Exam 1 (Lectures 1-6) Flashcards by Shereen Huff

average formation of 3rd molar formation is ____

20-24 years

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pathognomic indicating md fracture

sublingual hematoma

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cleft lip with or without cleft palate is the failure of fusion between the

median nasal process and the maxillary process

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osteomyelitis results in

ischemia and bone necrosis

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skeletal defiency secondary to oligodontia

ectodermal dysplasia

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option for intrusion

allow passive eruption (deciduous teeth) orthodontic traction stabilize 2-3 months

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Name six indications for orthognathic surgery

skeletal discrepancy with masticatory difficulty impingement on palatal tissue speech difficulty OSA psychosocial problems esthetics

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what procedure has low morbidity

Lefort 1

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limited correction is possible for this type of movement

growth redirection

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open apex of avulsed teeth (<2 hours) (7) steps KNOW FOR CLINIC

reimplant immediately 2. transport in Hanks soln or milk 3. Doxycycline 4. LA, socket irrigation, Tetanus 5. Replant 6. Splint for 7-10 days 7. Apexification (Ca(OH)

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why do we close in layers

to eliminate dead space

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position of 3rd molars does not change substantially after _____

25 years

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non-surgical treatment of fractures is indicated in which situations

fractures without malocclusion and a compliant patient

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are vertical impacted md 3rds easy or hard according to winter’s classification?

generally easy

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which type of healing has a little bit of movmenets

secondary healing

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closed reduction requirements

good teeth

favorable fracture

min-mod displacement

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palatal repair of cleft palate patients should be done when

12 months

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velopharyngeal flap helps eliminate _____

nasal speech

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the role of age in third molar surgery

  Surgery less complicated §  Healing process quicker

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if pt has a fractured mandible they will have

malocclusion

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attaches part of soft palate to posterior wall of pharynx

velopharyngeal flap

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periodontal compromise

orthodontic camouflage

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in orthognathic surgery what does the stent determine

AP and transverse

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how long can an avulsed tooth last in milk

six hours

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incidence of cleft lip with or without palate in african-american

1:2000

full bony impaction of 3rd molar

D7240

area between the mental foramina

symphysis

what winter's classification is this

mesioangular

vertical maxillary deficiency

class 3

posterior to canine and anterior to mental foramen

parasymphysis

\<2 hours closed apex tx of avulsed teeth

1. Store in hank's solution 2. Replant 3. Splint for 7-10 days 4. Perform endodontic cleansing and shaping of canal 5. fill canal with Ca(OH)2 (6-12 months) 6. perform gutta percha obturation (6-12 months)

fusion of facial structures occur at what week

week 7

how often do vertical impacted md 3rds occur (winter's classification)

38%

disadvantages of extraoral approach for surgical

external scar potential for facial n. damage

surgical procedures for mx

maxilla anterior segment, posterior segment, Lefort 1, high lefort 2 and 3

Principles of Management for Fractures

1. Reduction 2. Stabilization 3. Immobilization 4. Prevent Infection

why does osteomyelitis occur

Smokers End-stage process of long wound healing Immunocompromised

dentition used as the handle to reduce the fracture

closed reduction

orthognathic movements on cleft palate patients have to use what

distraction

big advantage of a BSSO (Saggital Split Ramus Osteotomy)

can advance the jaw without doing a bone graft

pt's occlusion and teeth then wired together

maxillo-mandibular fixation in closed reduction

fracture of the cheekbone

zygomaticomaxillary complex ZMC

most commonly selected time for alveolar bone graft for cleft lip/palate

mixed dentition grafting

what winter's classification is this easy or difficult?

horizontal difficult

TMJ considerations for this type of movement

growth redirection

Class 2 bites have what percent occurrence

10%

what winter's classification is this

vertical

which type of healing has no movements

primary healing

lacerations tx

return tissue to proper orientation

Class 2 bites need surgery what % of times

Subperiosteal Abscess occurs when

2 – 3 weeks post op

metallic sound upon percussion

intrusion

AAOMS / OMSF •  7 year study •  Advised that even most 3rds that are asymptomatic and free of disease are at

Advised that even most 3rds that are asymptomatic and free of disease are at **risk for _chronic oral infections_** **_tooth decay_ and should be considered for removal in young adulthood**

impacted/unerupted. FIll in blank Not all __________ teeth are \_\_\_\_\_\_

unerupted/impacted

high mortality rate and brain trauma resulting from this fracture

LeFort 3

extraction technique for mx third molars

Flap design •  Approach

Name four advantages of orthognathic surgery

decreased treatment time improved esthetics improved occlusion increased esthetics

Based on inclination of impacted tooth to long axis of 2nd molar

Winter’s Classification

what is the easiest winter's classification

mesioangular

Bleeding: Intraopeatively from 3rd molar extractions

give local, bone wax, Gelfoam, Surgicel, pressure pack if needed

velopharyngeal flap complications

mouth breathing, OSA, complicates intubation for surgery

incidence of isolated cleft palate

1:2000

reimplanted tooth (mature) stabilization periods

7-10 days

tx of abrasions

DEBRIDEMENT 1) scrub with mild soapy water/irrigate with saline 2) cover with thin antibiotic ointment

advancement of set back of mandible

BSSO bilateral saggital split osteotomy

in orthognathic surgery the vertical position is determined by what

k-wire placed in the nasion

fratures involving upper, middle, and lower face

panfacial trauma

Treatment options for facial fractures

No treatment Closed Reduction Open Reduction with rigid internal fixation Combination

what % of time does distoangular classifications occur for md molars

general facial form is defined by what

Na-A-pg form

convex profile is usually what

skeletal and dental class 2

complex, full bony impaction of 3rd molar

D7241

fractures of medial orbital walls

ethmoid fractures

class 3 bites have what percent occurrence

2.5%

crown formation of thirds

14 years

frontal sinus fractures can lead to

brain abscess

continuous bleeding may lead to

hematoma

in cleft lip with or w/out cleft palate the lip/alveolous is contiguous without any

vestible

theories behind impacted thirds

Differential root growth between mesial & distal •  Inadequate arch space •  Dental development lags skeletal development •  Obstruction secondary to cyst, tumor, supernumerary teeth

mesioangular impacted md 3rds occur what % of time

43%

how to manage thirds in pt \>40 yrs

Monitor with panoramic x-ray every 1-2 years •  Surgical intervention for clinical symptoms or radiographic signs

secondary to \_\_\_\_\_\_\_\_\_\_\_\_, _______ remains open during speech and \_\_\_\_\_\_

velopharyngeal incompetence, nasal airway remains open during speech and air escpaes

treatment for extrusion and lateral displacement

reposition tooth fully at socket splint tooth for 1-3 weeks

move maxilla in all planes

Lefort 1

classify this

distoangular impaction of mx third molar

INTRAOPERATIVE COMPLICATIONS •  Sinus Perforation what to do?

*   Sinus Perforation *   Antibiotic *   Decongestants *   Afrin nasal spray *   Written & verbal instructions •  Suture tight •  Follow-up (ADAWSF)

tooth not having perforated the oral muocsa

unerupted tooth

what has shown to remove 100% of the cpap in patients

maxillo mandibular advancements

recovery period of 3rd molar extractions

3-4 days

how long can an avulsed tooth last in Hanks solution

24 hours

chief complaint of pts who have md fracture

malocclusion

may not be stable when used for anterior open bite

BSSO (bilateral saggital split osteotomy) BSSO

fracture common in fights

ZMC complex

what makes the cleft palate patient different?

large maxillary AP defiencies scar tissue VP incompetence vascular compromise palatal and nasolabial fistulas

stable treatment of anterior open bite

Lefort 1

incidence of cleft lip with or without palate in whites

1:1000

Alveolar fractures treatment

stabilization, reduction, RCT

residual _______ at _______ and in _______ is common in palate repair

residual fistula at anterior of palate and in vestible is common

what bacteria are we considered about in animal bites

pasteurella multocida (gram-negative rod)

root fracture stabilization periods

2-4 months

compression fracture of alveolus to accomodate new position

intrusion

opposite movement of pre-surgical orthodontics

orthodontic camouflage

what symptoms are associated with osteomyelitis

imflammation and edema

pt has grossly displaced md fracture what tx to use?

open reduction with internal fixation (ORIF)

lacerations management

cleaning/debridement/hemostasis/closure

what winter's classification is this

distoangular

failure to fully erupt within the expected developmental time period

impacted tooth

painful, owing to exposed nerve endings

abrasions

classify this

mesioangular impaction of maxillary third molar

Ideal Patient Selection for 3rd molar removal (5) \_\_\_\_\_ root formation \_\_\_\_\_\_age + 3 others

2/3RD root formation *   18-25 year old *   Healthy *   No psychological contraindications *   No job restrictions to “numb lip”

dentition is used as a handle to reduce the fracture

closed reduction

between sigmoid notch and the top of the condylar head

condyle

what type of movement has a possible periodontal compromise

orthodontic camouflage

T or F Most healthy 3rd molar patients benefit IVSA / GA

true

for minimal discrepancy

orthodontic camouflage

Nerve Injury

*   Nerve Injury *   Follow *   Document, document, document *   Steroid dose pack *   Neurosensory testing *   When to refer? *   Malpractice

results in multiple fractured segments

comminuted fracture

extraoral approach for surgical approach

excellent access for reduction/fixation

pt has facial fracture and has lung disease

open reduction with internal fixation (ORIF)

Midface Fractures

LeFort 1,2,3 ZMC, ZOE

partial bony 3rd molar impaction

D7320

intraoral surgical approach disadvantages

oral contamination fracture reduction can be difficult to reduce

what is noticed with chronic osteomyelitis

\> 1 month Dull discomfort Paresthesia Moth eaten appearance of bone on film

how common are mesioangular mx 3rd winter's classifications

12%

how common are horizontal mx 3rd winter's classifications

1% -rarely seen

most frequently used md procedure

BSSO (bilateral saggital split osteotomy)

removes papillary dermis and epithelial layer

abrasions

how common are distoangular mx 3rd winter's classifications

25%

when should lip repair be done in cleft palate/lip patients

Rule of ten pt is 10lbs WBC\<10 HG\>10 10 weeks

what percentage of BSSO patients have IAN nerve damage

50%

classification of soft tissue 3rd molar impaction

D7220

between sigmoid notch and angle

ramus

how often does horziontal md molar 3rd impactions occur

possible esthetic compromises

orthodontic camouflage

allows segmentalization of maxilla

Lefort 1

whole part of midface is fractured, most severe

LeFort 3

what to do for bleeding vessels

clamp/tie/cauterize

how long does post-surgical orthodontics take

6 months

in mixed dentition graft in cleft lip/palate patients and lateral incisor is absent or pt is small or cleft is large, \_\_\_

delay until later

what tooth is functionally missing in cleft lip/palate patients and what %

80% lateral incisor

expose fractures and use direct visualization and dentition to manipulate segments into place then fixate with plates and screws

open reduction with internal fixation (ORIF)

POSTOPERATIVE COMPLICATIONS •  Secondary bleeding

Suction oral cavity •  Examine site *   Apply pressure for 5 minutes *   Local *   Curettage *   Identify and control source of bleeding *   Monitor for 15 minutes before discharge

bone healing in the wrong position

malunion

stabilization periods for displaced tooth

3-4 weeks

Contraindications to removal of 3rd molars

Extremes of age: Yo u n g a g e : mandible may grow to accommodate 3rd molars Old age: most common contraindications for removal

tx for pasteruella multocida

augmentin po for 7 days

what is problem in speech evaluation of cleft lip/palate patients

nasal speech

rarely need for intermaxillary fixation (wiring of the teeth together)

orthognathic surgery

class 3 bites need surgery what percentage of time

40%

pt has facial fracture and has seizures what treatment to use

open reduction with internal fixation

direction of the fracture line is different then the muscle line

favorable

classify this

vertical impaction of maxillary third molar

how long is maxillo-mandibular fixation needed for in closed reduction

4-8 weeks

layers of the lip

1) muocsa 2)orbicularis oris-muscle 3) skin

incidence of cleft lip with or without cleft palate with male and females

male: female 2:1

regions involved in panfacial trauma

frontal bone ZMC NOE region maxilla and mandible

how long does pre-surgical orthodontics take

12-18 months

mandibular intraoperative complications of 3rd molar removal

*   Root tip out lingual plate *   Submandibular, lingual *   Nerve injury *   Fracture

indications for 3rd molar removal

Indications for 3rd molar removal Therapeutic To treat a currently active process/disease Prophylactic To prevent future disease or other problems

what type of movement has a possible esthetic compromise

orthodontic camouflage

incomplete fracture

greenstick

how common are vertical mx 3rd winter's classifications

63%

possibly less stable

orthodontic camouflage

name the maxilary winter's classification

vertical distoangular mesioangular horizontal

must have remaining growth to work

growth redirection

what may improve speech evaluation/therapy in cleft palate/lip patients

velopharyngeal flap

stable rigid fixation possible

BSSO (bilateral saggital split osteotomy) BSSO Lefort 1

a callous/cartilage involves which phase of healing

secondary phase

which trauma to tooth has the worst prognosis

intrusions

maxilary intraoperative complications of oral surgery

Infratemporal fossa •  Tuberosity “tuberectomy” •  Oroantral communication

what is used for large AP discrepancies

distraction

fracture line is allowing the bones to be displaced

unfavorable

where are incisions made for orthognathic surgery

intraoral

what to expect after 3rd molar surgery as far as pain/swelling

Expected mild-moderate pain •  Expected mild-moderate swelling to peak at day 3 and decrease after •  Expected to feel lousy – dental surgery – makes talking, eating, and social situations hard for a few days

tx of subperiosteal abscess

Flap and irrigate • Antibiotics

has potential for iAN nerve damage

bilateral saggital split osteotomy (BSSO)

reimplanted tooth (immature)

3-4 weeks

combined orthodontics and surgery are used to manage a skeletal malocclusion

orthognathic surgery

incidence of isolated cleft palate in females: males

2:1

single fracture line

simple fracture

vertical maxillary hyperplasia

class 2

stabilization periods for mobile tooth

3-4 weeks

accentuate dental compensations

orthodontic camouflage

bleeding under the skin

contusion

what is the critical driving force in cleft palate repair

speech

odontogenic bacteria invade bone marrow describes what process

osteomyelitis

communication with the external environment

compound fracture (open)

what percentage of patients are happy with BSSO even with IAN numbness

90%

concave profile is usually what

skeletal and dental class 3

advances the anterior pharyngeal palate and enlarges the mandible

maxillo-mandibular advancement

◦ \_\_\_\_moved the envelope of discrepancy further out for the dental movements

TAD

pyramidal fracture bc of shape involving orbit

LeFort 2

how long can an avulsed tooth last in ViaSPan

a week

abrasions leaves what exposed

raw bleeding reticular dermis

lacerations are a tear in what

epithelial and subcutaneous tissue

just the fracture of the maxilla

LeFort 1 fracture

patients occlusion established and teeth are then wired together

maxillo-mandibular fixation

Three ways to treat skeletal malocclusion

1. Growth Redirection 2. Orthodontic Camouflage 3. Orthognathic Surgery

first treatment of avulsed tooth

put it back

straight profile is usually what

skeletal and dental class 1

indicating of a fractured mandible

floor of mouth hematoma

what systemic problems are seen in cleft lip/palate patients

middle ear disease cardiac disease

Collection of purulence between periosteum of flap and bone

Subperiosteal Abscess

intraoral surgical approaches benefits

no external scar no f. nerve damage

what three signs are noticed with acute OM

Duration \< 1 month Pain Minimal to no radiographic changes

root formation is approximately ____ by _____ years

Root Formation approximately 50% by 16 years

compliance and burnout are possible for this type of movement

growth redirection

pt has a condylar fracture

open reduction with internal fixation (ORIF)

not healing, bone segments are still moving

nonunion

in mixed dentition grafting if lateral incisor is present, consider grafting \_\_\_\_

early

name the 4 winter's classification

•  1. Mesioangular •  2. Distoangular •  3. Horizontal •  4. Vertical

purpose of stannous fluoride in a RCT

prevents root resorption

purpose of citric acid in a root canal

disinfects dentinal tubules

stabilization period for mobile tooth

3-4 weeks

stabilization periods for displaced tooth

3-4 weeks

stabilization periods for roor fracture

2-4 months

stabilization periods for reimplanted tooth (mature)

7-10 days

stabilization periods for reimplanted tooth immature

3-4 weeks

blunt trauma can cause this type of injury

contusion

subcutaneous or submucosal hemorrhage wihtout breakage of the soft tissue

contusions

treatment of contusions

surgical exploration if arterial involvement is involved antiobiotic if contaminated

removes epithelial layer and papillary dermis

abrasions

soaps which enter a wound can cause

cellular damage and necrosis

Exam 1 (Lectures 1-6) Flashcards

(223 cards)