Al-assaf NOTES 08 (3)

Al-Assaf NOTES (PART 8), 25-30 December 2021
1. Patient has radiographic bone loss 50% and plaque accumulation and calculus around teeth, after scaling
and root planning. What appropriate recall visits?
• 2 months
• 3 months
• 6 months
• 12 months
• Carranza’s Clinical Periodontology

2. The most common type of malocclusion:
• Class I
•
• Contemporary Orthodontics
NOTES By: Moath Al-assaf Twitter: @mo3ath44

3. Picture of open window sinus lifting:

4. In embryonic development when the start of teeth formation?
• 4th weeks
• 6th weeks
• 12th weeks
•
• McDonald and Avery's Dentistry for the Child and Adolescent
5. Pediatric patient has a posterior crossbite and anterior open bite due to tongue thrusting, what is the
appropriate management?
• Quad helix
• W arch
• Tongue crip / Palatal crib
•

6. Picture of complete cut of upper lip how many layers of suture?

• 3 layers
•
• Contemporary Oral and Maxillofacial Surgery
7. What is the maximum number of carpules of lidocaine consider safe for patients with heart disease?
• 2 carpules of lidocaine with 1:100,000 Epinephrine.
• https://www.youtube.com/watch?v=5Ujl1VbAcgc&ab_channel=MentalDental
8. Lateral intraoral picture for patient with malocclusion class II
• Check online
9. Lateral intraoral picture for patient with malocclusion class III
• Check online
10. 32-year-old female patient with Sjogren’s syndrome this is what medication you prescribed?
• Pilocarpine
•
• Neville, Oral & Maxillofacial pathology.
11. What test need in Sjogren’s syndrome?
• Anti-SS antibodies.
•
• A simple means to confirm the decreased tear secretion is the Schirmer test. A standardized strip of
sterile filter paper is placed over the margin of the lower eyelid, so that the tabbed end rests just
inside the lower lid. By measuring the length of wetting of the filter paper, tear production can be
assessed. Values less than 5 mm (after a 5-minute period) are considered abnormal.
12. Side effect of diazepam?
• Prolonged sedation
•

13. Patient with crack in the in a ceramic restoration on tooth number 21, what type of acid etch can be used?
• Hydrofluoric acid 33%
• Phosphoric acid 37%
• Phosphoric acid 33%
• Hydrofluoric acid 5-10%
•
• Contemporary Fixed Prosthodontics
14. Picture of customized impression technique (Custom impression coping):

15. HIV Patient with inflamed gingiva, the dentist did for him scaling and root planning and prescribed him
antibiotics, he came back in the evaluation without healing what is management?
• Fluconazole (the diagnosis is most likely to be candida infection)
• Dental Management of the Medically Compromised Patient

16. Dentist while he performing root canal treatment for 46 and take PA with SLOB technique mesially, which
canal will move mesial?
• Mesio-lingual canal
• Same Lingual Opposite Buccal (SLOB).

• Oral Radiology_ Principles and Interpretation
17. Picture about peripheral giant cell granuloma:
•
• The treatment of the peripheral giant cell granuloma consists of local surgical excision down to the
underlying bone. The adjacent teeth should be carefully scaled to remove any source of irritation
and to minimize the risk of recurrence. Approximately 10% to 18% of lesions are reported to recur.

18. What the safest antibiotic drug for pregnant women?

• List of safe drugs for pregnancy was mentioned in previous parts.
19. Picture of an enamel hypoplasia:
•
20. Multiple question about vertical Root fracture:
• So, let’s well cover the topic.
• Definition:
▪ A vertical root fracture (VRF) is a longitudinally oriented complete or incomplete fracture
initiated in the root at any level and is usually directed buccolingually.
▪ This definition separates a VRF from a split tooth, which begins with a crack of the crown
that propagates apically into the root as a longitudinal fracture.
• Etiology:
▪ Most vertical root fractures occur in endodontically treated teeth. VRFs usually do not occur
during the actual obturation of the root canal, but rather they occur long after the
procedure has been completed.

▪ Iatrogenic Predisposing Factors:

• Root Canal Treatment
• Excessive Root Canal Preparation
• Microcracks Caused by Rotary Instrumentation
• Uneven Thickness of Remaining Dentin
• Methods of Obturation
• Type of Spreader Used
• Post Design
• Crown Design
▪ Natural Predisposing Factors:
• Shape of Root Cross Section: Roots that are curved and deep facially and lingually
but narrow mesially and distally are particularly prone to fracture.
• Occlusal Factors
• Preexisting Microcracks
• Diagnosis:
▪ A sinus tract and a narrow, isolated periodontal probing defect associated with a tooth that
has undergone a root canal treatment, with or without post placement, can be considered
pathognomonic for the presence of a VRF.
▪ VRF Pockets: A flexible periodontal probe is mandatory in such examinations.
▪ Coronally Located Sinus Tract: Sinus tracts that are associated with a VRF pocket are often
found in a more coronal position, as the source is not from a periapical lesion.
▪ Radiographic Features: not useful for early lesions, however for late lesions, The J-shaped or
halo appearance, a combination of periapical and periradicular radiolucencies, was
associated with a high probability of a VRF.

▪ Cone-Beam Computed Tomography in VRF Diagnosis: the early destruction of the bone
along the suspected fracture may be visible in the cancellous bone (i.e., with an axial view)
at relatively early stages, whereas this early bone destruction would not be detectable in
traditional planar, periapical radiographs; such bone resorption may help to establish a VRF
diagnosis.
▪ Exploratory Surgery: When clinical and radiographic evaluations are equivocal in detecting a
suspected vertical root fracture, exploratory surgery may be indicated. Flap reflection
remains the only reliable diagnostic approach for fracture confirmation.
• Treatment:
▪ When a VRF is determined to be present, extraction of the affected tooth or root is
recommended as soon as possible. (Cohen’s Pathway).
▪ , the only predictable treatment is removal of the fractured root. In multirooted teeth, this
could be done by root resection (amputation) or hemi-section. (Endodontics: Principles
and Practice).
21. Question about what is the stain used for TB diagnosis?

• Ziehl-Neelsen or other acid-fast
•
22. 55-year-old woman patient came for dental check up with Lesion
asymptomatic what is management? (Picture of melanotic macule)
• Observation
• No treatment
• Excisional biopsy
• All oral pigmented macules of recent onset, large size, irregular
pigmentation, unknown duration, or recent enlargement should
be submitted for microscopic examination.
• Excisional biopsy is the preferred treatment method for esthetic
reasons.

•
23. Picture about amalgam tattoo:
•
• Management: No treatment is required if the fragments can be detected radiographically. If no
metallic fragments are found and the lesion cannot be diagnosed clinically, then biopsy may be
needed to rule out the possibility of melanocytic neoplasia.
24. Management of endodontic-periodontic lesions:
• Mentioned in part 7.
25. Pink tooth:
• Internal resorption usually is asymptomatic and
discovered through routine radiographs. Pain
may be reported if the process is associated with
significant pulpal inflammation.
• Two main patterns are seen:
• 1) Inflammatory resorption:
▪ In inflammatory resorption, the
resorbed dentin is replaced by inflamed
granulation tissue.
▪ The results of pulp testing are variable.
▪ When it affects the coronal pulp, the
crown can display a pink discoloration
(pink tooth of Mummery) as the vascular
resorptive process approaches the
surface.
▪ When it occurs in the root, the original
outline of the canal is lost and a
balloonlike radiographic dilation of the
canal is seen
• 2) Replacement or metaplastic resorption:
• Portions of the pulpal dentinal walls are
resorbed and replaced with bone or cementum-
like bone.

26. Cause of discoloration in MTA:

• Bismuth oxide
•
• Cohen's Pathways of the Pulp Expert Consult
27. Management of internal resorption:
• If the affected tooth is salvageable with reasonable prognosis, root canal treatment is necessary.
• The main purpose of the root canal treatment is to remove the intraradicular bacteria and disinfect
the root canal space.
• In IRR, the hard tissue defects caused by the resorptive process are challenging to fill adequately. To
obturate the resorptive defect, the root-filling material must be able to flow.
• If perforation has occurred, mineral trioxide aggregate (MTA) should be considered the material of
choice to repair the root wall.
• To sum up:
▪ If no perforation -> calcium hydroxide disinfection, then GP obturation.
▪ If perforated -> calcium hydroxide disinfection then RCT then MTA perforation repair.
• Cohen's Pathways of the Pulp Expert Consult
28. Management of gingival enlargement:
• Chronic Inflammatory Enlargement
▪ Treated by scaling and root planing.
▪ If enlargements include a significant fibrotic component that does not undergo shrinkage,
surgical removal is the treatment of choice. Two techniques are available for this purpose:
gingivectomy and the flap operation.
• Drug-Associated Gingival Enlargement
▪ Primarily with three different types of drugs: anticonvulsants, calcium channel blockers, and
the immunosuppressant cyclosporine.
▪ Overgrown tissues to have two components: fibrotic, which are caused by the drug, and
inflammatory, which are induced by bacterial plaque.
▪ First, discontinuing the drug or changing the medication if possible.
▪ Allow for a 6- to 12-month period between discontinuation and possible resolution of
gingival enlargement before a decision to surgical treatment is made.
▪ Second, plaque control: good oral hygiene, chemotherapeutics, and the frequent
professional removal of plaque decrease the degree of gingival enlargement and improve
overall gingival health.
▪ Third, in some patients, gingival enlargement persists these patients may require surgery,
which may involve either gingivectomy or the periodontal flap.
• Leukemic Gingival Enlargement (Chapter 47)
▪ Leukemic enlargement occurs with acute or subacute leukemia, and it is uncommon among
patients in the chronic leukemic state.
▪ Sc/Rp is confined to a small area of the mouth to facilitate the control of bleeding with
antibiotics are administered systemically the evening before and for 48 hours after each
treatment to reduce the risk of infection.
• Gingival Enlargement During Pregnancy
▪ Food impaction is frequently an inciting factor.
▪ Treatment requires the elimination of all local irritants.
▪ Marginal & interdental inflammation & enlargement are treated by scaling and curettage.

▪ The treatment of tumorlike gingival enlargements consists of surgical excision as well as the
scaling and planing of the tooth surface.
▪ Timing and indications:
• Gingival lesions during pregnancy should be treated as soon as they are detected,
although not necessarily by surgical means. Scaling and root planing procedures and
adequate oral hygiene measures may reduce the size of the enlargement.
• Lesions should be removed surgically during pregnancy only if they interfere with
mastication or produce an aesthetic disfigurement that the patient wants removed.
• Gingival Enlargement During Puberty
▪ Scaling and curettage, removing all sources of irritation, and controlling plaque.
▪ Surgical removal may be required in severe cases.
▪ The main problem in these patients is recurrence, which is caused by poor oral hygiene.
• Recurrence of Gingival Enlargement
▪ Recurrence is the most common problem in the management of gingival enlargement.
▪ Residual local irritation and systemic or hereditary conditions.
▪ Recurrence during the healing period is manifested as red, beadlike, granulomatous masses
that bleed with slight provocation -> corrected by removing the granulation tissue and
scaling and planing the root surface.
▪ Familial, hereditary, or idiopathic gingival enlargement recurs after surgical removal even if
all local irritants have been removed. The enlargement can be maintained at minimal size by
preventing secondary inflammatory involvement.

• Carranza’s Clinical Periodontology.

29. Stillman’s clefts & McCall festoons:
• Stillman’s clefts: describe a specific
type of gingival recession that
consists of a narrow, triangular-
shaped gingival recession.
• McCall festoons: describe a rolled,
thickened band of gingiva that is
usually seen adjacent to the cuspids
when recession approaches the
mucogingival junction.
30. Biologic width question:
• Biologic width = 2.04 mm (±30%).
• Junctional epithelium 0.97 mm
• Connective tissue attachment 1.07 mm
• It is recommended that there be at least 3.0 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.

31. Multiple questions about periodontitis diagnosis:
• Staging intends to classify the severity and extent of a patient’s disease based on the measurable
amount of destroyed and/or damaged tissue as a result of periodontitis and to assess the specific
factors that may attribute to the complexity of long-term case management.
• Initial stage should be determined using clinical attachment loss (CAL). If CAL is not available,
radiographic bone loss (RBL) should be used. Tooth loss due to periodontitis may modify stage
definition. One or more complexity factors may shift the stage to a higher level.
• Grading aims to indicate the rate of periodontitis progression, responsiveness to standard therapy,
and potential impact on systemic health.
• Clinicians should initially assume grade B disease and seek specific evidence to shift to grade A or C.

32. Multiple questions about gingivitis diagnosis:
• A:
Assumes a light probing pressure of 0.2 to 0.25 N.
• B:
The threshold was therefore set at ≤ 4 mm acknowledging that post-treatment clinical phenotypes
need to be considered differently to pre-treatment phenotypes.
33. Implant failure:
• Prosthetic or Mechanical Complications:
▪ Screw Loosening and Fracture:
• More common in implant retained FPDs than Crowns.
• Screw loosening is often corrected by retightening the screws.
▪ Implant Fracture:
• The ultimate mechanical failure is implant fracture because it results in loss of the
implant and possibly the prosthesis.
• Factors such as fatigue of implant materials and weakness in prosthetic design or
dimension are the usual causes of implant fractures.
• Causes that may explain implant fractures:
o Design and material
o Nonpassive fit of the prosthetic framework
o Physiologic or biomechanical overload
• Patients with bruxism:
o At higher risk for such events and therefore need to be screened, informed,
and managed accordingly.
o These patients should be fitted with occlusal guards in conjunction with
placement of the final prostheses.
▪ Fracture of Restorative Materials:
• This is particularly true for veneers (acrylic, composite, or ceramic) that are attached
to superstructures.
• Biologic Complications:
▪ Inflammation and Proliferation:
• Inflammation in the peri-implant soft tissues has been found to be similar to the
inflammatory response in gingival and other periodontal tissues.
• The reaction of peri-implant soft tissues to bacterial accumulation is profound,
almost unusual, with a dramatic inflammatory proliferation.
• Causes: Loose fitting implant to abutment connection or trapped excess cement that
remains buried within the soft-tissue space or “pocket.”
• Another type of lesion resulting from a loose abutment connection is the fistula.

▪ Recession: Recession is a common finding especially when soft tissues are thin and not well
supported and could be due to improper implant positioning.
▪ Periimplantitis and Bone Loss: (‫)مهم جدا‬
•
▪ Implant Loss or Failure
• Early implant failures occur before implant restoration.
o Did not achieve osseointegration
o Integration was weak or jeopardized by infection, movement, or impaired
wound healing
• Late implant failures occur after the implant has been restored.
o Infection and implant overload
• Regarding biologic causes for implant failure: Infections, impaired healing, and
overload were the most important contributing factors.
• Single dose of preoperative antibiotic therapy may decrease the failure rate of
dental implants.
34. Implant loosening or Motility:
• Mobility remains the cardinal sign of implant failure, and detecting mobility is therefore an
important parameter.
• Two noninvasive techniques that have been used for evaluating implant stability are
▪ Impact resistance (e.g., Periotest)
▪ Resonance frequency analysis (RFA).
35. Pictures of non-carious tooth loss:


36. Erosion:
• Erosion is the wear or loss of tooth surface by chemico-mechanical action.
• Erosion, often a saucer-shaped notch, occurs primarily as a result of chemical dissolution
• Regurgitation of stomach acid can cause this condition on the lingual surfaces of maxillary teeth
(particularly anterior teeth).
• The dissolution of the facial aspects of anterior teeth because of habitual sucking of lemons or the
loss of tooth surface from ingestion of acidic medicines.
• Management: cause should be stopped then restored according to the defect.
37. Abrasion:
• Abrasion, in the form of a notch, often V-shaped, is a loss or wearing away of tooth structure
resulting from mechanical forces, such as strenuous toothbrushing with a hard bristle toothbrush or
abrasive toothpaste.
38. Patient with bruxism asking for veneers treatment:
• Veneers are contraindicated for patients with bruxism.

39. What the 2nd and 3rd numbers represent in the instrument formula?
• 1st number: indicates the width of the blade or primary cutting edge in tenths of a millimeter.
• 2nd number: in a four-number code indicates the primary cutting-edge angle, measured in clockwise
centigrade. The angle is expressed as a percent of 360 degrees.
▪ If the edge is locally perpendicular to the blade, this number is normally omitted, resulting in
a three-number code.
• 3 number: (2nd of a three-number code) indicates the blade length in millimeters.
rd
• 4th number: (3rd of a three-number code) indicates the blade angle, relative to the long axis of the
handle in clockwise centigrade.
•
• Sturtevant’s Art and Science of Operative Dentistry
40. Adverse effect of not polishing the amalgam restoration:
• Increased chance of tarnish and corrosion.
•
• Sturtevant’s Art and Science of Operative Dentistry
41. Shade selections related MCQs:
• Metamerism: Two colors that appear to be a match under a given lighting condition but have
different spectral reflectance are called metamers, and the phenomenon is known as metamerism.
• Fluorescence: Fluorescent materials, such as tooth enamel, re-emit radiant energy at a lower
frequency than it is absorbed.
• Hue is defined as the particular variety of a color. The hue of an object can be red, green, yellow, and
so on, and is determined by the wavelength.
• Chroma is defined as the intensity of a hue. The terms saturation and chroma are used
interchangeably both mean the strength of a given hue or the concentration of pigment.

• Value is defined as the relative lightness or darkness of a color or the brightness of an object. The
brightness of any object is a direct consequence of the amount of light energy the object reflects
and/or transmits. A restoration that has too high a value (is too bright) may be easily detected by an
observer and is a common esthetic problem in metal-ceramic prosthodontics. Most important and
most difficult
• Vita Lumin vacuum shade guide:
▪ Hue selection: Choosing the nearest hue first and then selecting the appropriate match of
chroma and value from the tabs available is the recommended technique.
▪ Chroma selection Once the hue is selected, the best chroma match is chosen.
▪ Value selection: last to be chosen and.
• Vitapan 3D-Master shade guide:
▪ The manufacturer recommends selecting the lightness first, then chroma, and finally hue.
42. Management of periodontal Abscesses
• Chronic Abscess:
▪ Usually treated with scaling and root planing or surgical therapy.
▪ Surgical treatment is suggested when deep vertical or furcation defects are encountered that
are beyond the therapeutic capabilities of nonsurgical instrumentation.
• Acute Abscess:
▪ Treated to alleviate symptoms, control the spread of infection, and establish drainage.
▪ Before treatment, determine the need for systemic antibiotics:
▪
▪ Drainage through Periodontal Pocket:
• If the lesion is small and access uncomplicated, debridement in the form of scaling
and root planing may be undertaken.
• If the lesion is large and drainage cannot be established, root debridement by scaling
and root planing or surgical access should be delayed until the major clinical signs
have abated. In these patients, use of adjunctive systemic antibiotics with short-
term high-dose regimens is recommended.
▪
▪ Drainage through External Incision:
• A vertical incision through the most fluctuant center of the abscess is made with a
No. 15 surgical blade.

o Carranza’s Clinical Periodontology

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Al-Assaf NOTES (PART 8), 25-30 December 2021

• Carranza’s Clinical Periodontology

NOTES By: Moath Al-assaf Twitter: @mo3ath44

3. Picture of open window sinus lifting:

• Carranza’s Clinical Periodontology

NOTES By: Moath Al-assaf Twitter: @mo3ath44

6. Picture of complete cut of upper lip how many layers of suture?

NOTES By: Moath Al-assaf Twitter: @mo3ath44

NOTES By: Moath Al-assaf Twitter: @mo3ath44

• Dental Management of the Medically Compromised Patient

• Same Lingual Opposite Buccal (SLOB).

NOTES By: Moath Al-assaf Twitter: @mo3ath44

18. What the safest antibiotic drug for pregnant women?

NOTES By: Moath Al-assaf Twitter: @mo3ath44

▪ Iatrogenic Predisposing Factors:

NOTES By: Moath Al-assaf Twitter: @mo3ath44

21. Question about what is the stain used for TB diagnosis?

NOTES By: Moath Al-assaf Twitter: @mo3ath44

NOTES By: Moath Al-assaf Twitter: @mo3ath44

26. Cause of discoloration in MTA:

NOTES By: Moath Al-assaf Twitter: @mo3ath44

NOTES By: Moath Al-assaf Twitter: @mo3ath44

• Carranza’s Clinical Periodontology.

NOTES By: Moath Al-assaf Twitter: @mo3ath44

31. Multiple questions about periodontitis diagnosis:

NOTES By: Moath Al-assaf Twitter: @mo3ath44

32. Multiple questions about gingivitis diagnosis:

NOTES By: Moath Al-assaf Twitter: @mo3ath44

NOTES By: Moath Al-assaf Twitter: @mo3ath44

• Neville, Oral & Maxillofacial pathology.

• Contemporary Fixed Prosthodontics

NOTES By: Moath Al-assaf Twitter: @mo3ath44

NOTES By: Moath Al-assaf Twitter: @mo3ath44

NOTES By: Moath Al-assaf Twitter: @mo3ath44

o Carranza’s Clinical Periodontology

NOTES By: Moath Al-assaf Twitter: @mo3ath44

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