Dr.

Manal Alharbi
‫دعواتكم‬

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 onewallpresent
2 wall crater( most common)
3 wall trough
4 wall circumferential (extration socket)
Moat
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

60
30
30
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 t
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
A
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
6 8Week
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

Mount and Hume classification =

Site = 1-pit and fissure 2- contact area 3-cervical area

Size = 0- no cavity 1-minmum dentin involved(cavity without weakened cusp) 2-moderate dentin
involvement (cusp weakened) 3-remaining tooth structure weakened 4-extensive caries + bulk of structure
loss

Sickle scalers
supragingival calculus + Triangle in cross section

Curettes O
semicircular in cross section

ED Ant
Universal currettes= two cutting edges
Gracey currettes= one cutting edges
1-2 and 3-4 — anterior
5-6 — premolars S G pre
7-8 and 9-10 — posterior, facial and lingual
11-12 — posterior, mesial
13-14 — posterior, distal

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

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

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

osteoectomy= remove supporting bone

osteotomy= remove non supporting bone

Distal wedgs incision Pocketreduction forterminal molar

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

wetakegraftfrom
postwar
 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
Hostresponsemoduation t
Sharpey’s fibers = type l collagen
Acellular
BMWs Acellular cement = coronal + middle , Cellular cementum = apical
cellular
Blood vessels supply gingiva = supraperiosteal blood vessels

Type of mucusal gingva = masticatory mucosa

and palate
Principal cell of gingiva = keratinocytes

Bacteria asso with periodontal health = gram + facultative spp

Linear gingival erythema = in HIV gingivitis

Initial stage l = PMN

gingivitis Early stage ll = lymphocyty , Erythma
Sinop 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 bacteroidesprovitalla intermedia

X Active periodontitis? = causing apical migration

8 Healty crestal bone 2mm below CEJ

Most accurate radiograph for bone loss = vertical bitewings

 Common patteren of bone loss = horizontal
Bone
Inflammatory mediator indicated disease activity = IL-1 destruction
Toa in

To 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

14 + doxycycline
Local delivery for chronic periodontitis = minocycline 7 10

Ttt aggressive periodontitis = amoxil + mertonidazole

Indication for locally adminsteration antibiotic = pocket > 5mm

0
Microbe asso with hairy leukoplakia = candida albicans , antifungal nystatin + fluconzole

Root sensitivity = movement of fluid

Fremitus = vibration or movment of tooth in functional occlusion

berotomy or pericision is an
antiep Ca
Gingival hyperplasia = phenytoin
Channel immunosup
+ nifedipin + cyclosprine orthodontic surgical procedure
designed to sever the gingival
es
Interproximal knives = orban 1/2 , gingivectomy = kirkland 15/16 bers around a tooth. It usually
reduces the tendency to relapse of
Odontoplasty = reshaping root
escorrected by dental
tooth rotations
Most involved in root amputation = max molars braces or other treatments.

Fiberotomy = perio surgery adjunctive to ortho for tooth rotation to prevent relapse
un
Gingival augmentation = inadequate attached ging
i
Primary reason for free gingival graft failure = inadequate blood supply

Sloughing free gingival graft = dies of superficial layer of graft

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

I The final outcome of periodontal pocket healing:

s.gs1- 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 ) probingforce 0.75N
probing forces well tolerated = 0.75 N
JE 30g
prob forces to remains within the junctional epithelium = 30 g B one L Sog
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 l Z S U S 6 7 8 9 lo al iz l3 in
WHO = 0.5 ball , 3.5 8.5 11.5
I me
Marquis prob = 3 6 9 12 , in 3mm sections

Space b/w implamt and natural teeth = 1.5-2mm PsdCn9E.d

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

0 Om
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

s
percentage of osseous crater = of all defect one-third 3
35.2% , for all mandibular two-third 62%
um
tooth is hopeless = caries reaching furcation area

t.gg
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

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

Best wall defect prognosis= three wall

present
 fromocclusion
fatrama
effect of occlusal forces TFO = influenced by magnitude + direction + duration + frequency
e
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

mm
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

op
Percentage of Osseos craters = 35% Mand defect 621
most seen in Pregnant Women = gingivitis , gingival overgrowth
a
5A's 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)
e anticonvulsant phenytoin = carbamazepine + valproic acid
nifedipine = diltiazem or verapamil
alterative 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
 Complete Healing
4 5week
CHX = antibacterial + Substantivity
1CompephealingHealing 7 weeks
cT
Smoking effect on gingivits = less bleeding and less inflammation2 Complete
Imouth
3 Healing alterscaling
Type of floss depends on = personal preference

Resective periodontal surgery = open flap and root depridment

t
WComplete healing of the gingivectomy = takes 4–5 weeks
After gingivectomy : Complete epithelial repair takes 1 month
complete Connective Tissue repair takes 7 weeks

E
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

or oneinstrument one finger
Sir lace research

8 8% = rapid progression of periodental deisease

81% = moderate periodental with loss attachment

11% = no progrestion of destrutive disease

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

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

k I
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
I
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

flap
B toprotectthe
Main component of Pedicle swelling = palatal stent > to allow for swelling occur
shouldmakeretene on
you
Heavy smoker > or equal 20 cigarettes / day - light smoker < 19 cigarettes /day
of
Occlusal trauma = injury -2healing -3adaptation u- normal
response

µ etrumao
during
Easier Root planning = convergent + short root

Difficult root planning = divergent + long root trunk

Dental floss = waxed nylon

cut of point that requires periodontal surgery = >5mm or 6mm probing depth
pical
probing
depth
mm I
biologic width = physiologic dimension of the junctional epithelium and connective tissue attach- ment 2

healthy gingival sulcus depth = of 0.69 mm

t is recommended that there be at least 3 mm between the gingival margin and bone crest > This allows for
adequate biologic width when the restoration is placed 0.5 mm within the gingival sulcus (subgingival)

proper amount of ferrule for adequate resistance form of the crown preparation = 1.5 mm

Creating a ferrule with orthodontic extrusion > reduces root length + whereas crown length remains

Eas
unchanged > preferred, because even though the root is effectively shortened, the crown is not lengthened

Surgical crown lengthening > reduces root length + but increases crown length > resulted in a weaker
restored tooth

Cementum at cervical area completely removed and exposed dentine results in scaling = lead to
sensitivity

allogeneic bone graft =more effective in augmenting the width of the alveolar ridge and is much less
effective in improving hight (vertical augmentation) of a deficient mandible.

Pregnancy associated = a. gingivitis b. Pyogenic granuloma

PI
 Gingivitis modified by systemic conditions = exacerbate the gingival inflammatory response to plaque. but
the primary etiologic factor is still considered to be microbial plaque.

Localized periodontitis = first molar or incisor disease with proximal attachment loss on at least two
permanent teeth, one of which is a first molar •

Generalized periodontitis = Generalized proximal attachment loss affecting at least three teeth other than
first molars and incisors

Linera gingiva erythema management = scaling and Subgingival irrigation with chlorhexidine or 10%
with iodine - if persist erythema after reevaluated 2 to 3 weeks then anti fungal prescribed fluconazole, for 7 to 10

ate day

Therapy for NUP = scaling and root planing, + irrigation antimicrobial chlorhexidine gluconate or iodine ,
severe NUP = antibiotic therapy metronidazole 5-7 days

Gingivitis in smoker = less inflammation - less plaque accumulation - decrease bleeding

It Former smoker smoked >100 in life but currently do not smoke

b
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 O

Reamer = triangle shape st steel d Remer
O
K-flex = rhomboid or diamond-shape st steel
p RexR
O
flex-R = triangle
D
RC-prep = canal lubricant , EDTA + urea peroxide + glycol-based Glyde (wax-based )
Guo
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

mmmm
 7 4 T'S I It's 4
BFI f
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 Crosssection

g
C
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

C
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
W
 class ll Enamel + dentin
class lll enamel+ dentin + pulp
class lV non vital ( Kills the tooth )

B
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

o
O
Pulp Necrosis = (concussion least, intrusion most)
EE
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

O
Calcium hydroxide pH = 12.5

Ind
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

EEE
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 for postprep

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

8
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

to Hr
resorbable sealer = ZOE

Calcium hydroxide PH = 11
12.5
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

ftp
more flexible file = K-reamer
moreflexible
Differentiate between pulp and periodontal abscess = Vitality test

metallic sound = lateral luxiation Intrusion

component of ledermix which use in endo to reduce pain = Triamcinolone acetonide ( steroid)
pffnmatrrJ
Gates Glidden sizes= Intracanalmedication.FR T
#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

2
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

Epoxyresin
sealer
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 and Pedo
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 mm

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

mechanical compactor
Thermomechnical compaction = McSpadden CompactorThermo

thermoplastic injection technique = Obtura Il ( internal resorption )

vertical
thermoplasticized technique = open apex (external resorption) warm

D
warm vertical compaction + continuous wave compaction technique = System B f contwave
Carrier-Based Gutta-Percha = thermafil + pro taper + SuccessFil compaction
to
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

26.2C Endo ice temperature = -26.2°C

Remove silver points = Stieglitz pliers and removal of brocken instrument

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

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

Most effective solvent and fastest and low risk = chloroform

Chek partial palpetomy

NiTi file less incident of ledge ? = non cutting tip

Ledermix ( corticosteroid antibiotic paste) = contains triamcinolone acetonide 1% as an anti-inflammatory

agent - intracranial medicaments - pH 8.13

x Formocresol: pH 12.45 CaOH10 14

formed 12 45
x Sodium hypochlorite: pH 11 to 12 NaCl 11 12
x Calcium hydroxide (Calyxl): pH 10 to 14
x AH plus: pH 7.81 to 7.17 at 3 hours to 240 hours
x Antibiotic-corticosteroid paste (Ledermix): pH 8.13
x Eugenol: pH 4.34 Metroneda
CHX is a strongly basic : pH 5.5 Minocydine
Ciprofloxacin
triantibiotic paste (metronidazole, minocycline, and ciproflox- acin)

Revascularization = 1- medicated with triantibiotic paste 2-overinstrumentation 3- subsequent blood clot is

overlaid with MTA , forming a scaffold for invasion by stem cells from the apical papilla (SCAP cells)

- canal disinfected without mechanical instrumentation but with copious irrigation with 5.25% NaOCl,

- followed by triantibiotics (equal amounts ) of ciprofloxacin, metronidazole, and minocycline for 3 weeks

- antibiotic was rinsed out after 3 weeks, and a blood clot produced to the level of the CEJ followed by
MTA

Necrotic pulp contains = PMN leukocytes + histiocytes

What to after ledge formed = bypass precurve file

Needle irrigation to WL= 2mm short

Operative

Glum
critical pH =
Enamel FA ( outer side of enamel ) 4.5
enamel surface remains intact and the sub surface minerals
Enamel CHA ( near the DEJ ) 5.5
Dentine + Cementum = 6.2 - 6.7 Hydrox
is lost
pits
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 salinecoating agenzl
coupling in composite = 3-methacryloxypropyl-trimethoxysilane (gamma-MPS) Melhacryloxypro
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
ingoingtoward 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 Conseraratine
way
GIC = Calcium fluoride 15.7% - 10 - 16% - Acide-base

Dentinal tubules diameter=

9
t2
Y.TT
25 • 2.5 μm near the pulp
• 1.2 μm in the middle of the dentin
12
• 0.9 μm at the DEJ
922
Removal undermined enamel in class 2, broximal box floor = gingival margin trimer

DB MP optY
DDR 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

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

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

us
 Camilla
spindle

tuft
 I Luting
I Brase liner
estoration
HI
Type of GIC
I fl Sealent
Type l = luting cement
ortho
Type ll = restorative Tl Core buildup
so
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
3DeepPaulofloor
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

a
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

complete thesetting
glazed layer above GI = to prevent dehyderation
Byraslin or varnish to
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 BL

minimal base thickness under amalgam = 1mm

main disadvantage of composite= polymerization shrinkage

Pin depth = 1.3 to 2mm

C
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 )

o o
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

x
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

X Xfirst
Mand 2nd premolar = have steep cusp ( sharp buccal cusp resemble canine )
4
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 Cement

O
Calcium hydroxide liners = dental thickness 0.5mm or less

Enamel - dentin fracture follow up = 6-8 weeks , 1 year

Before pit and fissure = polish with pumice and bristle
sedunt
Gingival margin trimmer = unsupported enamel on gingival wall

Enamel hatchet = 2 sides , for facial and lingual wall

Composition of dentain = 75% inorganic (hydroxyapatite crystallites) + 20% organic (collagen

Type l)

Composition of enamel = 96% inorganic

edge-to-edge relationship = contraindication to the all- ceramic crown,

Fiber Post failure = 1-debonding , 2- post fracture

Carbon fiber post = easy removal

mechanisms of adhesion =

Mechanical adhesion—interlocking of the adhesive with irregularities in surface

Adsorption adhesion—chemical bonding b/w adhesive and the adherend; the forces involved 1-
primary(ionic and covalent) or 2-secondary (hydrogen bonds, dipole interaction, or van der Waals) valence
forces
Diffusion adhesion—interlocking b/w mobile molecules, such as the adhesion of two polymers

O 0
Electrostatic adhesion—an electrical double layer at the interface of a metal with a polymer that is part of the
total bonding mechanism

Gold is the most ductile and malleable pure metal, and silver is second.

Galvanic shock = sudden, sharp pain,

Dimenional change = causes: insufficient trituration + condensation
delayed expansion = contamination of the Zn-containing amalgam with moisture during trituration or
condensation- intense pain 10 to 12 days after the amalgam is inserted. Hyperocclusion = pain one day after
an amalgam restoration - shiny abrasion marks indicating hyperocclusion

Initial white spot lesions = partially or totally disappear when the enamel is wet

White spot hypocalcified enamel = affected less by drying and wetting

sign of active caries = develops an irregular surface that is rougher than the unaffected, normal enamel -
Softened chalky enamel that can be chipped away with an explorer

Dentinal bridge formation = 6-8 weeks , radiography 10-12 weeks

to
Errors in class ll amalgam = isthmus cut too wide - great flare of proximal walls

remaining dentin thickness 0.5-1 mm = use thin layer 0.5-0.75 mm (RMGI) base.
remaining dentin thickness < 0.5mm to be and a pulpal exposure = thin layer 0.5-0.75 mm calcium
hydroxied placed

Mesial aspect of upper first premolar is concave. Which often lead to overhang + supracrestal perforations
and gouging
Concave

Arcand 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 ExcessiveInterocc restspace Reduce vDo
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.
a unilateralbalanced occ
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

pHingaxsis
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 - for gold alloygpsumofhfopf.at'IFM
Silica-bounded investment = high metallic base for RPD

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.
during Latrusine movement
imaginary line "hinge axis" = around which the mandible may rotate in the sagittal plane

I
sagital

Supporting cusps called = Stamp cusps

hemostatic agents for Retraction Cords =
Epinephrine 0.1, 0.8%:
2 Potassium aluminum sulfate:
Aluminum chloride 5–10%:
Et U Ferric sulfate 13.3%: discolors tissue temporarily, so use with caution in the anterior
5 Zinc chloride 8%, 40%
6 electrosergery
Function of post =
1- retain a core restoration and crown and
2- redistribute stresses down onto the root

astigM hemodent = Aluminou chloride , epinephrine-free , avoid cardic reaction belone impression forConhalthe
I bleeding
fracture in retentive arm of clasp = electric soldering , Optimal place for retentive arm > gingival third
 incisal reduction = 2mm

O
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

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

D
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

w ductility def = ability of material to deformed under tension

id malleability = ability of materal to deformed under compression

viscosity = resistance of liquid to flow , controlled by frictional force within liquid

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

fullmouth neha
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 tilted lingually

Tiaras
 guiding planes = parallel to the path of insertion

landmark determine antroposterior arrangement of anterior teeth in CD = incisive papilla

jw
best type of pontic with handicapped = Sintary ( hygienic) d1018 b OF
mm
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)

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

cigar interference between DB lower and ML = protrusive

0
Purpose of rest = prevent gingival impingement + distribute occlusal loud

I
Strength of Feldpathic = 65-120 Mpa mostceramicthathare
glass
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
Nap
non vital bleaching = cervical root resorption, external root resorption

I
Fox plane = guide rests on the occlusion rim, it should be parallel to the interpupillary line
mm
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 >8mm most common (unfavorable soft tissue contours)
vestibule measurement = from MG to frenum start
2-lingual plate = vestibule <8mm , lingual sulcus so closely approximates the lingual gingival margin,
lingual tori , if all posterior teeth missing, lingual inclination of the remaining lower premolar and
incisor , For stabilizing periodontal compromised teeth
3-sublingual bar = vestibule < 6 mm , not used with tilted remening teeth

direct retainer materials (clasps) = Cobalt-chromium

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

o
Function of proximal plate = Stability
 Suprabulge = above survey line
Circumferential (Akers) > most common
2 Ring
3 combination
y Embrasure
Infrabulge = Below survey line
i I bar ( for undercut area) , T bar , Bar type , Y type
Wrought wire = perio compromised + endo
distal extension use = RPI , RPA , wrought wire I I
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

c
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
c 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 Tetrahydrozoline oxymdazoline
IT
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 distributethe heatgeneration
Distal extension clasp = Bar clasp RPI

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

I
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.

To
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 Horizontal overlap

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 OCC
Organic occlusion = Mutually protected

Thickness of ceramic inlay = 1.5 - 2 mm

Action responsible for disto lingual molding = wetting lip with tongue

O 0
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

crack
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.

O
opaque material added on the metal surface in metal ceramic crown?= for shade

D
Denture movements , rocking = indicates reline
o
 Geraniums.IE wnrnkiw7ni
5
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)

pierabutment
non rigid connector = tilted abutment

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

yoad in between (indirect retainer)

Lever Class 2 = fulcrum at end - effort in other end - resistance

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

O
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

I 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 the action by willingthetip
Indication for relining = immediate denture after 3-6 months - ridge resorption
Rocking of the Denture
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

pilot
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

D
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

Cantilever bridge = support only one abutment , for : distema case - missing incisor

Maryland bridge (resin bounded )=

- composite resin with a low film thickness for luting
- lingual+ proximal surfaces + occlusal rest seats + groove/slots must = resistance form
- Enamel must not be penetrated
- Indication = Replacement of missing anterior teeth in children and adolescents - Short span -
Unrestored abutments - Single posterior tooth replacement
- Contraindication = Parafunctional habits - Long edentulous spans - Restored or damaged
abutments - Compromised enamel - Nickel allergy

Check occlusal relation of inlay/onlay = articulating film

Check occlusal reduction/clearance = wax
Check occlusal contact /proximal = shim stock

Ovate Pontic = high smail line

Casts are prepared for mounting on an articulator by? = placing three index grooves in the
base of the casts. Two V-shaped grooves are placed in the posterior section of the cast and one
groove in the anterior portion
For tissue recovery leave old denture for = 24hrs

Leave denture Minmum hrs prior impression = 24hrs , ideal or desirable 48 - 72 hrs

Prefabricated posts + cast post/cores = used on anterior teeth or single-canal premolars that have little or
no remaining coronal tooth structure.

Bleeding control before impression taking = ferric sulfate after bleeding controlled cored is placed ,
polyether impression taking ( hydrophilic)

For Sub gingival metal collar , prep depth = 0.5mm

flux function in soldering = to prevent oxidation of the parts to be joined and the solder itself. 1-
borax-type flux is used with gold alloys , 2- Fluoride-type flux used with chromium- cobalt alloys ,
3- When a gold + chromium-cobalt alloy, a fluoride-type flux should be chosen.

To remove provisional restoration easelly= provisional cement can be mixed with petrolatum or
silicone grease and applied only to the margins of the restoration

Etched veneers = used with dark discoloration

Porcalin
small non adjustable articulators = for cast restorations - leads to restorations with occlusal discrepancies
(because do not reproduce the full range of mandibular movement) - distance b/w hinge and the tooth to be
restored is less (premature contacts)

semi adjustable articulator = most fixed prosthesis use it - more anatomically correct - used wax to recored
interocclusal
for class I and I ExcepthreeRecord facebow Centricrecord Protrusive
two basic designs of the semiadjustable articulator:

- arcon : adva: condylar path is fixed to the maxillary occlusal plane + mandibular movements easier

- nonarcon : complete denture , easier control when artificial teeth are positioned , condylar path is fixed i
to the occlusal plane of the mandibular > angle changes as the articulator is opened

Fully (or highly) adjustable articulator = for interarche recored special pantographic tracings ability to
track irregular pathways of movement > enables the fabrication of complex prostheses, with minimal
adjustment - disad: time consuming + require a high skill - indication : when all four posterior quadrants are
to be restored + restore an entire dentition ( in the presence of atypical mandibular movement)
Firerecord facebow centricrelation Protrusive Lahat intercondylav record
Zinc phosphate = mechanical bonding

Zinc polycarpoxylate = chemical bonding to teeth

intra-sulcular = sub-gingival , supra-sulcular = supra-gingival

Advantage of sub gingival = easier to prepare without trauma -easily kept plaque free - Impressions easily

Utility wax and wax caliper in FPD = used for Verification of occlusal clearance/reduction in cast metal
preparation

most type retention = complete crown , less type retention = intracoronal restoration (onlay/inlay)
Montluting nelenninzadhesineresin GIC ZOE
Most luting retention = adhesive resin and GIC the second , less luting retention = ZOE

Metal cast prep = axial reduction (finish line) = 0.5mm chamfer , occlusal clearance = minimum 1.5 mm

D
(functional cusps) + least 1.0mm (nonfunctional cusps) , 6 degree taper

Metal - ceramic prep =

anterior: 2mm occlusal reduction > permit translucency

preferable incisal (Occlusal) reduction is 1.5mm - axial reduction = smooth chamfer 0.5 mm width , sholder
at least 1mm

failure of a restorations = adhesive failure ( Porcelain-metal fracture , Porcelain-metal) - cohesive

( Porcelain-porcelain fracture , metal-metal)

ferrule = 1 to 2 mm necessary for adequate retention of crowns

In CD most critical of the retention factors atmospheric pressure =

pressure of the air b/w denture and underlying tissues is less of the atmospheric air pressure > excellent
retention expected
g air underlaying dentureLess atmosphericpressure Excellentretention
the
loss of this posterior palatable seal = caused by resin shrinkage during polymerization. Acrylic resin
shrinks toward the area of greatest bulk of the denture, around (the denture teeth).
mm
vibrating lines = most distal extent of both the posterior palatal seal and completed denture

Tissue growth under mandibular denture = bcz overextension ttt remove denture and reevaluate after 2
weeks , surgical excision if needed

Ortho
class III
maxillary
def
types of headgear =
1- cervicl-pull headgear : intraoral , class ll div l ,ditlaization of maxilla
frankel face
C
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 maskReverseHea
4- reverse-pull headgear( face mask) : extraoral , class lll , to protract maxilla

P
tt for max deficiency = Frankel app , facemask

class 1 malloculsion = MB cap

of upper molar occluded in MB groove of lower molar

physiological tooth movement = 0.25

Frankelfort plan = from porion to orbital

D
ANB = A max , N Nasion , B mand
increase > class II

ANB SNA SNB

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
Rotation of premolar
y
psedo class lll = the maxillary incisors retroclination, and the mandibular incisors are proclined
r
class II malocclusion = extraction of first premolars
ad pInt
Techniques the brush for ortho = Charter's tech

O
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

Passive Tooth-Borne = ex: Bionator , Activator , Herbest

Tissue-born: is the only tissue-borne functional appliance and expander , expander addition its effects on
jaw growth because the arches tend to expand when lip and cheek pressure is removed.
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 Slow Yweek
ANB = increased - skeletal class ll Rapid 051
day
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
ClassI Class
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 Delmand Def may
Class ll only = extract upper 4 + lower 5 Herpst Twinblock facemask frankel
Class lll only = extract lower 4 + upper 5 progmay progmand
Distalization only in max = class ll Headgear chincup
FL
00 Rectangular wire used for = Torque (faciolingual root movement ) , space management
class ll div l = increase horizontal overlap - flat Idevl o.la HO flat
TO
class ll div ll = increase vertical overlap - steep

points in cephalometric =
Idiv2 pt VO Step
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

D triangle wire uses = retainers + removable

Anterior Bite Plane Appliance = used to correct deep bite
for
Rectingular ptorque
spacemang
Frankel line FH line = horizontal , porion to orbital
Retainer Removable
Tingle 0
D f
effect of habits depends on = Frequency + duration

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

L
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 class I skeletal

Y
Retainer for tooth was in cross bite = Hawley retainer

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

A point = deepest concavity of ant maxilla

B point = deepest concavity of ant mandibule
Inter arch = cross bite - overbite

I
Intra arch = tipping - rotation

pedo

primary space = max > lateral and canine , mand > canine and 1st molar
mmmarginal ridge + at contact point + 1mm above marginal gingiva
Loop of the space maintainer= below

serial extraction : Timely removal of both primary teeth and selected permanent teeth in guidance and serial
extraction protocols optimizes the use of available space. Indicated if no skeletal problem + and space
0
discrepancy is > 10mm per arch
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

o
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 Twinblock

fluorid used in pedo = NaF ( sodium fluoride)
5
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 =srimceea.se 3 6 oPeasize
leeway space= primary canine, first primary molar, and second primary molar being larger than the
mesiodistal widths of the corresponding permanent canine and pre- molars

. relieving any incisor malalignment

Fauiler of pulpotomy = internal resorption

orofacial trauma is present in = physical abuse.

I
Form cresol concentration = 1;5 , fifth saturated
formecresol
YsConc
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 - 14 months

One visit pulpectomy material = ZOE

O
To slow osseous replacement of avulsed open apex = 2% sodium fluoride 20mins

Best Media to immerse open apex tooth before re implantation = Doxycycline

2
Child should weaned from pacifier = 18 - 36 months If 46
18 36
Common complication of pulpotomy = internal resorption

o
2 yreas LA = 1% or 2% Lidocaine , Articain for children younger than 4 yrs not recommend

Most common supernumerary tooth = in anterior maxilla , mesiodens

Gingival wounds
Abrasion = superficial wound loss thin epithelium partly covered with epithelium
as Contusion = bruise without a break in t mucosa submucosal tissue hemorrhage, contusion may be isolated to
soft tissue or indicate an underlying bone fracture
Laceration = wound penetrating into soft tissue , tear
 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
Lastgrasp
a t.ae
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
Id I
Nonnervous tissue diffusibility > Onset > Increased diffusibility = Decreased time of onset

ago 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

LpGowgate
 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
3 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
Liner
plasma
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 into parotidCapsules
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 decreaseEcirculation tastefor30min
Intra1cg
mentry Cancause
slowest onset = procaine + Tetracain ( Esters)
mostpotentvis
Cocaine = the only LA that consistently produces vasoconstriction , most Vasoconstrictor
atthebegin ng vDthenintensVC
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

a
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
fatwpodIf 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

I
Wilkes Classification for Internal Derangement of TMJ =

I
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

I 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.

more lingual force than buccal during extraction = mand molar will removed easily

Incisive nerve block ( Nasopalatine nerve block ) = from canine to canine , ant hard palate

incisive nerve block > mand = premolars, canine, and incisors, including

osteitis sicca/ alveolar osteitis (dry socket) = delayed healing but is not associated with an
infection - pain develops on the third or fourth day after extraction - lower molars - cause: high
 levels of fibrinolytic activity - prevention : topical antibiotic tetracycline - ttt : saline irrigation +
dressing with Eugenol

Lateral pterygoid = one muscle > shift mandible to opposite side , both muscle > protrusion of mandible

terminal branches of IANB = 1. The incisive nerve 2. The mental nerve.

reconstruction of defective or atrophic alveolar ridges = The most common extraoral donor sites include
the ilium and tibia. , most common intraoral donor sites > mandibular symphysis, mandibular ramus, and
maxillary tuberosity.

Mand 2nd and 3rd molars root displaces may into = submandibular space during extraction

Long buccal nerve = buccinator nerve block

inchildren
Types of mandible fracture = green stick ( fracture of condyle ) - simple ( angle of mand) - comminuted
( small fractures on anterior ) - compound (one fracture in anterior)

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 .
TDRoot
0 Dentin dysplasia type I (dicular dentin dysplasia) : short roots( rootless tooth) , absence of pulp canals.
peaown
5
Dentin dysplasia type ll (coronal dentin dysplasia) : blue-to-brown coloration , large pulp stone within the
pulp chamber

0
Regional odontodysplasia: ghost teeth ( enlarged pulps and extremely thin enamel and dentin) also with

O
ectodermal dysplasia radiograph

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

Nicotinic Stomatitis = SMOKER’S PALATE stomatitisnicotina smokerkeratosis age

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

e
 hemophilia B= factor lX
staticbonecyst
Stafne defect = asymptomatic radiolucency, below the mandibular canal in the pos mandible, between the
molar teeth and the angle of the mandible, under IAN notreatment

Ameloblastoma = multilocular lesion , mandibular angle , “soap bubble” appearance, ttt simple ttt>
orogen
enucleation and curettage , Marginal resection is the most widely used ttt
myxoma

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 , ttt
coricosteroids (usually prednisone)

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
mm
 2cm
than
Larger

µOsteoblastoma by
smaller1ha2cm Released aspirin
not by
retene aspirin
( osteoid osteoma ) = bone tumors from osteoblasts,

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

0
Burkitt’s lymphoma = malignancy of B-lymphocyte, “starry-sky” appearance pattern , tumor mass post jaw
, teeth mobility , aggressive malignancy , ttt chemotherapeutic
EBV
9Behçet’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

I
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)

nfralemporal
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
UP
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
finger
HPV Papilloma = Cauliflower like projection in lateral border , benign epithelial lesion related to the human
papilloma virus (HPV) , changed in sizesurgicalExcesion orlaser

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 , replacement of normal bone by proliferation of cellular
fibrous connective tissue with irregular bony trabecula , 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

To 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, Large dentigerous cysts treated by marsupialization (permits decompression of the cyst+
reduction in the size of the bone defect) The cyst can then be excised at a later date, with a less extensive
surgical procedure.

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

I
canine. , remnants of dental lamina , snowflake calcifications

Dentigerous cyst encloses only the coronal portion of the impacted tooth
Dulhend
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
62cm i
osteoblasts ma P2cm not
welded
I
cleidocranial dysplasia =bone defect in clavicles and skull - or completely absent of clavicle -
brachycephaly - narrow high palate - unerupted supernumerary teeth (hyperdontia)
Ectodermaldysplasia Hyperplasiain skin hair sweetgland Anadontia

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

S Associated with Hypercementosis = Artheritis + rheumatic fever + pagets

g I l
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, tttt of
simple bone cysts of the long bones often is more aggressive and includes intralesional steroid injections or
thorough surgical curettage,

Not asso with pain = reticular lichen planus

He Antifungal
 iron
Plummer vision syndrome = iron def - glossitis - dysphagia - angular cheilitis
e

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

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

SLE
Lupus erythematosus = fever , arthritis , butterfly rash(Malar rash) , systemic corticosteroids
ttt= NSAIDs + antimalarial drugs (hydroxychloroquine) . For more severe, acute > systemic corticosteroids

secondary Sjögren syndrome = associated any other autoimmune disease, common associated disorder is
rheumatoid arthritis. In addition + with systemic lupus erythematosus (SLE).
2J Sjogrensyndrome Rhomatoidarthritis
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

Multiple myeloma = malignancy of plasma cell , Bone pain , punched- out radiolucencies or ragged
radiolucent lesions

Increase fequency of Osteomyelitis = DM , sickle cell anemia

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)

sik
Cluster headache = 100% Oxygen will relief it
 fatal when combined with narcotic(opioids)analgesics= monamine oxides inhibitors
an
+ 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

M Acute HBV = HBsAg + IgM
G 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 moreBCproducebybonemarrow

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

Decrease MCV <80 = iron def + Thalassemia

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

(anticonvulsant) cyclosporine
2 13 12
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 Bo noo
WBCs count needed before period surgery = >2000

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

4 normal platelets = 150,000 to 400,000 platelets per microliter
50 400
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

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

Hyperthyroidism
O C
Hypoparathyroidism= calcium level regulated by parathyroid hormone (PTH) , Enamel hypoplasia

Hyperparathyroidism = “ground glass” appearance + loss of lamina + renal osteodystrophy +brown tumor
F ifI + multilocular radiolucency + Stones > elevated calcium

k 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 and be used with epinephrine , but adverse reaction with aluminum chloride

infective endocarditis not able to take orally = IM ampicillin

angina bullosa heamorrhagica = hemorrhagic or dark red dots on palate - Asthma patient - corticosteroid
inhaler use

ABAerythematous candidiasis = atrophic - received a broad- spectrum antibiotic - burning sensation - “bald”
appearance of the tongue

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

f
w 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
Ew
am
o
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

prolonged BT
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

D D
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 , erythromycin

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 ) =

side
ella SE:
ionMetallic 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

y ALARA = (As Low As Reasonably Achievable)

if For SCC received radiotherapy have dry mouth medication = pilocarpine

SCC effective adjunctive therapy after surgical excision = radiotherapy

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 = for invasive or minor surgery :

INR is between 2.0 and 3.5, no adjustment ,

INR is greater than 3.5, the dentist should request that the dosage be reduced will take 3 to 5 days for the
desired reduction

drugs should be avoided with warfarin= aspirin and other NSAIDs (cause bleeding increase the action ) ,
metronidazole, erythromycin, barbiturates, steroids,

Nafcillin antibiotic (penecillin) = antagonize (decrease) the action of warfarin

metronidazole and tetracyclines with warfarin = cause decreased warfarin metabolism.

Staple angina = exertion by activity - pain relived with rest or nitroglycerin (glyceryl trinitrate) sublingual
administration - good prognosis - less than 15 mins

Unstaple angina = exertion by less effort - pain not relived by rest or nitroglycerin - poorer prognosis - more
than 15 mins

past history MI = Defer care of patient who has a history of MI that occurred <1 month (IM less than 30
days) , avoid the use of epinephrine , retraction cord , stress reduction protocol benzodiazepine ( 1 hour
before procedure) + nitrus oxide + avoid rapid position changes

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
1toluidineblue aDye
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 -
o or O
OO
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)

I
Chronic HBV test = CBC , ALT , AST , PT , BT

antibiotic cause C.difficile diarrhea = clindamycin

insulin shock = is hypoglycemia

Pernicious anemia is caused by = deficiency of intrinsic factor > a substance secreted by the gastric parietal
cells for absorption of vitamin B1
glositis
bisphosphonate complication after surgery= osteonecrosis of the jaw

autoimmune disease = Sjögren syndrome - systemic lupus erythematosus - rheumatoid arthritis -

Pemphigus vulgaris / pemphigoid - Pericious anaemia - Systemic sclerosis

tumor like gingival enlargement = pregnancy tumor

Angular chilitis = due to mixed infection of the Candida albicans, staphy and strep - drooling, Vitamin B12,
iron def anemia, and loss of vertical dimension asso with HIV - denture stomatis

Ramsey syndrome come with VZV,VII,VIII,deafness

VZV > Varicella-zoster virus - VII > facial nerve - VIII > vestibulocochlear nerve (deafness)

Ramsay Hunt syndrome is a herpes zoster infection of the sensory and motor branches of the , and in some
cases the auditory nerve (VIII). Symptoms include facial paralysis, vertigo, deafness, . The tongue can also
be involved via the chorda tympani. (loss of taste in the anterior two-thirds)Lossoftaste inAnt Corda
lap
Fusion = Union of two normally separated tooth buds leading to the formation of a jointed tooth and
separate root canals - tooth count as one( missing )

Gemination = called double tooth - two joined crowns and single root. Attempt of a single tooth single canal
bud divided leading to a tooth formation with bifid crown and usually. Tooth count as one (normal)

Vasoconstrictors should be avoided in patients taking digoxin > inducing arrhythmias.

Pt has depapillted filiform and redness how to perform the biopsy? Culture( find germs bacteria or a
fungus)

Pt takes Steroids managemen=

Primary Adrenal Insufficiency

Routine : None

Minor surgery: 25 mg of hydrocortisone equivalent, preoperatively on the day of surgery

Moderate surgical stress: 50–75 mg on day of surgery and up to 1 day after

Major surgical stress : 100–150 mg per day of hydrocortisone equivalent given for 2–3 days - Or
preoperative dose, 50 mg of hydrocortisone IV every 8 hours after the initial dose for the first 48–72 hours
after surgery

Secondary Adrenal Insufficiency

Routine : None

Minor surgery + Moderate surgical stress + Major surgical stress : Daily therapeutic dose

evaluate the need for steroid supplemental by = health status, anxiety , infection, invasiveness of
procedure

for overdosing = heparin (protamine) give> Antidotes - warfarin > vitamin K

 do not require antibiotic prophylaxis = ischemic heart disease, coronary artery stents (device), or CABG
surgery

HIV test = oraQuick test using mouth swab , takes 20-40mins for results

ELISA this test widely used in diagnosis of AIDS

Herpes labialis fever blister / cold sore = Multiple small, erythematous papule , recurrent HSV-1

Pemphigus vulagris, which is the most common site of occurrence? palate, labialmucosa,
buccal mucosa, ventral tongue, and gingivae are often involved”

Dens invagenatous = lateral incisors, Type I > confined to the crown type II extends below CEJ , Type III
extends through the root and perforates in the apical or lateral radicular area without any immediate
communication with the pulp. Common in max lateral

Ttt: type l restored only - larger invaginations calcium hydroxide base - if pulp communicated RCT

Dens Evaginatus = occlusal interference , removed by periodic grinding , should maintain vitality
g 3 Necrotizing ulcerative periodontitis = seen in HIV+ patients with very low CD4 counts (AIDS) , local
ulceration and necrosis of gingival tissue with exposed bone.

Bisphosphonates (BPs) inhibit osteoclast-mediated bone resorption. BPs are used to manage
osteolytic bone disorders such as osteoporosis, Paget disease, malignant multiple myeloma.

Clenching and bruxism = with margine - tension-type headache

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
er
170 °C (340 °F) 1 hour
190°C (375°F) 6 wrapped to 12 minute unwrapped
218 C (450) seconds
121 H

190 comin
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
D

D
Chemical vapor = 132 C (270 F ) = 20-30 min
e
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 to ensurethatallthe
Disinfection of wax rims : spray-wipe-spray method using an iodophors or phenolics.
Partcored
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 )

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

X aweek
Active failure = needle puncher the bag when they put in non sharp container

best diagnostic test of all type of oral tissue condition = biopsy

Sink instruments = 1-sink deep with dispenser and set-down washing , or 2-double sink washing and
rinsing

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
THE
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
is 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)
plasterofParis
Flappyridge mucostatic
by
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

purpose of liner in casting ring = casting ring > restric setting expansion , liner > placed inside
the ring to allow more expansion

thixotropic = fluid became less viscous and flowable upon repeated pressure ex: plaster ,
si prophylaxis paste , resin cements - advantage? Material doesn’t flow until it placed

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, 500mg(Lethal dose)

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

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

Is a J f
j
 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

Endemic = particular region or population ex: caries

Epidemic = outbreak disease attack one or several coummounities
Pandemic = spread throughout the world

Milk calcium carbonate , and aluminum-magnesium based antacids are recommended to slow the
absorption.
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 3mm

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

remote fractured implant screw = ultrasonic tip

fracture implant = trephine burs
is
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

Lp
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 =X2mm

minimum implant to tooth = 1.5mm
3mA
Minmum implant to vital structure IAN canal = 2mm

reaction to plaque around implant = more than teethSameastheteeth

Average hight of papilla from crest to bone :

MM
Implant b/w natural teeth = 5mm or less 4.2
b/w tooth and implant = 4.2mm
b/w implants = 3.4mm E
Ei do
b B Bg
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

Healthy implant prob depth = 3mm

Time of osteointegration? 3 months (for implants placed in the mandible) and 6 months (for implants
placed in the maxilla)

management of trigeminal neuralgia = Carbamazepine

Ethics
1. Non-maleficience (primum my A – No harm
non nocere)
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

Competence ( capacity) = is the intellectual capacity to understand, analyze, and judge information
am to make rational decisions

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

For an informed consent to be ethically acceptable, there are conditions that it should fulfill = capacity,
disclosure, and voluntariness
EH
Disclosure > information given to the patient, in simple and understandable way

voluntariness > freedom to take these decisions without by family members or the health care team.

You referred pt unnecessary to another doctor, against= Beneficence

I
E o of autonomy
3 essential components of dental ethics = Compassion, competence,

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.

GA
Principlism = stating principles ex: benefice , non maleficence , repeat for person , justice

deontology = duty-based a search for the well de ned rules for moral

Taking consent before surgery ex of autonomy

Dose calculation
For peds =
Ibs 8 long 20
Paracemol = 10-20 mg Para 10 20mg
Amoxil = 20-30 mg Amex 20 30mg
Iboprophin = 8-10 mg

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

20120 400 32 s 12
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
Dr. Manal Alharbi
e

‫دعواتكم‬ e

Perio
Biologic width = 2.04mm

connective tissue attachment occupies 1.07 mm space above the crest of alveolar bone

J D
junctional epithelial attachment below the base of the gingival sulcus occupies 0.97 mm space
above the connective tissue attachmen

Calculus reach deepest point below crest bone = 4.7mm to 5mm

Primary truma from occlusion =resultsfrom alteration in occlusal force high filling

Secondary truma from occlusion = reduce ability of tissue to resist force

30-50% bone loss = secondary trauma

Scaling and RP =

Periodontal abscesses pain discharge swelling after scaling management ttt:

1- drainage through pocket retraction or incision , scaling and RP , systemic antibiotics .

2- abscesses manifesting with severe swelling and inflammation, aggressive mechanical

instrumentation should be delayed after antibiotic therapy

chronic abscess = treated with scaling and root planing > Surgical suggested when deep vertical
pocket or furcation defects

gingival abscess = LA > scaling and root planing are completed to establish drainage > in more
acute do incision > any foreign material removed eg: dental floss, impression material) > irrigated
with warm water > If the residual lesion is large or poorly accessible, surgical required

periodontal abscess causes =

1- incomplete subgingival scaling, and residual calculus due to the depth and gingival
fibroedematous , due to the smoking

2- The class II furcation area presents a access problem for both the patient’s ability to remove
biofilm and the clinician’s ability to scale and root plane. so, periodontal abscess occurs often in
these furcation areas

3-Attempting to scale and root plane the entire mouth on first visit is not possible

4-Smoking is a risk factor for periodontal abscesses

 throat
and
oropharynx
fb GI j
Vincent angina = UNG , trench mouth , fusiform bacterium , fusospirochetal infection , can extend
to the larynx and the middle ear. , common in IDP + MG area

NUG = predisposing factors, stress, smoking, and immunosuppression, lesions are extremely
sensitive to touch, radiating, gnawing pain that is intensified by eating spicy or hot foods and
chewing. There is a metallic foul taste, ttt: antimicrobial therapy + scaling and root planning

NUG first visit : superficial calculus removeal antibiotic if symptomatic - 2nd visit : after 1-2 days

Different b/w NUG and primary herpetic gingivostomaitis =

NUG : bacteria fusospirochetes - ulcerative - punched put margin - reach to margin ging only -
uncommon in children - not contagious

Primary herpetic gingivostomatitis : viral - diffuse erythema - vesicles - buccal mucosa may
involved - common in children - contagious

Biological width = 2.04 mm

biologic width violations when the restoration margin is placed 2 mm or less , gingival tissues are
inflamed with no other etiologic factors evident.

most common area of calclus = buccal of maxillary molar + lingual of anterior mand

which affords in protecting and stimulating supporting tissue in mastication = tooth contour
( convexity ) , located at cervical area of all teeth + lingual of incisors and canine

sources of the malodor = tonsils, lung disease, gastrointestinal disease, and metabolic
abnormalities (e.g., diabetes) should be investigated.

genral bone width = panorama

Wegener’s granulomatosis = (strawberry gingivitis)

g g'S
Scarlet fever = strawberry tongue
IB
Antibiotic for periocronitis = metronidazole 400mg , or phenoxymethylepencillin 500mg , can be
uses both for severe infection

Metronidazol kills = anaerobic bacteria + spirochetes (NUG)

concept of the critical probing depth of 5.4 mm has been advanced to assist in making the
determination to proceed to surgical intervention

Sickle scaler = supra gingival calculus > when 1-2 mm calculus subgingivally
Curettes = spoon shaped blad and round tip - offset blade
Five basic scaling instruments = curettes - sickle - file - chisel - hoe

Positive architecture = radicular bone is apical to the interdental bone.

“negative” architecture = interdental bone is more apical than the radicular bone.
Flat architecture = reduction of the interdental bone to the same height as the radicular bone.

less than 3 mm of soft tissue b/w the bone and gingival margi + no adequate attached gingiva,>
osseous recontouring are required for crown lengthening. (bone + soft tissue remove )

If more than 3mm gingival crown lengthening by only gingivectomy. ( soft tissue remove)

minmum b/w bone and margin of restoration after crown lengthing = 3mm to allow 0.5mm
restoration

Health gingival sulcus depth = 0.69mm

Calculate estimation of the loss of alveolar bone = in posterior region two options
1- periapical radiographs the worst site affected is esti- mated gross as a percentage of the root
length,
2- bitewing radiographs in which the worst site affected is estimated in millimeters.
* One millimeter percentage is divided by the age *

Bone loss in periodontitis = 0.2 facial - 0.3 proximal

ofinnerwallofthe
Cause of pain when prob the pocket = inflammation Laceration
pocket

MMPs = group of enzymes that break down structural proteins of the body MMPs include
collagenases, which break down collagen. MMPs in periodontitis include MMP-8 and MMP-9,
which are produced by neutrophils

Plaque composition = gelatinous accumulation of bacteria to enamel

Osteoblasts = bone deposition and resorption

Fibroblasts = production and degrading PDL fibers

CHX mechanism of action on bacteria = inhibit growth and bactericidal

Mean distance from calclus (periodontal pocket) to bone crest = 1.97mm

Distance from attached plaque to bone = never less than 0.5mm and never more than 2,7mm

Note : the order calculus - attached plaque - unattached plaque - JE

Listerine = reduce supragingival plaque and gingivitis - active ingredients ( methyl salicylate) +
three essential oils (eucalyptol, thymol, and menthol) - exacerbate xerostomia because of its high
alcohol content, 21.6% to 26.9%
if
.forsthyia termonella = for periodontitis

Strep.salivaruis = most common bacteria on tongue

Pseudomonas + staph = implants

Sequence of osseous surgery =

1-vertical grooving (first step)
2-radicular blending
3-flattening interproximal bone
4-gradulizing marginal bone
 To
4-gradulizing marginal bone
Pt is diabetic uncontrolled has periodontitis with deep pockets and heavy calculus, best
treatment = Mechanical + Tetracycline ( Doxycycline 20mg)

Peripheral giant cell granuloma occur mostly in = gingiva

Enamel pearl =
Strongly associated with furcation involvement
Predispose to peridontal disease And Attachment loss

Marginal gingiva width = 1mm

Cheisl = push motion while the side of the blade is held firmly against the root.
Hutch
File = to crush large deposits + remove overhanging restoration

Plaque induce gingivitis = no bone loss + no attachment loss or with attachment loss that is stable
and not progressing

Ttt of desquamative gingivitis (DG) = Topical steroids

Endo
gouging or perforation = Failure to analyze this penetration angle carefully
Avulsed immature tooth better prognosis than closed apex = there is a greater chance of
regaining pulp vitality after replantation

Sequel of avulsed tooth = Undesirable periodontal ligament reactions causes> replacement

resorption (ankylosis) or inflammatory resorption of the root

A patency file = small K-file #10 or #15 passively extended slightly beyond the apical foramen. use
for most rotary to remove accumulated debris

Peeso drills = coronal flaring + post preparation.

Sings of mishap = instrument fracture , perforation,Canal transportation , ledge

Canal transportation = removal of canal wall structure on the outside curve in the apical half of the
canal

ledge = dentinal shelf that is created by shaping instruments that straighten and dig into the convex
side of the canal wall

MTA = repair the perforation even the cavity is contaminated with blood , its biocompitable

Granuloma = asymptomatic + non vital + no response to percussion test

Abscess = can be symptomatic + extreme senstive to percussion

Hyperalgesia = exaggerate response to painful stimuli - allodynia painful response to non painful
stimuli
Gp sterilaization with sodium hypo = 1 mins

DG-16 explorer = locate canal orifice and determine canal angulation

Explorer = detect root smoothing

Full pulpectomy = indication Traumatic exposures after more than 72 hours (3 days) and carious
exposure of a young tooth with a partially developed apex

Calcified canals = First CBCT then sharp explorer , color change in dentine , use ultrasonic tips ,
statin with 1% methylene blue dye , sodium hypochlorite ( champagne bubble test ) >leave NaOCL
on chamber then bubbles will appears indicate position of orifies

Overfilled GP = better to remove GP with heat plunger before sealer sets otherwise > No
treatmen (follow up unless there is sign and symptoms)

Hero file = similer to H file in cross section without radial lines , non cutting passive tip

Voxel sizes (in CBCT) = endo imaging require high spatial resolution > smallest voxel size = the
higher resolution - The absolute maximum voxel size for endodontic imaging should be 0.2 mm

most sealer has problem in long term stability = Calcium hydroxide based

Trephination = in absence of welling , for drainage abcesse to relive pain

Flare up = acute exacerbation of periradicular pathosis - reasons: 1- overinstrumentation 2-

chemical irritants ( Caoh, sealers , obturation ) - management: prophylactic antibiotic

Furaction + Strip perforation = MTA

Cervical perforation = resin ionomer , disadvantage of MTA long setting so its not preferable for
cervical

GP = 20% gutta percha - 75% ZOE - radiopacifiers - plasticizers

Length of D16 = 0.32

Taper at D16= 0.32 + (file number) = Answer

Crack + fracture = block the light transmission

Fungi found in persistent endodontic infections = Candida albicans

MTA =

Advantages : good seal + antimicrobial + set in presence of moist and blood

Disadvantage : cause pulp obliteration +long setting time

Main component : tricalcium silicate + tricalcium aluminate

Intraoral periapical radiograph = 2mm of bone below root should be visible

 Opertive
treatment for broken drills and broken pins is to choose an alternative location, at least 1.5 mm from
the original pinhole

Convenience form = features that allow adequate access and visibility preparation ex extension of
the outline

Calcium hydroxid above exposure pulp= dentaial bridge formation

GIC under composite = low modulus of elasticity to absorb shrinkage stress

Macro fill composite = 4 and 40 microns. not polishable - more these materials polished, the
rougher they got - poor wear resistance.

Micro filler composte = 0.04 microns , very polishable - excellent esthetic - unsuitable for stress
bearing restorations contraindicated for Class IV + posterior teeth - low modulus of elasticity

Hybrid composite = combination of small and large filler - excellent anterior + posterior- 1-2
microns - ex packable composite

Minimum tooth structure around composite core = 2mm , amalgam core = 2-3mm

High-copper alloys tend to be stiffer than low-copper alloys

Amalgam core = need sufficient width and depth to provide adequate bulk and retention of and
dentin thickness - preferedwith metal posts Not used with structurally compromised teeth

Composite core = can be used in association with metallic, fiber, or zirconia posts. So used with
structurally compromised teeth.

MGI core = used in: small build up , bulk of core material is possible, significant sound dentin
remains, caries control is indicated

Inlay fracture = Beveled margins must be avoided, as thin areas of ceramic are prone to fracture -
preparation isthmus at least 2 mm in faciolingual width so as to avoid inlay/onlay fracture

Gold alloy types = type l : class V , type ll : inlay , type lll: crowns , type IV : RPD

Hue = “pure” colors found , basic colors , terms such as redder, yellower, greener, or bluer.

Hue enables the distinction and differentiation among different colors, chroma is related to
variation in strength of the same color

streptococcus detection = catalase test stnepto pcast.LI

time for etching by 10% poyacrylic acid for GIC : 20- 15 sec
 Class IV bevels cavosurface margin = 45-degree angle to the external tooth surface with a flame-
shaped or round diamond instrument

Galvanism Amalgam + gold = “electrical shock” or metallic taste. These symptoms typically are
self-limiting and are not considered serious problems , reassure pt until amalgam complete setting
reaction and oxides if presist change restoration

Matrix band = 1mm beyond gingiva + 1mm over ridge , if amalgam 2mm over ridge

Dual GICs + RMGIs = finished and polished immediately after light or complete chemical/ dual
curing. Dual cure takes = 6-8 mins , chemical cure = 2-3mins

slot retention in preparations with vertical walls > allow retention - more structure removal

Pin retention > with few or no vertical walls. - less structure removal - self-threading pins may
causes an inflammation if placed within 0.5 mm of the pulp.

Self-threading pin extension into dentin and amalgam = 1.5 to 2 mm

remaining dentin thickness <0.5 mm thin layer (0.5–0.75 mm) of a calcium hydroxide liner may be
placed

thickness of remaining dentin + thickness of the base or liner = at least 2 mm for pulp protection

abrasion= The loss of tooth structure in the cervical areas - rounded notch in the gingival portion of
5 the facial aspects of teeth
abfractions= cervical lesions that develop from abrasion processes, idiopathic erosion lesions,
wedge-shaped defects (angular as opposed to rounded) -excessive flexure of the tooth as a result of
heavy, eccentric occlusal forces

metal- ceramic crown is also contraindicated = with large pulp chambers > more conservative
restorative option = composite - porcelain laminate veneer - all-ceramic with less reduction

Stain in composite in marginal ridge = small repair or resurfacing

For polishing proximal surface = dental tap , kept at right angle of tooth , labiolingual motion

prophy-jet (air-powder polishing) = using sodium bicarbonate + aluminum trihydroxid - for both
supra - sub gingival teeth scaling + implant + restoration

sodium bicarbonate = remove the stain and soft deposit

gycine / erythritol = sup and supra gingival biofilm in implant and restorative material

GIC etching = 10%polyacrylic acid for 20sec

Reparative dentine = form when there Is strong caries + odontoblast cells death

Ledermix = root resorption inhibitors property in avulsed tooth

Sodium perporate is safe in walking bleaching

Thermocatalytic tech and heat in walking bleaching = causes cervical resorption
Calcium hydroxide = reduce cervical resorption

Preparing amalgam =
1 inital depth and outline form
2 primary resistance form
3 primary retention form
4 convenience form

macroabrasion = superficial white spots - not conservative - 12-fluted composite finishing bur /
diamonds finishing bur in high speed handpiece
Microabtasion = young pt - flourosis stains - rubber cup - discoloration is within 0.2 - 0.3 mm
depth

Tobacco stain : pumice with rubber cup

mechanical
A chemical
Micro abrasion : prema compound with special rubber cup with fluted edges/ prophylactic paste
base under amalgam thickness = 0.5 to 0.75mm

Masticatory mucosa = Gingiva + hard palate

Spesalized mucosa = dorsal tongue

Amalgam composition = silver(70%) - Mercury - copper - Tin - palladium

Light induce florescence + diagndent = Quantitive

Disadvantage of GIC base = postoperative sensitivity

Microfilld composite = very polishable - esthetic - unsuitable for stress bearing area + class Vl
hyprid composite(small + large fillers)(nanohybrid - micro hybrid) = polishable - used in
anterior + posterior

Acid base reaction = ZOE - polycaroxylate - zinc phosphate - GIC

Acid base reaction + chemical activation = MRGI

Prosth
rocking with an orangewood stick FPD = remove excess cement has escaped , dynamic seating
force is important. Applying an orangewood stick with a rocking motion against the restoration ensures that all
excess cement is expressed.
ridge loss classification = class l loss of width - class ll loss of hight - class lll both

direction of mandibular resorption = downward and outward

maxillary resorption = upward and inward

Gingival displacment = acceptable up to 4mm , lip coverage of incisors up to 4mm

O 2mm
Rest = vertical support - distribute occlusal loads to abutment - prevent impingement of soft tissue
Denture base = primarily tooth supported. As going away become more tissue supported- distribute
the load equitably b/w the abutment and tissues of edentulous ridge.

Chromium-cobalt alloys = great rigidity preferable for splint bar in RPD

CD difficult swallowing = overextension in posterior , too thick in posterior upper + lower ,remove
uvula (proplem with sleep apnea) causes it

Balance occlusal = contact in centric and eccentric position

reasone for falling the veneer? Contaminated durung cementation (not proper etching)

Copal varnish under amalgam = reduce leakage

Sensehrity
Post during cementation insert gently to avoid Hydrostatic pressure = cause root fracture
Pressure during cementation of parallel side post = hydraulic pressure > to minimize it vent the
parallel side by creating longitudinal channel to allow escape of cement

single missing tooth can almost always be replaced by a three-unit FDP that includes one mesial
and one distal abutment tooth. An exception is when the FDP is replacing a maxillary or
mandibular canine need 4 units

Interocclusal space (freeway space ) = 2-4mm

Drug causes xerostomia = antcholrogenic (Atrophen)

Free way space = statice > pt mouth at rest - dynamic > when speech
Old denture asso with increased freeway space and decrease VOD > aged appearance
If Not enough freeway space > reduced VOD
AFWS LVOD
Flabby ridge after CD seen = anterior max opposite remaining anterior mand ( combination
syndrome ) causes poor support to denture - the cause of this inadequate posterior occlusion

denture stomatitis (denture sore mouth)(inflammatory papillary hyperplasia)(chronic

atrophic candidasis) = asymptomatic redness under denture, reasons: wearing denture(relining
with tissue conditioner )/ candidasis(antifungal)

Epulis fissuratum = chronic overextended denture , pain , ttt surgical remove + denture adjustment

Pt with Complete Denture come with numbness = pressure on mental foramen

Small tori not not extended to junction of hard and soft pallet = anterior posterior strap
Large tori extended posterior = u shape / horseshoe

High caries risk or restored tooth MOD in RPD = use rest fitted within surveyed crowns. Full
coverage crown

Torch solder, metal-ceramic (gold) = using the reducing portion of the flame (prevent oxidization)
test efficiency of tungsten carbide= Brinell hardness test

Maxillary dislodgment during function = overextended buccal flanges , buccal notch ,

verextension in the hamular notch

Max dislodgment during rest = underextende buccal flings + excessive saliva, or xerostomia

Mand Dislodgment during function = overextended post in masseter groove , overextension of the
lingual flanges , underextension of the lingual flange

gagging or vomiting in CD = as a result of loose dentures; poor occlusion; incorrect extension

fulcrum line= diagonal axis between the two terminal abutments

What to put in metal ( myrland bridge) to increase retention = sandblasting with 50 Mm

alumina+ silicate (for fin abrasion of metal)

Gold = most ductility malleable - silver, is second

ductility—the capability of undergo- ing permanent tensile deformation > can be well-polished
fracture then fracture prevented

Border molding materials = compound - PVS - polyether

Christensen’s phenopme = occurs b/w opposing occlusal during mand protrusion

For increase retention = increase surface roughness - taper should not be increased or decreased
select proper size - decrease taper and increase roughness

For resistance = decrease taper increase hight

Remove flabby tissue to = improve stability - reduce resorption- provide retention to denture

Flux function in soldering? = improve flow of metal , reduce oxides

Bridge with food accumulation of the margin = if there is no open margin > overcountour large
convexities promote the accumulation of food debris and plaque

chromium alloy advantages = most common used - low weight - high modulus of elastisicity
(stiffness) - resist to tarnish

Posterior Teeth arrangment in CD =

1- buccal horizontal overlap of the posterior teeth = required to reduce creating cheek biting

2- teeth aligned vertically= contraindicated > creating a cheek-biting.

Flexural strength for =

3 until bridge : 1 pontic =3

4 until bridge : 2 pontic = 8

5 until bridge : 3 pontic = 27

type of suture under immediate denture = 1- interrupted or 2- continuous

I bar (RPI) undercuts

Ring clasp (tilted tooth)

Circumferential clasp (good oral hygiene )

Reverse clasp ( rotated tooth)

Aked cause stress on the tooth

Curve of spee = beginning from canine cusp following premolar and molars

Curve of Wilson = mediolateral curve (b/w mand arches)

Loose retainer of abutment = bubbles appears when pressure applied

Indication for fiber-reinforced composite (FRC) = esthetic - Metal free(allergic pt) -

Conservative - Decreased wear to opposing teeth

changethetaste
Indirect sequela of wearing CD = Atrophy of masticatory muscle 1

Overpacking Retraction cord = tearing gingiva attachment + irreversible recession

Improper clamp placment = loss of epithelium keratinization

Types of patients :

1-philosophical = easiest to treat - accept needs for prosthesis

2-exacting = need explanation for every step - more treatment time - difficult to satisfy

3-Histerical = complaining - will never wear prosthesis

4-Indifferent = lack motivation - uncooperative - prognosis poor

Pedo
cause of root dilaceration = indirect trauma , occurs at later stage 4-5 yrs
Why use zoe in pulpectomy = slower resorption than primary tooth

O
More than one tooth mobile and displace indicate = Alveolar fracture
 1-3 yres = smear past

3-6 years = pea-size past

Using GIC cement for SSC = short setting time, short to working time, high comprehensive
strength, release fluoride

nonfluoridated tooth cleanser = only child with 1 year old

Calcium hydroxide because its alkalynati PH 12 is caustic that when it is placed in contact with
vital pulp tissue, the reaction produces a superficial necrosis of the pulp. To stimulate calcific barrier

formocresol is caustic > causes tissue necrosis

If distal shoe is contraindicated =:1 mmm below the mesial marginal ridge (1) allow the tooth to
erupt and regain space later, or (2) use a removable or fixed appliance that does not penetrate the
tissue (reverse band loop),

Leeway space = in mand +1.7 mm per side exists, max +0.9 mm per side

Strip crown ( celluloid crown ) (jacket crown ) = for restoring primary incisors with large or
multisurface caries

Oxygenating agents = ex: peroxide , per carbonate > cleanser for denture to remove dpries

Retentive arm = Between gingiva/cervical and middle third - Terminal part at gingival/cervical
third

Innervation of maxillary teeth =

Second primary molar = posterior superior alveolar nerve

First primary molar = middle superior alveolar nerve

Disadvantage of ZOE in primary teeth = irritation to periapical tissue - slow incomplete

resorption - alteration to path of eruption

Ortho
Headgear type for class ll hyper divergent mandible = high pull
Headgear type for class ll hypo divergent mandible = cervical pull
Retainer forcrossbites
For anterior crossbite no need for retainer
For posterior crossbite hawley retainer t
there’s sufficient space and we need to do incisor retraction = reinforcing incisor anchorage > to
place active lingual root torque in incisors , if extraction needed 2nd premolar or molar

pseudo-Class III = class l molar relation - shifting into anterior crossbite because of incisor
X interferences skeletalclassI
 Treatment of pseudo class = if there incisors roatated > Banded and bonded fixed appliance

if NOT rotated - 1- if pt cooperative > Maxillary lingual arch with fingersprings … 2-

uncooperative > Maxillary removable appliance with fingersprings

True unilateral maxillary constriction = unilateral posterior crossbite , ttt : Treatment: unilateral
posterior expansion or asymmetric W-arch

Thump sucking = causes posterior cross bite ( result maxillary constriction ) ttt:W arch / Quad
helix

Sequence of ttt for cleft palate =

F 2-4 weeks lip closure lowed softpalate 8 18months

Hardpalate 4 5 years
12-18 months palatal closure

7-8 years alignment teeth

Holo 10Years
7-9 yres alveolar bone graft (before lateral + canine eruption )

Late adolescence orth surgery

Wits analysis = by drow line b/w cusp tips of molars and premolars (Functional Occlusal Plan ) ,
the problem FOP cant be easily located

Enamel (cusp) fracture = results in heavily restored teeth. (during band seater or removal or
brackets)

ceramic brackets = can cause wear to opposing tooth in deep overbite + buccal crossbites

Heavy force = undermined resorption (alveolar bone)

Lighter forces = frontal resorption(socket resorption)

Surgery
Most common impacted tooth = third mortar , second canine

Impacted canal x ray = CBCT

Superimposed third molar = Canal is usually on buccal aspect , my cause damage to IAN
paresthsia to lower lip and chin to affected side

To diagnose facial asymmetry = cephalometric or CT/CBCT Anterior posterior

For vertical maxillary excess lip incompetence, and excessive gingival exposure = maxillary
osteotomy with superior repositioning combined with advancement genioplasty

incisive nerve block = alternative to the IANB when treatment is limited to premolar, canine, or
incisor teeth
ALARA = (As Low As Reasonably Achievable) = exposure radiation should kept as low as
reasonable , adjusted on basis of patient size

Rotating condyle: see SIDE CONDYLE - Translating condyle: see NONWORKING SIDE
CONDYLE
working
Risk for orontral communication = little or no bone between the roots and sinus - and if roots
widely divergent (do sectioning of tooth roots) - two sequelae (1) postoperative sinusitis and (2)
chronic oroantral fistula -

diagnosis of an oroantral communication = nose-blowing test (f a communication exists, there

will be passage of air through the tooth socket and bubbling of blood )

Management = small (2 mm or less), no additional treatment - moderate (2 to 6 mm) > figure-of-

eight suture to maintain blood clot - large > 7 mm flap most common buccal flap (perforeme the
same day the opening occurred)

Trechostomy = faciliate ventilation in major accidents

Responsible for the direction of infection = muscle attachment Bonethickness

major blood supply to the floor of the oral cavity= sublingual (lingual nerve ) + submental (facial
nerve)

Temporomandibular disorders TMDs = most common cause: muscular dysfunction (myofacial

pain and dysfunction

Causes of reduction of opening = TMJ dysfunction , truisms asso with infection , muscle fibrosis

Submandibular gland = Wharton’s duct

Sublingual gland = rivinus

Paroitd gland = stensen’s dut

When to remove mesiodens tooth = Immediately

Adverse reaction to LA = allergy - Anxiety (syncope)

Location of mandibular foramen =

Adult above occlusal plan 7.4mm

Children at hight of occlusal plan

Medicin
Hypercementosis Other name ? Cementum hyperplasia

Generalized loss of lamina dura is seen in? -Hyperparathyroidism

Digoxin = with epinephrine increase risk of arrythmias , drug increase gag reflex
Nitrus oxide contraindecated with heat failure

Pic about caliber-resistant artery = lesion on upper labial mucosa, no treatment

Paget’s disease = “cotton wool” appearance.

Anti-ssa / anti-Ro = in SEL + sjoren syndrome

Down syndrome = macroglossia + hypodontia + hyperdontia + gingivitis + decrease caries +

hypersalivation

Blood test report with low ferritin levels = Iron deficiency anemia

Epinephrene for emergency = IM

Inflammatory papillary hyperplasia = wearing denture 24 hrs, poor hygiene , ill fitting denture

Sickle cell anemia = sickled shape results from deoxygenation or decreased blood pH > Use pulse
oximeter and maintain oxygen saturation above 95%. > when maintain Nitrous oxide keep oxygen
50%

* Pulse oximetry monitoring is prudent during invasive dental treatment of all patients with
anemia.

Papollon-lever syndrom = planter keratosis of feet

Smoking in pregnant cause = Cleft lip and palate for infant

Diabetes = Monitor blood pressure because diabetes is associated with hypertension - If diabetes is
not well controlled fasting blood glucose =
If <70 mg/dL Defer elective ttt or give carbohydrates.
if >200 mg/dL Defer elective ttt. Give hypoglycemic (or insulin) or refer to physician.*

Mucous membrane pemphigoid = lesions may be in conjunctival, nasal, esophageal, laryngeal,

and vaginal mucosa, as well as the skin, oral blisters , desquamative gingivitis , intraoral vesicles,
upper eyelid of this patient to turn inward (entropion), diagnosis with Direct immunofluorescence ,
ttt topical steroids If topical corticosteroids are unsuccessful, systemic corticosteroids

Type 4 hypersensitivity = 2-3 days

Dentinogenesis imperfecta = amber color , defect during histodifferentiation

cavernous sinus thrombosis = infratempral

asthma attack = use B-adrenergic agonist inhaler most effective and fast bronchodilator
Recurrent aphthous stomatitis = topical corticosteroid (triamcinolone)

Management HIV positive pt and asymptomatic may receive all indicated dental treatment. If
CD4+ cell count of more than 350/μL

eruption cyst = most common with the deciduous mand central, + first permanent molars, +
deciduous max incisors

Meta ceramic crown = At porcelain-metal interface, ceramic should be at least 0.5 mm thick.

Dentinogenesis imperfect = blue- grey , translucent

Amelogenesis Imperfecta = yellow - brown

Gardner syndrome = bone disorder- inherited as an autosomal dominant - multiple

osteomas(compact type of bone histo )> limit opening - bowel polyp - colonic polyps - epidermoid
cysts - high rate to malignant transfer (bowel adenocarcinomas )

With renal disease avoid = (aminoglycosides, acetaminophen in high doses, acyclovir, aspirin,
other NSAIDs, tetracycline) - antibiotic prophylaxis if there abcsess -

Small white non indurated patch on cheek when to take biopsy in smoker 2w

Smoker came for check-up border of tongue indurated ulcer 2x3cm what to do? Biopsy

Tranexamic acid = can be administered orally, intravenously, or as a mouth wash.

Maximum epinephrine with heart disease HTN = 0.04

maximum dose of epinephrine for a healthy patient= 0.2mg

leukemic pt and less Absolute Neutrophil Count ANC and need prophalxi antibiotic = consult
physician

Mesiodens = delay permeant tooth eruption

Drug treat xerostomia = pilocarpine - cevimeline

HCV tests for surgery = PT + BT liverdisease

Midazolm side effect = increase irritability
infection mononucelosis
p
Bracket Hairyleukeoplasia
D
Human herpes virus 4 (kissing disease) = causes by EPV

Moth eaten appearance = SCC - chronic osteomyelitis

pleomorphic adenoma ttt= surgical excision with wide margin

Erythroplakia = red patches , erythrolukoplakia = red + white

Erythroplakia = early invasive SCC - red lesion cant be diagnosed - floor of mouth + tongue + soft
palate- sever epithelial dysplasia - lack of keratin explain the red color
Actinic cheilosis = in lower lip vermilion results from longterm or excessive exposure to the
ultraviolet of sunlight - trophy of the lower lip

ACE inhibitors in hypertension = causes Angioedema of lips - rapid onset - nontender tissue
swelling

german measles (Rubella) = fever , rush in face first then spread to extremities hands - feet -
caused by : Rubivirus

Fiberous dysplasia = Ground glass + orange peel appearance

Most common benign tumors of parotid gland = pleomorphic adenoma

Most common malignant tumors parotid gland = mucoepidermoid carcinoma

Adenoid Cystic Carcinoma = perineurial invasion ACC

Angular cheilitis = candida albicans

Scarlet fever : common in children - involve tonails + pharynx + soft palate +tongue erythema
(strawberry tongue ) + rash

Common Age : 3 - 12 years

Treatment: antibiotic ( penicillin)

Primary herpetic gingivostomatitis : viral - diffuse erythema - vesicles - buccal mucosa may
involved - ulceration of tongue - common in children

Common Age: 6 months - 5 years

Treatment : antiviral

Recurrent herpes :

1- herpes labialis(cold sore / fever blister ) = vermilion borde

2- herpetic whitlow (herpetic paronychia) = fingers

3- intraoral recurrent herpes = gingiva + hard palate

Antibiotic prophylactic before procedure 30 - 60 mins =

2g amixoxllin

Unable to take oral: 2g Ampicillin IM or IV

Allergic to penicillin : 600 mg clindamycine

Mycobacteria = have waxy cell wall ( makes it difficult to stain ) - Ziehle Neelsen staining used by
heat to help staining , Methylene dye used as counterstain
Epilepsy pt had sezuire , management = Oxygen 100% - airway protection

Condition seen with AIDS pt = pseudomembranous candidas

Infection control
Hepatitis B (HBV) prophylaxis = within 48 hours , no later than 7 days. If not vaccinated = do
Hepatitis B immune globulin (HBIG) and HB vaccine

No post exposure prophylaxis or vaccination is available for Hepatitis C (HCV), do the following:
test anti-HCV + liver enzymes 4-6 months after exposure.

Perform HCV RNA testing at 4-6 weeks if an earlier diagnosis of HCV infection is desired.

HIV prophylaxis = ASAP no later than 24 hours. 7 2h to 4weeks

O O_O
risk assessment steps are = identify hazard > decide the harm > evaluate the risk > record > review
the assesment

Recommended biopsy = for lesion persist for 2 weeks after remove stimuli

Incisional biopsy = by 15 blade

HBeAg = high infectivity + poor prognosis

Anti HBe = low infectivity + good prognosis

Minimum concentration of HBV Ab after 3 doses of vaccenation ? 9-12 mIL/ml the

Waterline bacteria = aeroigenosa(common) - legionella - Pseudomonas

Chemical indicator placed = left side of pouch

Metallic taste :
1- ACE inhibitors - hypertension
2-Adenosin / Flecaininde (CCB) - Arrythmias
3- Metranidazole
4- Metformin - DM
5- Xerostomia
4- NUG
6- Galvanism - amalgam

Autoclave 131 C ( 270F) = 3min

Impression

O
Perforated try will affect = used to carry low viscosity impression > help to retain of material by
mechanical interlocking
Major component of alginate is water

Fluoride
Dental Flourosis = 1.5 - 3 ppm 0.2 Weekly
Skeletal flourosis = 3 - 10 0.05 Doily
Cripping skeletal fluorsis ( sever osteosclrosis ) = > 10 ppm

Fluoride mouthwashes and gels at home = 200ml mouthwash , 30ml gel

Fluoride therapy =
low level ppm for community
Higher level - 200-5000 ppm for dental products
Maximum level - 22,000 ppm for professional applied

Most cost effective flouride = systemic fluoride

Fluoride mechanism = dissolved hydroxyapatite crystals result into fluoridated hydroxyapatite
(more resistant to acid)
Clindamycin = promote growth of Clostridium difficile diarrhea (flare)

Implant

Reason to put screw above implant = To avoid micro movements during healing
Bone loss At first year = 0.9 to 1.6mm
Mean annual bone loss after one year = 0.05 to 0.13mm

Plastic or titanium instrument for implant = Because implant surface can be easily scratched

Ethics
Beneficence is the concept of acting in the best interest of the patient or “doing good - You
referred pt unnecessary to another doctor, against it , if not found then veracity would be the answer

Pt with down, consent from > guardians

Lap tests
Liver disease = CBC - ALT - AST , PT - BT
Dr. Manal Alharbi

‫دعواتكم‬

Perio

Iatrogenic factors predisposing to periodontal inflammation =

- Contour of restoration
- space between margin and restoration/ crown
- Root perforation
- Vertical root fracture
Pyogenic granuloma = tumor like gingival enlargement as an exaggerated condition from

minor trauma

Width of attached gingiva =

Greatest in maxillary incisor region 3.5 to 4.5mm

in the maxillaey first premolarr 1.9mm

narrowest in Mandibular first premolar 1.8mm

Pocket depth result gain of attachment after scaling and root planning = deeper than
2.9mm , if less than 2.9mm will result in loss of attachment

Gingival inflammation depends on = severity ( 0 = normal , 3= sever spontaneous bleeding )

Management of localized ulceration = topical corticosteroid ( 0.05% fluocinonide - 0.05%

betamethasone)

Schwartz Periotriever = used to retrieval broken curette tip from pocket

Bacteria communicate with each other by = Quorum sensing ( which triggered by changes
in cell density )

Cell responsible granulomatous inflammation = Macrophages

Dental floss + toothbrushing = disrupt and remove dental plaque

Fold run from floor of the mouth to ventral surface of tongue = lingual frenulum

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Tumor like gingival enlargement ( pyogenic tumor ) = reported incidence is 1.8% to 5% ,
Recurrence is 15%

Periodontal pathogens suppressed after systemic metronidazole and amoxicillin =

a.actinomycetemcomitans

Materia alba = soft accumulations of bacteria, food matter, and tissue cells that lack the
organized structure of dental plaque and that are easily displaced with a water spray.

Increase susceptibility of diaetic patients to infection caused because = defective

chemotaxis of neutrophils function

Detecting suppuration by = periodontal probe

Localized aggressive periodontitis = A.Actinomycetemomitans

Generalized aggressive periodontitis = P. Ginginvalis / P. Intermedia / T. Forsythia / T.

Denticola

CHX = is bacteriocidial+ bacteriostatic depends on concentration

With gingival massage Increase keratinization occurs on = oral epithelium

During Mestruatio = increase of bacterial count

Penetration of probe depends on = probe diameter (width), force .

interproximal brush size= should be slightly larger than embrasure

calculus is = contributing factor

Primary Goal of periodontal flap = access to root

Wideman flap = may cause recession

Endo

EPT = measure pulp neural responses.

Reason for endodonticlly treated posterior teeth fracture = loss of coronal structure
“resistance to fracture reduced in MOD cavities”

Location of second canal in mandibular canine = Lingual

root canal preparation should stop at = minor diameter

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Obturation should be 1-2 mm short of the radiographic apex

Etiology of internal resorption = loss of predntin

Gates-Glidden drill = limited to straight canals

I
diameter of Tranmetal Carbide bur = 1.6mm

IKI ( Iodine potassium iodide ) = is root canal medicaments ( disinfectant ) - able to kill
Ca(OH) resistant bacteria - don’t use it with pt has iodine allergy

Pulp stone removed by = ultrasonic scaler

action of inflammation which causes pulp necrosis = vascular dilation Ppressure insideth
Canal
Tug back of gutta percha = to prevent excessive obturation materials into PDL

Root canal treated tooth and exposed to oral environment When you should do re-endo =
after 2 - 3 months

shape of access cavity for the mandibular first molar= rhomboid or trapezoid

Gingival diseases of specific bacterial origin =

Neisseria gonorrhoeae
Treponema pallidum
Streptococcus species

Which disease accumulated glycation end-products (AGEs) in gingiva takes place ? =

diabetes … the formation of AGEs occurs at normal glucose levels , but in hyperglycemic
AGE formation is excessive

Dental/pulp trauma = is intrinsic stains

positive-pressure irrigation methods = cause risk of expressing debris or solution out of the
to pressure irrigationmetro
apex ( apical extrusion of irrigation i.e sodium hypochlorite accident )

Lateral perforation prognosis = of

Extrusion f
- at or above hight of crest of bone > favorable NaoCL
- Below the crest of bone > poor
Location of MB2 = mesial and palatal to MB1

Ledermix = inhibition of the ribosomal protein synthesis inhibitionof resorption

D5=0.20 + (0.1)
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tao.pe D tfile.nf
Yellow crown discoloration after Endo = pulp oblitaratio ( calsification )

Opertive

Primer function = bonded to dentin

bonding = bonded to the primer and to the restoration

Resone for whiter the color shade? = Selection shade under rubber dam / after dehydration

Inadequate polishing for amalgam restoration causes? = great risk of tarnish and corrosion

Cervical enamel projections (CEPs) = ectopic deposits of enamel apical to the CEJ , most
common found in mandibular second molar

Access cavity through lingual surface on anterior teeth to achieve ? = straight line access +
reduce esthetic concerns

fifth cusp in maxillary first molar ( cusp of carabelli) = present in mesiopalatal

GiC in deep caries ? = Increase Postoperative sensitivity reasons : (1- aggressive tooth
preparation 2- overdrying 3- contaminated with saliva )

preventive resin restoration indicated = When some fissures are with shallow
caries and others sound

Post trimmed = 1.5 to 2 mm above the tooth preparation

Anaesthesia test fr om where we start = most posterior tooth in maxillary arch

Scale to measure marginal deterioration = Mahler scale ( rate 1 = none , rate 11 = extensive

Dimension For small cavity preparation class l premolar should be = 1/4 intercuspal
distance

Disadvantage composite with large particles = difficult to finish and polish

Haversianacanalicdpiostocyte
Connects haversian system to osteocyte called = Canaliculi

Connectes osteon to another osteon called = Volkmans canal Odeon osteon

volkmans
canal
Pt with bruxim and had old broken amalgam what the best to change it with = new
amalgam

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 O
Color at cervaical = Chroma ( more chromatic)
O
Reason of flowable composite systems preferred over packable composite = easy to apply
+ less microleakage

most common cause of lose of teeth = Caries

When composite is placed over an RMGI material, this technique is called = “sandwich”
technique

most susceptible site for caries in high risk pt = cervical area of buccal posterior max

Zinc in amalgam = deoxidizer

A line that occurs in the isthmus region in large amalgam restoration = indicates a
fractured amalgam > should be replaced

Discolored areas or “amalgam blues” results either from =

- the leaching of amalgam corrosion products into the dentinal tubules

- the color of underlying amalgam seen through translucent enamel > when the enamel has
little or no dentin support( undermined cusps, marginal ridges, and regions adjacent to
proximal margins)

Prosth

Width of chamfer finish line = 0.5mm

Width of shoulder finish line = 1mm

systemic conditions can result in gagging in old denture wearers = adenoids +

gastrointestinal tract disorders

Restoration after crown lengthening = (temporary crown/impression) after 4-6 weeks -

(final crown) after 3 months

Normal maxillary gingiva display upon smile = 1 -2 mm

Normal max incisors display upon smiling = 7 - 8 mm

Normal max incisors display on rest = 2- 4 mm

Angle between occlusal rest seat and vertical minor connector < 90

Rest fracture due to = improper preparation rest seat / shallow preparation

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systemic disturbances cause chewing difficulty in denture wearers = Diabetes > bcz dry
mouth

primary requirements of major connector = compatible - Rigid

Percentage of palatal tori= 20% to 35%

best way to record Centric relation = Bimanual manipulation , while the pt in spine

Proximal plates ( minor connector ) function = stabilization

For Glass Ceramic , what cement is used? = resin cement

Mixing Zinc polycarboxylate cement = P/L ratio should be 1.5 by weight

Overpacking of retraction cord cause = tearing of the gingival attachment, which leads to
irreversible recession.

Repeated use of displacement retraction cord in the sulcus cause = gingival recession

Material make wear to enamel = Porcelain

Die ditching means = carving apical to finish line > this is not required to

Repairs of veneers =

- composite veneers repair … with the same material after roughening the area
- Small porcelain veneers repair … with hydrofluoric acid 10%, silane coupling agent,
adhesive then place composite

- Large porcelain veneers fracture… replace entire porcelain veneer

Ridge mapping = determine the hight and width of ridge ( in diagnostic cast )

Direct sequela of wearing CD =

- altered taste sensation

- Burning mouth syndrome
- Residual ridge resorption

Indirect sequela of wearing CD =

- masticatory muscles atrophy

Page 6
Interference reduction :

- Protrusive = DUML
O
- Working = BULL
- Non working= LUBL
- Centric+eccentric =cusp
DL
MUof upper + distal inclination of lower
- Centric = mesial inclination

Developing traumatic ulcer after deliver new complete denture takes = 1 - 2 days

e
Lingual border molding muscles = palatoglossus , superior constrictor , Mylohyoid ,
Genioglossus

occlusion concept allows freedom of movement in anterior posterior direction = long

centric

boley gauge = used to check the palatal thickness of complete denture

willis gauge = recored vertical dimension

primary stress bearing =

- mand : buccal shelf

- Max : hard palate , ridge slopes
saddle or ridge lap = is not accessible to cleaning with dental floss,

internal occlusal rest = support and horizontal stability

Clasp used in case of soft tissue undercuts and high feral attachment = RPA clasp

To Blockout inter proximal undercut use = cingulum bar ( contiguous bar )

Major connector = Part of denture direct forces to supporting structure

Page 7
 Pedo

Two types of dental pain : 1-provoked (reversible). 2- spontaneous (irreversable).

Sign of transition pulp (reversible pulp) in primary teeth = provoked pain > stimulated by

Thermal and eliminated when its removed .

recommended amount (oz/day) of fruit according to the American Academy of pediatrics

=
I 3Y 404day p I Cup
- For pre school aged ( 3-6 years ) : 4-5 oz/day
Lz to Cup
- For School aged (6-12 years) : 8-12 oz/day ICup
1- Flush terminal plane = anterior-posterior positions of the distal surfaces of opposing
primary second molars are in the same vertical plane … developing Normal class l

2- Mesial-step terminus = mandibular second primary molar terminus mesial to the maxillary
primary terminus … developing class lll Qs
3- Distal-step terminal plane = mandibular second primary molar terminus distal to the
maxillary second primary molar terminus … developing class ll of
After pulpotomy with formocresol , hyperemia of the pulp indicates = flammation present
beyond coronal pulp , pulpectomy should be established

Primary molars VS permanent molars =

- Enamel + dentin are thinner compared with permanent teeth

- Crowns of primary characterized by cervical constriction > more prominent cervical
contour than permanent teeth

- contact areas of primary are flat + broad buccolingually

- color of the primary is whiter and a lighter.
- primary molar roots are longer and more slender

Page 8
 Ortho

In cephalometric radiograph =

- Distance b/w x-ray source(tube) and patient( midsagittal plane ) = 1.5 - 1.8 meter ( 5
feet )

- Distance b/w patient’s head and film = 15 cm

Need for orthographic surgery when =

Increase overjet > 9mm

Reverse overjet > 3mm

Normal axial inclination (inter-incisal angle) angle formed b/w max to mand incisors is =
135° - 137

Wits analysis = Functional occlusal plane

Treatment for White Spots =

- 1st step allow natural remineralization

- 2nd step external bleaching followed by topical fluoride ( is good oral hygiene )

- 3rd step micro abrasion

Heavy forces leads to = undermined resorption

In overbite cases=

- If the display of the maxillary incisors on smile is appropriate repositioning the lower
incisors

- If display is excessive, intrusion of the upper incisors

Surgery

facial skeletal deformity with cleft lip and palate = class lll due to maxillary deficiency

Unilateral Condylar fracture = open bite malocclusion on affected side + deviation to

affected side , if Bilateral fracture = anterior open bite + retrognathic mandible

Condyle and rams fracture graft = costochondral of rib

Classification of TMJ disorders :

Page 9
Classi cation of TMJ disorders :
1. Myofascial Pain

2. Internal Derangements

3. Degenerative Joint Disease (Arthrosis, Osteoarthritis)

4. Systemic Arthritic Conditions

5. Chronic Recurrent Dislocation

6. Ankylosis

7. Neoplasia

8. Infections

Ludwig space and related muscles ? = mylohyoid muscle.

In lefort 1 fracture where to put beaks of Rowe’s disimpaction forcep = one inside the
mouth and the other inside the nose ( nostril)

Anesthesia the slowest onset = procaine > tetracaine > bupivacaine

local anesthesia technique used to block the buccal, lingual and mylohyoid nerves = Gow-
Gates Technique

Depth of penetration needle for inferior alveolar block = 20mm to 25mm ( Two third of
long needle )

Salivary gland ducts =

1- Parotid gland … Stensons duct (opens opposite to maxillary second molar )

2- submandibular gland … Warthons duct ( opens on side of frenulum tongue)

3- sublingual gland … Bartholin duct + Rivinus duct

Procedure exclusive for mandibular setback (in case of mandibular excess) = Vertical

Vertical ramusosteotomy fsetback

ramus osteotomy

Procedure Most widely used for mandibular advancement (in case of mandibular
deficiency ) = bilateral sagittal split osteotomy BSSO
I 13550 0 Hand def
stylomandibular ligament function = limits mandibular protrusion

O
during condyle hinge movement mouth opening = 45 to 50 mm , lateral 12mm
Page 10
 Medicin - Pathology

Onion skin appearance = Ewing’s sarcoma

CHRONIC OSTEOMYELITIS WITH PROLIFERATIVE PERIOSTITIS (GARRE'S OSTEOMYELITIS, PERIOSTITIS

Cotton wool appearance = Paget’s disease - cementoossous dysplasia - Gardner’s syndrome

Cotton lion
Lion face /lionlike facial deformity (leontiasis ossea) = Paget’s disease

Cardiac Conditions Asso With the Highest Risk of Endocarditis ( Prophylaxis Is

Recommended) =

1-︎ Prosthetic cardiac valve ︎

2- Previous infective endocarditis ︎

bacterial infection (NOT a fungus infection) caused by
3-Congenital heart disease (CHD) Actinomyces israellii, an anaerobic, gram-positive lamentous
bacterium.
IX
actinomycosis = fungal infection, Sulfur granules

sulfonylureas ( treat DM) drug interactions with = NSAIDs (ibuprofen) + warfarin +

aspirin + fluconazole > they causes hypoglycemia

If using bronchodilator not effective with asthma attach what should you use then =
Epinephrine injection 0.3-0.5mL1;1000 / inhaler

Popping sound left to the ear = TMJ disorder

Bulima effect which teeth surfaces = Lingual and palatal

Mechanism action of penicillin = inhibit synthesis of wall peptidoglycan

Abnormal in morphodifferentation stage ? = peg shape tooth

microorganism assosited with median rhomboid glossitis = Candida albicans

Thermal burn (ex: hot pizza roll) = yellow- white epithelial necrosis

Asthma medication contribute of = oral candidiasis + gasteroesophageal acidereflux >

erosion
Trismus associated with = Multiple sclerosis + Parkinson’s disease

anticholinergic drugs(ex: propantheline bromide ) = avoided with asthma

paint
Most sever anatomical space infection = lateral pharyngeal - deep neck spaces -
mediastinum- intracranial infection

Page 11
Minor aphthous ulceration = ulceration demonstrates a yellow-white, fibrinopurulent
membrane that is encircled by an erythematous halo - ttt : topical corticosteroids ( 0.05%
Betamethasone gel )

Human papillomavirus HPV associated with = oropharyngeal cancer

Syphilis is chronic infection produced by = Treponema pallidum

higher recurrence rate associated with = odontogenic keratocysts

Hemangioma= most common tumor of infancy

Infectious mononucleosis = Epstein-Barr virus

Hodgkin’s lymphoma = The prominent supraclavicular and cervical masses represent

Hodgkin’s lymphoma.

sulfur granules = seen in actinomyces

Patient with history of stroke or transient ischemic attack (TIA) = defer elective dental
treatment for 6 months.

Post kidney transplantation = defer elective dental treatment for 6 month

Patients with a history bleeding but with normal results on coagulation tests and normal
platelet counts = HHT, Cushing disease, scurvy, Ehlers-Danlos syndrome.

Avoid dental care on day of hemodialysis = because blood anticoagulant therapy

administrated during dialysis therapy and causes > bleeding

Different between NUG and streptococcal gingivostomatitis = necrotic tissue

Test for platelet disorders = platelet function analyzer (PFA-100)

Impression

To prevent dimensional change in the surface of gypsum casts, they rinsed or

soaked with water saturated with = calcium sulfate

Impression that has best tear strength = polysulfide

ZOE accelerator = alcohol

Accelerate polysulfide setting by = heat and humidity

Dispose of dental waste = when it’s 3/4 full

Page 12
 Fluoride

Fluoride in over the counter dentifrices in ppm is = 1000 ppm (daily )

stannous fluoride concentration =

- in regular toothpaste= 0.1%

- in high F toothpaste= 0.4%
- 8% for professional application

Implant

osseointegration =

- Maxillary 4 - 6 months

- Mandible 3 - 4 months

First follow up after implant = 3 months in mand , 4 in max

Implant analogue = It represents the top of impant fixure or abutment in labaratoy cast

Peri-implantitis = inflammation both hard and soft tissue around implant , ttt: non-surgical
( antimicrobial rinse , irrigation , local antibiotic) - surgical ( full thickness flap )

Peri-implantitis mucositis = inflammation confined to soft tissue around implant , ttt:

curettes - ultrasonic scaler , polishing with prophy paste

Abutment = Part of implant hold the fixture to prosthesis

Narrow diameter implant = 3.25mm ( 6mm space )

Standard diameter implant= 4.1mm ( 7mm space )

Wide diameter implant = 5mm ( 8mm space )

3.25 6mm
4 I 7mm
5 p 8mm

Page 13
 Ethics

Ethics = the system of moral principles that govern the conduct of an individual or a group of
individuals and according to which human actions are judged as right or wrong, good or bad.

Patient Abandonment

i - If dentist start specific procedure he shouldn’t leave the pt until treatment is

Is I completed.

at patient Abandonment happened when =

- Dentist Refusal to see a patient without a valid legal reason

- Failure to provide proper follow-up after treatment
- Failure to provide coverage for patient with another dentist during a vacation
Deontology = well found rules that can serve as the basis for making moral decision

E E I EYF IE a Es E Deontology

I
Edf E
I ki ab W l

74 2 2021

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