Ors Exam 3

Osteogenesis

Osteoinduction

Osteoconduction

Osteogenesis: Survival of cellular elements allows synthesis of new bone at recipient site.

Osteoinduction: Active recruitment of host mesenchymal stem cells, including growth factors and bone proteins from surrounding tissue allows formation of new bone.

Osteoconduction: Graft material facilitates invasion of blood vessels and connection of bone cells to lattice framework

2 phase theory of osteogenesis

Phase 1: Osteogenesis: This phase has most bone formation. The cells are transplanted from the donor

Phase 2: Osteoinduction and Osteoconduction: Begins at second week. The graft bed undergoes changes and fibroblasts differentiate to osteoblasts and begin to lay down new bone

Immune response for graft is mainly ______ mediated

Cell mediated by T lymphocytes

True or False: Immunosuppression with medications are used in graft for oral surgery?

False

Autogenous

Allogeneic

Xenogeneic

Autogenous: Tissue from same individual (most ideal bone graft)

Allogeneic: Same species

Xenogeneic: From another species

Which graft provides viable cells for Phase 1 of osteogenesis

Autogenous

Most optimal and gold standard

Management of odontogenic infections is primarily ________

surgical

Antibiotics are an adjunct

Most common aerobic bacteria isolated from odontogenic infections

Most common anaerobic bacteria isolated from odontogenic infections

Strep viridans

Bacteroides

Infections progress through the path of _______ resistance

least

4 stages of infections

Inoculation (edema): Soft, doughy, red swelling mildly tender

Cellulitis: Intense inflammatory response

Abscess: Anaerobes predominate, purulence is hallmark

Resolution: Host defense destorys bacteria when infection is drained

What is the hallmark of abscess stage?

Purulence

Pus forming or Pus

Which is more serious: cellulitis or abscess

Cellulitis: Diffuse and can cause shock

Fistula and Sinus tract

Fistula: Canal develops between 2 points to drain infection

Sinus: Only has one ending

Elevated temperature above _____ (38.3) indicates bacteremia and systemic involvement

101

Needs immediate intervention

What does high bands indicate

Acute infection and bone marrow is increasing production to fight infection

After drainage, WBC count may _______ due to surgical trauma

increase

Hyperglycemia causes _______ leukocyte chemotaxis and phagocytosis

decreased

Steps of source control of infection

Endo, Perio, Extraction

Local Anesthesia and Infection

Penetration of local is difficult due to low pH

Can seed infection to uninfected tissues (change needle)

Regional blocks preferred over local infiltration

Incision shoud flow for ______ dependent drainage

Make incision _______ in length, down to bone

gravity

10-15 mm

When to remove drain?

After 24 hours with no purulent drainage

Narrow spectrum for simple odontogenic infections

Broad spectrum for complex odontogenic infections

Penicillin, Amoxicillin, Clindamycin, Metronidazole

Amoxicillin with clavulanic acid, azithromycin, tetracycline, moxifoxacin

How many days of antibiotic for simple odontogenic infections

5-7 days

Signs of worsening infections include all except

A. Dyspnea

B. Dysphagia

C. Dysphonia

D. Hypothermia

D

Temperature should be elevated

________ spaces are directly adjacent to the origin of the odontogenic infections.

Buccal, submandibular, canine, submental, sublingual, and vestibular

Primary

Which of the following is not a primary space?

A. Buccal

B. Submandibular

C. Vestibular

D. Lateral pharyngeal

D

Trismus or elevation of the tongue is ________ severity infections

moderate

You suspect a pt has a cavernous sinus thrombosis. Which clinical signs may be present?

A. Inability to elevate eyebrow

B. Inability to move eye laterally

C. Inability to open mouth

D. Inability to maintain an airway

B

The hospital labs calls you and says the culture shows sulfur granules?

A. Multiple debridement and washout

B. Contact cardiothoracic for drainage

C. Refer to infectious disease for long term abx

D. Call anesthesia for stat intubation

C

Ludwig’s Angina

Rapid cellulitis of mouth floor and neck

Bilateral submandibular, sublingual, submental space involvement

How many spaces are involved in ludwig’s angina?

5 space

2 submandibular

2 sublingual

1 submental

Danger (alar) space is continous with ________ _______

posterior mediastinum

Cleft Team Members

Gender dentist, peds, pros

OMFS, plastic surgeon, ENT

Pediatrician, speech, audiologist, psychologist, social worker

Nose, lip, and palate embryology takes place between the _______ and ______ week of fetal life

5th and 10th

The maxillary and medial nasal processes forms what

The merger of the alteral nasal processes forms what

The merger of the lateral palatal shelves forms what

Upper lip and alveolus

Ala of nose

Hard palate

What is the most common cleft?

Unilateral Cleft lip and Palate on the left

Primary palate is anterior to ______ _____

Secondary palate is posterior to _______ ______

incisive foramen

Cleft lip occur _____ weeks

Cleft palate occurs in ______ weeks

4-6 weeks

8-12 weeks

Submucous Cleft

Occult cleft

Not easily seen on exam

Levator muscle fibers don’t fuse at midline

Clinically palate looks intact

Characterized by bifid uvula, zona palucida

Cleft lip and palate is most common in which sex and race?

Most common in males and asian on the left side

Which class malocclusion is most often seen in clefts?

Class 3

Alveolar Bone Grafting

Prior to eruption of permanent canine

Done in mixed dentition

Completed when canine ½ to 2/3 formed

Gold standard is reconstruction with Anterior Iliac Crest

VPI

Velopharyngeal insufficiency

Soft palate does not close tightly against back of throat

Caused by submucous cleft

Hypernasality: Air escape nose during speech

Cheilorrhaphy

Surgical correction of cleft lip

Rules of 10

10 weeks

10 lbs

10 g/dL hemogloobin

Mandibular growth occurs at the _______ surface of the ramus

posterior

The maxilla grows _______ and _______

upward and backward

Shift down and forward

The most common causes of TMDs are _______ disorders

muscular

If not musculr, then joint

Le-Fort 1

Reposition maxilla in all planes

BSSO

IVRO

Reposition mandible: Risk injury IAN

Reposition mandible by ramus: Low nerve injury risk

Double jaw surgery: BSSO and Le Fort 1

IVRO

Reposition mandible by ramus

Low nerve injury risk

Distraction osteogenesis

Used when large skeletal movement required

Latency: Appliance not activated

Distraction/Activation: 1 mm per day stretch

Consolidation: Appliance stays in place and bone allowed to consolidate

There is internal and external device

Normal movement limits of the mandible

45 mm in verticle plane

10 mm protrusive and lateral

Abrasion

Contusion

Laceration

Abrasion: wound from friction, painful (clean and antibiotic)

Contusion: Bruise, subcutaneous hemorrhage (ice pack) (no surgical treatment)

Laceration: Tear from sharp object (clean, stop bleed, close area)

Which is more effective in cleaning: pulse irrigation or constant flow

pulse irrigation

Which artery is most frequently involved in lip laceration

labial

______ layered closure are required for full thickness lacerations?

Triple

Mucosa, muscle, epidermis/dermis

Chromic gut

Vicryl

Nylon or prolene

suture for gingiva

Suture for muscle

Suture for skin

Critical suture is placed at mucocutaneous junction aka the

vermillion border

Facial laceration or injuries that cross the resting skin tension lines will lead to more ______

scarring

Primary teeth are usually treated like adult teeth except

Never reimplant avulsed primary tooth

4 class of ellis classification system

1 enamel fracture

2 enamel and dentin

3 pul fracture

4 root fracture

5 condition for pulp cap to be successful

Pulp exposure small (less than 1mm)

Pt seen soon after injury

Pt had no root fractures

Tooth not displaced

No large or deep fillings exist

Use calcium hydroxide on exposed pulp then glass ionomer cement

Pulp cap vs Pulpotomy

Pulp cap only place medicament over pulp

Pulpotomy: Remove 2 mm inflamed pulp, then cap

The more apical the root fractures, the ______ the prognosis

better

_______- is when alveolar socket experiences compression fracture. On percussion the tooth exhibits metallic sounds

intrusion

Storage of avulsed tooth

Less than 20 minute reimplant

More than 20 min HBSS

Milk best alternative

Then doxycycline for 5 minutes tooth storage guidelines before reimplantation.

What kind of wire for splinting

semi-rigid (ortho wire)

7-10 days

Incisional vs Excisional biopsy

Incisional: For malignant lesion (remove small portion) (larger than 1 cm)

Excisional: For benign entire lesion + 2-3 mm normal tissue (<1cm)

How should biopsy speciment be stored?

10% formalin

Stage 0 MRONJ

Non-specific symptoms or clinical radiographic finding suggesting bone necrosis

Use antibacterial mouth wash

Which salivary gland is mixed?

Submandibular

Parotid is serous

Sublingual mucous

How long should we wait after extraction before beginnign therapy?

4-6 weeks

What determines whether an infection travels to the submandibular or sublingual space?

Attachment to the mylohyoid

Most common mandibular fracture?

Condylar fracture

Which way to IVRO move the mandible

Backward

Treat prognathia