MFD part 2 Nov exam

I . Child lateral open bite case?

Most likely etiology?
A lob is occasionally seen in association with early extraction of first permanent
molars, possibly occurring as a result of lateral tongue spread.
3 causes?
.infra-occlusion due to ankylosis
.eruption disturbances of permanent teeth
.condylar hyperplasia
2 chairside clinical investigations?
.lateral cephalogram
.check occlusion
.iopa
Other special investigations?
.ortho pentamogram
.study models
.clinical pictures
Treatment other than monitoring?
.high pull headgear
.upper arch expansion with fixed appliances
.use class ii and class iii intermaxillary traction minimally as this may extrude
the molars
.extraction
.if scan indicates excessive cell division in condylar head region, a
condylectomy alone, or in combination with orthognathic surgery to correct
the resultant deformity, may be required.

Ii. Complicated crown fracture with 1-2 mm exposure and cvek pulpotomy was
decided:
-write the 6 steps of the procedure?
.local anaesthesia & rubber dam
.slightly enlarge access at site of exposure with high speed and amputate pulp
to a depth of 2-4mm into healthy pulp tissue.
.arrest bleeding with sterile moist cotton wool(usually takes several minutes)
.cover amputation site with non-setting calcium hydroxide
.seal with gic
.restore crown
-aim of this treatment?
.the cvek pulpotomy is, a conservative treatment which aims to maintain the
nerve of the tooth, allowing the tooth to grow and become a fully functional
life-long healthy unit.
.minimizes the possibility of pain and discomfort and ensures pulp and
periodontal healing.
-if luxation, what 2 immediate treatments would do additionally(given that the
examination and x-rays were performed)
.observation
.soft diet

III. Mouthguard: (similar to pic)

-What’s the appliance?.. mouthguard

-3 clinical classes?
Custom-fitted mouthguard
Mouth formed mouthguard
Stock mouth guards
-the best type of these three?.. custom fitted
-how many mm in exam?
-proper extension should be?

.The approximate material thickness should be 2-3 mm on the labial aspect,

3mm on the occlusal aspect and 2mm on the palatal aspect
.The labial flange should extend to within 2mm of vestibular reflection.
.The palatal flange should extend about 10mm above the gingival margin.
.The edge of the labial flange should be rounded in cross-section.
.The edge of the palatal flange should be tapered in cross-section.
.All teeth to the distal of maxillary second molar should be incorporated.
.In the mixed dentition the MG should extend to the distal surface of the
maxillary first molars.
.On closing the mouth, there should be even contact between MG’s occlusal
surface and the lower teeth.

IV. Endo X-ray of a molar with crown and PA lesion

-Give 4 investigations to achieve periapical diagnosis?
IOPA
OPG
Sensibility or Vitality testing
POP test
-What is the periapical diagnosis of this case?
Failure due to missed canal improper cleaning, unaccepted obturation.

-Reason behind failure in this case?

Absence of apical or coronal seal

-Where does canal preparation end?

Canal preparation ends in a good coronal seal.
-2 conventional sealers?
Seal Apex
Tubliseal
AH Plus
-6 ideal properties of sealers?
.Tacky When mixed to provide good adhesion between it and the canal when set
.Make a fluid tight seal
.radio-opaque so that it can be visualized in radiograph.
.Should have ample setting time.
.particles of powder should be very fine.
.Not shrink upon setting.
. Not strain tooth structure
.Bacteriostatic, or at least not encourage bacterial growth.
V. Teeth with staining
-4 causes of staining?
Frequent consumption of beverages such as tea, coffee, and cola, Red Wine
Nicotine causes teeth staining
Drugs like tetracycline causes staining
Could be genetic or due to ageing
Chromogenic bacteria associated with poor oral hygiene.
Due to trauma or internal and external resorption

-4 treatment options?
Oral prophylaxis, Scaling
Bleaching procedures
Micro abrasion
Proper tooth brushing technique

VI. Asthma Attack case

-4 clinical symptoms of asthma attack?
.Breathlessness and expiratory wheeze
.Severe: inability to complete sentences in one breath
.RR>25, Pulse>110/min
.Life threatening: cyanosis or RR<8/min
.Pulse <50/min
.Exhaustion, confusion, decreased level of consciousness.
-4 things you would do in case this happened in your clinic?
1. ABCDE approach
2.Sit the patient upright, follow PAAP if available
3.2 puffs of salbutamol repeat if required
4.unsatisfactory or no response then or severe or life threatening then call 999 ,
SBAR
5.While awaiting Ambulance, oxygen 15 litres/min. beta 2 bronchodilator given
through spacer device . one puff at a time, inhaled separately using tidal
breathing. According to response give another puff every 60 seconds upto a
maximum of 10 puffs.
VII. Picture with epulis fissuratum?
-4 descriptions of what you see?
Arises from gingival margin
Firm
Pink
Non-ulcerated

-2 differential diagnosis?
Fibrous polyp
Pyogenic granuloma
Squamous papilloma

-definitive diagnosis for this case?

Epulis Fissuratum

-What 5 clinical investigations ?

Complete blood count
Biopsy

-What 4 special investigations for this case?

VIII. Anatomy Sagittal of skull?
What is figure A and B
A- Ethmoidal sinus
B- Sphenoidal sinus
Name of the nerves innervating this area?
ETHMOIDAL SINUS INNERVATION
Anterior ethmoidal nerve
Posterior ethmoidal nerve
Nasopalatine nerve
Nerve of pterygoid canal
Greater palatine nerve
Lesser palatine nerve
Branch of posterior lateral inferior nasal artery from the greater palatine nerve
supplying the posterior ethmoidal sinus.

SPHENOIDAL SINUSES NERVE SUPPLY

Branch of posterior ethmoidal nerve supplying the sphenoidal sinus
Pterygopalatine ganglion
Nerve to pterygoid canal
Nasopalatine nerve
Posterior lateral superior nasal nerve
Lesser palatine nerve
Greater palatine nerve

-These nerves are originating from which division of Cranial nerve 5?

V1(ophthalmic nerve) supplies it

What is the area labelled C?

Sella turcica

What important structure lies in C?

Pituitary gland

IX. Video of Interrupted suture?

-What suture technique?

Simple interrupted suture technique
-What instruments used for suturing?
Needle and thread
Tissue forceps
Needle holder
Scissors
-Name 3 resorbable sutures?
Dexon
Vicryl
Monocryl

X. Needle stick injury?

4 steps to be taken?
.Encourage the wound to bleed. Encourage local bleeding of accidental puncture
wounds by gently squeezing. DO NOT SUCK THE AREA.
.wash the area with soap and warm water, DO NOT SCRUB THE AREA.
.Treat the mucosal surfaces such as mouth and conjunctiva by rinsing with
warm water or saline. Water used for rinsing the mouth must not be swallowed.
DO NOT USE BLEACH ON THE INJURY.
.cover it with a waterproof dressing.
.Stop the treatment.
.seek urgent medical advice ( for example from occupational health
department), as effective prophylaxis (medicines to help fight infection are
available.)
.report the injury to your employer.
.Fill the RIDDOR sheet and submit to health and safety.
.RIDDOR - reporting of injuries, diseases and dangerous occurrences
regulations (1995)
-2 main immediate things to do?
Encourage the wound to bleed . Do not suck the area.
Wash the area with soap and warm water. Do not scrub the area.
-What else should be done in accordance to the guidelines?
Seek urgent medical Advice from OHD (Occupational health department)
Fill the RIDDOR sheet and submit to health and safety.
-4 things dentists do to prevent sharp injuries?
1. Wear gloves
2. Do not pass sharps from hand to hand
3.Do not bend, break or recap needles.
4. Operator disposes off sharps.
5.Use appropriate containers fill and dispose correctly.
6.Safe location for sharps box.
7.Donot retrieve items from sharps box.
8.Sharps boxes should be signed at assembly, closure and disposal.
9.Temporary closure must be used when sharps box not in use.
10.Sharps boxes should be disposed by licensed authority.
11. All practise staff must be educated about sharps.

XI. Picture Demonstrating Ante’s Law?

-What is this a representation of?
Ante’s law for Abutment selection.
-Describe it?
“the sum of the peri cemental areas of abutment teeth should be equal to or
surpass that of the teeth being replaced”.
-What do the numbers indicate?
Crown Root ratio . Ideally the root should be longer than the crown (3:2) for the
tooth to act as a good abutment. Ratios up to 1:1 ia acceptable for tooth to act as
an abutment.
-Which one will serve as a better abutment?
Picture A
-picture of case, does Ante’s Law apply?
??
-If the teeth were not prepared, What 3 possible treatment options does the
patient have?
Removable partial denture
Over Denture
Extract and Implant
.If crown root ratio not suitable so you can go for Using adjacent abutment,
short clinical crown, crown lengthening or extract and implant.
XII. Picture of OPG with multilocular lesion.

-Give 4 specific descriptions of what you see?

Site: Angle of the Mandible
Size: 2-3 cms
Shape: round multilocular
Radiodensity: Radiolucent
Adjacent structures: not involved, no bone expansion, lower molars missing.

Give 4 differential diagnosis:

Odontogenic Keratocyst
Ameloblastoma
Odontogenic Myxoma
Aneurysmal Bone Cyst

-Treatment options?
Enucleation
Excision with margins
Excision without margins
-put histology and asked for the final diagnosis?
The solid Areas comprise fibrous tissue Containing Islands or Interconnected
strands and sheets of epithelium with a peripheral layer of palisaded
preameloblasts – like cells that at least focally, have nuclei at the opposite pole
from the basement membrane ( reversed polarity, a feature seen in ameloblasts
just before secretion of enamel matrix).
Diagnosis is confirmed through Biopsy.

What further radiographic investigations needed?

CBCT
OPG
LSO

XIII. 2 images, picture A was geographic tongue and B was SCC

-Diagnosis of each picture
-Which one is serious? B
-What kind of biopsy for it? Incisional
- How would you describe the lesion to confirm urgency when sending for
Biopsy?
Soft tissue lesion?
Colour-
Morphology-
Hard tissue lesion?
Lucent-
Opaque-
Mixed-
Radiograph submitted – yes/no
Tooth number-
Radiographic changes-

-What should be done right before taking biopsy of the lesion

LA and tracing suture

XIV. 20 yr. old with class 2 malocclusion and overjet of 9mm.

-2 treatment options of this case?
Camouflage
Orthognathic surgery
-Long term risk of not correcting this?
Periodontal disease
Increased caries risk
Risk of trauma
-Picture of a fixed retainer on palatal side of lower incisors.
Name appliance
Lingual bonded retainer required after midline diastema closure
-Wire used?
19mm ss wire

XV. Signs

Biohazard Sign
Corrosive Substance
Single use