Verstraete Flashcards
What is the primary directional force of the following muscles of mastication: temporalis, pterygoid, masseter?
Ch 27
Rostrodorsal
What surface of the mandible undergoes the maximal tensile force?
Ch 27
Oral/tooth surface
Define the symphyseal separation types:
Type I
Type II
Type III
Ch 30
Type I - no soft tissue laceration
Type II - soft tissue laceration present
Type III - soft tissue trauma, comminution, exposed bone and fractured teeth
What are the key mediators of wound healing?
Ch 1
Platelet derived growth factors (PDGFs)
Transforming growth factor beta (TGF-Beta)
What cell type regulates formation of granulation tissue?
Ch 1
Macrophages
What is the primary difference between oral and extraoral re-epithelialization?
Ch 1
Oral epithelial cells migrate directly onto the moist, exposed surface of the fibrin clot instead of under dry exudate of dermis
Alveolar osteitis occurs when…
Ch 1
The extraction site blood clot fails to form or disintegrates
Likelihood of wound infection increases substantially when bacteria proliferate to levels greater than…
Ch 1
10^5 organisms per gram of tissue
Does the canine/feline mandible contain hematopoietic cells?
Ch 2
No
How much osteoid may be produced per day?
Ch 2
1 µm
Which forms first in fracture healing, woven or lamellar bone?
Ch 2
Woven bone
How much bone can osteoclasts resorb per day?
Ch 2
50-100µm
What is the fracture gap cutoff (µm) for direct vs indirect bone healing?
Ch 2
800µm
True or false - the term antibiotic refers only to natural compounds of microbial origin?
Ch 3
True
Verstraete Chapter 3 on antibiotics reports that for each minute in orthopedic surgery involving stainless steel plating the risk of infection increases by what percent?
Ch 3
2%
What are the positive benefits of local anesthesia mentioned in Verstraete Chapter 3?
Ch 3
Suppresses cortisol and catecholamine levels
Reduces muscle breakdown postoperatively
The AVDC antibiotics use position statement indicates that antibiotics should be used in what cases?
Ch 3
“For animals that are immune compromised, have underlying systemic disease (such as clinically evident cardiac, hepatic, and renal diseases) and/or when severe oral infection is present.”
What are the most common bacterial causes of canine infective endocarditis in order of frequency?
Ch 3
Staphylococcus spp
Streptococcus spp
Escherichia coli
Bartonella (affects almost exclusively the aortic valve)
In people the prevalence of bacteremia following third molar surgery was 67% at 15 minutes after finishing oral manipulations. This prevalence is almost as high as that for daily living true or false?
Ch 3
True
True or false: Most veterinary studies do not support the association between bacterial endocarditis and either dental/oral surgery or oral infections in dogs.
Ch 3
True
What is the only cardiac disease statistically shown to predispose dogs to infective endocarditis?
Ch 3
subaortic stenosis
True or false: There is no evidence that dogs with myxomatous mitral valve disease have increased risk of infective endocarditis
Ch 3
True - use of prophylactic antibiotics prior to dental procedures for dogs with MVD controversial, further studies needed
Examples of clean contaminated oral surgeries
Ch 3
Noninfected dental extraction
Bone grafting
Orthognathic surgery
Infection rate of contaminated surgeries when antibiotics not used
Ch 3
20-30%
Infection rate of dirty surgeries when antibiotics not used
Ch 3
50%
Mandibular or maxillary fractures have a higher rate of infection?
Ch 3
Mandibular
Review of 547 human patients with major contaminated oncologic head and neck surgery concluded (Johnson 1988 Ann Surg)
Ch 3
Perioperative antibiotic administration should be performed
No evidence exists to support prolonged antibiotic administration beyond first 24 hours
What are the 2012 guidelines of the International Association of Dental Traumatology’s recommendations for antibiotic usage following reimplantation of luxated/avulsed teeth?
Ch 3
Recommend antibiotics for 7 days following tooth reimplantation
First choice is tetracycline followed by penicillin or amoxicillin
True or false: Subgingival microflora was highly susceptible to commonly used antibiotics in 1995 (Harvey CE, Thornsberry C, Miller BR, Shofer FS. Antimicrobial susceptibility of subgingival bacterial flora in dogs with gingivitis.J Vet Dent. 1995;12:151–155.)
Ch 3
True
True or false: In a 2006 study resistance of subgingival aerobic and anaerobic flora to commonly used antibiotics in dogs with perio was high (Radice M, Martino PA, Reiter AM. Evaluation of subgingival bacteria in the dog and susceptibility to commonly used antibiotics. J Vet Dent.2006;23:219–224.)
Ch 3
True
Resistance to amox-clav lowest of commonly used antibiotics → still significant
Prevotella intermedia 33%, Porphyromonas gingivalis and Peptostreptococcus spp 25%
Bacteroides fragilis resistant to all antibiotics
Doxirobe (subgingivally delivered, sustained release doxycycline polymer) is registered for veterinary patients for treatment of…
Ch 3
periodontal pockets with probing depths 4mm or deeper after periodontal debridement
What is the subantimicrobial dose of doxycycline according to Verstraete?
Ch 3
20mg PO q12h for 9 months or 2mg/kg PO q24h for 8 weeks
Concentrations of antibiotics needed to inhibit subgingival plaque in biofilms reported to be how many times greater than concentrations needed to inhibit the same strains grown planktonically?
Ch 3
250-1000
What is primary hyperalgesia?
Ch 4
Primary → related to changes in sensitivity of peripheral neurons
Release of various mediators → reduce the threshold for further stimulation of nociceptors in the injured area
What is secondary hyperalgesia?
Ch 4
Secondary → due to changes in central processing of neuronal input
Nociceptive input into the spinal cord interacts with adjacent neurons and sensitizes them to further stimuli
Manifests as change in nociceptive threshold outside the area of injury
What is the definition of allodynia?
Ch 4
Pain due to a stimulus which does not normally provoke pain
What is the volume of collagen scaffold recommended to fill a critical size bone defect for regeneration?
Ch 53
Volume of collagen scaffold = 1/2 to 3/4 of the mandibular height and a length 2 mm greater than the defect span
What % volume should a collagen scaffold be infused with rhBMP-2 for regeneration of critical size bone defect?
Ch 53
50%
How does light cure composite become solid?
Ch 31
Polymerization reaction by the induction of free radical formation through a specific wavelength of blue light (400-500 (470) nm)
What concentration of light source is needed for light-curing composites?
Ch 31
400-500 nm → 470 nm
Name that wiring technique
Ch 31
Ivy loop
Name that wiring technique
Ch 31
Risdon
Name that wiring technique
Ch 31
Essig
Name that wiring technique
Ch 31
Stout
What is the definition of hypotension in mmHg?
Ch 4
systolic pressure <90mmHg or mean pressure < 70mmHg
What percent of crystalloids administered will remain in the vascular space?
Ch 4
50%
What is the standard for determining efficiency of ventilation in the anesthetized patient?
Ch 4
Blood gas analysis
What nerve provides sensory innervation to the hard palate?
Major palatine nerve
branch of the pterygopalatine n
Ch 4
Which branches of the infraorbital nerve primarily supply the maxillary fourth premolar tooth?
Ch 4
Middle superior alveolar branches
Which branches of the infraorbital nerve supply the rostral premolar, canine and incisor teeth?
Ch 4
Rostral superior alveolar branches
Which opioids can take up to 30 minutes to achieve maximal effect?
Ch 4
Morphine and buprenorphine
How long does it take for fentanyl patches to reach peak plasma concentrations?
Ch 4
6-24 hours
What is the mechanism of action of grapiprant?
Ch 4
Prostaglandin EP4 Receptor Antagonist
What are these instruments used for?
Ch 4
Percutaneous needle catheter technique for esophagostomy tube placement
esophagostomy tube set: esophagostomy introduction tube, 10G 50mm needle with Peel-away sheath needle, 10 F silicone catheter
What is the allometric RER formula?
Ch 5
RER (kcal/day) = 70( BW (kg) ^ 0.75)
Why does cone beam CT have poorer contrast resolution than conventional CT?
Ch 6
More scatter
What does increasing pitch do to signal:noise ratio for CT?
Ch 6
Increasing pitch reduces signal:noise ratio
An increase in pitch negatively impacts image quality for pitch >1.5
What is the dose for iodonated contrast?
Ch 6
600-800 mg/kg
What force does an elevator apply to the Sharpey fibers?
Ch 13
Rotational (lever)
What are the three requirements for acceptable retained tooth root?
Ch 13
<3-4 mm in size, deeply embedded in bone, no periapical lucency
How frequently are dichotomous roots of cats MaxP2s seen?
Ch 14
Greater than 50%
27.7% single root, dichotomous root 55.1%, two roots 9.2%
Which two arteries are located near the maxillary canine tooth alveolus in a dog?
Ch 15
Lateral nasal artery and branch of major palatine artery
What is the definition of asepsis?
Ch 7
Complete absence of any bacteria, viruses, fungi, molds or parasites capable of causing infection
What is the most common needle holder grip in oral surgery?
Ch 7
Wide-based tripod grip
What is the maximum speed of a high speed handpiece?
Ch 7
40,000rpm
Have emphysematous complications from using a high speed hand piece been documented in animals?
Ch 7
No
Why is deionized water used in dental machines?
Ch 7
Tap water is harmful to canine fibroblasts
Microorganisms may be present in tap water and biofilm may form in waterline
What does low level disinfection achieve?
Ch 7
least effective - does not kill bacterial endospores or Mycobacterium tuberculosis. Can kill most bacteria, some viruses and some fungi
What is intermediate level disinfection?
Ch 7
kills M. tuberculosis bu not bacterial endospores. kills vegetative bacteria, most viruses, most fungi
What is high level disinfection?
Ch 7
kills some but not all bacterial endospores, M. tuberculosis
Monocryl loses what percent of its tensile strength after 2 weeks?
Ch 8
20-30%
What is the most commonly used suture needle in oral surgery?
Ch 8
3/8 circle needle
What are the most recommended sutures for intraoral use?
Ch 8
Monocryl and Vicryl-Rapide sizes 4-0, 5-0, 6-0
What is the frequency needed to cut mineralized tissue with a piezotome?
Ch 9
25-35 kHz
What is the cutting rate of the piezotome?
Ch 9
0.25-0.3mm per second
Which of the following is correct in the prevalence of traumatic dental injuries?
a. The majority of cases affected cats more than dogs
b. The most common age of animal affected is >5 years old
c. Concussion is the most common type of injury
d. Avulsion is the most common type of injury
Ch 24
c. Concussion is the most common type of injury
“Concussion (with tooth discoloration) was the most common periodontal injury (83.1%), followed by avulsion (9.0%), lateral luxation (4.8%), extrusive luxation (1.2%), intrusive luxation (1.2%), and subluxation (0.6%) injuries.”
Which teeth are most commonly affected by TDI?
Ch 24
Incisors and canines
How long does the clinician have before necrosis of the PDL starts to occur for an avulsed tooth without storage in an appropriate solution?
Ch 24
60 minutes
What properties are important to preserve an avulsed tooth?
ch 24
Osmolarity
pH
Temperature
How long does the clinician have before necrosis of the PDL starts to occur for an avulsed tooth WITH storage in an appropriate solution?
Ch 24
3 hours
What are complications of TDI replantation?
ch 24
Coronal discoloration
Marginal bone loss
Pulp necrosis
Ankylosis and resorption
The removal of the blood clot prior to replantation of experimentally avulsed dog teeth resulted in less ankylosis and resorption
Where do the efferent lymphatics of palatine tonsils drain to?
Ch 63
Medial retropharyngeal lymph nodes
No afferent lymphatics
What is the arterial and venous anatomy of the palatine tonsils?
Ch 63
Lingual artery –> tonsilar artery –> branches 2-3 times to enter base of each tonsil
Numerous small veins leave each tonsil and empty into palatine venous plexus
What are the indications for tonsillectomy?
Ch 63
Chronic recurrent tonsillitis, adjunct therapy to radiation for canine tonsillar SCC, removal of benign tonsillar polyps and cysts, less commonly to treat brachycephalic syndrome
The tonsillar pathology in images A and B are most consistent with what neoplasms?
Ch 63
A. Malignant lymphoma
B. Unilateral tonsillar SCC
For what tonsillar neoplasia is tonsillectomy not indicated?
Ch 63
Malignant lymphoma
Chemotherapy treatment of choice
What is the most commonly reported tonsillar tumor in dogs? Ch 63
Ch 63
SCC
What surgical tonsillectomy technique has not been described in dogs?
A. Parker-Kerr suture pattern
B. CO2 laser
C. Bipolar vessel sealing device (Ligasure)
D. Transection with monopolar cautery
B. CO2 laser
commonly performed in people but not described in dogs. A and C most recommended
What suture pattern is demonstrated in this image?
Ch 63
Parker-Kerr suture pattern
What is the arterial blood supply of the hard palate?
Ch 62
Major palatine arteries, lesser extent from minor palatine arteries caudally, sphenopalatine arteries dorsally
Venous drainage via diffus venous plexus to maxillary vein
Bilateral carotid artery ligation may result in death in what species?
Ch 62
Cats
The image below demonstrates which procedure and technique?
Ch 62
Temporary carotid ligation using a Rummel tourniquet
What surgical techniques for control of hemorrhage during nasopharyngeal surgeries are recommended?
Ch 62
Temporary carotid artery ligation, lavage with cold saline, suction, epinephrine 1:100,000, bipolar electrocautery for individual vessels
What oral approach is recommended for acess to the caudal nasal passages and nasopharynx?
Ch 62
Ventral approach through hard palate
What is the difference between a pharyngostomy and a pharyngotomy?
Ch 61
A pharyngostomy is a surgical formation of an artifical opening into the pharynx for a feeding tube that will remain in place after surgery.
A pharyngotomy is a surgical incision into the pharynx for placement of an endotracheal tube or feeding tube that will be removed immediately after the procedure.
What are the names of the labeled neurovascular structures?
A. Hypoglossal nerve
B. External carotid artery
C. External jugular vein
D. Linguofacial vein
E. Lingual artery
F. Linguofacial vein
G. Epihyoid bone
During a staphylectomy what tissue layer is not included in the closure?
Ch 60
The palatine muscles are not included. Nasopharyngeal mucosa and oropharyngeal mucosa are sutured together with a simple continuous pattern.
What are the two types of unerupted teeth?
Ch 59
Embedded teeth - do not erupt due to lack of eruptive force
Impacted tooth - failure to erupt due to physical obstruction
What is pericoronitis?
Ch 59
Inflammation around the operculum (mucosa over an unerupted tooth) or inflammation around a partially erupted tooth
What is the defintion of osteonecrosis of the jaws?
Ch 58
Exposed nonvital bone in the maxillofacial region that fails to heal after 6-8 weeks in patients with no history of maxillofacial radiation
What breed may be prone to osteonecrosis of the jaws?
Ch 58
Scottish Terriers
The following images demonstrate which disease process and etiology?
Ch 58
Osteonecrosis caused by blastomycosis
Tight-lip syndrome is seen exclusively in what breed?
Ch 57
Shar-Peis
What are the indications for frenuloplasty?
Ch 57. frenuloplasty: repositioning the frenulum
Dermatologic infection of the lower lip, chronic periodontal disease of the distal mandibular canine teeth, Shar-Pei’s with tight-lip syndrome
Which of the following is true?
a. Odontoma → benign, locally aggressive
b. Odontogenic myxoma → benign, some recurrence potential
c. Canine acanthomatous ameloblastoma → malignant
d. Odontogenic myxoma → malignant
Ch 45
d. Odontogenic myxoma → malignant
What % of ameloblastomas are located at the rostral mandible?
Ch 45
41%
6% at caudal maxilla
What breeds have predispositions to gingival hyperplasia?
Ch 46
Collie, Great Dane, Boxer, Doberman, Dalmation
Oral eosinophilic granuloma in siberian huskies involves lesions typically of what anatomy?
Ch 46
Tongue
ALSO! Oral eosinophilic granuloma in siberian huskies often presents with a peripheral eosinophilia → 80% of cases
What breed is associate with Craniomandibular osteopathy (CMO)?
Ch 46
West Highland white terriers
disease is inherited as an autosomal recessive trait
Ddx: Idiopathic calvarial hyperostosis
What is the typical presentation of Mandibular periostitis ossificans?
Ch 46
Large-breed puppies around 3–5 months of age are presented for swellings centered on the mandibular first molar tooth, around the time of its eruption.
Characteristic radiographic finding of a double cortex at the ventral aspect of the mandible. (Stanley et al, JVD 2010)
What is the most prevalent odontogenic cyst in the dog?
Ch 47
dentigerous cyst
What is the most common presentation of a dentigerous cyst?
Ch 47
Age 2-3yo, brachycephalic, 1st premolar impacted tooth
What type of odontogenic cyst is depicted?
Ch 47
Perapical/radicular cyst
Note the RCT – non-vital tooth prereq for this cyst, most commonly secondary to failed RCT in humans
What histopatholgic feature distinguishes an Odontogenic keratocyst form other odontogenic cysts?
Ch 47
parakeratotic keratinization of the cyst lining
What is the typical location of a OKC in a dog?
Ch 47
Maxilla - may go unnoticed until facial deformity/exopthalmos/bone erosion?
Define a lateral periodontal cyst?
Ch 47
developmental, noninflammatory cysts that occur on the lateral aspect or between the roots of vital erupted teeth
typically incidental finding
What are the two most common sites of sialoceles in dogs?
Ch 55
Cervical, sublingual
What veins does the mandibular salivary glad lay between anatomically?
Ch 55
Jugular and linguofacial veins
Define embedded tooth and impacted tooth
Ch 59
An embedded tooth is unerupted usually because of a lack of eruptive force
An impacted tooth is prevented from erupting by some physical barrier in the eruption path, such as crowding from adjacent teeth
In shallow unerupted teeth, what % of crown is sufficient to expose via operculectomy?
Ch 59
1/2 - 2/3 of crown
What laryngeal structure should the pharyngostomy site be rostral to?
Ch 61
Epihyoid bone
What gross characteristics are specific to tonsilar lymphoma?
Ch 63
Malignant lymphoma may also affect the tonsils, but animals with tonsillar lymphoma tend to have uniform bilateral enlargement rather than the irregular, firm, unilateral enlargement seen with tonsillar carcinoma
What is the most commonly reported tonsilar tumor in dogs?
Ch 63
SCC
What are the most common sites for sialocele development in order of frequency?
Ch 55
1.) Cervical site
2. Ranula
3. pharyngeal site
Disruption to what salivary gland system most commonly results in sialocele formation?
Ch 55
Disruption of the small tributary ducts of the monostomatic section of the sublingual salivary gland
What is the most common location of sialoceles in the cat?
Ch 55
Sublingual sialocele/ranula
What size locking titanium mini plates should be used in medium/large breed and small breed dogs respectively? for internal fixation?
Ch 53
Medium/large dogs 2.4mm
small dogs 2.0mm
What is the compression resistance matrix (CRM) or scaffold for recombinant human BMPs (rhBMP) made out of?
Ch 53
collagen with embedded granules of hydroxyapatite (HA) and tricalcium phosphate (TCP)
MasterGraft Matrix
How much collagen matrix should be applied to a defect for BMP reconstructive surgery?
Ch 53
Fill defect with collagen sponge 1/2 to 3/4ths of mandibular hieght and length 2mm greater than defect span
How much volume of rhBMP-2 should be added to the compression resistance matrix scaffold for regeneratie surgeries?
Ch 53
50% of the volume of the prepared scafold
scaffold 4cm x 1cm x 1cm, defect volume 4 cm^3 = 2ml rhBMP-2
What is the definition of an axial-pattern flap?
Ch 52
A pedicle flap of skin and subcutaneous tissue that incorporates a direct cuteaneous artery and vein into its base
What blood vessel is part of the caudal auricular axial-pattern flap
Ch 52
Sternocleidomastoid branch of the caudal auricular artery
This image demonstrates which axial pattern flap and corresponding artery?
Ch 52
Superficial temporal axial pattern flap
cutaneous branch of superficial temporal artery
Flap is equivalent to length of zygomatic arch
Which axial pattern flap is most indicated for rostral maxillofacial defects including the nasal planum? Ch 52
Ch 52
Angularis Oris axial-pattern flap
This image depicts which axial pattern flap and corresponding artery?
Ch 52
Angularis oris axial pattern flap
Cutaneous branch of angularis oris artery
What axial pattern flap is most indicated for periocular reconstruction, wound closure following orbital exenteration, and midfacial defects?
Ch 52
Transverse facial axial-pattern flap
This image depicts with axial pattern flap and corresponding artery?
Ch 52
Transverse facial axial pattern flap
Cutaneous branch of the transverse facial artery
How long after axial pattern flap surgery should revision be performed if the flap is devitalized?
Ch 52
4-7 days
What are the frequencies used for electrosurgery and radiosurgery for gingivectomies respectively?
Ch 20
electrosurgery 0.5 - 2.9 MHz
radiosurgery 3.0-4.0 MHz
Does electorsurgery or radiosurgery result in a smaller zone of thermal necrosis?
Ch 20
radiosurgery
What waveforms of electro and radiosurgical units are appropriate for gingivectomy/gingivoplasty?
Ch 20
Fully filtered waveform - smoothest incisions with least amount of thermal necrosis, no sig hemostasis
Fully rectified waveform - cutting and coagulation, wider zone of thermal damage
What is the definition of biologic width?
Ch 19
The physiologic dimension of the junctional epithelium and connective tissue attachment
Multifilament sutures have what fold higher affinity for bacterial adherence than monofilaments?
Ch 8
5 - 8 fold
What intraoperative hemostatic agents should be removed prior to closure?
Ch 8
Bone wax
Ferric sulfate
Bone wax- can cause inflammatory reaction
Ferric sulfate/VicoStat: can impede bone healing
How long does it take for GelFoam (absorbable gelatin sponge) to be absorbed and what part of bone formation may it impede?
Ch 8
Absorbed in 4-6 weeks
Can impede cancellous bone replacement
Fibrillar (oxidized regenerated cellulose) is absorbed in how many days and may swell up to what percent?
Absorbed in 7-14 days
May swell up to 135% of size
What are the advantages of oxidized regenerated cellulose for intraoperative hemostasis?
Surgicel, Fibrillar
Absorbable glucose polymer based sterile knitted fabric that acts as matrix for clot formation and clot stabilization
Does not impeded epithelialization, is bactericidal, and scaffold function
What is the hemostatic MOA of CollaPlug/hemostatic collagen?
Ch 8
Causes hemostasis via compression and is held in place for 5 minutes
made from bovine deep flexor tendons
Resorbs in 7 weeks
Polysaccharide hemostatic agents like Arista AH degrade in how many days?
Ch 8
1-2
What mechanical principle is utilized for extraction when luxators are employed?
Ch 13
Wedge
What mechanical principle is utilized for extraction when elevators are inserted perpendicular to and between two roots and turned to lift the root from the alveolus?
Ch 13
Wheel-and-axle motion
What mechanical principle is utilized for extraction when elevators are used with the blade along the root and directing the handle downward to lift out the root?
Ch 13
Leverage
Rotational forces are used to tooth roots during extraction using what instrument?
Extraction forceps
root rotated slightly to fatigue apical PDL fibers
What force is used with extraction forceps to deliver the tooth from the alveolus?
Ch 13
Tractional force
What are the 3 fundamental requirements for satisfactory surgical or simple extractions?
Ch 13
1.) Adequate visualization of the tooth to be extracted
2.) Unimpeded pathway for removal of the tooth
3.) Use of controlled force to luxate or elevate and remove the tooth
What length of root fragment requires surgical removal?
Ch 13
> 4mm
When is it appropriate for clients to resume teeth brushing following extractions?
Ch 13
3-4 days postop
What is the crown:root ratio of incisor teeth in a dog?
Ch 14
1:3
What permanent teeth are appropriate to extract in closed fashion?
ch 14
Incisors (often minus maxillary I3)
First premolar teeth
Second premolar teeth in cats
Maxillary first molar teeth in cats
Mandibular third molar teeth
What tooth is shown below?
Feline maxillary first molar
What concentration of chlorhexidine gluconate should the mouth be rinsed with prior to extraction to decrease oral bacterial contamination and reduce incidence of postoperative infection?
0.05-0.12%
What vessels may result in major hemorrhage during extraction of the dog maxillary canine?
Ch 15
The lateral nasal branches of the infraorbital artery and its anastomosis with the branches of the major palatine artery
What is the name of the groove present on roots of large premolar and molar teeth?
Ch 16
radicular sulcus
The white arrowhead corresponds to what structure?
Ch 16
Interradicular septum
How much buccal bone removal is recommended for the maxillary second and third premolars and mandibular second, third and fourth premolars?
Ch 16
Only 1-3mm to expose the furcation for sectioning if needed
According to Verstraete is it acceptable to leave the maxillary first molar extraction site open to heal by second intention?
Ch 16
Yes
Dorsal slippage of a luxator when extracting the maxillary second molar can lead to traumatization of whate vessel?
Ch 16
Minor palatine branch of the maxillary artery
What is the definition of TR1?
Ch 17
TR1: mild dental hard tissue loss (cementum or cementum and enamel)
What is the definition of TR2?
Ch 17
Loss of cementum or cementum and enamel with loss of dentin that does not extend into pulp cavity
What is the definition of TR3?
Ch 17
Deep dental hard tissue loss with loss of dentin that extends into pulp cavity
Most of tooth retains its integrity
What is the definition of TR4 including, a, b and c?
Extensive dental hard tissue loss that extends into pulp and most of tooth has lost its integrity
TR4a: crown and root equally affected
TR4b: crown severely more affected than root
TR4c: Root more severely affected than crown
What is the definition of TR5?
Ch 17
Remnants of dental hard tissue visible only as irregular radiopacities with complete gingival covering
What stage of tooth resorption is acceptable to perform crown amputations/coronectomy in cats with gingivostomatitis?
Ch 17
TR4c
root more severely affected than crown
What 4 variables influence both the mechanism of laser-tissue interaction and the resulting effect on tissue?
Ch 10
Wavelength
beam intensity
time domain of energy delivery
tissue handling
In laser surgery what is the temperature cut off above which tissues can no longer be viable and below which they experience thermal injury but remain viable?
Ch 10
60 degrees Celsius
What is the definition of the dentogingival complex?
Ch 23
The sum widths of the gingival sulcus, junctional epithelium and connective tissue attachments
What is Type III crown-lengthening?
Ch 23
Forced eruption with an orthodontic device to expose more of the tooth
When performing Type II crown-lengthening when a fracture or caries extends below the gingival margin or to increase the crown length for prosthodontic work, the new alveolar margin should be placed how many millimeters apically?
Fracture or caries: 2mm or more apical to apical most extent of lesions
Prosthodontics: minimum of 3mm apical to planned new free gingival margin
What is healing by third intention?
Ch 1
Staged procedure where wound is allowed to granulate and heal by second intention before a delayed primary closure is carried out by bringing together the two surfaces of granulation tissue
What are the key mediators of wound healing/chemoattractants?
Ch 1
Platelet-derived growth factors (PDGFs)
Transforming growth factor beta (TGF-Beta)
Recruit inflammatory cells that begin to remove damaged tissue and bacteria from injured area
What is the predominant inflammatory cell during the first 2-3 days following injury and what what cell(s) are they replaced by?
Ch 1
Neutrophils: first 2-3 days
Then outnumbered by macrophages derived from mobilized monocytes
Macrophages regulate the formation of granulation tissue through release of what modulating cytokines?
Ch 1
Platelet derived growth factor (PDGF)
Vascular endothelial growth factor (VEGF)
In general –> the maximum strength of a healed wound is reached in how long?
Ch 1
6-12 months
Never reaches the strength of unwounded tissue
Organization of the clot within the extraction site begins how soon after extraction?
Ch 1
within the first 24 to 48 hours
What occurs in the first week of extraction site healing?
Ch 1
Clot forms forms a temporary scaffold for inflammatory cells to migrate upon
Epithelium at wound periphery grows over surface of organzing clot
Osteoclasts accumulate along the alveolar bone margin (crest in humans)
Angiogenesis begins in remanents of PDL
What occurs in the second week of extraction site healing?
Ch 1
Continued clot organization through fibroplasia and neoangiogenesis penetrating toward center of clot
Trabeculae of osteoid extend into clot from alveolus, osteoclastic resorption of cortical margins more distinct
What occurs in the third week of extraction site healing?
Ch 1
Extraction socket filled with granulation tissue
Poorly calcified bone formed around periphery of wound
Surface of wound completely reepithelialized with minimal or no scar formation
At what time frame after extraction is the alveolus completely epithelialized when left to heal by second intention?
Ch 1
3 weeks
When does radiographic evidence of bone formation at an extraction site become apparent?
Ch 1
6 - 8 weeks following extraction
When does the extraction site become radiographically inconspicuous?
Ch 1
6 to 8 months
Collagen deposition and wound tensile strength are limited by what factors?
Ch 1
Tissue perfusion and oxygen tension
What condition is primarily responsible for poor wound healing in diabetic patients?
Ch 1
Diabetic microangiopathy
Local ischemia, secondary to poor oxygen delivery at the tissue level, and small vessel occlusion play an essential role in the pathogenesis and delayed healing of diabetes
What is the key amino acid of wound healing?
Ch 1
Methionine
Metabolized to cysteine which plays a vital role in the inflammatory, proliferative and remodeling phases of wound healing
What are the three most important conditions necessary for bone formation and mineralization?
Ch 2
Pluripotent precursor cells
ample blood supply
mechanical stability
What are Volkmann canals?
Ch 2
contain nutritional vessels that arise from the periosteal and endosteal bone surface
connect with Haversian vessels within osteons
What is extraosseous circulation?
Ch 2
Development of a temporary blood supply external to the bone when normal blood supply interrupted by a fracture
Arises from surrounding soft tissue/buccal mucosa
Health of surrounding soft tissues crucial for fracture repair
Direct bone healing is a synergism between what types of healing?
ch 2
Contact and gap healing
Why do maxillary fractures tend to heal faster with fewer complications than mandibular fractures?
Ch 2
Bones of maxilla consistent of relatively thin lamina and so have a much greater bone surface area per unit volume that is exposed to soft tissue
Greater proximitity to vascular supply of soft tissues –> greater healing potential
What is the term for replacement of cartilage by bone in fracture healing?
Ch 2
Endochondral ossification
Direct bone healing occurs when only what type of connective tissue forms between the fracture fragments?
Ch 2
Bone
What criteria are necessary for contact healing to occur?
Ch 2
No gap and direct cortical contact
Bone union and Haversian remodeling occur simultaneously
What conditions need to be present for gap healing to occur?
Ch 2
Gap in fragments > 200 micrometers < 800 micrometers
Bony union and Haversian remodeling are separate sequential processes
gaps filled in with transversely oriented lamellar bone that is parallel with fracture orientation
Then Haversian remodeling occurs across fracture line
In gap healing, replacement with lamellar, transversely oriented bone is completed within how many weeks, and Haversian remodeling to replace the lamellar bone with cortical bone occurs after how many weeks?
Ch 2
Lamellar bone: 4-6 weeks
Haversian remodeling and cortical bone: 10 weeks
What craniofacial fracture repair technique provides the optimum environment for direct bone healing?
Ch 2
Miniplates
What are major and minor contacts of screws with tooth roots?
Ch 2
Major > 50% screw diameter penetrating tooth root
Minor < 50% screw diameter penetrating tooth root
Minimal morbidity for human patients with major or minor contact
Is interfragmentary compression necessary for direct bone healing in the craniomaxillofacial skeleton? (not the mandible)
ch 2
No!
Administration of what types of medications can cause osteonecrosis in people?
Ch 58
Bisphosphonates
Denosumab
Antiangiogenic medications
What are the potential causes of osteonecrosis?
Ch 58
Administration of certain systemic medications
Iatrogenic drauma –> extractions
Radiation therapy
Dental infections
Idiopathic
What factors are commonly reported in dogs with ONJ?
Ch 58
Recent dental extractions
Oral Antibiotic use to treat oral/dental disease
Maximal compressive stresses exit the mandible at what surface?
Ch 27
Aboral
What are the anatomic names of the rostral/medial, lateral and caudal buttresses of the maxilla/face?
Ch 27
Rostral/medial: Nasomaxillary buttress
Lateral: zygomaticomaxillary buttress
Caudal: Pterygomaxillary buttress
What interdental wiring technique is shown?
Ch 31
Ivy Loop
What interdental wiring technique is shown?
Ch 31
Stout loop
What interdental wiring technique is shown?
Ch 31
Risdon wiring with secondary wires anchoring around individual teeth
What interdental wiring technique is shown and what type of fractures is it best used for?
Ch 31
Essig interdental wiring
Reduction and stabilization of luxated canine teeth with alveolar bone fracture
Intraoral splints are best applied in what types of fractures?
Ch 31
Transverse or favorable fractures in the mid body or rostral mandible
At least two teeth should be available on either side of fracture to stablize
What is the name of this instrument used to fracture the splint into segments for removal?
Ch 31
Bond removing forceps
What is the defintion of a malunion?
Ch 35
Healed fracture in which anatomic bone alignment was not achieved or maintained during healing
What is the definiton of a nonunion?
Ch 35
A fracture that has failed to heal and does not show any further signs of progression towards consolidation
What is the difference between a viable and nonviable nonunion?
Ch 35
Viable nonunions are hypervascular
Nonviable nonunions are avascular
