary mucocele become painful?
Acute inflammation or secondary infection
Definitive treatment of salivary mucocele
Removal of associated glands
Conservative treatment for salivary mucocele in high risk patients
Percutaneous aspiration.
Hard to make a difference with this treatment
Treatment for salivary mucocele as a salvage procedure, or in high risk patients
Marsupilaization of Ranula.
Doesnt treat the cause and you are suturing the edge to granulation tissue and it will still heal in no matter the hole. Still might have to remove the gland in the future.
During excision of mandibular and sublingual salivary glands…
Make sure you remove rostral components or mucocele will re form
Incision orientation for removal of mandibular/sublingual salivary gland
Horizontal.
Vertical limits exposure to entire gland. Though it allows access to the parotid gland
Avoid this during salivary gland surgery
Digastricus muscle
Will loose ability to open mouth
Attempt to do this during mucocele surgery to improve visualization
Aspirate the mucocele
Thought to occur as result of trauma to the parotid duct. Treat by ligating allowing for atrophy
Parotid fistula
Most important component of treatment for small animals with solid tumors
Surgery
Useful for diagnosing certain round cell tumor malignancies. Be causous because inflammation can resemble malignancy
Cytology
Imaging of primary tumors is important for
Intracavitary tumors, firm and non-mobile tumors
Gold standard for diagnosis of neoplasia
Biopsy.
Recommended before any definitive treatment is performed for certain tumors.
When taking a biopsy consider
Taking from multiple areas of mass, Sample size, Should contain junction between normal and abnormal tissue
Use when less invasive sampling techniques have not yielded a diagnosis. Does require a second surgical procedure and may contribute to tumor seeding. Should do deep and narrow cut for better closure
Incisional biopsy
Removes tumor along with margin of surrounding normal tissue. Allows removal of smaller non invasive masses (<5mm). Dont do if tumor is too large
Excisional biopsy
When to consider an excisional biopsy
Gingival lesions, lesion known to be benign, lesion too small, treatment would not be altered by tumor type.
Best chance of cure is at first surgery
Use contains the most aggressive of cells within the tumor
Capsule
Type of excision used for lipomas and benign masses. Goal is microscopic disease for malignant lesions
Marginal/Cytoreductive
Excision with removal of 2-3cm normal tissue and 1 fascial place deep.
Should be based on imaging and histopath report from biopsy including: grade, mitotic index, and degree of differentiation
Wide excision
Excision with removal of the entire compartment. Includes amputation and hemipelvectomy
Radical excision
Tumors to be removed with wide excision
Mast cell tumors (high grade) and soft tissue sarcomas (High grade and vaccine associated sarcomas)
Good for use with Mast cell tumors. Can be done on FNS. Done preoperatively and correlates with histopath grading after surgery allowing for surgical planning
Agmor scoring
A debulking surgery but leaves part of tumor behind which can be biologically active. Goal is to enhance efficiency of other treatments
Cytoreductive surgery.
Can be done before photodynamic therapy and cryotherapy
Injection of a drug and after it accumulates in tumors activate the drug with a light such as a laser as treatment for tumors
Photodynamic therapy
If tumor is fixed to a structure assume
It has invaded that tissue and remove it also
Do this to local draining lymphnode prior to surgery on neoplasia
Aspirate and perform cytology
Local lymphnode excision is prognostic for these tumor types
Mammary carcinoma
Mast Cell Tumors
Apocrine Gland Adenocarcinoma of the anal sac
Uses radioactive material and nuclear scintigraphy or fluoroscopy to tract lymph nodes that drain a mass
Sentinel Lymph Node mapping
Will improve quality of life but not extend life or alter course of disease
Palliative treatment
Examples of palliative therapy
Splenectomy for hemagiosarcoma
Amputation for OSA
Partial cystectomy for TCC
Surgical margins should be marked by these on tumor excisions
Dye covering excised area, sutures, excising additional tissue from surgical bed
How to fix tissue for histopathology
Allow ink to dry 1 hour before fixing
10% Formalin
Formalin to tissue ratio of 10:1
Bread load cut lesions that are >1cm to allow uniform fixation
Why is immunhistochemistry helpful for tumors
Can determine the cell of origin as tumors become less differentiated
Needs to be requested when submitting histopathology
Margin evaluation
Most common malignant oral tumor. Occurs more often in males.
If mucocutaneous and nail bed- malignant
If haired skin- benign
Melanoma
Locally invasive. Metastasizes early to regional lymphnodes and lungs. Gingival most common place
Oral melanoma
Which three lymphocentrums drain the oral cavity
Mandibular, parotid, retropharyngeal
Palliative treatment for nonresectable tumors (oral melanoma)
Radiation therapy once a week for 4 weeks
Second most common malignant oral tumor
Squamous cell carcinoma
Type of oral squamous cell carcinoma. The further caudal in the mouth the worse the prognosis. Locally invasive and slow to metastasize. Surgical resection recommended. Piroxicam chemo can be used
Nontonsillar Squamous cell carcinoma
Highly malignant, usually occurs unilateral in oral cavity. Early metastasis to distant sites.
Tonsillar squamous cell carcinoma
In cats, common on gingiva or under tongue. Can have extensive bone involvement. Often advanced disease at diagnosis. Treat with Piroxicam chemo, radiation doesnt work.
Oral squamous cell carcinoma
Oral tumor in large breeds. Gingiva is common place, usually on maxilla caudal to the canine tooth. Locally invasive and slow growing in older dogs. Treat with wide surgical resection. Aggressive in young dogs. Local recurrence common
Fibrosarcoma
Benign oral tumor. Proliferation of fibrous connective tissue containing displaced cells of dental supporting structures. Local excision curative
Peripheral odontogenic fibroma
Oral tumor that arises from remnants of epithelial cells that produce periodontal ligament. Contains sheets of squamous epithelium in fibrous connective tissue stroma. Benign but locally invasive. Treat with surgical excision and radiation
Acanthomatous Ambleoblastoma
Odontogenic tumor. Arises from dental laminar epithelium. May be cystic or multiloculated with considerable bone destruction. Mesenchyme not stimulated to produce dental hard tissues.
Central Ameloblastoma
Odontogenic tumor. Mesenchyme induced to produce hard tissues. Containers tooth structures if compound, dental tissues cant be differentialted if complex
Odontoma
Oral tumor in young dogs (6-24 months). Very aggressive and early metastasis. Usually on maxilla caudal to canine tooth. Usually external facial swelling and loss of teeth. Often surgvive less than 1 month.
Undifferentiated Malignant Oral Tumor
When performing a mandibular to my going caudal to this results in interference with the tongue and eating/drinking
1st Molar
After this mandibulectomy usually need feeding tube
3/4 Mandibulectomy
When beforming total mandibulectomy (total or subtotal) dissect and remove at least up to the
Medullary canal
Improves ability to pretend food and drink water and prevents tongue loll on that side after mandibulectomy
Shortening of the lip commissure
Post op car for mandibulectomy or maxillectomy
IV fluids for first 24 hours.
Pain medication including nerve blocks
Possible feeding tube
More common complication with rostral mandibulectomies
Wound dehiscence
Possible mandibulectomy complications
Swelling
Wound dehiscence
Mandibular drifting (clicking)
Inability to prehend food.
How to reduce nose dropping from bilateral rostral maxillectomy caudal to canines
Remove the canines or decrease crown height
Long term follow up for malignant oral tumors
Recheck every 2 months. Then chest rads every 6 months and yearly exam
Vaccine available as treatment for stage 3 or more
Malignant oral melanoma
Low grade oral tumor. Likes to go to flat bones and vertical ramus of the mandible
Multlobularosteochondrosarcoma
Indications for exodontics
Retained deciduous teeth
Severe periodontal disease
Non-vital teeth or fractured crown with root exposure.
Teeth undergoing resorption
Curved root tip
Dilaceration
Expansion of the apical portion of the tooth root
Hypercementation
Wider space between teeth
Diastema
Toward the root or away from the crown
Apical
Toward the crown
Coronal
The only visible part of the periodontium int e normal mouth
Gingiva
Potential space between tooth and gingiva. Where you probe for disease
Gingival sulcus
Communication between tooth root and the pulp
Lateral canal
Where the pulp exits the teeth in dogs and cats
Apical delta
Very common place on tooth for periodontal disease to begin. Spot up between the roots on molars and premolars
Furnication
Carnasal teeth in the dog
Upper P4 and Lower M1.
Transitional teeth
Teeth with three roots in canine
Upper P4, M1, M2
Teeth with two roots in canine
Upper P2, P3 Lower P2, P3, P4, M1, M2
Functions of the periodontal ligament
Attaches tooth to alveolus
Absorbs shock and provides proprioceptive info during mastication (make sure you dont break teeth)
Supplies nutrients to alveolar bone and cementum and drains
Isolates the tooth from the surrounding bone and the osteoclasts that remodel the bone.
Periodontal ligament
If osteoclasts invade tooth will reabsorb essentially
The shelf on the palatal surface of the maxillary incisors where the mandibular incisors occlude or rest
Cingulum
Releases saliva and makes tartar accumulate faster on Upper P4
Parotid Salivary Gland Papilla
Form in utero and give rise to permanent buds
Deciduous buds
Forms dentin throughout the life of the tooth
Odontoblasts
Formed by ameloblasts on the crown of the tooth prior to eruption
Enamel
Formed by remnants of the dental sac on the outer dentinal surface of the root when the tooth is almost mature. Produced throughout life
Cementum
Thickness of enamel in dogs
<0.1 mm to 0.6mm
Thickness of enamel in cats
<0.1 to 0.3 mm
Part of the tooth not replaced if damaged
Enamel
Part of tooth consists of blood vessels, lymphatics, nerves, and connective tissue
Pulp
Age at which apex of tooth should be closing and dentin thickening occurs
1.5 years
Dogs erupt permanent incisors and canines at
3-6 months
Dogs erupt deciduous incisors and canines at
3-4 weeks
Dogs erupt permanent premolars at
4-6 months
Dogs erupt permanent molars at
5-7 months
No deciduous molars
Cats have all permanent teeth by
3-6 months
Dogs have ____ deciduous teeth
28
Dogs have ____ adult teeth
42
I 3/3 C 1/1 P4/4 M2/3
Any carnivore that is missing teeth are considered to be missing
Premolars from the front and molars from the back
Cats have ____ deciduous teeth
26
Cats have ___ adult teeth
30
I 3/3 C 1/1 P 3/2 M 1/1
3 Maxillary premolars are 2, 3, and 4
2 Mandibular premolars are 3 and 4
In schnauzers and shelties caused by retained deciduous tooth
Lancet tooth
Retained deciduous teeth are most commonly
Incisors and canines
In reference to permanent teeth, deciduous teeth are located
Buccal and labial
Maxillary canines erupt _____ to deciduous canines
Mesial
Common issue with tooth position in brachycephalics. Maxillary 3rd premolars most commonly effected
Crowding
Supernumerary teeth. Usually unilateral, and in maxilla. Often incisors or premolars. Can cause malocclusion, overcrowding, or incomplete eruption. Remove them if concerned
Polyodontia
Incomplete splitting into two teeth. Two crowns and one root
Gemination
Genetic defect where teeth never develop. Most common in premolars. If deciduous tooth is missing adult tooth will be also. Radiograph will show if missing or impacted. Common in brachycephalics
Anodontia or Oligodontia or Hypodontia (missing teeth)
Class 1 Malocclusion
Malpositioned teeth, jaw length is normal
Can have cross bite, base narrow canines
Class 2 Malocclusion
Mandibular brachygnathism.
Parrot mouth, overshot
Class 3 Malocclusion
Mandibular prognathism
Undershot (mandible sticking out) think bulldogs
When maxillary premolars are lingual to mandibular premolars or molars. Type of class 1 malocclusion. Probably inherited but not common
Posterior cross bite
When incisor crowns meet. Class III Malocclusion. Leads to abnormal wear on incisors commonly repaired by tertiary dentin. Called attrition
Level bite
Malocclusion with unequal arch development. Caused by trauma or inherited. Maxillary and mandibular midlines dont line up
Wry mouth
Removal of primary teeth to avoid or correct problem
Interceptive Orthodontics
Uncommon in the dog and cat. Suggested causes are lack of space in the dental arch or mal-alignment of the tooth bud
Impacted teeth
Occurs from damage to ameloblasts during enamel development or exposure to corrosive material. Can result from high fevers with infection or endocrine dysfunction.
Enamel hypoplasia/hypocalcification
How to treat enamel hypoplasia
Restore defect with composite if focal or cap teeth
Yellowing of teeth from exposure to this in utero or while younger than 6 months. Dentin is the affected layer
Tetracycline staining
Caused by abnormal contact with crown surface by foreign objects like tennis balls or rocks. Establish if there is endodontic exposure, if so treat with root canal
Abrasion
Uncommon but could occur on flat surfaces of teeth. Caused by bacteria. Appear brown-yellow and soft spots. Cap, extract, or root canal
Dental caries
Results from endodontic and periodontal lesions. Signs include fistulas, fractures, and abscesses
Periapical infections
Parulis
Draining tract associated with teeth
Caused by issues with roots of maxillary molars 1 and 2 in the zygomatic arch, and apical disease
Retrobulbar disease
Occurs focally from periodontal disease or generally in boxers. Drugs like cyclosporine, ca channel blockers, and anticonvulsants can result in this. Treat by removing excessive tissue to return sulcus depth to normal. Rinse BID with 0.2% chlorhexidine for 2 weeks after tx
Gingival hyperplasia
Possibly reversible and causes discoloration of tooth. Check if tooth is viable with translumination and radiographs.
Pulpitis
Objective is to maintain a viable tooth that will continue to mature. Can only do in young animals usually. Better success if done in less than 48 hours since injury, buys time for tooth to mature. Monitor yearly at least.
Vital pulpotomy
Perform at greater than 24 months old because pulp chamber might still be too wide. Maintains tooth function but tooth is dead. Completely removes pulp contents. Seals tooth from enviornment
Complete root canal
Stage 1 tooth resorption
Mild hard tissue loss. Basically just small defect in enamel noticed only. No sensitivity yet
Stage 2 tooth resorption
Moderate tissue loss including enamel and cementum and hasnt reached pulp cavity
Stage 3 tooth resorption
Loss of cementum, enamel, and dentin and reaches into pulp chamber. Most of the tooth is still viable
Stage 4 tooth resorption
Extensive loss of hard tissue and tooth has lost its integrity. Sub-stages a-b means crown loss through c which has root loss
Stage 5 tooth resorption
Only remnant of tooth remain covered by gum tissue leaving raised area
Features of type 1 tooth resorption lesions
Focal or multifocal. Periodontal ligament is intact. Gingivitis and periodontitis. Treat with extraction
Features of type 2 resorption lesions
Focal or multifocal. Disappearance of periodontal ligament no evidence of periodontitis. Treat with amputation of crown
Might be caused by calicivirus. Signs include pytalism, halitosis, dysphagia. Severe marginal gingivitis. Diagnosis with histopath. Remove entire tooth with steroids, Oravet q48hr, Cyclosporine, antivirals.
Gingivostomatitis (lymphocytic plasmacytic gingivostomatits)
Starts less than 9 months of age. Severe gingivitis and periodontal disease. Usually outgrow by 2 years old, might need extractions
Juvenile onset periodontitis
Most common oral disease and number 1 cause of tooth loss
Periodontal disease
Stages of periodontal disease are based on
Gingival appearance, Sulcular depth, percentage of bone loss, and tooth mobility
Normal sulcus depth
1-3 mm in dogs 0-1mm in cats
Stage I gingivitis
Erythema, Gingiva bleed when probed, Normal sulcus depth. Reversible with treatment
Stage II gingivitis
Gingiva bleed, minor pockets, minimal bone loss, no mobility, Periodontis controlled but cant be reversed.
Stage III gingivitis
Gingival recession, deep pockets, bone loss, mobility of teeth
Stage IV gingivitis
Deep pockets, recession, bone loss, furcation exposure. Advanced disease and mobility of teeth
Objectives in treatment of periodontal disease
Remove biofilm
Minimize attachment loss and pocket depth
Maintain adequate attachment gingiva (2-3mm)
Number 1 preventative method for periodontal disease
Mechanical abrasion and surface active agents. HOMECARE
Start daily tooth brushing prior to professional treatment
Rinse used in dental cleanings
0.12% chlorohexadine rise
Best type of dental power scaler to use
Ultrasonic
Used for subgingival calculus removal
Curette
How to check for missed calculus
Disclosing solution or air from a 3 way syringe
Essential step to dental cleaning
Polishing
Measures the amount of overall tissue loss. Recession measurement plus the pocket depth equals the amount of attachment loss.
Periodontal index
When using dental film the dimple is always pointed
Coronally and toward the xray tube
Most common technique for dental xrays
Bisecting angle
The SLOB rule is used for this tooth during dental radiographs
P4 or 108.
Same Lingual Opposite Buccal
