?' Diameter - ?strength as cubic function (x3).

" 0.10 to 0.20 wire: increase strength by 8 times.

? diameter x 2 - ?' Stifhess x 16 (x4).
? diameter x2 - & range x 2.

4. SS WIRES: 18% Chrominum, 8% Nickel.

Chromium: prevent corrosion.
Nickel: adds flexibility.

13. BONDING.
1. Enamel etching: 37% phosphoric acid.
2. Porcelain etching: 10% Hydrofluoric acid.
3. Omission of Air-dispersion step decrease shear bond strength in self-etching
primer system.
4. Bracket adhesive with fluoride releasing etching gel has significantly higher
bond strength.
5. Fluoride nrevent dental caries bv decreasing solubilitv of enamel.
6.

a. Perio disease: k u l p u y l omas G i ~ ~ ~ l v i l u a

b. During ortho: Bacteroides Gingivalis.
c. Juvenile perio: A.a.

d. Class TI furcation: halfway in the furcation.. ... Graft, GTR.

Class IT1 furcation: through and through.. ..Hemisection with exo

Open flap curettage.

Upright + Intmde : no change in furcation/poclcet

e. 3-wall defect: 1 wall missing.. ...the best prognosis.

Treat ment is C3TR (Gu ided tiss~ eration).

f. Ossoeus craterlinterde~.,,. ,.rot.- ~ e r :conch,., ,.P.7f

nt-1 . m"t.7
,,.,,,.
, .ub,u. .....uu..~alls
2 wall defect.
Treatment is osseous resectionlosseous recontou ring.

g. Higher perio risk: Uncontrolled diabetics, Rheumatoid arthritis.

h. FGG: Free gingival graft: PRE-ORTHO.. ..less than 2mm gingiva.
24
 i. 1-2nun of gingival when pt smiles

j. Gummy smile: 1. Excessive maxillary growth.

2. Short upper lip.
3. Increased eruption of maxillary teeth.
4. Delayed apical migration of gingival ver maxillary
anterior teeth.

k. Gingival margin: lmm coronal to CEJ.

1. Biologic width: 2mm (Bone to gingival margin
m. Vertical FX: Exo.

root fx:

o. Gingival inflammation 3 g r ~ kdown of bone b/c higher Prostaglandin

levels.

p. Teeth with perio in

Can be caused b, -....-.
Has period of remission ;~ n dexace~rbation.
Bacteria can be transmitted.

q. Frenectomy: after space clo:sure, befcIre braces off.

r. Current Pr : and Severity of P'erio dise;Ise comp ared to I!960: bothI up.

s. Supracrestal Yiberotomy:
Used to reduce rotational relapse.
Severes gingival and transseptal fibers.
Contraindications: Poor OH, Excessive labial root pro1ninence, Perio.

n. Closed Eruption Technique: preserves the attachment and mimics natural tooth
eluption by allowing the canine to be brought down through attached gingiva.

v. Maxillary ridge reduction after extraction in 6 months: 23%.

5 years: 33%.

X. G I I I ~ I VI CICIC S S I U I I .
V L L U L ~ 68% of tr--
LIIG.

Occur more in m;mdibular teeth.

Occur more symrnetrically
< ", 7
y. Gingival ~nrlamnlationcauses n~oreb ~ e a ~ a o wornnone because of ?PG level.

z. Which systemic antibiotics is least effective for sease? Metronidazole.

IMPLANTS

a. Implant head of fixture should be 4mm aplcal to desired gingival margin

 2004 Board Kev~ew

b. Maxilla healing time: 6-8 months.

Mandible healing time: 4-6 months.
c. Implant study on experimental animals: successful 94%.

d. Best time for implants (Kok~ch):

Implant maybe placcd if there is no change i r ~v c r ~ ~ t i afacial
r development talten
from serial cephs taken 12 months apait.
In general, Girls: 14 y s and older.
Boys: 19 yrs and older, have completed facial growth.
e. Bone on compression side of inlplant is thicker.

17. ENDO-ORTHO.
a. Apexification: immediate orttio ok

b. Horizontal root fracture: 2-yr observation before ortho, if the tooth become non-vital
then endo needed. Root fragment separation may happen during ortho but there is no .
worsening of prognosis of that tooth.

18. SURGICAL-ORTHO.

a F rally: Mandibular advancennent: not need to level both arches.

. " .
vel the curve of Spee in a bracnyrac~alpatient after surgery.
Brachyfacial, Short lower face height, Deep bite : level C(IS after surgery.
. .
b. Complication of sagittal split: condylar sagging and post-surplcal trismus??
BSSO (Mandibular advancement): cause most TMJ ssounds
(poppinglcrepitatio~~).

c. Complications of mandibular setback: condyles are located posteriorly and

create anterior open bite.

- Post surgical alterations in the position of the t

mandibular prognathis~ninclude:
l e following correction of

1. No significant changes ilL -:+:-.

ruaLLLuL, u L the hyoid bone in
A+-

relation to the anterior pharyngeal wall

2. Hyoid bone was directed downward but not backward
3. Physiologic adaptations occurred to insure maintenance of
the airway

d. Early intervention surgery is done only if functional condyle is needed in (

partial ankylosis + osteochondroma of one condyle.

e. Double jaw surgery vs. Single jaw surgery: Single jaw surgery shows fcwcr
changes due to less movement??

- 26
. desirable side effect after maxillary impaction: Alar base widens.

Limits of surgical rnoveme~

1. Maxillary impaction: 5 - ~ u m m .
2. Maxillary advancement: 5-6mn
3. Maxillary expansion: ??
4. Mandibular advancement: 9-10L
~dibularsetback: IOmin.

Distraction Osteogenesis: can be used in maxillary detlclency (Crouzon's, Cielt

palate), mandibular crowding.

La,,..,, for mandibular Distraction Osteogenesis: 5-7 8--.-

Latency: period from bone division to the onset of traction.
Cleft palate patients: tissue scarring cause "rebound" and therefb~c;i ~ ~ a pdue s e to
lack of elasticity.
Distraction Osteogr:nesis carI increase:the max illa in all 3 planes of space by
"growing bone" witth concornitant tis!sue adapt ation.
A cascade of events after surgical fx: A hematoma fan;,, ,,,,,,d the fx site due to
vascular disruption. Once the clot has fonned, a reorganization process takes
place as a result of invading capillaries. This is characterized as the initiation of
healing and soft callus formation. By 5"' to 7"' day (latency) following the
osteotomy, inflammatory granulation tissue of the initial soft callus is conve~ted
into organized fibrous connective tissue zone similar to WE. At this point,
traction can be initiated.
Mandibular transverse deficiiency is breated by the use c~fmandib physeal
distraction osteogenesis.
-
The use ol€slow inc:remental traction has allonred up to 20mm of M d lengthening
with no associated :pain.

i. Contraindication for rigid fixation: condylar displacement.

j. Soft tissue cnange --*A Chin: 1:l.

Upper lip: 3:l.

k. Post-op paresthesia after exo lower 8 is common.

1. Lefort I posterior maxillary i~npactionfor Class I1 open bite : minimize relapse

by passive repositioning of the segments during surgery??

in. LeFort I osteotomy: effects lower 113 of face.

Maxilla~yadvancement result in more upper incisor show
Blood supply to maxilla: Ascending pharyngeal artery.
27
 Maxillary impaction: can make patient older

n. Indication for LeFoll: 11: rebu~sivenose + maxi11la.

o. Proximal segment: ccmdyle inc:luded.
Distal segment: teeth included.
~ ~~~

p. Rigid fixation promote stability.

q. Condylar resorption cause1predilection: Rheumatoid artluitis, Trauma, Neoplasia,
Ortho tx, Orthognathic surgery; Pre-existing TMJ, Age 15-35 female, High
nlandlbular plane angle.

19 ORTHO-RESTORATIVE.
a. Porcelain crown: Minimal OJ, 0.5-0.75mm OJ.
b. Conventional porcelain bridge: Minimal O J (0.5-0.75mm).
c. Porcelain veneer: Edge-to edge OJ (No OJ).
d. Bonded bridge (Maryland bridge): appropriate OJ and minimal OB (0.5-
0.7'5mm). Upright incisor aneulation ~ e r m ibet1
t ter retenti ging occhusal
force oriented vertica

e. Veneer 2-2: Place the lateral 113'~amray from Central,

Edge-to-edge OJ.

f Width to length ratio of Centrals: 65.75%.

g. After maxillary tooth extraction: 23% (Grnonths) ridge reuuulull.

33% (5 yrs).

h. Implant space for missing lateral incisor: 7mm, 213 width UI LGLILI~~

i. Restoration on Centrals is important when laterallzing Canines.

Inlportance: Sagittal relationshiv, Soft tissue esthetics, Need for extractions 111
lower arch, Size and

KOKICH
1. Buccoli~~gual
position of peg lateral: depend on type of restoration.

a. Porcelain crown: minimal OJ (0.5- I to avoid 11 tooth preparation on

lingnal surface.
b. :neer: Edge-to-edge OJ. (contact mandibular incisor in centric occlusion)
to allow sufficient space on labial for both temporary composite buildup and eventual
porcelain lami~ late.

2. Inci~ogingiv~,r u a ~ ~ ~determined
"1 +.A";+;" on: by position of gingival margin:
In some young patients, labial gingival level has not migrated to its adult level (Gingival
margin: lmm coronal to CEJ). So they need either gingivectomy or osseous surgery
depending on bone level: Biologic- width: 21nm (Bone to gingival margin).
3 . Abraded anterior teeih with gummv smile: Bracket heights more incisal and incisor
are intruded to match canlne gingival margin and posterior teeth are used as anchors.

4. Bulimic patient: intrude anterit3rs teeth for restor.ation space.

5. Posterior wcI r n teeth: intrude nlolar to avoid more occlusal preparation and avoid
crown lengtherling.

6. Gingival esthetics during finishing: lateral 0.5mm coronal to central.

If the teeth have greater than lmin of sulcular depth and gingival margins are at
different levels, the patient need gingival surgery before bracket removal.

.
7. FGG: Free gingival graft: PIUE-ORTHO....less than 21nm gingiva.
- -
Coslneltic reasons: Post-ortho.

catment c)f choice for denuded roots: Connective tissue graft

9. Ossoeus craterlinterdental crater: concavity confined to facial 2 51 walls.

2 wall defect.
Not improve with ortho.
Treatment is osseous resectioniosseous recontouring.

10. 3-wall defect: 1 wall missing- .....the best prognosis.

. -
Amenable to pocket reduction with regenerative perio therapy.
Treatment is Debridement, bone graft and GTR (Guided tissue regeneration).
Initiate ortho if stable perio 3-6 months.

11. Hemiseptal defects: 1-2 wall defects.

Found in mesially tipped or supererupted teeth.
Can be eliminated with ortho: uprighting and eruption will level the bony defect.
If the bone level is flat between adjacent teeth and the marginal ridges are at
different levels, correcting marginal ridge discrepancy will create hemiseptal
defect.

12. Class I furcation: osseous surgery with good prognosis.

Class I1 furcation: halfway in the furcation. ....Graft, GTR.

 Class I11 furcation: through and through.. ..Hemisection after ortho with exo
Open flap curettage.

13. Root proximity: 2-3mn of root separation will provide adequate bone and embrasul-e
space for perio heal:th.

4. 6 morlths.after
.
band relr oval for ;adequate
..
bone renlodeling, cessatio t tv and
narrowing of the penodontal ligaments.

15. Ankylosis lead to arrested development of the alveolar ridge: remove ankylosed
tooth at start of growth spurt
Adolescent rapid growth spurt: Girls 10"'- 13 yrs.
Boys: 121n - 15 yrs.

16. Implant should be placed in 2 months after extraction of over-retained primary

tooth.
b~zeneral implant should 1 in boys until 21 2

17. Indications for canine substitutic

a. Class I1 molar relationship.
b. Anterior tooth size relationship.
c. Length, shape and color of canine.

20. FINISHING.

a. Check for: Gingival margin, Crown form, Ginpival

2- - ~ width,
- Gingival fonn.

b. If pt with steep premolar cusps, should fmisl :ase wit:h deep overbite.

a. Reorganization or YLJL occurs in 3-4 monttIS.

b. Class II Div 2 most prone to relapse: Deep bite.

c. Case: Rotated incisors, D eep bite I e OJ: Rcvtation most likely

relupse.

Which fibers iml Transseptal fibers.

e. During post-ortho, the followings can occur: 1.Reduction in root length.

2.Reduced alveolar bone supper(.
3.Crowding.
4,Rotation.
 t-treatment study by Little: 213 relapse of mandibular incisors.

22. ESTHETICS.

a. David Sarver: "Smile line" - Smile to teeth.

a. Smile Line: 1. VME.

2. Mbscular acrlviry when smilj
3. OJ.
4. OB.
5. Interiabial gap.

b. Burstone: Upper occlusal plane should be relatively flat and not allow more than
3mm of incisal show at rest.

c. Soft tissue thickness in fern ales incr'ease mol-e than n

23. STERILZATION.

a. Sterilization: destroy all microbial life.

Disinfection: destroy pathogens.
Low level:
Medium level: alcohol
High level: ethylene oxiae, gmteraldehyde.
 EMBRYO
1. Tuberculum impar give rise to tongue
Foramen cecum -thyroid.

2. Interstitial growth: result of hyperplasia and hypertrophy. In soft tissuG.

Appositional growth: hard tissue

3 . Ovum: fertilization to 14 days.

Embryonic period: 2-8 wks.
Fetus: 8-36 wks.

Bone formation starts out as mesenchymal condensation.

4. Branchial arches.

First (Mandibular) Trigeminal (V) Mx, Md, Incus, Malleus M of mastication

Zygomatic, Temporal,

Second (Hyoid) Facial (VII) Stapes, Hyoid. M of lBcial exp

Third CN I X Posterior 113 of tongue.

(Glossopharyngeal)

Fourth and Sixth Vagus (X) Tongue M of larynx.

5. Meckel's cartilage.

a. associated with lStbranchial arch.

Forms: incus, malleus, sphenomandibular ligament and spinous process of the spl~e~loid.

6. Growth curve (Scanmon's)

a. Lymphoid : tonsillar and adenoid tissues show decrease in size beginning in the
circumpubertal period. Lymph tissue regress as genital tissue develop.
b. Neural - the first system formed in the embryo.
c. Maxilla
d. Mandible.
e. General
f. Genital.
Skeletal curve is inversely proportional to lymph curve.
Females 50% of gi-owth complete at age 6 .
Soft tissue thickness increase illore with age in females than in males.
32
 Lymphoid is inversely proportional to skeletal.
Facial growth curve parallels most closelg somatic curve.

I1
l Years 20 Years

a. Upper lip: fusion of medial and lateral nasal processes.

Frontonasal processes + medial and lateral nasal processes.

Contribute to formation of Philtrum.
Medial nasal process rise to bridge and septum of nose, premaxilla and
phllt~m.
Lateral nasal process rise to Ala of nose.

b. The primary palate (nonnally unaffected) is formed by the 6"' week from the two
maxillary processes and the medial nasal processes and separates the developing
oral and nasal tissues. As the oronasal cavity expands, the secondary palate is
formed b/w 6-8"' week by the two palatal processes which are outgrowths of the
~naxillaryprocess.
c. In fetal life (8-36 wks), palate close by 12 wks: Generally it takes place by 7.5 to
8 wits which iuarks the end of enlb~yonicperiod. After the palatal processes have
fused, they continue to grow further posteriorly, while merging in the midline to form
the soft palate and the uvula. This process is completed by 12 wks.

d. Cleft Palate ....

33
 1. Rotated incisors.
2. Missing laterals.
3. Posterior X-bite.
4. Ectopic eruption.
5. Supernemeraries.

*Not: Impacted centrals.

e. CL: repair at lowks, 10 lbs, Hg level 10.

Cleft Lip: failure of fusion of lateral nasal and median nasal processes and
maxillary prominence.

g. CP: repair 10-18 months.

CP forms by 6 wceks.
Cleft palate: failure of fusiaIn of pal: tine pro of maxillary
process).

Infants with repaired cleft lip and palate have detlclency of soft palate and likely
VPI.
A patient with a cleft palate is best ret,ained wit 11 retainer with a pontic
Cleft patient's speech is affected by inability to build up intraoral pressure due
to co~nmunicationbetween nasal and oral cavity.
Isolated cleft of soft palate gives problem with hypernasality and VPI
(velopharyngeal insufficiency).

11. Incidence.
Indian> Asian> White> Black
Whites: 1/700.

i. Hypotelorism: associated with oro-ocular cleft

j. Cleft Palate probability: 4% if 1 sibling or kin is affecte

9% if 2 siblings are affected.
4% if 110 sibling atfected but 1 kin is affected.
4% if 1 parent is affected but no sibling is affected.
rent and 1 sibling.

k. Failure of fusion of LLULLUML

d ~ l r i ~ cervical
b .
I..*+"
CLCIL.
..A
auu ULYGL LLLI

s.Tooth buds.

34
 a. Dentin, PDL, Pulp, Ceme~ltum,blood vessels, skeletal-muscular
Mesoderm or Ectomesenchyme (comes from Neural Crest).
Sltin, nail, hair, Enamel: Ectoderm.

b. 0-3 months - 1'' molar buds

3 yrs - 2ndmolar buds
9 yrs - 3rdmolar buds

c. Dental lamina: origin of the enamel organ (enamel epithelia, enamel reticulum,
ameloblasts.. .)

d. P rimary t eeth star,t to calci 1s by 14 wks (4 months).

Form in utero bji 6ks.
,., ..,.
Calcifv i,,n ,,tern h,v 4 mont,,,. dibular incisors have been calcified at birth.
Permanent teeth form in utero by 4 months.
Permanent teeth begin to calcify at birth.
Mandibular second premolars show greatest vanatlon m onset or
mineralization.
Calcification of the upper and lower third molars varies greatly.

e. Minimum number of lobes:

f X-chromosome and Chromosome 4 play important role in tooth develop~nent

9. Most &JS the skull close between 2-4 yrs.

*" Occipito-shl suture becomes c 3 betweel
: Both end( 1 and intramembra owth.
 a. Spheno-ethmoid: 7 yrs.
b. Inter-spenoid: before birth.
c. Spehno-occipital: 9-14?
18-20?

** FACIAL GROWTH*"
eatest din t birth: 'idth.

U.
,JL.~ .
w ~ u i n---f. A-r --f v erilcal.
.~L!.

Post-natal incremental changes in the face: Most in vertic in width.

c. Downward + Forward direction result from:

1. Upward + Backward growth of the maxillary sutnres and thie mandilbular
condyle.
.
2. Vertical e r u ~ t i o nand mesial drift of the dentition.
~~

Case?: A l l y ,b male, in 2 year period the mandibl Irs are

expected to erupt: -3mm ramus height increase so lzalf oj3mm is 1.5mm
eruption of lower molars.
Case: 1 I y/o male, lowerfacial height increase Imm/yr.

d. Gal-tilaginous growth site post- ccipital sylchonrosis, mandibular

condyle, nasal septun

e. Interstitial growth site: Sheno-occipital synchonrosis, mandibular condyle.

f. Bone tissue grows by differentiation of cartilaginous tissiue

g. Cartilage differs from bone that cartilage can increase in size by interstitial
growth.

h. Cartilage tissue is avascular and contains intracellular matrix of proteoglycans

i. Newly fonned bone is U.

j. Remodelling of bone results in histologic structure called osteons.

k. Haversian system: found in adult skeleton and structural unit of bone

I. At birth, the right and left side of the maxilla are not fi~sed.

m. Implant placed at age 7 will be displaced with the maxilla d u r i n ~growth.

11. FMT: Mandibular fui~ction(Deglutitioi~)

influences mandibulai- growth.

o. ADENOID FACES: 1. Narrow width dimensions.

36
 2. Protruding teeth.
3. Incompetent lips.
t. Not obligatory mouth breathers.

p. Upper ""A
nuu
-:A
ilzruurr: part of face has both intramembraneous and endochondral
sutures

q. N ~ U ~ O C I ~ ITIIII U
I II
U II ~
I C ~ ; unee twes of a o w t h occur:
endochondral and appositional.

r. Best genetic prototype for predicting racial growth: same sex SlDllng.

s. Changes in soft tissue pr.ofile from teens to adult is greater than facial skeleton.

t. Behrents study (from Bolton study): "There is an increase in all facial

dimensions in adults." + The cumulative effect on adult facial skeleton over
time was large.

u. Nose never stops growing in males.

v. Nasal floor higher up in child than adult.

10. Nasomaxillarv growth.

a. Growth at sutures and nc
b. Passive displacement vi; onlprimary displal ) accommodate brain

c. Palatal growth: Vertical; nosu~ptionalong floor ol LIIC lluse and deposition on

roof of the mou ;ition on the lingual) with resultant downward movement
of the palate.
1. Transverse: apposition along the midpalatal suture facilitate transverse
growth. (Sutural).

d. Downward and forward direction of facial growth result frorn:

I. Down + forward growth of the maxilla.
2. Upward + backward remodeling of the maxillary sutiIres.

I I. Mandibular growth.
a. Steady growth before puberty.
b. Ramus: 1-2mmlyr.
Body: 2-3mmiyr.

c. Mandible is the smallest st~uctureat birth compared to the size of adulthood

d. Mandibular growth stops after maxillary growth.
e. Condylar growth: Endochondral/Proliferatio~~ of cartilage.
 Body: Intramembraneous.
f. Mandibualr hypoplasialCondylar hypoplasia: most common in early
childhood.

g. Rotational growth of mandible: shown by bending of canal and condylar neck

angle.
11. Mandibular growth rate in females: greater in vertical growth than anterior-
posterior.
i. Body of madible lengthen by Remodeling of anterior ramus: Resorption at the
anterior border of the ramus allows for increase in mandibular corpus length.
. Condylar pole is 2x wide transverse than A-P.

k. Mandibular growth sites: Condylar process, posterior border of ramus and

I :olar proc

1. m,,,,ut growth of the chin is caused by bone deposit ion.

I . BJORK: 7 Structural signs of growth rotation:

I . inclination of the coildylar head

1. curvature of the ma~ldibularcan;
2. shape of tile lower border of the ..,,.,.
38
 :lination of the symphysis
4. lilcerincisal angle
5. interpremolar or intermolar ar
6. anterior face height.

m. Late mandibul;Ir growtlI in a patiient with tight ant1:nor occlusion may cause:
1. Distal displacem~ent of the: mandibl e.
..
2. Flaring ot the mixillary inc=nr~
,"L"-Lu.

3. Crowding of the mandibu lar inciso

12. Functional Matrix Theor.

4. Temporalis muscle acts as perlost.-..
teal
5. Primary growth sites, such as condyle and sutures respond by
compensating for translational forces.
6. Translation: movement of bony segments in space without any internal or
localized changes.

13. PVH.
a. Growth peaits: 1. Early infancy.
2. Adolescence (PVH).

b. Peak Velocity Height: highest growth rate any age (heigl ear)
usually occurs at age 12-13 for girls (Stage I1 of develop ld
age 14-16 in boys (Stage IIT).

c. Late maturing girls: PVH occur 6-1 1 months before Menarche.

Late rnaturers: show larger increments of srowth.

d. Females: Puberty* nonths P - 18 montl arche ( end of Spurt)

e. Males Fat spurt 12 months Puberty 8-12 mo PVH 15-24 lno End of Spurt.

a. Sesamoid osslllcatlon: tirst appears around 12.5yl-s (at Puberty).

2-3 years of growth spurt after the first appearance.
SMI =4.
Female: 33% growth completed. 1 lyrs.
Male: 29% growth completed. 12 yrs.
So there is 60-70% growth remaininq. The s ~ ~ ~ u.nrlrLa L ~ . 1~ yr. ~
prior (at start of puberty) to the pubertal maximum growth
spurt.
 b. SMI=6 (MP3 capping): 50% of growth complete(
Between SM16 and SMI7 is growth spurt.
SMI=7 (MP5 capping): 75% of growth completed.

c. Important indicators of skeletal maturity:

ossification adductor.sesamoid of thumb.
fusion of epiphysis and diaphysis 3'* finger, distal phalan:

f. Carpals -Wrist. ?????

Metacarpals -Hand.
Phalanges- Fingers.
diaphysis - shaft of long bones. ??'
epiphysis - capping part in between growth center).
iuetacarpals in wri st.
carpals in fingers.

d. Chronologic age vs Hand-wrist ??

e. The percentage of growth completed at 10 years of age: ??? 65%???

18. HISTOLOGY.
a. Primary ostec n bone, immature bone, new bone.
Secondary osteon: replacement of existing bone (lamellar bone), bone remodeling,
occurs thoughout life.

Woven bone: new ortho bone and embryonic bone.

b. Cortical bone: compact bone , ie, mandible.

Trabecular bone: cancellous bone.
Basal bone and alveolar bone are no different histologically.

c. Vital staining: deposition of dye in animal bone growth studies

d. Cartilage can grow by both Appositional i :itial growth.

e. Bone fom~ationstarts as mesenchymal c

f. Enamelin: inajor organic component of mature enamel.

Matrix of developing enamel: Ainelogeni elin and Tuft protein.

g. Rate of bone modeling decrease with z,-.

 PATHOLOG

1. * Primordial: cyst in place of missing teeth.

" Residual: arise from inf helium at apex 01 non-vital
* Dentigerous: follicular (

2. " Ameloblastoma: Multilocular RL (Soap bubble).

Come from epithelial rests of Malaize (Odontogenic origin).
More common in males??/No sex prevalence?
More common in angle of mandible.
Usually benign but destructive.

Recur.rent.
Occur s around age 40.

3. Osteop etrosis (f Ylbers-Sc 3 bone): ' normal c:

cartilage, f ?agile b ones.
~

4. a. Positive ted. Earl iest indic :Ute Hep

active infection.
b. Surface Ab: patient is immune.
c. Core Ab: patient is infected.
d. Most common symptom: 110 syr O%), Jau ndice.
Incubation period: 1-6 month.

5. k'osltlve TB test: patient has been exposed

5. Cemen na: Young adult patients.

RO
Occurs around lower nlolar rol
Tooth is sacrificed.
Case: Apntient wzth cnrzes urru ~ L I L I L O J I L I L L L ~ LIL i~glzt~nolar.
L V W L ~ ~

vpercenzentosis.

6. usreosarcoma: can manifest itsel~as mvos~tis.

7. Paget': ; disease (Osteitis Deform ans): 1'a Cotton

appearance. Potential of undergoing "spontai~eous"mal~mantt r a n s i o m ? + ~ n ~ ~
Wonuian bone.

8. Fibrous dysplasia: "ground glass" appearance.

9. Rheumatoid arthritis: Synovia affected early. Systemic disease with diffuse

infla~l~mation
of synovial lining.

10. Myositis: lnuscle pain. Si~uilarsyi~~ptoms

as osteomyelitis
41
11. Herpetic gingivostornatitis: low made fever, lymphadenopathy, malaise, lnultiple
ulcer in oral cavit

12. Problem with nearr valve can cause: ~ u d w i g ' sanmna. infective endocaitis.
rheumatic fever, aortic stenosis.

13. Periapical cementa1 dvsolasia: Mansdibular anterior teern. nracK remales in 4u.s,
3 stages of RO and RL.

14. Cerebral palsy: muscular aysrunctlon.

15. Sublingual: Most conmoll sial

16. Most common malignant bone tumor: Osteosarcc lultiple myeloma.

Case: Multiple myeloma: punched out RL in mandible in 43 yr man.

Not associated with roots of teeth. Decrease in serum Ca. Normal
alkaline phospbatase.

17. Diabetets Mellitus: polyuria, polydypsia, polyphasia, increased infe

loss, keton increase, blurred vision, Blood glucose kevel >160mg/dl.

18. Rheumatic fever: caused by Streptococcal bactc

19. Subacute bacterial endocarditis (SRE): caused ,, ,L,,,,,v,Y,,,, YY.I.YU.

Staph causes acute endocarditis.

The portal of entry to the bloodstre am ofbac:tena in SBE is:
-:.~-.
a. Mucosal of ginglva~ o~eeding 1 3~ ~

b. Salivary glands
c. Lymphatics

* C a m As a result of dentalp~ophylaxia,n2zcroorgariisms aro und teeth enter the

hloodstreanz. This condition is an exanzple of. Bacter,emin.

20. Kaposi's sarcoma: multifocal in origin.

21. Candidiasis: The most co?imon oral manifestation or n l v mrecnon

22. Case: A 5 YO child has sjimn~etricbilateral en16rrgeinent in tlze po.rterior areas of

..
tlze nzaizdible. Radiographs reveal large, nzultilocular malolucenczes. >
The most iikelj~
diagnosis is: Cherubism (familial fibrous dysplasia).

23. Radiation therapy for oral cancer may result in osteoradionecrosis.

24. Osteomyelitis: caused by MBT(Mycobacterium tuberculosis).

25. Bacteremia -t Iufective endocarditis.
 RADIOLOGY

1. KvP: ability of x-ray photons to penetrate.

mA: quantity of x-rays produced.

TKVP -t .1contrast.
Root fracture -+ increa se KvP.
Time has no effect on p enetratit~g power l. It only increase # of
photons.

2. Density = kVp x mA
L
'?KV~,mA and time +?' density.
4density by increasing tube-patient distance.
3. Tr ial XR: Least reliable for condylar shape.
Only Lateral pole of the condyle vir

4. D [or internal derang f displaced disk: Arthrogram (for

soft 1 ect dyes).
Diagnosis for osseous components of TMJ - Tomogram.
MRI: best for TMJ soft tissue.

5. Manual pr ocessing of ceph require 5 min devc:lopment cycle and a 10 min fixation
cycle.

6. a. Light radiograph: under-development, excessivt:fixation,under-exposure,

film-source distance too great, film packet reversed.
.--
b. Dark radiograph: white light leaked into dark ro",,,, uvLL.-development,
over-
exposure, inadequate fixation, film-source distance too short.
c. Latent image: produced after exposure but before development.

7. Filtration of x-ray beam with Aluminum results in the preferential removal of low
energy photons: & intensity of the beam.
I'mean energy.
Intensifying screen: thinner phosphor layer results in less unsharpness.
(more sharpness). Thicker layer results in less sharpness.

*Case: When taking lateral cephalogrun~s,double intenszfiing screens and screen films
crre used to recluce: exposure time.

8. Water's view: maxillary sinuses.

9. Double film: do nothing or increase KvP ??

10. Fat person then change exposure time, given equal penetration.

11. ? Film-to-patient distance by 5cm: image is slightly enlarged.

12. Source to inidsagittal plane: 60 inches (5 feet).

Film to midsagittal
- plane: 15cm.

13. Post- 111shows nandible: Change in object to film distance

14. PANORAMIC X-Ray: Not useful in determining arch perimeter deficiencies,

cavities.
Focal trough: area of dental anatomy reproduced clearlv

15. Maximal permissible dose of radiation )er week: 0.01 rer

roentgenslwk = 0.5150wks
Erythema: earliest sign of excessive radiation
Minimum total filtration required b)r x-ray m;
equivalent.

16. Oral tissue most sensitive to x-radiation: Developing tooth buds :and saliv
glands.

17. Collimator: mandatory in protection for pt.

18. Radiographic ulsion is gelatin and silver

19. Tungsten usea ror target in the x-ray tuhe

20. Optimal detail sharpness: 1. Small focal spot i

. ..
- Increased kilovoltage.
~

Short obiject-film distance.

 PHYSIOLOGY

1. Anterior pituitary gland: Secretes ACTH, GH.

&omeealy (excess Growth Hc 30's-40's.
Enlargement of hands, feet and facial
features. ..
Gigantism in youths.

2. Thw-oid hormone and GH cause metabolic rate to incrc

3. IParathyr,aid hormone (PTH): ? Ca in extracellular fluid (4bone Ca).

-- .,,,erparathyroidism:
U.,... High Ca level, demineraALLaLLvburafhologic
I;..-+;-.. I,. calcification
of skeleton. brown tumors.

4. T ~ l k a l i n ephosphatase
a. during growth in children.
b. following fx.
g. during bone disease where high osteoblastic activity is required (Paget's disease).

5. Hypothyroidism (Cretinism) : Root Resorption: * Proffit: p314.

Retardation of growth of long bones.
Mental retardation.
Delayed eruption of teeth.
Large tongue.
I~ncompletely -oats of pennanent teeth.

"Case: Children with which of the following conditions have the greatest tendency
t o ~ ~ a r d es l a ~ z deruption o f the teeth? Hypothyroidisnz.

6. Pulp: no propnoceptors.

+ 7 . Hypocalcemia + decrease cardiac output.

(p.ndaL)
8. Adrenocorticosteriod produced by adrenal &--,
9. Electromyography measures action potential of individual muscle fibers.

10. 46 chromosomes in a sonlatic cell. (23 in reproductive cells)

1 1 . Case: A person drinks a lot of soda: I~ypocalcijcationof teeth

4enan~ellayer due to low pH (acidic).
 2004 Board Review

CPR
1. Child: above naval and below sten
1 breadths, 5 pumps.

2. Adult: locate xyphoid and compress between nipples.

2 breadths, 15 pumps.
Rescue breath: 1 breadth per 5 seconds.
 Pharmacology
1. Peak pain during ofitho tx occ:ur the dzly after ac , with a (
next 6-8 days.

2. NSAIDs given preoperatively decrease prostaglandin producti

inflaill~llatoryresponse and decrese post-operative pain.

3. - PGE could be detected in gingival crevicular fluid during orthodontic treatment.

PGE iiljected locally cause appearance of osLzoclasts and subsequent bone
I-esorptionin rats.
PGE injected locally cause 0th movement in monkeys and humans.
Use of pretreatment ibuprofen decrease pain during orthodontic treatment.

4. Cyclo-oxygenase mechanisn

a. Non-selective NSAIDS: Aspririn, ibuprofen, naproxen and ketoprofen.

Inhibit both protective COX-1 and inflammatory COX-2 enzymes.
Effective in alleviating acute inflammatory pain, eg. Chronic myofacial paiu,
ternpoi-omandibularjoint disorder.
Risk of GI ulceration, bleeding and renal toxicity.

h. Newer Cox-2 Inhibitors (Cyclo-oxygenase-2 inhibitors).

COX-1-sparing drugs.
Developed to limit the adverse effects seen with chronic NSAID tl~eranv- GI toxicity
and platelet inhibition.
- Celecoxib= Celebrex (Not effective in acute post-op pain)
Rofecoxib= Vioxx.(Long lasting analgesic upto 24 hrs).
Used for cilroi~icjoint pain and acute postoperative pain.
 Cyclo-oxygenase mechanism

Phospholipase A

Cytoprotective Prostanoids. Inflammatory Prostanoids.

-Normal physiology. -Induced with tissue injury..
-Healthy gastric mucosa. - .
3 tenderness.
-Platelet aggregation.

5. Three drugs that cause gingival enlargement: Procardia (Ca char

Dilantin, Cyclosporin.
 MISC..
1. ABO formed in Estes Park, CO in 1929 under guidance of Dr. Albert Ketcham.
50
2. CDABO was formed in 1979 at ABO's @' anniversary.
3. Preceptorship programs leading to orthodontic specialization were abolished by ADA
in 1969.

4. How long save employee needle sticlc record: 5 yrs.

5. Behavioral technique if you ask the pt to raise hand if it hurt:

6. Newly employed personnel should have Hep. B shots made available ASAP.

7. Strep mutants cause cavities.

8. Selecting digital camera: Lighting is the most important

9. Best camera: 35mm SLR with fixed focal length macro lens.

10. Which file format you don't lose quality of picture files: TIFF definitely, but is there
loss-less Jpeg??

1 1. Who was the first editol- of AJO-DO?

12. Standard of treatment determined by who? Orthodontist?, ADA? ABO? AAO? The
court?

There are 2 sections out of 5 about case d~agnosisand treatment planning with
decent records. Start reading your AJO-DO Case reports. I thought most cases were
straight forward except maybe 1 or 2. Each section must had about 5 cases with about 10
questlolls for each case. Remember to read the questions for a case and get a general idea
where the case is going before thinking about your first question. And don't spend tiiile
tracing. Maybe SNA, SNB, ANB,Wits, Ul-Sn, L1-GoGn is all you need to measure.

1. Adult Open bite case

2. Adult Class 11, 100% Deep bite.

49
3. Know all al history, Surgical
options, etc.

4. A girl with Unilateral open bite etiology: tongue?

5 . Adult with no chin, previous ortho wit11 4-bicuspid exo and still Class 11.

6. Adult mutilated dentition.

7. Val-ious mixed dentition cases

8. Growing Class II patient: What do you want to do? Pendulum, HG, Herbst, Class I1
con-ectors, exo, etc. What is the effect of vertical pattern?

9. Hand-wrist x-rays for growiilg*+.+-.;.parrwrro.