Perio

Miller’s classification (mobility): ( fermitus)

■ Grade I—slight , horizontal mobility up to 1 mm.
■ Grade II—moderate , horizontal mobility ≥1 mm <2mm
■ Grade III—sever , horizontal mobility >2 mm and/or vertical mobility.

Glickman Furcation Classification

■ Grade I—Incipient bone loss. Furcation probe can feel the depression of
the furcation opening.
■ Grade II—Partial bone loss. Probe tip enters under the roof of the furcation.(cul-de-sac)
■ Grade III—Total bone loss with through-and-through opening of the fur-
cation. The furcation entrance is not visible clinically.
■ Grade IV—A Grade III furcation where the furcation entrance is visible
clinically

treatment of Furcation =
Class I furcation: scaling and root plan- ing (SRP) , furcation plasty
• Class II furcation: furcation plasty( elimination of the inter-radicular defect) ; tunnel
preparation( deep) ; root resection(deep); tooth extraction; guided tissue regeneration at
mandibular molars
• Class III furcation: tunnel preparation; root resection; tooth extraction.

infrabony defects
1 wall hemiseptal
2 wall crater( most common)
3 wall trough
4 wall circumferential (extration socket)

Miller classification ( Recession):

class l not exctending to MGJ , no loss of ID bone
class ll. exctende to MGJ , no loss of ID bone
class lll. extend to MGJ + partial ID bone loss
class lV. extend to MGJ + sever ID bone loss

Degree of gingival enlargement=

• Grade 0: No signs of gingival enlargement.
• Grade I: confined to interdental papilla.
• Grade II: involves papilla + marginal gingiva.
• Grade III: covers three quarters or more of the crown.

gingival index (Löe and Silness) =

assessment of gingival inflammatory before and after phase I therapy/ surgical therapy
0 : No inflammation
1: Mild = slight change in color , No bleeding
2 : moderate = redness , bleeding on sensing
3 : sever = redness , bleeding spontaneous , ulceration
4 : tooth missing

Grades of bleeding =
Grade l bleeding after 60 sec
Grade ll after 30 sec
Grade lll within 30 sec
Grade lV spontaneous

periodontal disease( severity)

slight: 1-2 mm CAL
moderate: 3-4 mm CAL
sever: >5mm CAL

periodontal disease (distribution)

Localized <30%
Generalized >30%

Bacteria
A.Actinomycetemcomitans = causes Aggressive periodontitis
P.Gingivalis = Chronic periodontitis
T.Denticola= ANUG/ANUP
P.intermedia= Pregnancy gingivitis

Extrinsic stains
orang = poor OH
brown = dark beverages
Dark-brown+ black = tobacco
Yellow-brown = CHX + stannous fluoride
green = chromogenic bacteria
blush-green = metalic dust

proinflammatory Mediators
IL-1 = bone resorption
MMPs= collagen destruction

Gingivitis
Stage1 = initial lesion 2-4 days , netrophil
Stage 2 = Early lesion 4-7 days , T lymphocytes , bleeding
Stage 3 = Establish lesion 14-21 days B lymphocytes , plasma cells , change color
stage 4 = advanced lesion , periodontitis

ANUG classification=
Stage 1 : tip of IDP
Stage 2: entire papilla
Stage 3: gingival margin
Stage 4: attached gingiva
Stage 5: buccal or labial mucosa
Stage 6: exposing alveolar bone
Stage 7: perforating skin

Treatment plan
0 preliminary phase = Emergency, extract hopeless teeth
1 non-surgical phase = plaque/ diet/caries control , correct restoration , SRP *periodontal re
evaluation occurs = 4-8 weeks
2 surgical phase = eliminate perio pockets flaps, Endo, implants
3 restoration phase = Fixed, RPD, final restoration
4 maintenance phase

*vertical bone loss Better prognosis than horizontal bone loss

*CAL is the most important factor in determining the prognosis

Sickle scalers
supragingival calculus + Triangle in cross section

Curettes
semicircular in cross section
Universal currettes= two cutting edges
Gracey currettes= one cutting edges
1-2 and 3-4 — anterior
5-6 — premolars
7-8 and 9-10 — posterior, facial and lingual
11-12 — posterior, mesial
13-14 — posterior, distal

Ultrasonic scalers
for Tenacious calculus
Magnetostrictive ultrasonic = elliptical patteren
Piezoelectric ultrasonic = liner patteren

initial insertion
currettes = 0 degree (closed-angle)
SRP = 45-90 degree (open-angle)

periodontal pack
ZOE , for 1 week , protect wound , do Not enhance healing
Gingivaectomy = eliminate suprabony pockets
Gingivoplasty = reshape tissue
Healing by Secondary intention Bcz there is no tissue to approximate

osteoectomy= remove supporting bone

osteotomy= remove non supporting bone

Distal wedgs incision

Max = full thickness flap with Parallel incision
mand = V- shaped incision

free gingival graft = to create band of keratinized tissue near to tooth cervical or around
implant and aboutment tooth , disav: asthetic color , uncomfortable healing ,
connective tissue graft = root coverage
Recession in upper anterior what graft to use = connective graft
palate most common site for FGG + CTG

Positive architecture = interproximal bone Coronal to radicular bone

negative architecture = interproximal bone Apical to radicular bone
Flat architechture = at same level

Mechanism of healing
regeneration =complete restor architecture + function
Repair = not complete restor architecture + function , long JE

bone graft
Autograft = from yourself
allograft= another human
xenograft = another animal
alloplast= synthetic

osteoconductive = scaffold
osteoinductive = convert neighboring cells into osteoblasts

1-2 wall defect = resection > restore positive architecture

3-4 wall defect = regeneration

NSAIDS = inhibit prostaglandins( causes inflammation)

bisphosphonate = inhibit osteoclasts , used for osteoporosis, IV have higher risk of
bisphosphonate-associated necrosis of the jow BONJ, recommended for patients with
osteoradionecrosis non surgical endo even if its retained root
subantimicrobial dose doxycycline SDD = inhibits MMPs

Sharpey’s fibers = type l collagen

Acellular cement = coronal + middle , Cellular cementum = apical

Blood vessels supply gingiva = supraperiosteal blood vessels

Type of mucusal gingva = masticatory mucosa

Principal cell of gingiva = keratinocytes

Bacteria asso with periodontal health = gram + facultative spp

Linear gingival erythema = in HIV gingivitis

Initial stage l = PMN

Early stage ll = lymphocyty , Erythma
Established lesion lll = plasma cells

Bacteria asso with NUG = fusospirochetal complex ( fusiform + spirchetes ) + P.

intermedia + Treponema

NUP differs from NUG = loss of attachment

Bacteria asso with gingivitis of pregnancy = black pigmented bacteroides

Active periodontitis? = causing apical migration

Healty crestal bone 2mm below CEJ

Most accurate radiograph for bone loss = vertical bitewings

Common patteren of bone loss = horizontal

Inflammatory mediator indicated disease activity = IL-1

Least amount of attached gingiva = in mand premolars

Narrow three-wall periodontal defect = most likely to repair after therapy

Antibiotic for acute periodontal abcess = penicillin V

Local delivery for chronic periodontitis = minocycline + doxycycline

Ttt aggressive periodontitis = amoxil + mertonidazole

Indication for locally adminsteration antibiotic = pocket > 5mm

Microbe asso with hairy leukoplakia = candida albicans , antifungal nystatin + fluconzole

Root sensitivity = movement of fluid

Fremitus = vibration or movment of tooth in functional occlusion

Gingival hyperplasia = phenytoin + nifedipin + cyclosprine

Interproximal knives = orban 1/2 , gingivectomy = kirkland 15/16

Odontoplasty = reshaping root

Most involved in root amputation = max molars

Fiberotomy = perio surgery adjunctive to ortho for tooth rotation to prevent relapse

Gingival augmentation = inadequate attached ging

Primary reason for free gingival graft failure = inadequate blood supply

Sloughing free gingival graft = dies of superficial layer of graft

Type of flap used with free gingival graft = partial thickness > periosteum is the blood
supply

Osseous coagulum = shaving bone and blood collected to defect during surgery

GTR = regenerate cementum + PDL + Bone

Ant mand = highest success rate

Post maxilla = highest failur rate

Bacteria asso with peri implantitis = A.actinomycetemcoitans + P.gingivalis +

P.intermedia

Indicate periodontal breakdown = bleeding

The final outcome of periodontal pocket healing:

1- If the epithelium proliferates reach 1st= the area, the result will be a long junctional
epithelium.
2- If the cells from the gingival connective tissue 1st = fibers parallel to the tooth surface
and remodeling of the alveolar bone with no attachment to the cementum.
3- If bone cells arrive first = root resorption and ankylosis may occur.

O’leary index = for plaque control record , disclosing agent ex: Bismarck brown + Diaplac

Mechanism of metronidazol = DNA inhibitors

mechanism of penicillin = cell membrane inhibitors
Minocycline inhibits = 30s ribosomes ( protein synthesis )

probing forces well tolerated = 0.75 N

prob forces to remains within the junctional epithelium = 30 g

prob forces to reach the bone level = 50 g

grading of fermitus = G1 Mild vibration , G2 palpable vibration but not visible , G3 visible
movements

UNC-15 prob = 5 10 15
WHO = 0.5 ball , 3.5 8.5 11.5
Marquis prob = 3 6 9 12 , in 3mm sections

Space b/w implamt and natural teeth = 1.5-2mm

b/w two implants = 3mm

Sickle scalers = to remove supragingival calculus (pull stroke) , triangular tip , two cutting
edge

thin scallped phenotype = sensitive to inflammation and trauma periodontal inflam

blade angle = universal Currettes ( 90 degree) , Gracey currettes ( 60 degree) to shank

*Gracy currettes =
0 = inser5on
45-90 = blade activatio
70-80 = blade angel
100-110 = blade to stone sharping

Blade angle = universal 90 , Gracey 60

pocket = formed by coronal movment of gingival margin (gingival pocket ) , apical

displacment of gingival attachment

percentage of osseous crater = of all defect one-third 35.2% , for all mandibular two-third
62%

tooth is hopeless = caries reaching furcation area

Biological width =2.04mm from base of the pocket to alveolar bone level.

Normal gingival margin = 1-2mm above CEJ

Tumor metastasis to the gingiva = adenocarcinoma of the colon + lung carcinoma,

melanoma + renal cell carcinoma

Angle used for sharpening instrument?100-110 , or 70

Best wall defect prognosis= three wall

effect of occlusal forces TFO = influenced by magnitude + direction + duration +

frequency

Healing after root surgery = long junctional epith

Acute inflammation response = Gingival abscess

Healing after scaling takes =periodontal tissue heals in 4 weeks

Most surface for calculus = Lower mand

Multi rooted teeth rotate around= At furcation

acquired pellicle = is a protein film / peptide / glycoproteins that forms on the surface
enamel , function as receptor for bacteria

Stephen curve def = determine the impact of ingested foods on the pH of dental plaque
and caries formation. to prevent decalcification

Terminal shank elongated for posterior teeth (gracy) = 3mm

Least tooth to be impacted = upper lateral

Percentage of Osseos craters = 35%

most seen in Pregnant Women = gingivitis , gingival overgrowth

5 Aides to smoking cessation = Ask > advice > Assess > assist > arrange

Primary occlusal trauma = excessive force applied to a tooth with normal supporting
structures.
Secondary occlusal trauma = excessive force to a tooth with inadequate support
(periodontal disease)

Reverse smoking causes= oral malignancy ( palate )

to improve gingival biotype (asso with thin facial bone) = connective tissue graft

Biological width = 1mm connective tissue and 1mm epithelial tissue

ttt Chronic inflammatory enlargements = SRP > if enlargement remains a gingivectomy

is used
ttt Drug-induce gingival enlargment = Alternative medications Or if small area <6 teeth
(gingevectomy at least 3mm of keratinised tissue) , large area >6 teeth (flap)
anticonvulsant phenytoin = carbamazepine + valproic acid
nifedipine = diltiazem or verapamil
cyclosporine = Tacrolimus

ttt Leukemic enlargement = SRP + antibiotic

ttt gingival enlargment in pregnancy = SRP
ttt enlargement in puberty = Scaling and currettes

Lysosome function in saliva = antibacterial / antimicrobial

perioChips = relase CHX for 7-10 days

Minocycline = Minocycline administered 200 mg/day for 1 week results in a reduction in
total bacterial

high labial frenum = Surgical frenectomy , Laser > if thin phenotype or bleeding disorder

CHX = antibacterial + Substantivity

Smoking effect on gingivits = less bleeding and less inflammation

Type of floss depends on = personal preference

Resective periodontal surgery = open flap and root depridment

Complete healing of the gingivectomy = takes 4–5 weeks

After gingivectomy : Complete epithelial repair takes 1 month

complete Connective Tissue repair takes 7 weeks

Factors for choice of dental floss= tightness of contacts+ roughness of proximal surfaces
 recommendations about type of floss should be based on = ease of use and personal
preference

Prognosis is poor f= short, tapered roots and large crowns > Because of the
disproportionate crown-to-root ratio

Disadvantages of Florida prob (Automated probe(electrical currate) =underestimate

deep pocket - less variability - little tactile sensitivity > difficult with’ walk ‘ the prob

Systemic condition asso with periodontal accesses = diabetes

Clinical signs for trauma from occlusion = mobility - thermal sensitivity - attrition -
recession (facial)

measuring gingival cervical fluid GCF = electronic method ,“blotter” (Periopaper )

Common microrganism in periodontal abscesses= F. nucleatum, P. intermedia, P.

gingivalis, P. micra, and T. forsythia

Measure horizontal mobility = pressure in 2 ends metal instruments

Sir lace research

8% = rapid progression of periodental deisease

81% = moderate periodental with loss attachment

11% = no progrestion of destrutive disease

McCall festoons = rolled, thickened band of gingiva , adjacent to the cuspids when
recession reaches the mucogingival junction , both McCall + still mans because > occlusal
trauma

Stillman’s clefts = narrow, triangular-shaped gingival recession

Schiller's potassium iodine test (Lugol's solution) = stain keratinaiezed gingiva , better
visualize mucogingiva junction

Gingival epithelium = Functions : Mechanical, chemical, water, and microbial barrier

Signaling functions

Major Cell Type in gingiva : Keratinocyte

Other Cell Types : Langerhans cells Melanocytes, Merkel cells 


Synthesis of basal lamina components: Hemidesmosome

scalloped, thin gingiva = more prone to recession, laser contraindicated , retraction cord
could be use
Measure of mobility = by two instruments Or one hand and one finger

Systemic Antibiotics for ttt of chronic periodontitis used with poorly controlled diabetes
may be beneficial

Main component of Pedicle swelling = palatal stent > to allow for swelling occur

Heavy smoker > or equal 20 cigarettes / day - light smoker < 19 cigarettes /day

Occlusal trauma = injury - healing - adaptation - normal

Easier Root planning = convergent + short root

Difficult root planning = divergent + long root

Dental floss = waxed nylon

Endo
Percussion test = positive when inflammatory process reached to proprioceptive fibers of
PDL , Pulp has no proprioceptive fibers.

Most accurate radiograph for endo ( tooth size) = paralleling technique

Acute alical abscesses no radiolucencies ? = infection not had enough time to

demineralize cortical bone, it takes 30%-50% of bone must altered to be visible.

K file = square shape st steel

Reamer = triangle shape st steel
K-flex = rhomboid or diamond-shape st steel
flex-R = triangle

RC-prep = canal lubricant , EDTA + urea peroxide + glycol-based Glyde (wax-based )

NaOCl = remove organic , proteolytic irrigation ( breaking down proteins)

EDTA = remove inorganic , chelating agents

Storage of avulsed tooth = best media HBSS then saliva, milk, saline

Resorption area contains acidic PH 4.5 -5 > Calcium hydroxide neutralized the acidic PH

CHX = effective against E.faecalus organisms ass with failed endo ttt
All sealer cements = highly toxic when freshly mixed > reduced on setting

Retreatment endo = initially > Drills ( Gates-glidden or peezo ) , Solvents > chloroform
(most effective)

Best tech for sterilization of GP = 5.25% sodium hypochlorite for 1 min

Balanced forced instrumentation = balancing the cutting effect quarter turn clockwise
with slight apical pressure , then half to three-quarter turn counterclockwise

Perforation near cervical area has poorer prognosis

Recommended tech for pulpectomy of max primary incisors= facial approach

Profile rotary = rounded tip + U shaped flute

Dentinal pain = caused by outflow in dentinal tubules , A-delta fibers, sharp pain , cold,
coronally, myelinated
Pulp pain = C fibers , dull thropping , heat , centerally, unmyelinated

Predominant pathogent in primary endo = gram - obligate anaerobic ( bacteroides)

Failed endo ttt = E faecalis > Facultative bacteria

Ttt of orofaical infection of endo origin = penicillins drug class > Amoxil , augmentin

If don’t respond to penicillins alone? = clindamycine , metronidazole (flagyl) add to amoxil

= effective against orofacial infection of endo origin

Antibiotics decrease the effect of birth control pills

Normal tissue pH ( 7.4 ) , in presence of inflammation decreases to 4.5 to 5.5

Gow-Gates block = indicated when unsuccessful of IANB becz of infection

Phentolamine (oraVersa , Septodent ) =local injection to reverse effetive of local anesthesia

11 or 12 = best scalpel for drainage of endo abscess

referred pain = preauricular pain ( behind the ears ) usually from man molars

cold test = dichlorodifuoromethane -30 , at middle third of facial surface for 5 sec , must be
dried first

EPT = least indicate for vista Sensory fibers , Not for Vascular , least pulp vitality test
ss hand files = .02 taper
Ni-Ti rotary files = .04 or .06 taper

NaOCl = dissolves organic material

EDTA = dissolves inorganic materials
Chloroform = dissolves GP in retreatment

GP and sealer based = ZOE

incision = soft tissue , trephination = opening hard tissue

orthograde = coronal direction canal restoration , retrograde = apical direction canal

restoration

strip perforation = due to excessive coronal flaring , Furcal perforation = through the
pulpal floor

Danger zone = distal wall of mesial root ( less dentine)

Ellis classification
class l Enamel
class ll Enamel + dentin
class lll enamel+ dentin + pulp
class lV non vital ( Kills the tooth )
class V luxation ( move the tooth )
class Vl avulsion ( kicks the tooth )

subluxation = loosening, no displacement but increase mobility , flexible splint 1- 2 weeks

Extrution = partially extruded from socket , flexible spilnt 2 weeks
lateral luxation = diplacment of tooth any dirextion except axially , flexible splint 6- 4
weeks , metallic sound
intrusion = apical displacement open apex > allow to reerupt , closed apex > replsition
and , RCT less than 3mm observation , more than 7mm surgically reposition splint 4 -8
weeks
Avulsion = flexible splint 2 weeks

Alveolar fracture = 4 weeks splint

storage media = HBSS > milk > saline > saliva > water

External resorption = damage to cementoblastic , internal resorption = damage to

odontoblastic ttt is RCT
calcific metamorphosis (canal obliteration) = extensive amounts of reparative dentine
(intrusion) causes> yellow-orang color

Calcium hydroxide pH = 12.5

apexogenesis = IPC , DPC , Cvek ( partial pulpotomy) , pulputomy of immature permemnt

tooth

apexfiction = pulpectomy of immature permenet tooth

crack tooth = usually extent mesiodistally

tissue will not regenerate = dentin

lentulo spiral = sealer in endo

K file= triangle/ squer

K flex = diamond or rhomboid
Flex-R = triangle
H file = round

internal resorption = RCT

external resorption = RCT + calcium hydroxide

Sinus tract = 25# , 30# GP

minimum to leave GP = 4-5 mm

biologic consideration =appropriate angle of root-end resection is perpendicular to the

long axis of the tooth

Diffuse swelling = Antibiotics and analgesics should be prescribed, and the patient should
be monitored closely

NaOCl mixed with CHX = cause orange-brown occludes the dentinal tubules known as
parachloroaniline (PCA)

CHX mixed with EDTA = wihte perciptate formation

EDTA = Ethylenediamine Tetraacetic acid 17%

silver points contact tissue fluids or salivai, =they corrode

furcal perforation = perforation in furcation / interradicular

Pulse oximetry = measure oxygen concentration in blood

Laser Doppler flowmetry = assess blood flow

irrigation for open apex =0.5- 1.5% NaOCl or diluted NaOCl

best effective irrigation for killing E, faecalis = MTAD

least effective for E. faecalis = CHX

coronal(cervical) fracture = poor prognosis , managment : extract coronal segment > ortho
reuption if root is longe > restoration

midroot fracture = coronal necrosis and apical vital , RCT for coronal segaments only

best media in open apex immerse before reimplant = Doxycycline , minocycline for
5min

pt came late at the end of day with sever lingering pain, management = with irreversible
pulpitis > pulp extirpation (pulpectomy) + NSAIDs

resorbable sealer = ZOE

Calcium hydroxide PH = 11

AH plus = not released Formaldehyde. , AH-26 = releases Formaldehyde

AH-26 , AH plus = epoxy resin sealers
Formaldehyde = called formacrestol + formaline , bactericidal

K files = reaming motion (clockwise rotation)

H files = filing motion (push and pull motion)

% of accessory canals in apical third = 74%

MTA = for its property to reduce external root resorption

more flexible file = K-reamer

Differentiate between pulp and periodontal abscess = Vitality test

metallic sound = lateral luxiation

component of ledermix which use in endo to reduce pain = Triamcinolone acetonide

( steroid)
Gates Glidden sizes=
#1 = 0.5 mm , 50
#2 = 0.7 mm , 70
#3 = 0.9 mm , 90
#4 = 1.10 mm , 110
#5 = 1.3 mm , 130
#6 = 1.5 mm , 150

Latex allergy which type of obturation material or eugenol allergy = Resilon ( resin-
based filling )

perforation sealing = immediately

Tappering of K file = 0.02mm

VRF = CBCT for diagnosis

poorest avulsed tooth = closed apex >24hr

Solvent for GP = chloroform

Zipping perforation = over prepartion of outer wall of apical curvature of canal

NaOCl accident= severe pain, edema of neighboring soft tissues, edema over the injured
half of face and upper lip, profuse bleeding from root canal, profuse interstitial bleeding
with hemorrhage of skin and mucosa (ecchymosis) - management : control pain with LA
and analgesics , cold compresses after 1day warm compresses .

Access opening shape = maxillary premolars ( oval )

AH plus = working time 4 hrs , sitting time 8 hrs

NaOCl = PH >11

Bismuth Oxide = Radioopacifier in MTA

Only tooth show 8 Endo configuration = max 2nd premolar

Least reliable in general = heat test

Least reliable for PFM = electrical
Best for PFM = cold
Least reliable for pedo = electrical

Gutta percha =
advantages : plasticity, ease of manipulation, minimal toxicity, radiopacity, and ease of
removal with heat or solvents.

Disadvantages: lack of adhesion to dentin and, when heated, shrinkage upon cooling

intrapulpal anesthesia = Deposit anesthetic under pressure. Resistance (back pressure) to

injection should be feltt for the success

ledge = an artificial irregularity created on canal wall that impedes the placement of an
instrument to the apex

artificial opening = perforation

Irrigation causes protein coagulation = eugenol - formocresol

Thermomechnical compaction = McSpadden Compactor

thermoplastic injection technique = Obtura Il ( internal resorption )

thermoplasticized technique = open apex (external resorption)

warm vertical compaction + continuous wave compaction technique = System B

Carrier-Based Gutta-Percha = thermafil + pro taper + SuccessFil

pulp vitality testing= pulp vascularity

common microorganism in endodontic abcess =

Ellis classification =

0 no trauma

1 simple crown fracture involving little dentin

2 extensive crown fracture involving considerable amount of dentin 3 fracture involving
dentin and pulp

4 non vital tooth and no loss of crown

5 total loss of tooth

6 root fracture with or without loss of crown 

7 displacement of tooth without crown or root fracture

8 IIIV fracturenof crown in mass

9 lX trauma for primary teeth

fibers not found in 6-12 years = apical fibers

Tug back - resistance of cone GP in apex

Endo ice temperature = -26.2°C

Remove silver points = Stieglitz pliers

perforations below the crestal bone in the coronal third of the root = poorest prognosis.

Factors affecting EPT test =

false + : partial necrosis - anxiety - improper isolation - contact with mestal
False - : obliteration - recently traumatize - immature apex - increase threshold

Best determination of crown root fracture = tooth sloth

cells magratis to periodontal pocket = oral epithelium + ging connective tissue +

alveolar bone + PDL

Cavit = not used with Vital tooth , used as temporary materials in RCT

Most effective solvent and fastest and low risk = chloroform

Operative
critical pH =
Enamel FA ( outer side of enamel ) 4.5
Enamel CHA ( near the DEJ ) 5.5
Dentine + Cementum = 6.2 - 6.7

pit and fissures caries = inverted V shapes ( narrow to wide)

smooth surface caries = V shape ( wide to norrow)

strep mutants = enamel caries gram +

lactobacillus = dentine caries
Actinomyces = root caries

Periapical radiograph = for anterior

Bitwinge = posterior

marginal gap ( ditching ) in amalgam = if >0.5mm considers as caries prone

gingival margin trimmer = enamel at gingival floor

composite contain of = bis-gamma

coupling agent is = chemical which improves the adhesion
coupling in composite = 3-methacryloxypropyl-trimethoxysilane (gamma-MPS)
Capping Vs shoeing :
Capping = functional cusp ( palatal max + buccal mand) , resistant to fracture
Shoeing = non functional cusp ( buccal max + palatal mand ) , more esthetic , veenering the
cusp

instruments formula = ex: 10-85-8-14 ,

(1) blade width (2) cutting edge angle (3) blade length (4) blade angle

Fluorescent tech=
1- fiberoptic transilluminition = proximal caries + early caries detection
2- digital fiber optic transilluminition = more sensitive in detecting incipient caries

Diagnodent = laser induce fluorescent, fissure + smooth caries reading , incipient caries

types of pins = self-threading more retentive > friction > cemented

Enamel tufts = hypomineralized of enamel rods and inter-rod substance that project
between adjacent groups of enamel rods from the DEJ may play a role in the spread of
caries

Enamel lamellae = thin, leaflike faults between enamel rod groups that extend from the
enamel surface toward the DEJ, sometimes into the dentin

enamel spindles = Odontoblastic processes occasionally cross the DEJ into enamel

ttt of incipient caries in molars and premolars = PRR ( preventive resin restoration )
Atraumatic Restorative Treatment (ART) = removal of decay by hand instruments
alone , self cure GIC ask the pt to bite on it , 4-5 yrs

GIC = Calcium fluoride 15.7% - 10 - 16% - Acide-base

Dentinal tubules diameter=

• 2.5 μm near the pulp
• 1.2 μm in the middle of the dentin
• 0.9 μm at the DEJ

Removal undermined enamel in class 2, broximal box floor = gingival margin trimer

oblique ridge of maxillary molar = Distobuccal to mesiopalatal

most composition of enamel = inorganic materials: calcium and phosphate ions that make
up hydroxyapatite

bone around the tooth = inner part is cancellous bone

Quantitative light-induced fluorescence? = system uses a blue light (∼488nm wavelength)

facial and lingual wall in amalgam prepration = 90 degree , Converge occlusally -

retention form

Type of GIC
Type l = luting cement
Type ll = restorative
Type lll = liner and base
Type lV = fissure and sealent
Type V = ortho
Type Vl = core build up

marginal ridge of molar in amalgam in mm = 1.6mm premolars , 2mm molars

Composite filler particles =

macrofillers = 10 to 100 μm
midifillers = 1 to 10 μm
minifillers = 0.1 to 1 μm
microfillers = 0.01 to 0.1 μm

Composite resin = Bis-GMA its from a type of epoxy , sets by a polymerization reaction ,
monome mol larger than monomeric methyl methacrylate > less polymerization shrinkage

advantage of Indirect composite than direct = more biocompatible, more wear resist
disad = more sensitive

Resistance form = Flat floors, rounded angles, box-shaped

primary retention = convergence occlusal
secordary retention = Grooves, slots, locks, pins
Deep plural floor = resistance form

Retention form:
amalgam Class I or II = converge occlusally , Class III and V = secondary should created
= coves or groove
Composite = micromechanical etching
cavo-surface (margin) angle = angle formed by junction of prepared wall and external
surface of the tooth

Liner = varnish + Calcium hydroxide + ZOE + GI

Base = zinc polycarbixilate + ZOE + zinc phosphate + GIC

Anderws occlusal six keys for normal occlusal =

molar relationship
crown angulation MD = positive , mesially
crown inclination FL = facial , positive
No rotation
Tight contact
occlusal plan = mandibular curve of spee should not be deeper than 1.5 mm

Cervico-occlusal length of mand molar crown = 7.5 mm

caries on the cusp tip which restoration = composite ( most conservative)

Reperative dentin / Tertiary dentin = moderate-level irritants , external stimuli caries +

attrition + truma , irregular
Sclerotic dentin = aging , slow caries

Diagnodent =Quantitative

Ditching = enamel wear beacuse of amalgam restoration - ttt : if gap is less than 0.5mm no
need bec its self-cleaning , if gap deep replace restoration

Rubber dam =
holes are too far from each other - wrinkles
holes are too close - leakage
holes too low - cover pt’s eyes
holes too high - will not cover upper teeth

glazed layer above GI = to prevent dehyderation

matrix best for MOD amalgam = Tofflemier metal matrix with precountored metal band

restoration with pt have heavy bruxism = Amalgam

name of silane coupling agent of composite = Metha acryloxy propyl- trime theoxy silane



mesiodistal width of molar = 10 , Cervico-occlusal length = 7.5

Bunco-lingual of crown = 11

Collagen in dentine = Type l

Amalgam prep = Divergent to proximal surface , converge occlusally

minimal base thickness under amalgam = 1mm

main disadvantage of composite= polymerization shrinkage

Pin depth = 1.3 to 2mm

split Dam tech = badly broked tooth +isolated abutment on bridge + patrial erupted + single
fixed prosthesis

incremental composite tech = reduce polymerization shrinkage

caries removed by chemoMechanical = Cariosolv

home bleaching = 10% carbamide peroxide , 30% hydrogen peroxide - 1:3

improper or loos clamp = gingival recession

Copal varnish = short time sealing of margins

Composer = releases fluoride

Best Materix for MOD involved = Amalgam ( universal matrix Tofflemer ) , composite
( tofflemire retainer with ultra thin 0.025 mm )

High-copper amalgams = increase in copper content to 12% or greater , decease corrosion

amalgam= unique property of being “self-sealing“ Microleakage between the restoration

and the adjacent tooth structure is reduced as corrosion products fill the space.

Pinholes = parallel to adjacent surface of tooth , pins = perpendicular to increase retain the
restoration

Type IV hypersensitivity ( delayed )= 2 to 3 days

Diagnodent disadvantage = false positive

metamerism = different shade color when changing light source

better shade selection= before rubber dam

After bleaching = composite at least after one week

Best restoration for caries extend to roost = RMGI

First thing to check before bleaching = caries

Digital imaging fiberoptic transillumination = use fluorescence by camera (image)

more corrosive phase (weakest phase) = (gamma-2)

major noble metals used in dentistry = gold, platinum, and palladium

initiation of caries by = mutans streptococci

polymethyl methacrylate restoration = exhibit a yellow-orange discoloration on exposure

to carbamide peroxide. > temporary crowns should be made from bis-acryl materials

Hydrogen peroxide ( vital bleaching ) = passes enamel + dentin

Tunnel tooth preparation = preparation joins an occlusal lesion with a proximal lesion

Wedge-sahpe defect = abfraction

Mand 2nd premolar = have steep cusp ( sharp buccal cusp resemble canine )

primary retention form in Class II =

amalgam : converging occlusally

inlay : slightly diverging occlusally

Opaque fissure sealant is better than lighter/transparent ? = because transparent

sealant is esthetic but difficult to detect at recall visit
composite veneer = hybrid

Calcium hydroxide liners = dental thickness 0.5mm or less

prosth
cantilever = single retainer
pier = intermediate aboutment

crown to root ratio = optimum 2:3, 1-1 minimum(accepted ) , 2-1 poor

shared landmark for upper and lower when take impression = pterygomandibular raphe
All-ceramic restoration—shoulder or deep chamfer
• Metal-ceramic with porcelain extended to marginal edge—shoulder or deep chamfer
• Metal-ceramic with metal collar—shoulder with bevel or chamfer
• Full gold crown— feathered edge, bevele
• metal crowns = chamfer

screw Vs cement = screw is retriveability

- Most retentive type of pin + most common = self-threading pins

Zinc Phosphate = use chilled glass slab These precautions arenecessary to reduce reaction
speed, alter the pH in a controlled manner, dissipate heat

Zinc Phosphate irritate the pulp = use varnish

causes of surface roughness or irregularities of casting :

dark casting or black casting = because of overheating
Air bubbles = inadequate of vibration , inadequate of vaccum , lacks of wetting agents
more heat and more L:P ratio = rough surface
Trapped gas = porosities

dislodged denture while moving tongue = overextension of lingual flanges

Commissural cheilitis, = excessive interocclusal distance managment? reduced occluding
vertical dimension
gagging or vomiting = loose dentures; poor occlusion; incorrect extension or contour of the
dentures
burning sensation on palate = pressure on the nasopalatine area. managment? Relief of
the denture over the incisive papilla

group function occlusal scheme = leaves the posterior teeth, that heavily restored, prone
to fracture.

unreacted benzoyl peroxide can cause = color changes for provisional restoration ،
estoration in 100°C water promotes greater polymerization efficiency and removes any
unconverted monomer, cause a sensitivity reaction in a patient

For recording of vertical dimension = Caliper

lingual plate/ sublingual bar = if less than 8mm

Face-bow = caliper to relate the maxillary bite rims to the TMJ and determining aesthetic
+ occlusal plane.
Ring clasp = for tilted isolated molar

Non rigid connector = pire abutment long span bridge

PFM crown what type of bur = diamond in porcelain , transmetal in metal

Phosphate-bonded Investments = Staple for casting metal-ceramic alloys, PFM

Gypsum-bonded Investments= unstaple not for PFM

denture stomatitis = antifungal Nystatin

replacement of the missing tooth with minimal invasive and conservative = Maryland
bridge

cast pot indication = small teeth ( mand incisors ) , most coronal structure missing ,
weakened root structure

bennett angle = angle b/w saggittal plane and condyles , movement of the working side
condyle in the horizontal plane.

imaginary line "hinge axis" = around which the mandible may rotate in the sagittal plane

Supporting cusps called = Stamp cusps

hemostatic agents for Retraction Cords =
Epinephrine 0.1, 0.8%:
Potassium aluminum sulfate:
Aluminum chloride 5–10%:
Ferric sulfate 13.3%: discolors tissue temporarily, so use with caution in the anterior
Zinc chloride 8%, 40%
electrosergery

Function of post =
1- retain a core restoration and crown and
2- redistribute stresses down onto the root

hemodent = Aluminou chloride , epinephrine-free , avoid cardic reaction

fracture in retentive arm of clasp = electric soldering , Optimal place for retentive arm >
gingival third

incisal reduction = 2mm

function of proximal plate = retention + stability , indirect retention

Eccentric tooth contact tested with = Mylar shim stock

Major connector ( palatal or lingual bar) distance from marginal ridge =

maxillary minimum 6mm
mandibular minimum 4mm

clasp used in tooth with no distal teeth = back action clasp ( modification of ring clasp)

clasp used when Ethetics is not a concern = Ring

Clasp for mid-buccal poterior + undercut area = I bar

prefer modified ridge lap Pontic? = high esthetic

material causes wear on opposite teeth = Porcelain

force that cause most destruction = non working

pontic of posterior teeth = hygienic + modified ridge lap

pontic for anterior = ovate > incisors + canine + premolars

cement for ceramic = resin

intraoral bone mapping =instrument to assess the thickness of the soft tissue and measure
the bone dimensions at the proposed surgical site

ductility def = ability of material to deformed under tension

malleability = ability of materal to deformed under compression
viscosity = resistance of liquid to flow , controlled by frictional force within liquid

occlusion of Fixed-Implant canine = Canine guidance ( Mutually protected occlusion)

Increase VD = generalized soreness over the alveolar ridge + swallowing and sore throat+
fatigue of muscles of mastication + clicking + too much teeth exposed + clenching
Decrease VD = Angular cheilitis + cheek ,tongue biting + pain in TMJ (coston’s syndrom)+
prognathism

clicking = increase VD + porcalin teeth

To repair broken occlusal rest = Soldering

fracture clasp = wrought wire is attached to the framework by electric soldering
complete denture in moist environment = compensate for shrinkage

upper incisors , and maxillary second premolar how many rest seats = 4 rest seats + 5
connectors

5 mm from tooth gingival margin until bone crest = sufficient BW, and ferrule

measure metal thickness during try in of metal in PFM = iwanson caliper

Swing-Lock major connector = used for remining ant teeth with periodontal compromised
and mobility

extended over metal = less colar

guiding planes = parallel to the path of insertion

landmark determine antroposterior arrangement of anterior teeth in CD = incisive

papilla

best type of pontic with handicapped = Sintary ( hygienic)

occlusal clearance = 1.5mm functional - 1mm non functional

reciprocal arm = above the height of contour , at junction of gingival 3rd and middle 3rd
retentive arm = above hight of contour and passes below (terminal)

Denture material not heat sensitive ( heat resistance) = polyamide ( nylon )

interference between DB lower and ML = protrusive

Purpose of rest = prevent gingival impingement + distribute occlusal loud

Strength of Feldpathic = 65-120 Mpa

leucite-reinforced = 120-140
lithium disilicate = 300-400
Corrosion of metal framework of denture why ? use if NaOcl

bleaching at home = carbmide peroxide > ︎polymerhyl methacrylate restorations exhibit a

yellow-orange discoloration on exposure to carbamide peroxide. For this reason, temporary
crowns should be made
bleaching at office = 30% hydrogen peroxide , affects enamel + dentin + pulp
walking bleaching = Sodium perborate

non vital bleaching = cervical root resorption, external root resorption

Fox plane = guide rests on the occlusion rim, it should be parallel to the interpupillary line

carbonated drinks( soft drinks) = causes erosion, pitting in the enamle , PH ramge 2 to 3.5

arrested caries= hard surface , ttt only for esthetic

major connecter = provide rigidly

1-complete palatal plate = most rigid, class l
2-horseshoe = least rigid, palatal tori

1-lingual bar = vestibule >7mm most common (unfavorable soft tissue contours)
vestibule measurement = from MG to frenum start
2-lingual plate = vestibule <7mm , lingual tori , if all posterior teeth missing, lingual
inclination of the remaining lower premolar and incisor

direct retainer materials (clasps) = Cobalt-chromium

3-labial bar (swinglock)= missing canine , Questionable perio prognosis
Retentive clasp = below height of contour / survey line ( Retention )
Reciprocal clasp = above height of contour / survey line ( Stability)
Rest = Support

Function of proximal plate = Stability

Suprabulge = above survey line

Circumferential (Akers) > most common
Ring
combination
Embrasure
Infrabulge = Below survey line
I bar ( for undercut area) , T bar , Bar type , Y type
Wrought wire = perio compromised + endo
distal extension use = RPI , RPA , wrought wire
why clasp break = cold working ( manibulating the metal at ambient temp /room
temperature)
tech for visualizing Vibrating line =1- pt say Ahh. 2- Valsalva maneuver (blow air throw
nose while holding tongue ) b/w soft and hard tissue

Gypsum Materials types =

Type l = impression plaster
Type ll = model plaster
Type lll = dental stone ordinary model cast for RPD/CD
Type lV = dental stone high strength
Type V = dental stone high strength + high expansion

Metal-ceramic = incisal reduction 2mm

restoration with heavy bruxism = Onlay or complete coverage is better

cracked tooth ttt = Full ceramic

incisive papilla = small tubercle in palatal side b/w central incisors. facial natural central
incisors, when present, were approximately 8-10 mm anterior to the middle of the incisal
papilla,

Minimum interarch space for fixed implant supported prosthesis = 7mm

Most destructive occlusal interferences = Non working interference

cement has chemical bond with enamel = zinc polycarpolyate

Chipping of porcelain = deformation in design and location of metal porcelain junction

Final step before cementation = glazed to create a shiny surface

V To F = anterior teeth setting

For hypertension + cardiac pt = retraction cord with phenylephrine used

Minmum accepted level of attachment loss in PFM = 25% , poor = 50% loss

Minmum inter arch space for Screw-retained = 5-7 mm , cemented-retained = 7-8 mm

Winged clamps = apply to rubber dam simultaneously

Cool glass slab in zinc phosphate = retards (reduces) setting

Distal extension clasp = Bar clasp RPI

RPI contraindication = buccal or lingual tilts, severe tissue under- cut, or a shallow buccal
vestibule
For class III clasp= bar type - circumferential (Aker) - combination

Sequence for evaluation prosthesis = proximal contacts > margin > stability > occlusion

ferrule =Extension of the axial wall of the crown apical to the missing tooth structure
provides

Retention— resists movement of the denture away from the tissue.

Stability—resists movement of the denture in a horizontal direction.

Support—resists movement of a denture toward the tissues.

In CD max teeth should > buccal horizontal overlap of the posterior teeth = aligned
vertically is contraindicated to avoid cheek-biting



bur for prep V shaped cingulum rest = started with inverted, cone- shaped diamond +
progressing to smaller, tapered stones with round ends to complete the preparation.

tripoding the cast = Positioning the cast on surveyor, original path of placement

Best location prior casting (sprue) = more bulky area - non critical (non functional cusp)

Swing-lock major connector = Unfavorable tooth/sot tissue contours , questionable

prognosis

occlusal scheme for full mouth rehabilitation= canine guide (Mutually protected )

Organic occlusion = Mutually protected

Thickness of ceramic inlay = 1.5 - 2 mm

Action responsible for disto lingual molding = wetting lip with tongue

avoided temporary material crown with vital tooth = poly methyl methacrylate

Contraindication of the use of I-bar = sever titled abutment

RMGI = causes crown fracture in All ceramic

Component of RPD not found in FPD = saddle (base under artificial teeth )

dimension rest seat = at least 2.5mm , base > triangular shape , Reduction =1.5mm and
<90 degree

disto lingual molding = patient forcefully protrude the tongue and move it from side to side
, (for lingual flange ), wetting lips with tongue.
opaque material added on the metal surface in metal ceramic crown?= for shade

Denture movements , rocking = indicates reline

Best rest seat in premolar with MOD amalgam restoration + free saddle = rest with
metal restoration

Protrusive interference = b/w distal incline of upper facial cusp, and mesial incline of
lower facial cusp , b/w non working(upper) and working(lower)

non rigid connector = tilted abutment

Lever class 1 = resistance - fulcrum - effort > fulcrum b/w effort and resistance (dital
extension RPD class)

Lever Class 2 = fulcrum at end - effort in other end - resistance in between (indirect
retainer)

Lever Class 3 = fulcrum at end - resistance other end - effort in between (TMJ muscles +
teeth )

Cast crown (metal/gold) = Minimum 1 mm on nonfunctional (non- centric) cusps + 1.5

mm on functional (centric )

Torus Palatines major connector = anterior posterior strap

Thickness of ceramic only = 1.5 - 2mm

soft sub gingival prep = low pressure with high speed

reason of check biting = anatomical teeth with increase buccallingual width

mesially tipped abutment = extended occlusal rest more than one-half the mesiodistal
width > 1-minimize further tipping. 2-ensure that the forces are directed down the long axis
of the abutment

Sequence of abutment prep of RPD = 1- proximal prep 2-tooth contours modified

(lowering hight) 3- impression taking (if needs adjustment) 4- occlusal rest prep

Vita shade start with = 1-Hue 2-chrome 3-value

3D mater system = Value - hue - chrome

Leave old denture for tissue recovery = at least 24 hrs

In Border molding disto buccal determined by action of = Masseter muscle

Disto lingual area determined by = superior constrictor muscle

Indication for relining = immediate denture after 3-6 months - ridge resorption

Contraindication for relining = excessive ridge resorption - TMJ + aesthetic + occlusal

arrangement problems

Parallel post Vs taper post = parallel > elliptical cross section 6-8 degree taper - more
retentive than taper - weaken the root (wedging effect ) - high stress during pos insertion

Resin-modified GI cements = gold inlays, onlays, partial veneer and full veneer crowns
and fixed partial dentures, metal-ceramic crowns

Most common failure of inlay/onlay = bulk fracture , management is replacement of restoration

Indication of attachments in over denture= severe xerostomia - minimal alveolar ridge

height in edentulous areas - loss of a part of the maxilla or mandible - congenital
deformities ( cleft palates )

Overdernture tooth abutment prep = contoured to dome-shaped surface

Contraindications of over denture = poor oral hygiene - recurrent periodontal disease - mobile
teeth

Number of teeth as abutment in over denture = mand ideal 4 or more spread out rectangular
area

Implants in over denture = mand > at least two implants - maxilla > 3 or 4 implants
and a bar substructure for support and retention.

Bar substructure attachment = when mare than 2 implants used , provide support In premolar
region

ball/O-ring attachment = is single retainer

U-shaped palatal connector maxillary ( Horse shoe) = least rigid - large palatal torus

wrought wire in cross section= Round

reasone For removal of epulis fissuratum = relive of pain

epulis fissuratum causes ? = overextended flange

Border molding = compound - 490C (1200 F) to 600 C (1400 F) - borders can be corrected
before the material cools - should be put in cold water - multiple small areas

CD doesn’t hold when pt smile = bcz of thick buccal notch and buccal flanges

Ortho
types of headgear =
1- cervicl-pull headgear : intraoral , class ll div l ,ditlaization of maxilla
2- stright-pull heargear: intraoral , class ll div l , ditlaization of maxilla
3- high-pull headgear: intraoral , class ll div l , for ditlaization of maxilla
4- reverse-pull headgear( face mask) : extraoral , class lll , to protract maxilla

tt for max deficiency = Frankel app , facemask

class 1 malloculsion = MB of upper molar occluded in MB groove of lower molar

physiological tooth movement = 0.25

Frankelfort plan = from porion to orbital

ANB = A max , N Nasion , B mand

increase > class II
decrease > class lll

• ANB <2°→class 3
• ANB = 2-4°→class 1
• ANB = > 4 class 2

unilateral crossbite = due to unilateral maxillary constriction

Looped Coil Space Regainer = b/w premolar and molar to gain space for unerupted
premolar

psedo class lll = the maxillary incisors retroclination, and the mandibular incisors are
proclined

class II malocclusion = extraction of first premolars

Techniques the brush for ortho = Charter's tech

quad helix= interrupted. , Fixed appliance , sucking habit , expansion for posterior
cossbite , 1/3 skeletal and 2/3 dental changes
Headgear = intermittent

vertical stops or bite blocks = to control the vertical dimension (functional appliance)

functional appliance =
passive tooth-borne : ( depends on soft tissue and muscular activity)
1- Bionator > removable class ll
2-Activator > removable class ll
3- twin block > is removable but can be fixed

- Herbst appliance > fixed tissue-borne

Tissue-born:
1- Frankel appliance > removable class ll + lll

Hybrid functional appliance = jaw asymmetry

Interincisal Angle = angle formed b/w angle of upper and lower incisors , meane angle
130-131 degree , increased = class ll div l , decreased = class ll div ll

slow expansion of appliance = 1mm / week

rapid expansion = 0.5mm / day

ANB = increased - skeletal class ll

ANB = decrease - skeletal class lll
SNA = increased - prognathic maxilla
SNA = decreased - retrognathic maxilla

SNB = increased - prognathic mandible

SNB = decreased - retrognathic mandibule

ortho band is impeding on gingiva , will caause = gingival enlargment

slow expander = Haas-type turned twice for 0.5 mm of expansion per day

Vertical growth = is the last growth to stop

Functional appliacne ( skeletal )

Head gear - class ll prognath max
Face mask (reverse head gear) + Frankel = class lll > def maxilla
Herpest + Twin block- class ll > def mand
Chin cup - prognathic mand

camouflage ( Dental )
Bimaxllary protraction = extract upper 4 + lower 4
Class ll only = extract upper 4 + lower 5
Class lll only = extract lower 4 + upper 5
Distalization only in max = class ll

Rectangular wire used for = Torque (faciolingual root movement ) , space management
class ll div l = increase horizontal overlap - flat
class ll div ll = increase vertical overlap - steep

points in cephalometric =
most anterior inferior point = orbital
most post inferior point of angle of mandibule = Gonion
inferior of symphysis = menton
anterior of symphysis = pogonion
most anterior inferior of symphysis = Gnathian

triangle wire uses = retainers + removable

Anterior Bite Plane Appliance = used to correct deep bite

Frankel line FH line = horizontal , porion to orbital

effect of habits depends on = Frequency + duration

Distance b/w cephalometric and photographer = 2 meters > 6 feels

Frenectomy = after space closure , after Otho

posterior cross bite, ant upper protrusion, ant lower retrusion = thumb sucking

Splint extrusion tooth = 2-3 weeks

pseudo class lll = class l malocclusal

Retainer for tooth was in cross bite = Hawley retainer

Shearing cusp (nonfunctional cusp )in crossbite = max will be linguay , mand will be buccally

pedo

primary space = max > lateral and canine , mand > canine and 1st molar

Loop of the space maintainer= below marginal ridge + at contact point + 1mm above
marginal gingiva

serial extraction : Timely removal of both primary teeth and selected permanent teeth in
guidance and serial extraction protocols optimizes the use of available space.
3 tech =
1- Dewel : dec. Canine > dec. 1st molars > 1st premolars = CD4
2- Tweel : 1st dec. molars > premolars + dec. Canine = D4C
3- Nance : same Tweel

Radiographic survey for 5 yrs = 2 occlusal , 4 PA molars , 2 bitw = 8 filmes

Radigraphic survey for mixed dentition = 12 filmes
Radiographic survey for permenent teeth = 16 filmes

Space maintainer for replace one tooth=

Band and loop— unilateral loss of the primary first molar
Distal shoe— primary second molar is lost prior to the eruption of the permanent first molar

Space maintainer to replace multiple teeth =

Lingual arc/arch— multiple teeth missing + permanent incisors are erupted
Nance/transpalatal appliance = for bilateral loss of primary maxillary molars.

Removable appliance for class ll = activator , bionator , twin block

Fixed appliance for class ll mandib def = Herbst appliance

fluorid used in pedo = NaF ( sodium fluoride)

when the child have abuse = Treatment > record > report

Natal teeth:- which may erupted at the time of birth.

Neonatal teeth:-prematurely erupted deciduous teeth in first 30 days

IANB for Child = below occlusal plane

Cvek pulpotomy = partial pulpotomy

most restoration ued in Pedo = GIC > bonding capability + pharmacological therapeutic
(flouride)

Types of child Abuse =

Physical abuse : nonaccidental physical injury 25% around mouth

Neglect : most frequent type , permits child to suffer and failure to seek adequate dental care
Emotional abuse :behavior that impedes a child’s development and self-esteem failing to
provide love and appropriate guidance.

Fluoride toothpaste in 2 yrs =

leeway space= unerupted canine and premolars = arch space available . relieving any
incisor malalignment
Fauiler of pulpotomy = internal resorption

orofacial trauma is present in = physical abuse.

Form cresol concentration = 1;5 , fifth saturated

Most effected age for dental truma = 7-12 years

intruded tooth =

less than 3 mm > without intervention.

“ If no movement is evident after 2 to 4 weeks, the tooth may be repositioned ortho or

surgically before ankylosis”

If 7 mm or more > repositioned surgically + 4 to 8 weeks flexible splint.

development of tooth in embryo = sixth week

Fibers not found in 6 -12 years pt = apical fibers

Failure of pulpotomy = internal resorption

Breastfeeding + nursing bottle stoped at = 12 months

One visit pulpectomy material = ZOE

To slow osseous replacement of avulsed open apex = 2% sodium

fluoride 20mins
surgery
Dentoalveolar splint= rigid splint for 4 to 6 weeks , most commen anterior region The
dento-osseous segment must be stabilized for approximately 4 weeks to allow osseous
healing

sequence of extraction :
posterior > anterior
max > mand to avoid falling of fragments
6 + 3 least to be extracted to gain proper plate expansion

grasp the suture needle to preserve the tip of the needle = 2/3 of needle b/w tip and
swage

Factors Affecting Local Anesthetic Action=

Lipid solubility > potency > Increased lipid solubility = Increased potency
Protein binding > Duration > Increased protein binding allows anesthetic cations
Nonnervous tissue diffusibility > Onset > Increased diffusibility = Decreased time of
onset
Vasodilator activity > potency and duration > Greater vasodilator activity = Rapid
removal of anesthetic > potency and duration are
decreased

Lefort l (transverse maxillary) = Mobility of maxilla +intact nasofrontal + Buccal

vestibule ecchymosis (Guerin’s sign: ecchumosis in greater palaine vessels) + Epistaxis

Lefort II (pyramidal): Mobility of maxilla + mobile nasofrontal complex + Periorbital

edema and ecchymosis + ballooning moon face

Lefor lll (craniofacial dysjunction) =

Mobility of maxilla + mobile nasofrontal + craniofactial seperation from skull base +
Periorbital edema and ecchymosis + Rhinorrhea (cerebrospinal fluid [CSF] leak into nasal
cavity)

Zygomaticomaxillary complex fracture (ZMC): “Cheek bone” fracture + Buccal

vestibule ecchymosis + limited mouth opening if interfere with coronoid process , diplopia ,
most common fracture

Long sphenoPalatin = nasopalatin runs through incisive canal , supply gum of incisors
nerve supply anterior palate = nasopalatin

Anesthesia technique used for trismus = Vazirani-Akinosi closed mouth tech

Nerve Responsible for the gag reflex = glossopharyngeal

Lower first molar was not anasthetized after IANB what will give the patien = long
buccal ? has high successful rate

anterior disc displacment with reduction = crepitus - clicking with opening mouth x joint
tenderness
anterior disc displacment without reduction = condyle cant make full anterior extent ,
restricted opening - deviation to affected side - no clicking

layers of Lips = 3 layers suturing

gow-gates technique the anesthesiais directed toward = lateral of condylar neck

Vazirani-Akinosi closed-mouth = Limited opening trismus + Inability to visualize

landmarks for IANB (e.g., because of large tongue) ( bcz of anatomical variation)
Gow-gates = unsuccessful IANB
Nerve Anesthetized palate of upper premolars = Middle superior alveolar nerve +
Greater anterior palatine nerve

extraorally on the Ramus of mandible muscle of mastication = Masseter

Condylar rotate in = Hing axis ( imaginary line around which the condyles can rotate
without translation )10 - 15 dgree

bilateral parasymphesial fracture, most important to check first = Airway > tongue
falls back

Indications of intraligmantry injection =

one or two teeth in a quadrant
isolated teeth in two mandibular quadrants (to avoid bilateral IANB)
when block anesthesia is contraindicated
adjunctive after block anesthesia if partial anesthesia is present
contraindication = primary tooth ( causes enamel hypoplasia to permanent tooth)

nasopalatine nerve block pic

Submandibular swelling extra oral pic which tooth = Lower 1 molar MH muscle

Space infection from maxillary =

1-buccal space :maxillary molars -swelling below zygomatic arch + above the inferior
border of the mandible.
2-intfraorbital space : maxillary canine -swelling along the inferior orbital rim , swelling of
nasolabial
Infra temporal : max third molar , infections may spread into the cavernous sinus

Space infection from mandibular =

1-Space of the body of the mandible infection: It appears as if mandible is enlarged
2-submandibular : mandibular third molar
3-sublingual : premolars and the first molar - intraoral swelling
3-submental : mand incisors - b/w right and left digastric muscles and b/w the mylohyoid
muscle
4- submasseteric space is from the buccal space or mandibular third molar (pericoronitis)

symphyseal fracture how many plate need = two plates

Amides = Lidocaine + Mepivacaine + Bupivacaine + prilocaine

Esters = Novocaine + Procaine + Benzocaine + Tetracaine
Bupivacaine = -acting LA

Most common tooth root to be displaced into unfavorable anatomic spaces = Maxillary
molar root
Most common root fracture = maxillary 1st premolar ( king of fracture)
Most common mandibular fracture = condylar

Pedo pt fall in her chin what will mostly fracture = Condyle

IANB and patient cant move eyelids = Needle too posteriorly

Mesioangular impaction of third molar—most common and easiest impaction to remove

Zygomatic complex fracture = type of midface fracture , blow-out fracture blunt truma to
eye (diploma)

Intra ligamentary injection causes pulpal circulation to = Marked decrease , causes

cessation lasted for 30 mins

slowest onset = procaine + Tetracain ( Esters)

Cocaine = the only LA that consistently produces vasoconstriction , most Vasoconstrictor

muscle below submandibular space = platysma

muscle palpated extraorally = masseter

color coding for LA cartilage =

lidocaine 2% Light blue
lidocaine 2% 1:50:000 Green
lidocaine 1:100,000 Red
Mepivacaine brown
prilocaine yellow
prilocaine 200 black
Articaine 100 silver
Articaine 200 gold
bupivacaine blue

tooth causes alveolar fracture = Upper canine

Articaine = both ester and amide

Buccal space = lies between buccinator muscle and skin

Submandibular space = between platysma and myeloid muslce

oroantral communication antibiotic = penicillin, an antihistamine, and a systemic

decongestant for 7 to 10 days to prevent infection , pedicle flap to close it

LA avoided in children and pregnancy = Bupivacaine

Prefered LA in children and pregnant = Articaine

If normal lip and visible gum 9mm = Le fort impaction

If Lip is small = lip reposition
cavernous sinus thrombosis = serious, life-threatening infection , In cases involving the
canine space, headache, sweating, tachycardia, nausea, and vomiting , eye paralysis

Largest paranasal sinuses = maxillary sinus

Maximum dose of epinephrine for cardiac = 0.04mg

Wilkes Classification for Internal Derangement of TMJ =

Early stage : no symptoms - clicking - slight fowrard diplacment of disk

Early/internediate stage : few pain - joint tender - headache - anterior displacment + early
deformity of disk

Intermediate stage: multiple pain - tenderness - marked disk displacement and deformity

Intermediate /late stage : chronic pain + acute pain - headache - restriction of motion - no
perforation of disk or attachments 


Late stage : crepitus - grinding - cronich restriction of motion - filling defects - perforation
of posterior attachments
Rebound sedation phonemenon = because of high lipid solubility of diazepam after 4-6
hrs reabsorbed from intestine again > pt re-sedate

condyle on Working ( rotating )= rotates around vertical axis in latero posterior direction >
Bennett’s movement
condyle on Non working side ( balancing ) = moves forward downward and medially

Bennet’s angle = 15 , horizontal angle as condyle moves laterally( on non working side)
Horizontal condyle inclination = 30

Which teeth can be extracted with rotation movements = max central

Rotational movement = should be minimized for the lateral incisor,> becueas curvature
exists on the tooth

Vagus nerve = supply soft palate

Transient facial paralysis (facial nerve anesthesia):


complication of IAN by the deposition of LA into parotid gland > inability to
close the lower eyelid and drooping of the upper lip on the affected side.


Pathology

pierre robin sequence : micrognathia, and glossoptosis (airway obstruction caused by

lower, posterior displacement of the tongue) and cleft palate

Osteogenesis imperfecta : blue sclera , pulp obliteration , dental defects in association with
the systemic bone disease should be termed opalescent teeth

Dentinogenesis imperfecta: opalescent dentin (type II) , shell teeth ( abnormal pulp
enlargment ) , bulbous crowns, cervical constriction, and obliterated pulp canals .

Dentin dysplasia type I (dicular dentin dysplasia) : short roots( rootless tooth) , absence
of pulp canals.

Dentin dysplasia type ll (coronal dentin dysplasia) : blue-to-brown coloration , large

pulp stone within the pulp chamber
Regional odontodysplasia: ghost teeth ( enlarged pulps and extremely thin enamel and
dentin) also with ectodermal dysplasia

ectodermal dysplasia= hypoplasia of ( skin, hair, nails, teeth, sweat glands) , hypodontia

Nicotinic Stomatitis = SMOKER’S PALATE

White sponge nevus= thickened, white, corrugated, diffuse plaques affect the buccal
mucosa bilaterally

Headache behind one eye = Cluster

Hypothyrodism = myxedema coma (uncontrolled hypothyroidism)

Hemophilia A= factor Vlll. medical managment : desmopressin + Aminocapric acid

hemophilia B= factor lX

Stafne defect = asymptomatic radiolucency, below the mandibular canal in the pos
mandible, between the molar teeth and the angle of the mandible, under IAN

Ameloblastoma = multilocular lesion , mandibular angle , “soap bubble” appearance, ttt

simple ttt> enucleation and curettage , Marginal resection is the most widely used ttt

dentigerous cyst = around the crown of an unerupted tooth , most common type of
developmental odontogenic cyst
Eruption cyst = soft gingival swelling contains blood and can also called eruption
hematoma.
Odontogenic keratocyst = Large, multilocular cyst
Odontogenic myxoma= “soap bubble” radiolucency similar to that seen in an
ameloblastoma , multilocular

ttt of Apthous ulcer = topical corticosteriord ( Prednisone) (thalidomide) (Triamcinolone

Acetonide)

Epstein’s pearls= median palatal raphe and form cysts ( cyst of new borne)
( Bohn’s nodules derived from minor glands at junction of soft palate)

syndrome asso with rheumatoid arthritis = Sjogren’s syndrome

Pemphigus vulgaris= C/F irregularly ulcerations floor of the mouth, buccal , gingival
margin ttt= corticosteroids Or immunosuppressive medication ( azathioprine), bilateral
conjunctivitis. Nikolsky’s sign positive , histo > intraepithelial clefting above the basal +
Immunofluorescence biopsy is positive

bullous pemphigoid = deep , Niklsky’s sign negative , Subepithelial clefting ,

Autoimmune disease

lichen planus ttt =

Reticular lichen planus > Antifungal therapy

Erosive LP > Systemic corticosteroidsor topical (e.g., fluocinonide or clobetasol gels)

applied topically

Ectodermal dysplasia = hypoplasia or aplasia of tissues (e.g., skin, hair, nails, teeth, sweat
glands) , Anodontia ( congenital absence of all teeth )

syndrom asso with Taurodontism = Amelogenesis imperfecta + Ectodermal dysplasia +

Down

cleft lip = lack of infusion of medial nasal process + max process

cleft palate = palate shelves

lichen planus = Wickham’s striae, hyperkeratosis, saw-toothed rete ridges, ttt: Reticular
lichen planus > affect pt with candids , antifungal - Erosive lichen planus > of the open
sores in the mouth. > immunologically mediated , topical corticosteroids

classification of osteoradionecrosis =
Type l = shortly after radiation
Type ll = after 6 yrs after radiation + follows truma
Type lll = spontaneous without trauma b/w 6 months and 3 yrs

Osteoblastoma ( osteoid osteoma ) = bone tumors from osteoblasts,

Non-Hodgkin’s lymphoma (NHL) = second most common malignancy in HIV

Burkitt’s lymphoma = malignancy of B-lymphocyte, “starry-sky” appearance pattern ,

tumor mass post jaw , teeth mobility , aggressive malignancy , ttt chemotherapeutic

Behçet’s syndrome = orogenital ulcerations , Eye lesions , skin lesion , Positive pathergy
test
Crohn disease / inflammatory bowel disease IBD = swelling of the lips, cobblestoning of
the mucosa, linear aphthous-like ulcers

Ludwig’s angina = sublingual, submandibular, and submental spaces. protrusion of the

tongue (woody tongue) ttt : Maintenance of the airway ( most imp thing) > Incision and
drainage > Antibiotic therapy > may use systemic corticosteroid medications, IV
dexamethasone

calcium hydroxide = cause internal resorption

burning feeling + loss of filliform = exfoliative cytology ( test for candides )

ttt of compound odontoma = simple excision

Nevoid basal cell carcinoma syndrome (Gorlin syndrome) = asso with multiple
keratocyst

Mucoceles = result of rupture of salivary gland , dome-shaped mucosal swellings, ttt self
rupture if chronic > excision

Ranula = mucoceles that occur in the floor of the mouth, ttt > Marsupialization removal of
the roof of the intraoral lesion (conservative surgical intervention that decreases the size of
the cyst)

cavernous sinus thrombosis = swelling around the eye , formation of a blood clot within
the cavernous sinus, a cavity at the base of the brain , infraorbital infection

HIV patient with persistent erythema = indicate that AIDS will develop within 2 yrs ,
mangment : Nystatin not be effective > use clotrimazole ( antifungal) > or fluconazole
(antifungal) > if not working use IV amphotericin B (antifungal for serious infection)

swelling in nasolabial fold that extend to eye and cheek= causes upper canine

fibroma = most common benign “tumor” of the oral cavity - trauma from biting , ttt :
excesion

Papilloma = Cauliflower like projection in lateral border , benign epithelial lesion related to
the human papilloma virus (HPV) , changed in size

Filliform papilla = finger like progection ( histo) , middle of tongue , no change in size
Flliate papillae = leaf-like , finger like , lateral tongue , no change in size

Ossifying Fibroma = mixed density lesion with smooth and sclerotic borders, ttt :
enucleation
Fibrous dysplasia = ground glass appearance , 4 types :
1- Monostotic: one bone.
2- Polyostotic: two or more bones
3- Albright’s syndrome: Multiple lesions , hyperthyroidism
4- Craniofacial

Cemento-Osseous Dysplasia (COD) = production of bone and cementum-like

tissue , if periapical ( asso with vital tooth) , Focal ( asso with edentulous area) , Florid
( multifocal lesion in anterior mandibular teeth)

secondary hyperparathyroidism = caused by end-stage renal disease (renal

osteodystrophy), enlargement of the jaws + produce a “ground-glass”

Erythema multiform = ttt with systemic or topical corticosteroids

HSV- triggers erythema multiform ( herpes labialis) = ttt with antiviral ( valacyclovir)

Down syndrome = periodntal disease , class lll , round teeth with spaces ( low caries ) ,
absent of maxillary sinus , supernumerary teeth

Dentigerous cyst = unilocular radiolucent area that is associated with the crown of an
unerupted tooth ttt: enucleation, Three types :
Central= cyst surrounds the crown
Lateral = mesioangular impacted mandibular third molars that are partially erupted.
circumferential= cyst surrounds the crown + significant portion of the root

Adenomatoid odontogenic tumor= circumscribed radiolucency, crown of an unerupted

tooth, most often canine. , remnants of dental lamina , snowflake calcifications

Dentigerous cyst encloses only the coronal portion of the impacted tooth
AOT surrounding both the coronal + radicular , (snowflake) calcifications.

Dentigerous cyst = Third molars

Lateral periodontal cyst = Mandible from the lateral incisor to the first premolar
“Globulomaxillary” cyst = Maxilla between lateral and canine
Ameloblastoma = Mandibular molar–ramus area
Adenomatoid odontogenic tumor = Canine area in maxilla
Periapical cemento-osseous dysplasia = Mandibular incisors around the apices

Hand-foot-and-mouth disease = apthouslike ulcer , palate + palm of hand and fingers +

soles of feet , coxsackie 16 virus , fever

Hairy leukoplakia = Epstein-Barr virus EBV + associated with HIV pt

Osteoid osteomas = benign bone tumorsfrom osteoblasts - most often in the femur - rare in
the jaws. Pain is nocturnal (at night) - relieved by aspirin
cleidocranial dysplasia =bone defect in clavicles and skull - or completely absent of
clavicle - brachycephaly - narrow high palate - unerupted supernumerary teeth (hyperdontia)

Mucous membrane pemphigoid = sub epithelial location

pemphigus Vulgaria = intra epithelial

Smoking mothers = Cleft palate

Pleomorphic adenoma = Firm mass of the hard palate lateral to the midline miner salivary
tumor

mucoepidermoid carcinoma = most common malignant in the parotid gland

Associated with Hypercementosis = Artheritis + rheumatic fever + pagets

rheumatic fever = hypercementosis + scarlet fever

burning feeling of the tongue + loss of filiform papilae diagnosis = Exfoliative cytology

most common cause palatal abscess = lateral incisor

white lesions can be scrapped = White coated tongue + Pseudomembranous

candidiasis + Secondary syphilis

white lesions can Not be scrapped = Linea alba + Leukoedema (disappears when stretched
)+ Leukoplakia + White sponge nevus + Tertiary syphilis

white and red lesions = Erythema migrans Geographic tongue + Candidiasis + Lichen
planus + Nicotine stomatitis + Lupus erythematosus ( asso skin lesion )

Red lesions = Plasma cell gingivitis (from flavoring agents, dentifrices and hot or spicy
foods, free and attached gingiva demonstrates a diffuse enlargement + erythema and loss of
normal stippling)

Blue and purple lesions = Kaposi’s sarcoma ( AIDS , palate and maxillary gingiva) +
Mucocele (lower labial mucosa) + Ranula ( lateral floor of mouth) + Eruption cyst

brown and black lesions = hairy tongue (elongation of filiform papillae) + Melanotic
macule (Brown, on lower lip) + Peutz-Jeghers syndrome (Freckle-like lesions of vermilion
and perioral skin; intestinal polyps) + Addison’s disease (Chronic adrenal insufficiency,
associated with bronzing of skin )
Lupus erythmatous ttt= NSAIDs + antimalarial drugs (hydroxychloroquine) .
For more severe, acute > systemic corticosteroids

Papillon-Lefèvre Syndrome = palmar-plantar keratosis , oral + dermatologic , advanced

periodontitis + teeth float in the soft tissue radiography , ttt corticosteroid / Antibiotic /
retinoid for skin

bismuth = blue-gray line along the gingival margin

Mercury = gingiva may become blue-gray to black.

Pyogenic recurrence = 15%

Angular chilitis ttt = Nystatin combined with triamcinolone acetonide cream

bulimia = Erosion Palatal surfaces of the maxillary

condition asso with Sialadenosis (parotiitis ) = Anorexia nervosa - bulimia - DM -

acromegaly

Simple bone cyst = teeth involved Vital - large irrigular RL - common in premolar and
molar area

Not asso with pain = reticular lichen planus

Plummer vision syndrome = iron def - glossitis - dysphagia - angular cheilitis

Eruption cyst ttt = simple excision of the roof of the cyst

compound odontoma ttt = simple local excision, and the prognosis is excellent

Lupus erythematosus = fever , arthritis , butterfly rash , systemic corticosteroids

secondary Sjögren syndrome = associated any other autoimmune disease, common

associated disorder is rheumatoid arthritis. In addition + with systemic lupus
erythematosus (SLE).

Melanotic macule = No ttt needed . excisional biopsy for esthetic

Hutchinson incisor/ teeth = congenital syphilis

ulcerative colitis or Crohn’s disease/Pyostomatitis vegetans = inflammatory bowel

disease ,ulcers in soft palate, and ventral tongue , “snail track” ulcerations

Chemotherapy adverse effects, most commonly = mucositis

Osteosarcoma = most common malignancy of bone - resorption of the root (spiking
resorption > tapered narrowing of the roots) - sunburst or sun ray appearance massive tumor

Inflammatory papillary hyperplasia(denture papillomatosis) = ill-fitting denture , poor

hygiene , wearing denture 24 hrs

Odontogenic keratocyst = Large, multilocular cyst involving most of the ascending ramus - grow
in an antero- posterior direction - ttt enucleation and curettage - recurrence 30% recur within 5 years

Sarcoidosis = multisystem granulomatous disorder , histo > granulomatous inflammation -

fleshlike condition - dyspnea, dry cough, chest pain, fever - ttt corticosteroids

Condensing osteitis = at apex of nonvital tooth , periodical inflammation causes bone

production rather destruction

Medicine
Drug used to increase asthma = cholinergic , ttt of asthma =anticholinergic
Hemophilia = contraindicated ( inferior alveolar Nerve block may cuease bleeding ) , and
Interaligmentiry injection is indicated

Hemophilia A+B = give desmopressin / antifibinolytic agent (Aminocaproic acid /Amicar)

Cluster headache = 100% Oxygen will relief it

fatal when combined with narcotic(opioids)analgesics= monamine oxides inhibitors

+ tricyclic antidepressant

patients taking bisphosphonates= may have osteonecrosis of the jaw better to do RCT
rather than extraction ( contraindications for tooth extraction)

alteration to Nifedipine = diltiazem + verapamil + isradipine

HBV infectious = HBsAg

Acute HBV = HBsAg + IgM
Chronic HBV = HBsAg + IgG
Vaccinated = Anti-HBs
Recovery from HBV = Anti-HBs + IgG

Active carrier = HBsAG + ALT test increase > indicate liver problem

for AIDs pts most important finding in the lab result= CD4
normal CD4 = 500 to 1000 cells/mm3.
CD4 < 500 = HIV
CD4 count < 350 cells/mm3, = risk for acquiring an opportunistic infection.
CD4 count< 200 cells/mm3 = acquired immu-nodeficiency syndrome (AIDS)

basic unit of infilteration in kidney = Nephrons

Aspirin = cause fetal deformities ( cleft lip and palate )

antibiotic safe for asthma = erythromycin

Aplastic anemia = Normal MCV ( 80-100) , less reticulocyte

Hemolytic anemia (Sickle cell anemia ) = Normal MCV , increase reticulocyte

increase MCV > 100 = Pernicious Anemia + Folate def + Hypothyrodism

Decrease MCV <80 = iron def + Thalassemia

medications cause gingival hyperplasia = Nifedine (calcium channel blockers ) ,

Phenytoin (anticonvulsant)

Atrophic glossitis = absence of filiform papillae , asso with Vit B2 riboflavin , Vit B3
Niacin , Vit B12

renal dialysis and dental ttt = on day after dialysis

diabetic patient start sweating and feel dizzy what to give him = fruit juice , in sever
case IV glucose solu

Leukemia = Infection , Bleeding , Delayed healing, Mucositis - Extraction before 2 weeks

of chemotherapy- platelet replacement may required (if platelet count is <50,000/µL) ,
prophylactic antibiotics if WBC count is less than 2000/µL

WBCs count needed before period surgery = >2000

Normal WBC = 4,000 and 11,000 per microliter of blood.

normal platelets = 150,000 to 400,000 platelets per microliter
VasoVagal Syncope = most cause of loss os consciousness in dental office, because of
emotional stress , pt feel warmth + nausea + palpation

Beta blockers = interact with Epinephrine ( Vasoconstrictor interactions: nonselective—

potential increase in blood pressure )

Glossy pharyngeal neuralgia =pain affects one side of throat , tonsils , mand angle , ear

Hyperthyroidism ( Graves disease) = TSH levels are elevated , exophthalmos ( prominent

eyes)
Hypoparathyroidism= calcium level regulated by parathyroid hormone (PTH) , Enamel
hypoplasia

Hyperparathyroidism = “ground glass” appearance + loss of lamina + renal

osteodystrophy +brown tumor + multilocular radiolucency + Stones > elevated calcium

MRONJ ( medical related osteoporosis of the jaw) = stages

at risk = asymptomatic - No bone necrosis - No ttt

stage 0 = Asymptomatic - No necrosis - sinus tract - ttt mouth wash + if symptoms >
antibiotic
Stage 1= No pain - exposed necrotic bone - ttt Mouth wash + follow up
stage 2 = pain + exposed bone - ttt MW + antibiotic + debridment
stage 3 = exposed necrotic bone beyond Alveolar / fracture / extraoral fistula - ttt MW +
antibiotic + debridment

Lisinopril= treat hypertension

infective endocarditis not able to take orally = IM ampicillin

angina bullosa heamorrhagica = hemorrhagic dots on palate - Asthma patient

Autistic patient = ‫توحد‬

Necrotizing fasciitis = Diabetes mellitus associated , more likely to receive limb

amputation for infection control ( gangrene )

antibiotic cause pseudomembranous colitis = Clindamycine + lincomycine

Heparin therapy = stop medication and perform surgery the next day

Decrease MCV ttt = iron

bleeding in leukemia = less platelets

Agranulocytosis = (Neutropenia) Rare systemic disorder , complete absent of neutrophils

Schirmer's test = in Sjogren syndrome determines whether the eye produces enough tears ,
Normal >10mm in 5 min , Sjorgen = ≤5 mm in 5 minutes

Oral thrush ( oral Candidiasis ) risk factor = Steriod inhalation

TB test = acid fast , Skin test , interferon gamma release assay (IGRA) test blood test
scrofula = Drinking contaminated milk can result in a form of mycobacterial infection
scrofula. enlargement of the oropharyngeal + lymphoid tissues + cervical lymph nodes, skin
sinus tract

Denture stomatitis bchronic atrophic candidiasis / denture sore mouth = asymptomatic,

palatal denture-bearing mucosa

Acute myocardial infarction = DM is moderate risk > Aspirin administration

Prothrombin time (PT) = 10-13 sec

partial thromboplastin time = 25-35 se (aPTT)
Thrombin time (TT) = 9-13 sec

Hemophilia = PTT prolonged , PT Normal , platelets Normal , TT Normal

Von willebrand disease = PTT prolonged , platelets low
vit K def = PTT + PT prolonged
liver disease = PT prolonged , platelets low

Herpangina =is enterovirus infections caused by coxsackievirus , small lesions, 2-6 in soft
palate or tonsillar pillars

coxsackievirus / echovirus or enterovirus = causes Herpamgina + Hand foot mouth

disease + Acute lymphonodular pharyngitis

sequnace of Hypodontia = 3rd molars, 2nd premolars, lower incisors, and maxillary lateral
incisors.

end stage of renal disease ( Chronic kidney stage ) = Pollor ; pigmentation, and petechiae
(also ecchymosis) + xerostomia + altered taste (dysgeusia) + halitosis
• Infections: candidiasis, periodontitis, parotid infections
• Enamel defects of developing dentition (hypoplasia + hypocalcification)
• Osteodystrophy (radiolucent jaw lesions)
• Uremic stomatitis*

prednisone = Corticosteroids (erythema multiform) (lupus erythema) , increase in ESR may

bcz of them

side effects of hypertension drugs:

Thiazide diuretics = xerostomya , lichenoid reactions
ACE inhibitors = Salty or metallic taste or a decreased ability to taste , Angioedema of
the lip,; burning mouth; lichenoid reactions
Beta-blocker = lichenoid reactions
coronal artery in endocarditis causes= Problem in heart valves

Systemic sclerosis/ Scleroderma = deposition of collagen + shiny skin + fingers clawlike +

resorption of posterior mand ramus , coronoid + Raynaud’s phenomenon+ Xerostomya +
limit opening + widening PDL

Radiotherapy = Extraction at least 2 weeks before

Chemotherapy = extraction at least 10 days before
Preferable 3 weeks = 21 days

different b/w Bells plasy and ramsay hunt syndrome :

bells plasy = asso with herpes Zoster
Ramsy causes facial palsy

TNF(Tumor necrosis factor) = increase insulin resisrant

Asthma (pulmonary disease ) = High palatal vault +xerostomya (bcs B-agonist inhalers) +
candidiasis (pseduomembranous ) + gingivitis
Virus stay in clinic for:
HIV = 5-6 days
HBV = in room temp 7 days - 6 months
TB = 4-6 hrs

Drug interact with cyclosporine (immunosuppressants) = Fluconazole

Pt with (adrenal suppression) takes corticosteroids = for surgery double the dose on the
day , before , the day after surgery

Osteomyelitis = swelling radiated to ear , infection my spread to TMJ + Ear

digoxin/digitalis drug (Barbiturates - treat Heart Failure/Cardiac Arrhythmias ) =

SE: Metallic taste, burning sensation, hyper salivation (toxicity), bradycardia


headache, nausea, vomiting, altered color objects appears yellow/green , Vasoconstrictors
interactions > risk of arrhythmias

clindamycin in mg = 150-450 mg 600mg (maximum)- child 20mg/kg

︎ ︎Sickle cell anemia = prophylactic Ab

︎ Rebound phenomena = ︎appears on discontinuation of a prescribed dosage

Jaundice = bilirubin accumulates >rapid breakdown of RBC > yellowish skin > hemolytic
anemia or sickle cell anemia

Tranexamic acide = mouthwash hold it 2 mins , before surgery

Asthma attack = corticosteroids hydrocortison 200mg IV

leukemia = reduced > lymphocytes iassociated with increased edema, erythema, and
bleeding of the gingiva as well as gingival enlargement

ALARA = (As Low As Reasonably Achievable)

For SCC received radiotherapy have dry mouth medication = pilocarpine

Sympathic action = dilute pupil + increase heart rate + constrict blood vessels
Para sympathy action = constrict pupil + decrease heart rate

Iron deficiency = atrophic glossitis + decrease MCV microcytes RBC + dysphasia +angular
cheilitis + burning sensation + candidiasis

Pt with end-stage liver disease = vitamin k replacement

Diclofenac (voltarine )= most durg avoided during pregnancy even in 1st trimester
aspirin = avoided in 3thr trimester
Ibuprofen = avoided in 3thd trismester

Strongly asso with HIV infection = candidasis - erythematous -angular cheilitis - hairy
leukoplakia - kapok’s sarcoma - non Hodgkin’s lymphoma - linear erythema - NUG/P

B12 deficiency anaemia (pernicious anemia) = macrocytes

warfarin = coagulation testing to ensure the INR

Heparin = partial thromboplastin time test , stope 6 hrs before surgery

Aspirin = bleeding time test

Direct and indirect immunofluorescence biopsy = use Saline

Warfarin = INR less 3.5 surgery can performed , more than 3.5 stop it for 2 days

Staple angina = exertion by activity - pain relived with nitroglycerin - good prognosis

Unstaple angina = exertion by less effort - pain not relived by nitroglycerin - poorer prognosis

respiratory rate of 25 ≥breaths/min, tachycardia with heart rate of ≥110 beats/min = sings of asthma
attack , ttt repeat administration of fast-acting bronchodilator every 20 minutes

Lugol’s iodine = dye that used with toluidine blue to differentiate b/w cancer and normal cells,
normal cells brown stain , malignant doesn’t stain

Predisposing asso with Infective endocarditis in % = prosthetic valve 10 -30% , mitral valve
prolapse 25 - 30% , Aortic valve disease 12 - 30 % , congenital heart disease 10 - 20%
Chemotherapy = CHX mouthwash to manage mucositis

Liver cirrhosis = vit K def - angular cheilitis - candidal infection -

mucosal ecchymoses - petechia - enlargement of parotid
( sialadenosis)

Infection control
Biopsy = labeled with the biohazard
Perfect time to wait for wiping chair = 7-10 mins
Minmum =3min

Time for hand wash for surgery = 10 min

Water line = 20 to 30 sec after use on each patient - 2 min in beginning of the day

Air syring / handpieces = flush for 20-30 sec in each pt

specimen transport biopsy to lab= formailn and labelled bioazard

dry heat sterilization =

121 C ( 250 F) 6 to 12 hours
160 °C (320 °F) 2 hours
170 °C (340 °F) 1 hour
190°C (375°F) 6 wrapped to 12 minute unwrapped
218 C (450) seconds

steam sterilization ( Autoclave) ( moist heat) =

121 C (250 F ) 15–20 min 15 psi = normal cycle
126 C 10 min 20psi
132 C ( 270 F) 3min 30psi = Flash cycle
134 C 30psi = 3min

Chemical vapor = 132 C (270 F ) = 20-30 min

Hand washing = 40-60 sec

Hand disinfection = 20-30 sec
Surgical scrub = 2 min

time to Wait for disinfect clinical = 3 min

managment of needle stick = Report > wash under running water 4 mins > cover wound >
take blood sample and test for HBV , HCV , HIV
extracted tooth with amalgam=
For training : 10% formalin solution for two weeks
For disposal : biohazards
Extracted tooth without amalgam :
For disposal = medical waste containers. infectious

for Educational = Autocalve 121 for 40mins

Tooth to be given to patient = no special ttt

spore test for autoclave = weekly

cheek retractor = semi critical - high level disinfection

Worst sterilization: hand scrubbing = increases the handling of sharp items by dental
personnel > accidental injuries resulting to blood or body fluids. So ultrasonic
cleaners = inexpensive and effective

Sterilization = Steam (autoclave) + dry heat, rapid heat transfer + chemical vapor > critical
+ semicritical
High - level disinfection = 2% Glutaraldehyde > heat sensitive semicritical
intermediate - level disinfection = noncritical with visible blood or fluids (vomit)
Low - level disinfection = noncritical without visible blood or fluids

Vomiting on chair= follow manufacture instruction

Vomiting on floor = intermediate level disinfectant
Vomiting consider= infectious

why soaking instruments is better than holding it under water= to reduce aerosols

Disinfection of wax rims : spray-wipe-spray method using an iodophors or phenolics.

Nosocomial infection = hospital acquired infections

yellow + black = PPE (Infectious Waste)

white = amalgam
blue = expired drugs

why disinfect the impression with gluteraldehyde ? = to prevent cross infection

classification of Autoclave sterilization Cycles

N Type = un rwapped instruments
S Type vacuum =
B Type vacuum/ prevacuum = instrument can be stored for 30 days

wearing PPE = Gown > mask > faceshield > gloves

removeing PPE= gloves > facesheield > gown > mask

sterilization of instruments = submerges in 2% in sodium nitrate in perforated container

Handpieces sterilized = in Autoclave

HIV pos exposure = 4 weeks course antiretroviral drugs

Risk of needle stick = HIV (0.3%) , HBV (6% to 30% )

Causes rust(corrosion) to instrument = Autoclave

Disinfection: a process eliminates many or all pathogenic microorganisms, except bacterial

spores

spitting on the chair = intermediate level disinfection

Vomit = infectious wast , contaminated clinical waste > for any body fluids gloves
disposable bibs,

Best method to sterilize carbon steel instruments and burs = dry heat + chemical vapor
> reduce rust (corrosion)

needle stick= 1- Wash wounds under water 10 mins 2-report > request lap investigation

Recap the needle by one hand (scoop technique )

Post-exposure prophylaxis PEP in HIV expouser = take PEP at least 2 weeks

Impression
Addition silicone ( polyvinyl Siloxane ) PVS = inhibited by latex gloves , no byproducts ,
Poured more than once , bubbles bcz Gas

Flabby ridge tech = mucostatic ( no pressure) made with plaster , Window tech ( sectional
impression) , mucostatic ( no pressure)

Functional impression = selective pressure tech > plight-to-moderate pressure on areas of

the arches and minimal-to-no pressure on other areas. With the mucostatic technique
for diabetic pts = morning appointments are advisable since endogenous cortisol levels are
typically higher at this time; because cortisol increases blood sugar levels, the risk of
hypoglycemia is less

desifection of impression =
Alginate + compound + polyether = 0.5% NaOCl 10min
ZOE + polysulphide + PVS =2% Gultaraaldehyde

Alginate =
increase Setting time ( less working ) > Hot water + less water
Decrease Setting time ( more working ) > Cold water + more water
Imbibition = absorb water
Synesresis = loss of water

Elastomers
1- PolySulfide = water byproduct - hydrophobic > syneresis > do not absorb water
2- Polyether = very stiff to remove from pt - hydrophilic > imbibition > absorb water,
dimensional stable

3- Silicons =
Condensation silicon = alcohol byproduct > causes shrinkage of impression
Addition silicone PVS = No byproduct - inhibited by latex gloves > do not absorb
water , best dimensional stable

thin border at one side and thick border at the other side after impression cause =
improper position of impression tray

chalky white appearance of cast = impression left in stone for long time > Exudate from
the hydrocolloid , water or saliva remain in impression

Polyvinyl siloxanes PVS = release hydrogen gas > result in voids if impression poured to
soon after removal

pick-up / indirect impression tech = most common for implant

irreversible hydrocolloids display soft tissue = because of high viscosity

Aluwax (imbression for bite regestration) = immerse in hot water 130 F (54 C) for 30 sec

Impression very stiff = polyether

Atrophic ridge + macroglossiea impression = functional impression (muco compressive)
alginates = immersion (not more than 10 minutes may tear impression) in diluted
hypochlorite

(ZOE) and Compound Impression = glutaraldehyde or iodophor

Critical errors ( need remake ):

⁃ Portion of margin missing or torn
⁃ Margin looks shiny + not clearly marked (bcz of Moisture blood/ saliva)
⁃ Fold or wrinkles or gap on margin
⁃ Larg + small voids in margin
⁃ Impression materials seprated from try > distortion
Minor errors (no need for remake)
⁃ small voids <1mm + not on margin
⁃ Small folds or gap not on walls of margin
⁃ Slight seperation of impression away from preperation
Errors when making Alginate impression =
- Distortion - movement of try + premature remove try
- Tearing - impression remove before it set + slow removing of impression ( should be
snap motion) + thin mix + deep undercut
- Loss of detail - premature remove
- Dimensional change - delay in pouring
- Porosity - air entrapped in mixing
- Poor stone surface - delay in separation the cast from impression

Alginate impression displace tissue why = bcz of high viscosity

dental impression = negative imprint of hard (teeth) and soft tissues

Cast model (stone) = positive reproduction

Fluorid
recommended level of fluoride in the water supply = 0.7 to 1.2 ppm to prevent dental
caries

sodium fluoride concentrations in mouth wash =

0.2% NaF (900ppmF) for weekly
0.05% NaF (225ppmF) for daily
Acute fluoride toxicity = nausea, vomiting, hypersalivation, abdominal pain, and diarrhea.
chronic toxicity = long term ingestion of small amount > causes dental fluorosis

fetal dose = 5 g or more in an adult - In a child, > 400 mg or 500mg

Doses of 100 to 300 mg in children causes nausea and diarrhea.

permanent incisor fluorosis, exposure = 18 months - 3 years of age

fluoridation drinking water = optimum 0.7 to 1.2 ppm

CHRONIC Fluoride toxicity

2ppm or more = mottled enamel
8ppm = 10% osteosclerosis
20-80 mg / day = crippling fluorosis (skeletal fluorosis)
50ppm = thyroid changes
100ppm = growth retardation
> 125ppm = kidney changes
2.5mg to 5mg = death

fluorosis occurs = b/w 15 to 30 months

Flourid toxicity in adult = 32 - 64 mg /kg , 5 - 10mg

fluoride toxicity = 1- nausea, 2-Vomiting

Varnish fluoride concentration = 5.0% sodium fluoride( NaF)

Varnish fluorid for high risk pt = every 3 months recommended

Most important factor 0n fluoride supplement = child age

Implant
follow up after implant in first year = 3 months

• Bone loss around the implant in the first year = 1.2mm

• Bone loss around the implant after the first 1 year = 0.1mm

probing depth after 1 year of placement implant = 4mm

Gingival mask = : injectable materials to cover-exposed crown margins, To block out the
black triangles between teeth

fractured implant screw = ultrasonic tip

fracture implant = trephine burs
limit heat during implants placment = 47 C for 30 sec

dental implants classification under = IIb - Dental materials classification under = IIa

Bone intimate contact to implant but not ultrastructure = Oseointegration

measure width of ridge = CBCT

Primary stability= at the time of surgical placement, depends on the implant geometry
(macrodesign),
Secondary stability = over time with healing, depends on the implant surface
(microdesign), quality and quantity of adjacent bone ( ossteointegration)

Screw lossening or fracture = improper tightening , improper fit to prosthesis

Cover screw = first stage > seals occlusal surface of implant during osseointegration

minimal implant to implant = 2mm

minimum implant to tooth = 1.5mm
Minmum implant to vital structure IAN canal = 2mm

reaction to plaque around implant = same as teeth

Average hight of papilla from crest to bone :

Implant b/w natural teeth = 5mm or less
b/w tooth and implant = 4.2mm
b/w implants = 3.4mm

Resonance frequency analysis(RFA)= used to determin the stability the level of

osseointergration in dental implant ,evaluate implant stability

Cover screw = connected to the implant during the first-stage surgery-Part of implant
covered by ginigiva b/w 1st and snd stages

Best material for implant = PVS

Brand of implants = ADA : D1 - FDA : D2 - FDI : D3

Implant on anterior = cemented angulated abutment

Risk indicator for peri implantitis = 1- poor oral hygiene 2- history of periodontitis 3-
diabetes 4-smoker 5-alcohol

Implant mobility = Failure

Best area for implant = lower anterior

Denser bone area = Anterior mand > posterior mand > anterior max > posterior max

Ethics
1. Non-maleficience (primum non nocere) – No harm
2. Beneficience – to do good
3. Autonomy – respect for pa5ents rights/decision
4. Justice – treat everyone equally
5. Confidentiality – do not reveal patient records to others
6. Fidelity - faithfulness
7. Veracity - truthfullness

You referred pt unnecessary to another doctor, against= Beneficence

parternalism = assumes that he knows what is best for the patient and should make
treatment decisions without reference to the patient

3 essential components of dental ethics = Compassion, competence, autonomy

Collaboration = effectively work team with each other

The focus of healthcare system = Patient

Research ethics = identification, analysis, and resolution of ethical issues - collection and
further processing of human tissues, biological materials, or identifiable information. 


Dose calculation
For peds =

Paracemol = 10-20 mg
Amoxil = 20-30 mg
Iboprophin = 8-10 mg

Maximum dose * kg = X * 5ml / 160 = Y/ 3 TID = answer

New period classification

when they ask you about STAGE: you should know 2 things :
- cal”attachment loss”
- RBL”radiographic bone loss”
• stage 1 : mild cal 1-2 , RBL <15%
• stage 2: moderate cal 3-4, RBL coronal third loss
• stage 3: sever cal >=5 , RBL till middle third loss
• stage 4: very sever cal>5 , RBL till apical third loss
☀ when ask you about GRADE , they mean percentage % of bone loss /pt age , in the
Q he will mention age of pt , if the result :
• Grade A : result <0.5 slow bone loss
• Grade B : result 0.5-1 moderate
• Grade C : result >1 rapid