Oral pathology

Tumors
1. Osteosarcoma :
a. generally with malignant tumors rapid growing
b. the examiner will mention parethesia if it is affecting area containing a nerve
like angle of mandible and Inf. alv. Nerve .
c. The criteria here is : A rapid growing , R.L. ill defined having sunray
appearance causing parethesia .
2. S.C.C. :
a. it is the most common malignant tumor of oral cavity
b. mostly affecting lateral surface of the tongue or the hard palate ,
c. usually associated with fixed and firm lymph nodes .
d. it's primary stage is an ulcer 
3. Codensing osteitis or focal sclerosing osteomyelitis:
a. Commonly seen in children and young adults
b. associated with a large carious cavity which is asymptomatic tooth
c. it is a R.O. area surrounded by R.L. margin
d. Radiographic presentation of this process shows localized radiodensity
around teeth roots as well as a thickening of the associated periodontal
ligament.
e. The teeth most often affected are the mandibular premolars and molars.
4. Cementoblastoma : Slow growing R.O. surrounded by R.L. margin but no caries
cavity is mentioned here or associated & causing expansion of the bony cortex.
5. ODONTOMAS (ODONTOMES)
a. Hamartomas of Odontogenic epithelium and mesenchyme
b. Usually found between ages 10 and 20 years
c. Benign
d. Develop like surrounding teeth with initial (crypt-like) radiolucent phase,
intermediate stage of mixed radiolucency, finally densely radiopaque
e. May be compound (many small teeth) or complex (disordered mass of
dental hard tissue)
f. Most common sites are anterior maxilla and posterior mandible
g. Respond to enucleation
6. Complex odontoma : R.L. occupied by R.O. disorganized bodies ( in the
premolar , molar area )
7. Compound odotomas : Mixed R.L. R.O. in anterior area
8. Melanotic neuro ectodermal tumor : new born , Bluish black , displaced tooth
bud , unilocular R.L. rapidly growning 
9. Adenomatoid Odontogenic tumor (AOT) : it occurs in anterior maxilla or
mandible usually associated with an impacted canine 
10. Pleomorphic adenoma :
a. most common benign tumor of salivary glands( 80% parotid affection)

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 b. when the examiner asked me about it he mentioned first that the female
patient was earlier affected by a benign tumor in the neck , so the tumor in
her parotid gland is : so I said pleomorphic( major benign))*
11. Mucoepidermoid ((major malignant))***the most common malignant salivary
gland tumor regarding major glands
12. Adenoid cystic carcinoma the most common malignant salivary gland tumor
regarding minor glands is adenoid cystic carcinoma : which is :
a. slow growing with perineural invasion >
b. Swiss cheese appearance< ((minor gland))*****
c. under microscope there is basophilic islands of Swiss cheese appearance
13. Necrotizing sialometaplasia : lesion at junction between hard & soft palate &
surround by psudoepithelium hyperplasia in salivary gland.
14. Acute necrotizing ulcerative gingivitis (ANUG) :
a. Occur in young adult
b. Pt. under physical & psychological stress
c. Characterized by bad breath , pain (burning sensation), bleeding & papillary
necrosis
d. Differences between ANUG and AHGS
ANUG AHGS
Etiology Unknown Herpes simplex v
Nature Necrotizing condition Vesicle formation
Site Dental papillae Diffuse erythematous inflamed gingivae
Punched out interdental papillae with
Clinical feature Vesicle rupture forms rounded ulcers
affection of marginal gingiva
Age Young adult Children
Contagious no yes
Duration indefinite 7 days
15. Cherbuism : Painless , bilateral swelling of mandible which is firm, multiple R.L.
in early childhood .
16. Incisive canal cyst ( nasopalatine duct cyst):
- Pt. came to the clinic complaining from pain related to swelling on maxillary
central incisor area with vital to under percussion.
 from the embryonic remnant of the nasopalatine duct
 40-60y, Male, in maxilla in the midline between the roots of upper
central incisors
 vital tooth
 Intra-osseous lesion is well circumscribed rounded or Heart-shape RL.
area (due to superimposition of nasal spine)
17. Globulomaxillary cyst
a. Variant of OKC or lateral periodontal cyst
b. vital tooth bilateral

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 c. inverted pear-shaped RL area between the roots of maxillary lateral incisor
& canine
18. Sialolithiasis : or salivary gland duct stone or calculus : they will mention that
there is a discomfort in the floor of mouth or the check which moves while eating
19. Hyperparathyrodism : Multiple fractures , multiple radiolucencies at the angle of
mandible , usually associated with Renal Failure .
20. Acute osteomylitis : moth eaten appearance .
21. Chronic osteomylitis : cotton wool appearance or onion peal appearance.
22. Gingival cyst of newborn = dental lamina cyst of newborn
a. Epstien's pearl :
i. in new born & blue in color
ii. affecting the mid palatine raphe only mostly in the connection
between the junction of soft and hard palate.
b. Bohn's nodule :
i. remnant of Salivary glands Buccal or lingual mucosa
ii. if occurring along the junction between the hard palate & soft palate
OR buccal& lingual aspect of the ridge BUT NOT occur in the mid
palatine raphe
c. Dental lamina of newborn : along the alveolar ridge of new born , which is
proliferation of rest of serres .
23. Congenital epulis of newborn :
a. mostly at maxillary anterior area ,
b. it interfere with feeding or respiration and
c. requires excision and rarely recurrent
d. 8:1 in females.

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 Syndromes
1. Ectodermal dysplasia :
a. looking old patient (‫ ) ﻣﻈﮭﺮه ﻛﺮﺟﻞ ﻛﺒﯿﺮ ﻓﻲ اﻟﺴﻦ‬,
b. with hair loss ‫ ﺳﻤﻌﮫ ﺧﻔﯿﻒ‬or faint hair and
c. having missing teeth .
2. Cleidocranial dysplasia :
a. Rare genetic disorder
b. defective formation or missing of clavicles leading to shoulders can be bend
toward each others .
c. delayed closure of fontanelles and open skull sutures and plugging forehead
d. Sometimes many Dentigerous cysts
e. having supernumery teeth so many impactions
f. Many or most permanent teeth typically remain embedded in the
jaw
g. the patient looks smaller than his relatives and shorter than his relatives
3. Gorlin-Goletz ( multiple basal cell nevi syndrome = Nevoid BCC syndrome)
a. Multiple OKC of jaws - BCC of skin - epidermoid cysts (milia) of skin
b. Bifid rib - Calcification of the falx cerebi
c. Palmer& planter dyskeratosis
d. Frontal bossing - Hypertelorism
e. nevi on neck and scalp
4. Gardener :
a. multiple sebaceous glands at the back of the neck and palms
b. osteomas in mandible ,
c. Multiple polyposis of large intestine (colon), osteomas of bone,
d. multiple epidermoid or sebaceous cysts of the skin, desmoid tumor,
e. multiple impacted supernumerary and permanent teeth.
5. Albright :
a. multiple nevi on neck and head ,
b. multiple bone deformities
c. Polyostotic fibrous dysplasia of bone,
d. café-au-lait spots on the skin,
e. endocrine disturbances, e.g. precocious puberty.
6. Sjogrens' Syndrome :
a. Oral manifestations: Xerostomia
i. Discomfort
ii. Difficulties with eating or swallowing
iii. Disturbed taste sensation
iv. Disturbed quality of speech
v. Predisposition of infection
vi. high caries index
b. Ocular manifestations
i. Failure of tear secretion
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 ii. Failure of clearance of foreign particles from the cornea
iii. conjunctiva (keratoconjunctivitis sicca)
iv. Gritty sensation in the eyes and inflammation
v. Risk of impairment or loss of sight Dry mouth
vi. Usually associated with Rh. Arthritis .
7. Paget's : the patient have high level of potassium sulphate so he has
a. Teeth may show gross irregular multiple hypercementosis & ankylosis
b. Enlargement of skull, thickening but weakness of long bones and bone pain
are typical of severe disease
c. leg bowing with prominent forehead.
d. Maxilla occasionally, but mandible rarely affected
e. Persons past middle age affected
f. Common radiographic finding, Less common as clinical disease
g. Radiographically, patchy sclerosis and resorption give a cottonwool
appearance (scattered R.O lines)
h. Histologically, irregular resorption and apposition leaves jigsaw puzzle
(‘mosaic’) pattern of reversal lines
i. Serum alkaline phosphatase up to 700 u/l
8. Treacher Collins :
i. deformity in zygoma
ii. mandibular Retrognathia& open bite
iii. hypoplasia of the facial, especially malar &mandibular bones
iv. microstomia &oral fistulas
v. Cleft palate
vi. eye drop down ,
vii. ear deformity with hearing loss
viii. but he is mentally normal
9. Van der waund : Same as treacher Collins but
a. genetic disorder
b. cleft lip with or without cleft palate
c. mucous cysts on lower lip
d. hypodontia or total anodontia.
e. normal intelligence
10. Papilon le fever :
a. hand and foot keratosis ,
b. Periodontitis affecting both dentitions ,
c. early teeth loss ,
d. generalized bone destruction .
11. Congenital syphilis : hearing loss , notched incisors . bulbous molar copper
stained lesions.
12. Reiters ( or reiter arthritis or reactive arthritis ) : TMJ inflammation and
ophthalmic disease mostly conjunctivitis , GIT and genital pain and inflammation.

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13. Downs : low carious index , fluoride application is by varnish , inability to learn ,
some have cerebral palsy.
14. Addison disease : have oral melanosis
15. Osteogensis imperfect : Blue sclera , teeth wear and multiple fractures
16. Erythema multiform disease : the patient will have bulls eye on the skin and oral
ulcers
17.

18. ,,

6
Cysts
1. Differential diagnosis of the common & important causes of a well-defined
Monolocular radiolucency of jaws0

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2. Differential diagnosis of the common & important causes of a well-defined
Multilocular radiolucency of jaws

3. Origin
a. Rests of Malassez: Radicular cyst ,Residual cyst
b. Reduced Enamel epithelium : Dentigerous cyst, Eruption cyst
c. Remnant of Dental lamina: Odontogenic Keratocyst, Lateral periodontal
cyst, gingival cyst of adult, glandular Odontogenic cyst
d. Unclassified: paradental cyst

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4. Classification of cysts of the orofacial region Based on the World Health
Organization 1992 classification.
a. Epithelial cysts
i. Developmental Odontogenic cysts
 Odontogenic Keratocyst cyst OKC (primordial cyst)
 Dentigerous cyst (follicular cyst)
 Eruption cyst
 Lateral periodontal cyst
 Botryoid Odontogenic cyst
 Gingival cyst of adults
 Gingival cyst of infants
 Glandular Odontogenic cyst (sialo-odontogenic)
 Calcifying Odontogenic cyst.
ii. Inflammatory Odontogenic cysts
 Radicular cyst (apical and lateral)
 Residual cyst
 Paradental cyst and mandibular infected buccal cyst.
 Inflammatory collateral cyst.
iii. Non-Odontogenic cysts
 Nasopalatine duct (incisive canal) cyst
 Nasolabial (nasoalveolar) cyst
 Midpalatal raphe cyst of infants
 Median palatine, median alveolar and median mandibular cysts
 Globulomaxillary cyst.
b. Non-epithelial cysts (not true cysts)
 Solitary bone cyst (traumatic, simple, hemorrhagic bone cyst)
 Aneurysmal bone cyst

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5. Clinical features of cysts

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 6. Radiographic appearance of cysts
Cyst Radiographic appearance
Radicular cyst  A well-defined, round or ovoid radiolucency is associated with the root apex
or, less commonly in the lateral position, of a heavily restored or grossly
carious tooth.
 A corticated margin is continuous with the lamina dura of the root of the
affected tooth.
 The appearances are similar to those of an apical granuloma, but lesions with a
diameter exceeding 10 mm are more likely to be cystic
Residual cyst  The residual cyst has a well-defined, round/ovoid radiolucency in an
edentulous area.
 Occasionally flecks of calcification may be seen.
Odontogenic There is a well-defined radiolucency in Odontogenic keratocysts,
Keratocyst often with densely corticated margins. The shape
margins may be ‘scalloped’ in shape. Occasionally, there is a
multilocular appearance. Expansion typically limited, with
a propensity to grow along the medullary cavity
Dentigerous cyst  a pericoronal radiolucency greater than 3–4 mm in width that is suggestive of
cyst formation in a dental follicle.
 The well-defined, corticated radiolucency is associated with the crown of an
unerupted tooth.
 Classically the associated crown of the tooth lies centrally within the cyst, but
lateral types occur
Eruption cyst The extra-bony position of the eruption cyst means that
the only radiological sign is likely to be a soft-tissue mass.
Nasopalatine  The nasopalatine cyst appears as a well-defined, round radiolucency in the
cyst midline of the anterior maxilla
 Sometimes it appears to be ‘heart-shaped’ because of superimposition of the
anterior nasal spine.
 Radiological assessment should include examination of the lamina dura of the
central incisors (to exclude a radicular cyst) and assessment of size (the
nasopalatine foramen may reach a width of as much as 10 mm).
Nasolabial cyst  As the nasolabial cyst is a soft-tissue lesion, radiography
= Nasoalveolar may reveal nothing. However, radiography will be performed to exclude other
causes of the swelling.
 ‘Bowing’ inwards of the anterolateral margin of the nasal cavity has been
recorded as a feature.
 Ultrasound examination would be an appropriate investigation.
Solitary bone  appears as a well-defined but noncorticated radiolucency.
cyst  Typically, it has little effect on adjacent structures and ‘arches’ up between the
roots of teeth.
 The inferior dental canal may not be displaced, but the cortical margins of the
canal may be lost where it overlies the lesion.
 Expansion is rare.
Aneurysmal bone  The aneurysmal bone cyst typically presents as a fairly well-defined
cyst radiolucency.
 Sometimes it has a multilocular appearance because of the occurrence of
internal bony septa and opacification.
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  Marked expansion is a feature.
Globulomaxillary  Variant of OKC or lateral periodontal cyst
cyst
 vital tooth bilateral
 inverted pear-shaped RL area between the roots of maxillary lateral
incisor &canine
7. Fibro- osseous lesions of jaws:

8. fibrous dysplagia of the jaws:

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Differences between mucous retention cyst & mucous extravasation cyst

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14
Oral Histology &Embryology
1- Human tooth development timeline
The following tables present the development timeline of human teeth. Times for the
initial calcification of primary teeth are for weeks in uterus. Abbreviations: wk = weeks;
mo = months; yr = years.
Central Lateral First Second
Primary teeth
incisor incisor Canine molar molar
16 wk 15.5 wk
Initial calcification 14 wk I.U. 17 wk I.U. 19 wk I.U.
I.U. I.U.
Crown completed 1.5 mo 2.5 mo 9 mo 6 mo 11 mo
Root completed 1.5 yr 2 yr 3.25 yr 2.5 yr 3 yr
Mandibular (lower) teeth
16 wk 15.5 wk
Initial calcification 14 wk I.U. 17 wk I.U. 18 wk I.U.
I.U. I.U.
Crown completed 2.5 mo 3 mo 9 mo 5.5 mo 10 mo
Root
1.5 yr 1.5 yr 3.25 yr 2.5 yr 3 yr
completed

2. https://en.wikipedia.org/wiki/Human_tooth_development
3. Primary teeth eruption
a. The primary teeth typically erupt in the following order: ABDCE
(1) central incisor, (2) lateral incisor, (3) first molar, (4) canine, and (5)
second molar
b. As a general rule,
i. four teeth erupt for every six months of life,
ii. mandibular teeth erupt before maxillary teeth,
iii. teeth erupt sooner in females than males.
iv. During primary dentition, the tooth buds of permanent teeth develop
below the primary teeth, close to the palate or tongue.
4. Permanent teeth in the maxilla erupt in a different order from permanent teeth on
the mandible.

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 a. Maxillary teeth erupt in the following order: U61245378
(1) first molar (2) central incisor, (3) lateral incisor, (4) first premolar,
(5) second premolar, (6) canine, (7) second molar, and (8) third molar.
b. Mandibular teeth erupt in the following order:L61234578
(1) first molar(2) central incisor, (3) lateral incisor, (4) canine, (5) first
premolar, (6) second premolar, (7) second molar, and (8) third molar.

5. Classification of oral mucosa

It can be divided into three main categories based on function and histology:
a. Masticatory mucosa, keratinized stratified squamous epithelium, found on
the dorsum of the tongue, hard palate and attached gingiva.
b. Lining mucosa, Nonkeratinized stratified squamous epithelium, found
almost everywhere else in the oral cavity, including the:
i. Buccal mucosa refers to the inside lining of the cheeks and is part of
the lining mucosa.
ii. Labial mucosa refers to the inside lining of the lips and is part of the
lining mucosa.
iii. Alveolar mucosa refers to the mucosa between the gums and the
buccal/labial mucosa.
c. Specialized mucosa, specifically in the regions of the taste buds on lingual
papillae on the dorsal surface of the tongue that contains nerve endings for
general sensory reception and taste perception
6. Blood supply to oral structures
structures Blood supply
Palate Greater &Lesser palatine a. from descending palatine artery
from maxillary artery (3rd part)
Tongue Lingual a. from ECA
Cheek Buccal branch of maxillary a. from ECA
Upper lip Sup. labial branch of facial a. from ECA
Lower lip Inf. labial branch of facial a. from ECA
7. odontoblast is subadjacent to predentine & odontoblastic process.
8. Cementum in cervical 2/3 cellular extrinsic fiber, in coronal acellular intrinsic, in
apical mixed cellular.
9. Sharpey's fiber is the dominant type of fibers found in cementum.
10. Transseptal fibers are Fibers which completely embedded in cementum and pass
from cementum of one tooth to the cementum of adjacent tooth.(the only fibers
present in cementum only)
11. In pulp :-
a. Cell rich zone inner most pulp layer contain fibroblast
b. Cell free zone rich in capillaries & nerve networks
c. Odontoblastic layer contain odontoblast.

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12. PDL attachment is to: alv. Bone proper or called bundle bone
13. 1st endocrine appear in fetus thyroid.
14. 1st sinus developed maxillary.
15. 2 medial nasal process & fronto nasal process form:
a. middle portion of nose & middle portion of upper lip
b. ant. Portion of maxilla that carry incisor
c. 1ry palate.
16. Tongue from mandibular arch & tuberculm impar
17. Upper lip formed from maxillary process & medial nasal process.
18. Cleft lip due to incomplete union of maxillary arches & nasal arch.
19. Lower lip from merging mandibular processes.
20. Minor Salivary glands

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21. Major Salivary gland

22. In the anterior lateral regions of the hard palate the submucosa contains fatty
tissue.
23. The lateral regions of the posterior parts of the hard palate contain the palatine
minor salivary gland
24. Mand. 1st permenant molar look like 1ry 2nd mand. Molar.
25. .
26. Enamel tufts are enamel rods get crowded.
27. Enamel spindles extention of odontoblast in DEJ.
28. Hunter schreger bands are white & dark lines that appear in enamel when viewing
in longitudinal ground.
29. The nerve supply of tongue

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 a- Anterior sensation lingual nerve & taste chorda tympani branch
from facial
b- Posterior sensation & taste glossopharangeal
c- Motor hypoglossal
30.

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Periodontology and diagnosis
1. Healing occurs after scaling& Root planning by long junctional epithelium
2. Lateral periodontal cyst from rest of serres (dental lamina)
3. apical periodontal cyst from rest of malassez.( epith. root sheath of Hertwig)
4. Periodontal ligament fibers in middle third of root is oblique.
5. Seibert classified alveolar crestal defects
a. Class I: buccolingual loss of tissue with normal apicocoronal ridge height
b. Class II: apicocoronal loss of tissue with normal buccolingual ridge width
c. Class III: combination-type defects (loss of both height and width)
6. Miller's classification for measurement of gingival recession
a. Class I: Recession that does not extend to the mucogingival junction
b. Class II: Recession that extends to or beyond the mucogingival junction, but
without loss of interproximal clinical attachment
c. Class III: Recession that extends to or beyond the mucogingival junction, with
either loss of interproximal clinical attachment or tooth rotation
d. Class IV: Recession that extends to or beyond the mucogingival junction, with
either interproximal clinical attachment or tooth rotation that is severe
7. Tooth mobility
a. mobility is graded clinically by applying firm pressure with either two metal
instruments or one metal instrument and a gloved finger
b. Grades
i. Normal mobility
ii. Grade I: Slightly more than normal (<0.2mm horizontal movement)
iii. Grade II: Moderately more than normal (1-2mm horizontal
movement)
iv. Grade III: Severe mobility (>2mm horizontal or any vertical
movement)
8. The majority of Primary infection of Herpetic infection is Asymptomatic
9. Best healing after root fracture is interposition of bone and C.T.
10. Best measurement of periodontitis by attachment level
11. Tissue response to oral hygiene detected by less bleeding.
12. Schwartz periotriever To remove broken instrument from gingival sulcus
13. Color complex of calculus in 18 y yellow or purple.
14. With age cementum on root end becomes thicker & irregular.
15. Nabers probe is Probe used to detect furcation
16. Bass tooth brushing is the best method because
a. it enters interproximal area & cervical ,
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 b. can be used with gingival recession ,
c. advice to all types of pt. with or without periodontal involvement.
17. Modified stillman used with edematous , inflamed , loss of contour& progressive
recession .
18. Type of brushing bristles works as active part.(bass)
19. Most common method of burshing is Scrub.
20. Charter brushing is recommended after periodontal surgery.
21. Contraindication of gingivectomy suprabony is PDL abscess.
22. Apicectomy surgical removal of apical portion of root ,
23. Amputation removal of one or more roots ,
24. Hemisection root & crown cut length wise.
25. Lava flowing around boulder's is charactrestic to histological feature of type I
dentin dysplasia.
26. Body defend itself by antibodies from B lymphocytes.
27. PMNL cells present in acute infection , while chronic lymphocytes.
28. Conduction faster in mylinated nerves than unmylinated.
29. Punch is the most common oral biopsy.
30. Cyst acc to WHO recent classification become tumor: Keratocyst.
31. Early change result of radiation therapy of oral mucosa is mucositis.
32. Salivary calculi is the common disease affect submandibular salivary gland.
33. Pleomorphic adenoma is the most benign tumor of salivary gland.
34. Fibroma is The most common benign tumor of oral cavity .
35. Radicular or Periapical cyst is the most common oral cyst.
36. Mucocele The best ttt. is: Excision.
37. Pt. who work in glass factories have silicosis.
38. Herpetic ulcer common in attached mucosa & hard palate , while
39. Aphtous ulcer common in linning mucosa.
40. Tetracycline cause brownish discoloration in all teeth & appear yellowish with
UV light.
41. Syphilis 1st appear as ulcer.
42. The spaces are bilaterally involved in ludwig's angina submental , sublingual &
submandibular.
43. Dilantin (phynotoin ) don't give with metronidazole.
44. Isolated pocket in:-
a. Vertical root fracture
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 b. Palate gingival groove
c. Endo origin lesion
45. Components of cell:-
a- Mitochondria >>> ATP production
b- Ribosome >>>manufacture of proteins
c- Golgi apparatus >>> sorting of protein
46. Phagocytosis is the process of engulfing particles.
47. Chemotaxis is attraction of neutrophils to site of local injury.
48. Diapedesis is the movement of polymorphic cells in gaps of intracellular to blood
capillary outside.
49. In diabetic pt. , peridontium affected by neutrophil.
50. After periosurgery
a. Complete epthlilization occurs after 7-14 days
b. complete maturation needs 6 months after periosurgery ( this came to me at
the exam and I got full mark perio , fa plz ma7desh yeftyyy iam sorry y3ni )
c. Membrane removal :
i. if resorbable membrane then 9-12 Weeks
ii. Non- resorbable : 3-6 W
51. PDL attachment is to : alv. Bone proper or called bundle bone
52. Submandibular gland duct is Wharton duct .
53. parotid is Stenssons duct.
54. Autoclaving : 121 Co for 15-20 min or 134 Co For 3-5 minutes
55. Grafts : condyle : post chondral graft
a. Child for alveolar process : iliac crest
b. 3 wall defects in adult : mixed cortical and cancellous from his own intraoral
mixed with his blood.
56. Autography or autogenous : from same person
57. Allogenous from same species but another person and treated
58. xenograft is from povine or any other species.
59. Fluoridation dose required :
a. 0.25 mg 6m- 3 y
b. 0.5 mg 3y-6y
c. 1mg 6y till 12 years.
60. Fluorosis occurs at 3PPM , but lethal dosage or toxicity of fluoride is at 5-10 g
which is 32-64mg/ kg
61. U.S. ultra sonic devices : magnut. : 25000-40000 RPM .
- piezo speed is : 60000 – 80000 RPM
62. Bacteria method to form biofilm is called : signaling , and after plaque
accumulation the next step is to colonize , the next step is maturation .

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63. 2 hours is the time needed after aggressive brushing for plaque to form again..
and 24 hours is to compete maturation
64. Maxillary sinus volume is 15 ml
65. Fibroblasts are the cells responsible for remodeling during orthotreatment
66. Condylar growth is by deposition endochondreal
- skull is by endochondreal and intermembranous deposition .
- maxilla growth pattern is downward and forward , and deposition in the
tuberosity pushing forward also
67. Some tests:
a. HIV : ♥elissa♥ test . but for grading HIV : CD4 t-helper cells
b. diphtheria : shick test
c. Streptococcus : Fermentation
d. staphylococcus : catalase
e. P.Vulgaris : Immuno fluorescence
68. difference between Universal curette & Gracey curette
Gracey curette Universal curette
Area covered Area specific Entire mouth
Cutting edge One Two
Blade offset 70 90
Similar in Rounded back- Rounded toe -
Semicircular cross section or hemicircular

69. Gracey curette types & area used in

a. Gracey 5/6 in anterior area
b. Gracey 7/8 in buccal & lingual surfaces of posterior teeth (P& M)
c. Gracey 11/12 in mesial surface of posterior teeth (P& M)
d. Gracey 13/14 in distal surface of posterior teeth (P& M)
70. Here is a 3 tables the first of diseases and bacteria causing it and the 2nd is for
radiological examination and their usage the 3rd is for AB and their mode of action

Disease Causative organism

ANUG Fusibacteria and pirochetes
Pericronitis Strepto. Malleri or mallery
Endocarditis Staph. Aurues and strept viridians
Caries Strepto. Arueus and lactobacillus
Ch. Sinusitis Mixed anaerobic and aerobic
Hemophilus influenza and strept.
Acute sinusitis
Pneumonia
Osteomylitis Staph aures
In air water syringe Strept. Salivaris
Diabetic periodontium affected by Neutrophils
Chronic inflammation cells Lymphocytes

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 AB creation B-lymphocytes

Radiographic examination Use

Spect ( photon Emission) Condylar hyperplasia
Arhtrography TMJ topography and perforation
Submentovertex Base of skull and zygoma analysis
Occipitomental For mid face fractures
Reverse town Condyler and subcondyler area fractures
Waters view analysis of sinuses & mid face fractures
Panoramic x-ray For whole teeth analysis
PA view Vertical fracture displacement
Later ceph. Orthodontics
Horizontal displacement of fractures and ramus, body of
Lateral oblique
mandible tumors analysis
Soft tissue and hard tissue but show soft tissue better , than CT
MRI
and CT is better in hard structures
CT Hard tissue study
Sialogram Salivary glands study

AB
Penicillin ( b-lactam) :
Erythromycin ( macrolids)
Clindamycin and tetracycline
Gentamycin ( aminoglycosides)
Sulfonamides
Mode of action
Inhibit cell wall synthesis
Bacteriostatic ( inhibit bacterial growth)
Inhibit protein synthesis
Bactericidal ( kill bacteria direct)
Animetabolites inhibit folic acid and PABA , but it
causes aplastic anemia to the patient

71. Disinfection of HBV :-

-formaldhyde ,sodium hypochloride ,chlorohexidine ,iodophor
72. Metaplasia: an initial change from normal cells to a different cell type (such as
chronic irritation of cigarette smoke causing ciliated pseudo stratified epithelium to
be replaced by squamous epithelium more able to withstand the insult.
73. Dysplasia: an increasing degree of disordered growth or maturation of the tissue
(often thought to precede neoplasia) such as cervical dysplasia as a result of human
papillomavirus infection. Dysplasia is still a reversible process. However, once the
transformation to neoplasia has been made, the process is not reversible.
74. Etiological factors: The study of causes or origins or the branch of medicine that
deals with the causes or origins of disease.

24
75. A risk factor is any attribute, characteristic or exposure of an individual that
increases the likelihood of developing a disease or injury. Some examples of the
more important risk factors are underweight, unsafe sex, high blood pressure,
tobacco and alcohol consumption and unsafe water sanitation and hygiene.
76. Epidemiological studies: search for the causes of diseases, based on associations
with various risk factors that are measured in the study. In addition to the
exposures that the study is investigating, there may be other factors that is
associated with the exposure and independently affects the risk of developing the
disease.
77. Confounding factors (variables): is distorting factors if the prevalence of these
other factors differ between groups being compared, they will distort the observed
association between the disease and exposure under study.
78. Hypothetical Example of Confounding factor:
a study of coffee drinking and lung cancer. If coffee drinkers were also more likely
to be cigarette smokers, and the study measured coffee drinking but not smoking,
the results may seem to show that coffee drinking increases the risk of lung cancer,
which may not be true. However, if a confounding factor (in this example,
smoking) is recognized, adjustments can be made in the study design or data
analysis so that the factor does not confound the study results.
79. Epidemiology is the study of the distribution & determinant of disease in man
80. Anticholinergic as atropine used to decrease salivation , antidepressant &
antihistamine, & cardiovascular medications decrease salivation.
81. Bacteria method to form biofilm is called: signaling, and after plaque
accumulation the next step is to colonize, the next step is maturation.
82. Mandible originates from 1st arch
83. Tongue from mandibular arch and tuberculum Kampar.
84. Blood supply of palate from
a. Greater palatine>>> hard palate
b. Lesser palatine >>> soft palate
c. Long spheno palatine >>> ant. Part of hard palate
85. Condylar growth is by deposition (apposition) endochondreal (long bone)
86. Skull is by endochondreal and intermembranous deposition
87. Flat bone by intramembranous.
88. Maxilla growth pattern is downward and forward (intramembranous), and
deposition in the tuberosity pushing forward also
89. Mandible intramembranous & endochondral.
25
90. Mandibular growth just before maxilla.
91. Drug used to eliminate angina diltiazem , while prevention by transdermal
nitroglycerin.
92. Tetracycline will be impaired with pencillin.
93. Fluconazole 50 mg treat systemic candida , nystatin treat local , & amphotrecin
treat life threating cases.
94. U- shaped radiopaque at max. 1st molar area is zygomatic process , while
radiolucency in the same area is antrum.
95. The image show disk position & morphology of TMJ bone is MRI.
96. Radiograph for TMJ movement:
i. -computerized t
ii. -conventional
iii. -arthrography
iv. -transcranial not used.
97. Disk perforation by Arthrography (CT after injection of a high contrast fluid)
98. Radiograph show condylar head orientation & facial symmetry is Reverse town.
99. Bilateral condylar fracture reverse town.
100. In case of fracture of the ramus of the mandible, to evaluate if fracture favorable
or unfavorable :30 degree oblique radiograph.
101. Photon Emission SPECT (single photon emission computed tomography) for
Detection of condylar hyperplasia.
102. At the begining of the operation day in the clinic, you should start the water/air
spray for three minutes in order to get rid of which type of microorganisms:
Streptococcus salivarius. Pseudomonas aeruginosa
103.

26
Surgery
1. Walsham's forceps : for nasal fracture treatment , and if nasal bone is deviated it
will be straightened by Ach's forceps afterward.
2. Allis forceps : to hold tissues prior to excision
3. Addison forceps : to hold tissues for suturing
4. Stillis forceps : per wisdom teeth suturing because it is longer than addison's
forceps.
5. Artery forceps : to ligate ruptured arteries or arteries planned to be removed.
6. Minnesota retractor : retract flap and cheek together.
7. Farabeuf retractor the retractor which retract the flap and the cheek together
when doing surgery
8. Muscles of mandibular movement :
a. Muscles elevation of the mandible: Masseter, temporalis and medial
pterygoid
b. Muscles depression of the mandible: geniohyoid, mylohyoid, digastric,
lateral pterygoid and infrahyoid
c. Muscles protrusion of the mandible: Lateral pterygoid, medial pterygoid
assists, masseter
d. Muscle retraction (retruded) of the mandible:Temporalis
e. Muscle do lateral movement of the mandible: Lateral pterygoid, medial
pterygoid
9. Glenoid fossa (mandibular) found in temporal bone
10. Reduction of fractured bones mean realignment of fracture segment , while
fixation mean holding the fracture segment in place
11. The choice of local anesthesia depend on local anesthetic agent chemistry , while
technique by bone structure.
12. Additional tech. of anesthesia in hemophilia intraligamental
13. The mandibular foramen positions
a. at a level lower than occlusal plane of 1ry teeth , so injection slightly low
b. in adult at occlusal plane
c. in old above occlusal plane.
14. Mandibular nerve leave skull from foramen ovale ,while maxillary from
rotandum.
15. Ester type of local anathsesia metabolized by:plasma & secreted by kidney.
E(s)ter ...pla(s)ma Am(i)de lidocaine ...l(i)ver.
16. Slowest action of anesthesia by bupivacaine.
17. palatal root of upper 6 is the most pushed in max. sinus.
18. factors that make surgery more difficult:-
Distoangular , thin follicle , narrow PL , & divergent curved.

19. Lower ant. Labial mucosa supplied by mental nerve

20. Buccal branch of trigeminal is sensory , while buccal branch of facial is
motor
27
21. Upper teeth palatal mucosa supplied by anterior palatine & nasopalatine.
22. Mandible always deviate to the side of injury
23. Rarefaction: decreased density of bone such as a decrease in weight per unit of
volume.
24. Local anesthetic agents in dentistry ..
a. The most commonly used local anesthetic is Lidocaine (also called
Xylocaine or Lignocaine).
b. A modern replacement for procaine (also known as Novocaine). Its half-life
in the body is about 1.5–2 hours.
c. Other local anesthetic agents in current use include articaine (also called
Septocaine or Ubistesin), Marcaine (a long-acting anesthetic), and
Mepivacaine.
d. A combination of these may be used depending on the situation.
e. Also, most agents come in two forms: with and without Epinephrine
(Adrenaline) or other vasoconstrictor that allow the agent to last longer and
also controls bleeding in the tissue during procedures.
25. .
26. ggsggd

28
 Operative
1. Odontoplasia : affecting E, D , and pulp
2. Amelogensis imperfecta don’t affect D or P
3. Dentinogenesis imperfecta mostly have no pulp cavity
4. Oligodontia : 6 or more missing teeth, lack of development of alv. Process and
decreased facial height.
5. Streptococcus mutans initiate caries & lactobacilli progress caries
6. DL cusp of Upper E is the sharpest cusp in both dentitions ,and is the largest in
primary dentition
7. ML cusp of Upper 6 is the sharpest cusp in permanent dentition and the largest is
BL cusp.
8. MB cusp of Lower 6 is the largest MD cusp.
9. Dentinal tubules :
a. near pulp : they are 2-5 micrometers and count is 45- 60 thousands / mm2
b. while away at the DEJ they are 0.2 to 0.5 micrometers diameter and count is 15
to 20 thousands / mm2
10. 1st sign of calcification occurs at 14 weeks Intra uterine while first formation of
tooth bud is 6 weeks intra uterine.
11. Copper is added to amalgam to decrease gamma 2 phase
12. Zinc is added to decrease oxide layer but if zinc increase it will lead to increase
moisture sensitivity and late expansion and pain
13. differences between Erosion ,Attrition, Abrasion& Abfraction
Definition Site Causes
1. Bruxism.
2. Associated with snuff chewing.
the physical wear of
3. Associated with bettel nut and pan
one tooth against
Incisal and occlusal chewing.
Attrition other or tooth
surface of teeth 4. Associated with hypertensive
against restoration or
patients.
prosthesis
5. Associated with poor prosthesis
and poor restorations.
1. Hard tooth brushes or excessive
use of other cleaning aids.
1-Neck of labial
2. Abrasive tooth pastes and tooth
surface of anterior
physical wear of powders (smokers tooth powder).
teeth.
Abrasion dental hard tissues 3. Habits such as thread biting and
2-Neck of buccal
from external agents pipe smoking (can cause notches in
surface of posterior
the incisal edges).
teeth
4. Snuff chewing.
5. Pan and bettel nut eating
These lesions appear to result from
microstructural loss
occlusal loading forces, frequently
of tooth substance in Cervical region of
Abfraction have a crescent form along the cervical
areas of stress teeth
line where the enamel is brittle and
concentration
fragile
Erosion loss of dental hard According to type of tooth erosion:
29
 tissue as a result of 1- Regurgitation erosion.
chemical process not 2- Dietary erosion.
involving bacteria. 3- Industrial erosion
See next table

Regurgitation erosion Dietary erosion Industrial erosion

The erosive destruction of teeth
Definition caused by frequent exposure of
gastric acid to teeth
1. Palatal surface of maxillary
anterior teeth.
Site 2. Occlusal and buccal
surfaces of mandibular
teeth
1. Digestive disorders
including hiatus hernia
and chronic indigestion.
2. Anorexia and bulimia
nervosa (Perimolysis,
Causes
evident on maxillary palatal
surfaces).
3. Morning sickness
associated with pregnancy.
4. Voluntary regurgitation
dissolution of dental hard
loss of dental hard tissue by
tissue due to industrial
intake of acidic foods and
processes which produces
drinks
acid fumes and droplets
Labial surface of
Labial surface of maxillary maxillary anterior teeth
teeth and may also cause
pitting
1. Citrus fruits and fruit juices Effected individuals:
(contains citric acid). 1. Battery
2. Pickles and food containing manufacturers.
vinegar (contains acetic 2. Wine tasters.
acid). 3. Chemical and
3. Carbonated and energy pharmaceutical
drinks (contains carbonic
company workers.
acid
4. Alcohol. 4. Soft drink
5. Salad dressings. manufacturers.
6. Effervescent vitamin C 5. Dyers.
6. Tin factory workers (
tablets.
7. Acidic candies. tartaric acid).
8. Herbal tea

1. Tooth enamel erosion: teeth

are bathed in gastric acid
during vomiting leading to
decalcification
2. Tooth sensitivity to
temperatures
3. Parotid gland (sialadenosis)
or submandibular gland
enlargement: can be
disfiguring
Oral manifestation

4. Erythema of the oral

mucosa
5. Soreness in mouth
6. Cheilosis

30
14. Sharp pain due to mylinated A fibers , aching pain due to unmylinated C fibers.
15. The least reliable test of caries is electric test.
16. The most accurate , but invasive cavity test.
17. The most reliable appropriate test is thermal test.
18. pt. came to your clinic with pain in his mouth but he cannot localize which the jaw,
which test is useful :anesthetic test.
19. Smear layer composed of dentin debris , inorganic particles , & bacteria.
20. Reparative dentin ( 3ry dentin)
a. Produced by 2ry odontoblast in response to stimuli
b. Irregular &fast
c. Found at site of irritation
d. In direct pulp capping
e. Moderate irritation to pulp (caries)
f. Erosion
21. Secondary dentin
-regular , slow process , & through life time.
-by age
-indirect pulp capping
-with recurrent caries
-occlusal trauma
-attrition in dentin
22. Sclerotic dentin
-due to age
-mild irritation
-slow progressing caries
-harder , denser , less sensitive , & more protective to pulp than 1ry
-has 2 types
a- by age ( physiologic)
b- irritant reactive ( pathologic)
23. Incipient caries surface zone is relatively unaffected.
24. Bur least heat generation carbide , while with highest diamond.
25. To plane line angle of promimal cavity by binangled chisel ,
26. to form internal line angles and retentive groove angle former.
27. The most retentive pin is Self threaded
28. Carbide 12 fluted bur used to finish composite , while aluminum oxide disc or
paste used to finish GI.
29. To accelerate zinc oxide cement you add zinc acetate.
30. Mahler scale to measure marginal deterioration.
31
31. Thermal test
a- Vital pulp >> painful disappear soon after removal of stimulus
b- Inflamed pulp>> lingering painful response
32. Electric pulp test
 For vital similar to control tooth
 false negative response after trauma
33. Hydrogen peroxide is ideal bleaching agent
- It bleaches effectively at natural ph
- It bleaches faster than carbamide peroxide
- Protection for sensitive tissues can be incorporated
34. Copper is added to amalgam to decrease gamma 2 phase while
35. Zinc is added to decrease oxide layer but
36. if zinc increase it will lead to increase moisture sensitivity and late expansion and
pain.
37. Amalgam pain after restoration from 3 – 30 days due to zinc containing lead to
moisture contamination cause expansion.
38. Caries detection dye composed mainly from propylene glycol.
39. sharping of hand instrument mounted air driven better than unmounted due to fine
grift.
40. unmounted better due to less particles of instrument are removed.
41. cement should has high modulus of elasticity ( stiff – decrease flexibility )
42. luting cement should provide sealing.
43. bonding agent for enamel unfilled resin.
44. maxillary inlay has reverse bevel for retention.
45. composite composed of :
a. resin – BISGMA
i. Urethane dimethacrylate + monomer (highly polishable)
ii. TEGDMA
b. fillers – barium
- Strontium glass (macro)
- Colloidal silica (micro)
46. chemical break of composite called biodegradation.
47. mylar matrix used with composite because it can be light cured.
48. function of primer penetrate into collagen framework & copolymerize with resin &
raise surface free energy (wet ) dentin.
49. Glass ionomer:-
a- Powder (calcium fluoro alumino silicate glass)
b- Liquid (polyacrylic acid 50% + distilled water + tartaric acid)
32
50. GI compared to composite:-
a. -lower in coefficient of thermal expansion
b. -lower in wear resistant
c. -more soluble
d. -less stiff
e. -lower in polymerization shrinkage.
51. adv. Of plain GI over GI with additives less contraction.
a. Resin modified glass ionomer :-
i. Powder (radiopaque fluoro alumino silicate initated by light or
chemical )
ii. Liquid (hydroxyethyl methacrylate + tartaric acid)
b. Compomer Modification of resin by adding polyacrylic acid & fluoride
glass
c. Giomer Resin with active glass ionomer fillers.
d. Cermets = Glass ionomer + glass with silver powder + polyacrylic acid.
52. fluoride application
preeruptive posteruptive
improve crystallinity decrease demineralization
increase crystal size increase remineralization
decrease acid solubility decrease acid production in plaque
increase concentration of fluoride in
more rounded cusps
plaque
affect pellicle & plaque formation

53. fgsgs
54. sgsg
55. s

33
Crown and bridge
1. Sequence of shade selection is : VCH where
a. V is value ( lightness or darkness of color )
b. C is chroma which is degree of saturation of color .
c. H is the property of color itself .
2. If you want to make a darker cervical porcelain then choose higher chroma
3. Rochette bridge : a type of macromechanical retention
4. Meryland bridge : a type of micromechanical retention bridge bonded by resin ,
and need high oral hygiene and low caries index.
5. thickness of reduction
Occlusal clearance At margins
NON functional
Complete casted functional cusp cusp 0.5 mm chamfer
crowns finish line
1.5 mm 1 mm
Metal-ceramic anterior tooth Posterior teeth 1.5 mm shoulder or
crowns 2mm 1.5 mm shoulder with bevel
All ceramic 1 mm shoulder finish
Incisal clearance =1.5 mm
restoration line
6. Firing temperature of porcelain
a. high fusing =1400-13000 C
b. medium = 1300-11000C
c. ultralow = 1100-8500C
d. low = less than 8500C
7. Pier abutment Isolated tooth surround by edentulous area.
8. Spedding principle: Used for selection of stainless steel crowns.
9. Finishing the finish line by diamond end cutting.
10. Pontic design that give high esthetic demand when preparing teeth 9 & 11 is
modified ridge lap.
11. When porcelain is fired too many times it appears as a milky state and makes
glazing is very difficult.
12. Tooth to appear narrower
 MF & DF line angles closer & more closely positioning developmental
depressions
 vertical lines.
13. Tooth to appear wider
a. -horizontal lines.
b. -MF & DF line angles far from each other.
14. Tooth to appear wider
a. -horizontal lines.
b. -MF & DF line angles far from each other.
34
15. Provisional restoration tooth colored polycarbonate .
16. The best pontic is hygienic.
17. Pontic give illusion & clearance modified ridge lap.
18. Porcelain with high esthetic is impress , while with high strength is zircon
(reinforced in ceram).
19. Wax shrinkage due to internal stress.
20. Flux used for :- prevent oxygen from contacting alloy& dissolve oxide
21. Impressions :
a. Polyvinyl siloxane ( addition silicone ) : the best type and of highest
accuracy and the type of choice for inlay and onlays , and can be poured
many times.
b. Polyether : the 2nd accuracy after polyvinyl siloxane , and it is rigid and
having higher dimensional stability than polysulphides but they
unfortunately uptake water and swell& it causes allergy
c. Polusulphides : of bad taste unacceptable by the patient , they should be
poured within the first 24 hours.
d. Hydrocolloids are 2 types :
i. Reversible hydrocolloid = agar agar.
ii. Irreversible hydrocolloid = alginate.
iii. Reversible and Irreversible hydrocolloids ( agar agar and alginate )
are elastic impression materials and have the properties of syneresis
and imbibition.
iv. if delay pouring will have dehydration and appear chalky.
v. Agar agar sets by a physical reaction and this reaction is reversible.
vi. Alginate sets by a chemical reaction and this reaction is irreversible.
vii. Syneresis and imbibition are more in alginate than in agar agar.
viii. Only, agar agar has the property of hysteresis.
ix. Alginate is the least accurate impression material.
x. Alginate have tri sodium phosphate which is retarded for the reaction
and the insoluble part of alginate is calcium alginate
xi. Calcium sulphate is added to gypsum to prevent inhibiting gypsum.
xii. Alter the setting time of alginate by :-
- Alter temperature
- Alter ratio powder water
22. Impression materials that compatible with epoxy resin are polyether & polyvinyl
siloxane.
23. Retention of porcelain venner micromechanical from etching of enamel & venner.
24. Silane coupling agent used with porcelain to enhance wettability of bonding (
decrease surface tension) , while in composite act as adhesive between inert filler
& organic matrix.
25. Calcium sulphate is added to gypsum to prevent inhibiting gypsum
26. Most important criteria of full ceramic stronger in compression than in tension to
increase resistance to shattering.
35
27.
28.

36
Endo
1. E.Feacales is the main organism during R.C.T and is killed by MTAD preparation
which is mix of tetracycline and doxacycline .
2. to kill E.Feacales
a. MTAD is more effective than Naocl in killing E. faecalis.
b. NaOCl is more effective than MTA in killing E. faecalis.
c. Also, Chlorhexidine can kill E. faecalis
3. File length : 21 . 25 , 31 mm.
4. Increase in taper is 0.02/ mm so along the 16 mm of active cutting part the
increase in diameter is 0.02 x 16 = 0.32 mm
5. An example is file 50 means at the tip the diameter is 0.5 mm
6. The different between file and another is 0.05 mm from file 10 to 60
and 0.1 between files 60- 140
7. S-files is used to remove GP but after using solvent first
8. Reamer is the most flexible .
9. Cross section of files:
- K >>>> square
- H >>>>round
- Protaper >>>> triangle
10. More +ve rake angel in H file then K file
11. Patency filling push the file apically to remove any block at apex.
12. Steiglitz pliers is the best way to remove silver point.
13. The main link between the pulp and periodontium is: Apical foramen.
14. Most important criteria of sealer high resilience.
15. Discoloration of endo treated teeth due to incomplete removal of GP from pulp
chamber.
16. Continuous condensation of GP is system B.
17. Type of flab in apicectomy semilunar.
18. Opening an incision in a Periapical abscess in lower 1st molar in the most bottom
of abscess.
19. To measure blood flow use laser Doppler , to test vitality use thermal.
20. Thermomechanical condensation called Mcspadden tech.
a. disadvantages:
i. speed higher so cause poor seal & voids ,
ii. heat generation may damage PDL &
iii. cause resorption & ankylosis
iv. extrusion of filling ,
v. fracture of thermocompactor
vi. inability to use in curved canals.
21. Intrapulpal injection the needle should wedged in the orifice & has pressure back.
37
22. The most cause of failure in endo fractured instrument.
23. The most complication of ledge is perforation.
24. Stripping mean removal of dentin in dangerous zone to cementum.
25. Endomethasone is root canal sealer
- Dissolve in fluid , so weaken root filling
- Very toxic contain formaldhyde
- Contain corticosteroid
26. C- shaped canal found in lower 7
27. Rotary files used for crown down technique
28. Intracanal pressure is 10mm/hg and the intrapulpal arterioles diameter is 50
micrometers
29. External resorption is caused by necrotic pulp or forcable intrusion or extrusion in
ortho.
30. Internal resorption is caused by irreversible pulpitis .
31. Differentiation between
Acute periapical periodontitis Acute periapical abscess
Tooth vitality Vital or not Non-vital (false +ve EPT)
Severe-localized- throbbing-
Pain Mild &localized
continuous
Percussion Slight sensitive Sensitive
Same + fluctuation due to
Palpation Painful at root end but no swelling
presence of swelling
Swelling No present

Lateral periodontal
Acute periapical abscess Phoenix abscess
abscess
Tooth vitality Non-vital (false +ve EPT) Vital Non-vital
Pocket No Present No
Widening in PD
PD pocket with lateral apical
x-ray membrane space with
radiolucency radiolucency
apical radiolucency
Variable sensitivity
Percussion Sensitive
(lateral)
Sinus opening Via alveolar mucosa Via keratinized gingiva

Pulp polyp Gingival polyp

Attachment Pulp Gingiva
Bleeding Easy Not easy
Tenderness Not tender (non-vital tooth) Tender ( vital tissue)
32. difference between percussion &palpation
Percussion Palpation
Presence of inflammation in Extension of inflammation in
Indicates
periodontium periapical area
Duplication pain on Tissue swelling or bony
For
mastication expansion
Positive response means inflammation in periodontium inflammation in periapical area

38
33. Access Cavity of
a. upper 1 is triangle with base at incisal edge
b. upper 6 &7 are triangle with base at buccal cusps
c. lower 6&7 are trapezoid or rhomboid
d. all remaining teeth are oval or ovoid
34. Treatment of intrusion:-
a. Primary
i. Wait & see
ii. At time of permanent eruption →extraction of primary teeth
b. Permanent
i. Wait 2 months
ii. Apex complete extraction & reimplant with splint 10 days & RCT with
calcium hydroxide 2 weeks.
iii. Orthodontic movement of the tooth
35. fracture of tooth:-
a. apical third >>> no TTT
b. between middle & apical >>> good prognosis
i. Large space >> RCT to middle & remove apical
ii. Short space >> RCT to all tooth
c. between middle & cervical >>> poor prognosis
i. splint for 4 -5 weeks
ii. RCT for coronal
36. the best transport medium for avulsed tooth
a. HBSS (Hank's balanced salt solution)
b. cold milk
c. milk
37. The vertical fracture of the tooth detected by:( sever pain on biting)
a. Fiber optic light.
b. Persistent angular periodontal defects not responding to treatment
c. deep narrow pocket on the facial surface of the root
d. presence of sinus tract draining through the gingival sulcus
e. Halo-shaped radiolucency covering the root .
f. Hair-like longitudinal fracture line
g. Loosening of retrofilling
h. Extrusion of sealer from the fracture line
38. Weeping canal mean that apical part of canal can't be dried properly , so we put
calcium hydroxide for 2 – 3 weeks.
39. Adding of surfactant to irrigation solution during RCT to increase wettability of
canal walls by: lowering surface tension.
40. Laser for endo Nd (YAG) & for curing composite Argon/Hallogen led

39
40
Orthodontics
1. Functional appliances : if he asked about functional appliances in the exam just
mention posterior bite block even if he said active functional and do not worry you
will get the mark no idea how . but let's explain some notes about functional
appliances :
 Tooth borne appliances : a) bionator B) herbest ( pin and tube device )
 Tissue borne appliances : Frankele is the only tissue borne functional
appliance
2. Active appliances employ force to the teeth to change their position
-Most active appliances are fixed. Examples of active appliances
 Rapid maxillary expansion appliance (palatal expander(twice per day 0.5
– 1 mm/ day)
 Helix
 Bite plate
 Pin and tube
 Ribbon arch
 Edgewise
 Beg light wire
3. Blue grass appliance : for tongue thrust and thumb sucking habits , they are
used as soon as the habit is noticed and they are left for 6 months at least.
4. Cap splint device : for cleft palate .
5. 2x4 device : for anterior cross bite in mixed dentition
6. Chin cup apply to class 3 with long lower face.
7. Levering the curve of spee for correct deep bite.
8. Minimal Space needed between primary and permanent dentition IS
 7 mm in maxilla & 6 mm in mandible .
9. Primate space: Primate space is the gap between the primary teeth of a child.
These are normal. They are the result of the jaws growing to accommodate the
larger adult teeth. yet, spacing is normal in children, but the term "PRIMATE
SPACE" is more specific : In the mandibular arch, the primate space is between
the canine and the 1st molar (or 1st premolar in adults).Whereas, in the
maxillary arch, it is between the lateral incisors and canine
10. Leeway space: it is the space deference between the combined mesiodistal width
of the C,D & E teeth and that of their successors ( 3 ,4 and 5 ) which is
 1.9 mm in maxilla & 3.4 mm in mandible.
11. Freeway space: it is the space between occluding surfaces of maxillary and
mandibular teeth when mandible is at rest

41
12. Overjet is the measurement (usually in millimetres) between the upper incisal
edge and the labial surface of the lower incisors. The normal value is considered to
be approximately 2-3 mm.
13. Overbite is essentially the coverage of the upper incisors over the lower incisors
and this is sometimes measured in millimetres but more usually described as
reduced, normal or increased.
14. Overjet in excess of 6mm will qualify for orthodontic treatment within the NHS.
15. Increased overbite with trauma will also qualify.
16. COMMONLY USED SPACE MAINTAINERS
 BAND & LOOP
i. Most commonly used
ii. Unilateral fixed appliance
iii. Used in posterior segments
 CROWN & LOOP
i. Same as band & loop
ii. Stainless steel crown is used as an abutment
iii. Stronger than band and loop
iv. Cementation failure or loss are less likely
v. Excellent choice if tooth needs a restoration
 LINGUAL ARCH HOLDING DEVICE
i. Bands on first permanent molars
ii. Not be placed with primary incisors , but places on permanent incisors
iii. Bilateral in lower arch
 NANCE’S PALATAL HOLDING DEVICE
i. Bands on first permanent molars
ii. It’s a simple maxillary lingual arch but does not contact anterior teeth
iii. It has an acrylic button in the mid palate
iv. Bilateral in upper arch
 TRANS PALTAL
i. Can be used like a Nance.
ii. Advantage Lack of acrylic button so less tissue irritation and more
cleansable
iii. Disadvantage Lack of anterior stop = possible tooth shift
 DISTAL SHOE
i. Used when second primary molar requires extraction and first
permanent molar has not erupted
ii. Length &Position should be evaluated with radiograph prior to
cementation
iii. Will be replaced with another space maintainer when permanent teeth
erupt
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  REMOVABLE SPACE MAINTAINER
i. Types : Functional types &Non-functional types
ii. It is like a removable partial denture
iii. Maintaining Mesiodistal space & the vertical space.
iv. Masticatory Function is restored in functional type, Esthetics &
speech improvement is seen

17. Angle classification of malocclusion

18. British Standards Institute's classification of incisor relationship

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19. Canine relationship
 The canine relationship can be used as another method of classifying the AP
occlusal relationship. The classification is outlined below:
a. Class I – the maxillary permanent canine occludes in the embrasure
between the lower canine and 1st premolar
b. Class II – the maxillary canine occludes anterior to the embrasure
between the lower canine and 1st premolar. The severity of the
malrelationship can be described as a fraction of a tooth unit.
c. Class III – the maxillary canine occludes posterior to the embrasure
between the lower canine and 1st premolar
20. Clicking on open & close >>> reduction.
21. Shift to one side on open >>> unilateral.
22. Force of removable appliance tipping.
23. soft tissue protrusion in :Class II mod I
24.

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Removable prothodontics
1-Post insertion problems in complete dentures:
Errors Causes Treatment
Loose Dentures 1. Decreased retentive forces 1. Decreased retentive forces
Symptoms a. Lack Of Seal a. Treatment: Lack of Seal
• Speech i. Under Extended i. Under extended borders – soft tracing
• Denture falling borders – Depth or compound
• Food Width. ii. Incorrect posterior palatal seal – correct
entrapment ii. Incorrect Posterior placement of border
• Pain Palatal Seal. iii. Inelasticity of Cheeks – incremental
iii. Inelasticity of Cheeks. border moulding and functional
movements
b. Air beneath Impression b. Air beneath Impression Surface
Surface i. Relining the denture
i. Poor Fit. ii. Remaking the dentures
 Deficient iii. A rotational path of insertion in case of
impression unilateral undercuts.
 Damaged cast
c. Treatment: Xerostomia
 Warped denture i. Presence / Absence of glandular function
 Overadjustment of
ii. Artificial saliva substitutes
impression surface
ii. Undercut Ridge iii. Sucking on sour candy
iii. Excessive Relief. iv. Intermittent sips of water
c. Xerostomia as in Diabetes, v. Pilocarpine hydrochloride.
drugs, menopause, irradiation. d. Treatment: Poor Neuromuscular
d. Poor Neuromuscular Control Control
i. Incorrect denture i. Polished surface should occupy the
shape
ii. Changed shape neutral zone
relative to old dentures ii. Use of denture adhesives
iii. Motor – Neuron
disorders
2. Increased displacing forces
a. Overextended Borders.
b. Poor Fit
c. Denture not in Optimal
Position
d. Occlusal Problems.
Prematurities , Occlusal
Balance, Incorrect plane of
Occlusion
3. Support problems
a. Fibrous Displaceable
Ridge
b. Lack of Ridge
c. Bony Prominence
Discomfort 1. Impression Surface 1. Pain on eating – premature contacts / lack
Symptoms a. Sharp Acrylic Nodules of occlusal balance
1. Pain b. Un-relieved undercut areas  Use articulating paper to identify
2. Altered c. Overextension offending area
sensation d. Lower knife-edged ridge. 2. Pain / ulceration lingual to lower anterior
3. Difficulty in e. Deep Postdam- sore throat, ridge
chewing / difficulty in swallowing
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 swallowing 2. Polished Surface  CR and MIP do not coincide
a. Thick distobuccal flange of  A slide from CR to MIP
upper denture  Selective grinding to correct
3. Occlusal Surface 3. Pain / ulceration – labial aspect of lower
a. Pain on eating ridge & incisive papilla
b. Pain / Ulceration lingual to  Undercut or sharp acrylic
lower anterior ridge  Trim labial aspect of lower anteriors
c. Pain / ulceration labial aspect of 4. Excessive vertical dimension .If increased
lower ridge and incisive greater than 2mm, better to remake
papilla dentures.
d. Excessive vertical dimension 5. Biting of tongue
e. Cheek / lip biting  Usually due to
f. Tongue biting. a. Teeth placed lingual to lower ridge
b. Decrease in tongue space in patients
accustomed to old dentures
c. Changes in occlusal level
 Treatment
a. Remove lower lingual cusps
b. Reset and rearrange the teeth
6. Cheek biting
 Usually due to
a. Insufficient overjet, in posterior
region.
b. Very lax cheeks
c. Reduced vertical dimension
 Treatment
a. Increase buccal overjet and plump
the denture
b. Remove last molars
c. Grind buccal surfaces of lower
posteriors
Poor Appearance a. Insufficient or too much tooth a. Insufficient or too much tooth visibility
visibility • due to
b. Creases at corner of mouth. a. improper Orientation of occlusal
plane
b. Vertical dimension
c. Labiolingual & labiopalatal
positioning of anterior teeth.
• Difficult to correct appearance without
remaking dentures
b. Creases at corner of mouth
• Can be due to
i. Decreased labial fullness
ii. Decreased vertical dimension
• May require remaking of dentures
• Important to verify and take patient
consent for aesthetics at time of try-in
Speech problems 1. Sibliants : S • Takes few days for getting accustomed
2. Bilabial: P & B • Dentures may need to be remade
3. Labiodental: F & V • Causes include
– Incorrect vertical dimension
– Incorrect overjet / overbite
– Incorrect incisor position.
Difficulty in • Instability
Eating • Too narrow occlusal table
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 • Increased or decreased vertical
dimension
Clattering of 1. Porcelain teeth
teeth while eating 2. Increased vertical dimension
/ speaking 3. Increased incisor overlap
balance 4. Loose dentures
5. Cuspal interferences and lack of
balance
Nausea & 1. Loose dentures
Gagging 2. Poor occlusion
3. Thick distal termination in upper
dentures
4. Palatal placement of upper
posteriors
5. Low occlusal plane
6. Overextended retromylohyoid area
7. Underextended denture borders
8. Psychogenic
Commissural 1. Excessive interocclusal distance
Cheilitis 2. Occlusal plane of lower teeth is
too high
3. Elimination of Buccal Corridor
4. New Dentures
Burning Tongue 1. Anterior third of palate
& Palate 2. Association with menopause
Tingling or 1. Felt at corner of mouth / lower lip
Numbing 2. Excessive pressure from
sensation mandibular buccal flange
3. Impingement of mental nerve
4. Excessive resorption
Food under the 1. Usually by first time denture
denture wearers
2. A perfect peripheral seal is rarely
attained
3. Failure to keep dentures clean
4. Failure to polish denture surfaces

2. Causes of complete denture failures:

a. loosing denture while smiling due to inadequate relief of the buccal frenum
b. loosing of upper denture while opening mouth due to
i. excessive thickness of distobuccal flang
ii. interference of coronoid process
c. difficulty during swallowing due to
i. overextension of the lingual flange into the lateral throat
ii. increased VDO
d. pain & soreness during chewing due to deflective occlusal contact
e. mucosal attrition due to overextended dental borders
f. epulis fissuratum due to ill-fitting or overextended dentures
g. clicking noise during teeth contact due to increased VDO
h. burning sensation in anterior 1/3 of palate due to inadequate relief of incisive
papilla resulting in pressure on nasopalatine area
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 i. the denture is tight when inserted &becomes loose during usage due to errors of
occlusion
j. soreness on the slopes of ridge due to deflective occlusal contacts resulting in
shifting of the bases
k. soreness on the crest of ridge due to increased VDO resulting in heavy contact
l. cheek biting due to insufficient horizontal overlap of posterior teeth
3. Kennedy's Classification of partial denture :
a. Class I: Bilateral edentulous area posterior to the remaining natural teeth.
b. Class II: Unilateral edentulous area posterior to the remaining natural teeth.
c. Class III: Unilateral edentulous area with natural teeth anterior &posterior to
it
d. Class IV: Single Bilateral edentulous area located anterior to remaining5
natural teeth.

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Implantology
1. Distances
a. From implant to tooth 1.5mm
b. From implant to implant 3mm
c. From implant to maxillary sinus 1mm
d. From implant to lAC 2mm
2. Most place of failure of implant is in posterior max
3. Best place for success implant in anterior mandible
4. Minimal failure in mandible between mental foramen.
5. The best type of implant allowing oseeointegration root form
endosseous

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