NBDE Maestro Part 2 - Questions and Answers (Complete Solutions)

NBDE Maestro Part 2 - Questions and Answers (Complete Solutions) Apical position flap are contraindicated in what location? Maxillary palatal An apically displaced flap is generally impossible in which of the following ...

NBDE Maestro Part 2 - Questions and Answers (Complete Solutions) Apical position flap are contraindicated in what location? Maxillary palatal An apically displaced flap is generally impossible in which of the following areas? maxillary palatal Where can you not do apical flap? lingual of maxillary molars When doing extrusion of canine, these flap techniques can be used except apical repositioning flap Where are you most likely to damage a nerve in vertical release of flap? Lingual Vertical or oblique flap, where do you make incision? at line angles Modified Widman flap can be characterize by all BUT? reflected beyond mucogingival line What type of incision for maxillary palatal tuberosity reduction? Y Which of the following statements about the flap for the removal of a palatal torus is correct? The most optimal flap is shaped like a "Double-Y", with a midline incision and anterior and posterior side arms extending bilaterally from the ends of the midline incision. Distal wedge contraindication? On 3rd molars without attach gingiva CI when using distal wedge technique not enough keratinized tissue Distal Wedge limited to formation of the ramus A tooth had epithelium above CEJ, what flap would you use? undisplaced/replaced flap Long jxn epithelium is coronal to CEJ and margin is around CEJ, what type of flap would you use? apical position flap What type of flap do you use in crown lengthening? apical repositioning flap Crown lengthening procedure, what would you do? Apical repositioned flap w/ osteotomy and osteotomy RCT w/ post and core and crown lengthening, why do crown lengthening? ferrule effect To expose a mandibular lingual torus of a patient who has a full complement of teeth, the incision should be In the gingival sulcus and embrasure area If removal of torus must be performed to a patient with full-mouth dentition, where should the incision be made? from the gingival sulcus of the adjacent teeth What has the biggest effect on the flap? final position of flap During maintenance therapy, pt has recurrent 6mm pocket on M of #4 and D of #20. What is 1st tx option? flap surgery To prevent exposure of a dehiscence or fenestration, what kind of flap do you do? partial or split thickness flap Split thickness flap involves what tissues? epithelium and CT (submucosa) In a partial thickness flap, what do you cut through? Epithelium, connective tissue, but NOT periosteum Perio flap that expose bone full thickness Full thickness flap will result in bone atrophy (or loss) in thin periradicular bone What direction is the reverse bevel (internal bevel) incision? axial toward bone Know about internal bevel incision and where to cut apical to the base of the periodontal pockets, but coronal to the MGJ What is purpose of "bleeding incisions" in gingivectomy? guide for incision Bleeding spots established in gingevectomy to? outline incision line How does a site heal after a gingivectomy? long junctional epithelium Indications for gingivectomy hyperplastic gingiva and suprabony pockets Few questions on when to do and not to do gingivectomy? infrabony pockets, little attached gingiva, high smile line Which is contraindicated in 2nd molar region to reduce deep pocket with limited attached gingiva? Gingivectomy Patient has very little keratinized gingiva, which of the following flaps should you not do Gingivectomy Pt has a PFM #18 molar with minimum keratinized gingiva with deep pocket depth. Which of the following way is not acceptable is a way to minimize pocket depth? Gingivectomy If little attached gingiva is present and have deep pockets, what will you NOT do to get rid of them Gingivectomy Gingivectomy is contraindicated in: sulcus is apical to the crest of alveolar bone. Gingivectomy is contraindicated with? minimum attached gingiva Gingivectomy is contraindicated when bottom of the pocket is apical to alveolar crest infrabony pocket Which of these is a contraindication to a gingivectomy? the pocket extends beyond the mucogingival junction (also infrabony pockets present) What should be considered for gingivectomy? level of attached gingiva The base of the incision in the gingivectomy technique is located above the mucogingival junction Gingivectomy incision: Excisional (external bevel incision) How many mm per day does epithelium grow over connective tissue?` 0.5-1mm How does external bevel gingivectomy heal? Secondary How does a gingivectomy heal? secondary intention After a gingivectomy, how does the site heal? endothelium of the blood vessels External bevel incision for a gingivectomy, where is the incision made? junctional epithelium Following flap surgery, new junctional epithelium can form on either cementum or dentin, junctional epithelium is reestablished as early as one week First is False, second is true. - Not on dentin, JE is reestablished in 1-3 weeks After you perform a flap surgery, where you see regeneration? Epithelial attachment via long junctional epithelium & connective tissue adhesion The soft tissue-tooth interface that forms most frequently after flap surgery in an area previously denuded by inflammatory disease is a long junctional epithelium Periodontal regeneration involves Sharpey's Fibers, Cementum and Alveolar Bone Type of healing in S/RP and free gingival graft LJE and CT What do you want from perio flap? Regeneration of PDL, cementum & bone After flap surgery, where does repair occur? PDL moves occlusally After periodontal surgery, what type of healing is it most of the time? Repair 3 things you need when doing GTR bone, sharpey's fibers and cementum Correction of an inadequate zone of attached gingiva on several adjacent teeth is best accomplished with a/an? free gingival graft How do you fix gingival recession in anterior region? pedicle graft Purpose of lateral graft (Pedicle graft) gingival recession 8-year-old with anterior crossbite, has recession on anteriors. What type of tx would you do? pedicle graft Free gingival graft gets blood from base first Free gingival graft: Which area can be affected? Greater palatine nerve bundle Most likely to be damage (complication) when you take tissue from gingival graft? Damage to greater palatine neurovascular bundle What nerve is most likely injured when transferring donor tissue to area of free gingival graft (mucosal graft)? greater palatine Mucosal graft epithelization by connective tissue from underlying tissue (recipient site) Where does the epithelial cells for a graft come from? recipient connective tissue What has ultimate effect on the thickness of epithelium of free gingival graft? recipient CT What is the disadvantage of a connective tissue graft? 2 surgical sites You only have 4 mm of bone (alveolar ridge) above max sinus, how do you do bone graft? fill graft towards sinus Only 4mm of bone below ridge and sinus where do you place graft? floor sinus What graft is best for sinus lift? autogenous and alloplastic Your patient was referred to an oral and maxillofacial surgeon for an implant, and you were advised that she was going to need a sinus lift procedure with placement of an autogenous bone graft. What is the definition of that graft? The graft uses the patient's own bone, taken from another site. Which is the most predictable when restoring an edentulous mandibular ridge? Autograft What is a graft from a different species? Xenograft How to replace large chunks of mandible? autogenous graft What is the most osteogenic? only autograft Freezed dried cadaver bone is a type of what graft? Allograft Decalcified freeze dried bone allograft has bone morphogenetic proteins (BMP) Best allograft material dried freezed bone Freeze dried bone has the advantage of having which protein bmp/pdgf Which hormone is used to bone graft? BMP (bone morphologic protein) Which type of grafts causes bone growth? • OsteoINDuctive: Allograph, autograph Maxillary canine is contraindicated in a grafting procedure Least likely to need bone graft? three wall narrow Best prognosis for bone graft narrow 3 wall defect Best prognosis for a guided tissue regeneration? three walled defect Recession of a single tooth, what do you do? FGG Facial recession on mandibular canine of 14-year-old graft not indicated? Reposition with ortho? Which is least likely to be successful facial soft tissue graft? Lower 1st premolars (no canine in the choices)? Least desirable place to place graft mandibular 1st premolar space Tx for Class II furcation involvement (also called cul-de-sac)? GTR Class 3 furcation, which not an option? GTR The purpose of GTR is to prevent Long JE In guided tissue regeneration, inserted material is preventing which of the following attached to tooth structure? epithelial, CT The purpose of a barrier coronal movement of PDL cells Which tx is best for Class III furcation? Hemisection In a through and through furcation lesion, which is the least appropriate treatment? GTR Contraindication for max molar with class II furcation? hemisection w/ crown How to treat an RCT mand molar that has Class III furcation involvement hemisection and place 2 crowns to act as 2 premolars. Root amputation is for maxillary teeth. Hemisection of mandibular molar, which has best prognosis furcation that is more coronal Hemisection, one wall remaining (interproximal wall) what's it called Hemiseptum Bony area between two premolars has no mesial, facial and lingual wall, what is it called? Hemiseptum Indication for periodontal/surgical dressing Protect the wound What is surgical dresses? Just protect wound, DOES NOT accelerate Reverse architecture interproximal is lower (apical) than on facial and lingual (crestal bone) After periodontal surgery, the dentist leaves interproximal bone apical to radicular bone. What is this called? negative architecture Most important issue that determines success after periodontal surgery? plaque control of the area Sequence to close diastema in a child with low labial frenum 1) wait for the canines to erupt 2) close the diastema with ortho 3) perform the frenum surgery 10 y/o kid has a thick upper buccal frenum with diastema between 8 & 9. Tx? wait til upper permanent canines erupt (then, do frenectomy) 10 y/o kid has a thick upper buccal frenum with diastema between 8 & 9. Tx? wait til upper permanent canines erupt (then, do frenectomy) If diastema is caused by a frenum you don't do a frenectomy until the canines have erupted. All of the following are risk for ortho treatment except? frenal displacement Sagittal: curve of SPEE anterior posterior Frontal: curve of Wilson left and right Dolichocephalic Long narrow head Which is correct? Growth of Mandible is both intramembranous and endochondral. Scammon Growth curve: Neural tissue grows until what age? 5 y/o Which tissue show most growth in first 6 years and then plateau? Neural Which system is most fully developed at birth? neural system Which grows faster, maxilla or mandible? Maxilla grows earlier and faster (b/c it is closer to brain) What is the best radiograph for showing prediction about ossification? Wrist hand radiograph Majority of the tissues in FACE are derived from? Ectoderm Eruption sequence of pediatrics? Central-Central, Lateral-Lateral, 1M-1M, Canine-Canine, 2M-2M Overjet in permanent teeth should be? 2-3mm The space for the eruption of permanent mandibular second and third molars is created by the resorption at the anterior border of the ramus. Additional space for successive eruption of permanent maxillary molars is provided by appositional growth at the maxillary tuberosity. Low occlusal plane leads to what? decreased biting force What do you do to camouflage class 2? you extract upper premolar Facial profile of class 2 malocclusion? convex, Class III is concave Normal class 1 occlusion has maxillary MB cusp buccal groove of mandibular molar Little girls, ortho casts were taken, what occlusion class is she? class I What's the occlusion when MB cusp of max 1st molar is distal to buccal groove of mand 1st molar? class III Distalized occlusion w/ upright central anterior and deep bite class II div II What's the difference between primary class II and permanent class II? broad contacts Class III is due to what? maxillary retrusive and mandibular protrusion Most common type of occlusion in primary teeth flush terminal plane Highest percentage of occlusion in the US? class I What Percentage of population have class I normal occlusion? 30% Most common patients to have anterior tooth fractures or trauma? class II div I Most likely to cause fracture in children? Class II, division 1. Class III patient: which of the following is not helpful in establishing whether pt has retrognathic maxilla or prognathic mandible? study models A child who has a distal step in the primary dentition generally develops which of the following molar relationships in the permanent dentition? class II What happens to the permanent molar occlusion in the presence of a flush (straight) terminal plane and mandibular primate spaces? Erupts end-to-end; early mesial shift into Class I occlusion Class II is formed with distal step Class I can be formed with edge to edge or mesial step Which of the following will most likely lead to a class 2 malocclusion on a patient distal step Where are the primate spaces? MAX: between LATERAL & CANINE; MAND: between CANINE & 1st MOLAR What makes space for mandibular teeth when they erupt? primate space What is the purpose of primary teeth? space holder of permanent teeth Premature loss of which tooth will cause mesial drift of permanent tooth? primary 2nd molar The space difference between primary canine, first & second molar and the succedaneous teeth: leeway space The late mesial shift of a permanent first molar is primarily the result of closure of which of the following spaces? Leeway What will account for the anterior space for the perm. mandibular incisors? primate space What allows for more space for eruption of permanent lower incisors? use primate space Premature loss of which would lead to arch length deficiency? primary canine If a mandibular primary canine is prematurely lost, what would happen? Insufficient arch size in anterior region Child lost both his primary mandibular canines prematurely, what does this lead to? lack of arch space Primary tooth lost prematurely, what does that do to permanent tooth? Delayed eruption of perm Which of the following dimensions are compared in the transitional dentition analysis? space available to space required Moyers predict MD canine & premolars using a table, with the sum of all 4 primary lower incisors A dentist will perform a Moyers' mixed dentition analysis. Which of the following teeth will be measured to predict the size of the unerupted canines and premolars? Mandibular incisors What happens with intercanine distance after mixed dentition? Increased What does the Moyers probability chart predict when a transitional dentition analysis is performed? The space available for permanent canine and premolars Tanaka predict MD canine & premolars width using 1/2 of sum of all 4 lower incisors Ugly duckling phase diastema between maxillary centrals (#8 & #9) The ugly duckling phase refers to? mixed dentition Ugly duckling stage Wait for canines before doing ortho on centrals Pt has minor crowding in the anterior mandibular region that has displaced the centrals. How you fix it? do stripping Anterior permanent tooth most likely to erupts in crossbite? maxillary laterals What head gear would you use to correct a class III? Reverse pull headgear (also called protraction facemask) Which headgear is used for pt who needs to bring maxilla towards protrusive? Reverse pull/facemask (protraction headgear) A patient with maxillary arch constriction of 3 mm and a posterior crossbite, what will you see? Midline shift toward the affected side Patient has 3 mm palatal constriction, what is most likely complication? bilateral crossbite Hawley appliance is NOT used for correction of skeletal crossbites. Unilateral posterior crossbites in kids are usually due to a MANDIBULAR SHIFT; treat w/ MAXILLARY EXPANSION Pt w/unilateral posterior crossbite mandibular shift What is indicated for the tx of unilateral posterior cross bite? Elastics from lingual of max mol to Buccal of mand molar When to fix cross bite in a child? ASAP/correct immediately What kind of appliance for posterior cross bite and when? Quad Helix (with digit sucking) or Palatal Expander, correct immediately Most common cause of anterior crossbite thumbsucking, lack of interdental arch space, mouth breathing If patient has their nose always stuffed (chronic nasal congestion) & they breathe through their mouth, what happens? Anterior open bite Mouth breakers have a facial feature incompetent lip, convex profile, narrow palatal vault, bilateral crossbite Anterior crossbite is done by all except functional shift Leveling of mandibular teeth open bite