Cleidocranial dysplasia

Charu LataLeave a comment
Brachycephalic skull
Hypermobility of arms
Oral manifestations
Radiographic interpretation
Fun fact! Gaten Matarazzo , who played “Dustin” on stranger things is suffering from cleidocranial dysplasia!

Sources – Anil Ghoms textbook of oral medicine , osmosis.org

Image sources – Google images , researchgate.net

POTENTIAL DIAGNOSTIC CLUES TO CAUSES OF ACUTE LOCALISED INFECTIONS

Dr.Urusa InamdarLeave a comment

Written by : Dr. Urusa I Inamdar

  • ENT
  1. Tonsillar enlargement
  2. Exudate sinus tenderness
  3. Ear discharge
  4. Appearance of drum , mastoid tenderness
  • Cardiovascular
  1. New or changing murmur
  2. Peripheral signs of endocarditis
  • Hepatobiliary
  1. Tender hepatomegaly
  2. Murphy’s sign

https://youtu.be/2T0XUQ1M-x0

  • Genitourinary
  1. Suprapubic tenderness
  2. Renal angle tenderness
  3. Vaginal discharge
  4. Cervical motion tenderness
  • Skeletal
  1. Localised bone tenderness
  2. Mono arthritis
  • Dental
  1. Periapical swelling and tenderness
  • Respiratory
  1. Crackles
  2. Bronchial breath sounds
  3. Egophony
  4. Pleural effusion (unilateral)
  • Abdomen
  1. Tenderness in a specific quadrant
  2. Tender lump
  3. Guarding , rigidity
  • Skin and soft tissue
  1. Cellulitis
  2. Necrotising fascitis
  3. Discoloration
  4. Bullae , crepitance
Cellulitis of skin
Necrotising Infection
Bullous skin
  • Lymph nodes
  1. Lymphadenopathy in a single region.

Reference

  • Dental notes
  • Gsk – webevent console
  • YouTube.com
  • Google search

MANAGEMENT: TMJ ANKYLOSIS

harshulsinghLeave a comment
  • Ankylosis can ONLY be treated surgically.
  • There is no form of pharmacological management.
  • Type of surgery depends on age of the patient & extent of deformity.
  • Treatment also varies if ankylosis is unilateral/bilateral.

SINGLE STAGE V/S 2-STAGE SURGICAL PROCEDURES:

  • Surgery can be done in two stages.
  • In the first operation, only a release of ankylosis is done.
  • It is believed that growth takes place after release of ankylosis.
  • Second stage procedure,an orthognathic surgery can be performed to restore esthetics.
  • Some, however prefer to it as a single stage procedure,where release of ankylosis + esthetic correction is done in a single stage operation in adults.

SURGICAL PROCEDURES:

There are 3 types:

  • Condylectomy.
  • Gap Arthroplasty.
  • Interpositional Arthroplasty.

TMJ APPROACHES:

SURGICAL APPROACHES TO THE TMJ:
P1 and P2— preauricular approaches;
PA-postauricular approach;
I—inverted hockey stick approach;
E -endaural approach.
R-retromandibular approach.

1. CONDYLECTOMY:

CONDYLECTOMY

2. GAP ARTHROPLASTY:

GAP ARTHROPLASTY

3. INTERPOSITIONAL ARTHROPLASTY:

AUTOGENOUS COSTCHONDRAL GRAFT

KABAN’S PROTOCOL:

REFERENCES:

  • Textbook of Oral & Maxillofacial Surgery, Chitra Chakravarthy (2nd Edition)
  • interchopen.com
  • researchgate.net

ANKYLOSIS OF TMJ

harshulsinghLeave a comment

CLASSIFICATION:

1. Based on type of tissue causing Ankylosis:

2. Based on the Side Involved :

  • Unilateral Ankylosis
  • Bilateral Ankylosis

3. Based on Severity of Ankylosis:

  • Partial
  • Complete

4. Based on Etiology of Trismus:

  • Pseudo Ankylosis
  • True Ankylosis

SAWHNEY’S CLASSIFICATION:

Grading of Ankylosis in Children

CLINICAL FEATURES:

INVESTIGATIONS:

1. Radiographs:

– OPG

OPG: *Helps in bilateral comparison of the joint.**The antigonial notch can be appreciated in this type of radiograph.

-PA VIEW:

PA View:Medio-lateral extent of bony growth can be seen on this radiograph.

– Lateral Oblique View of Mandible:

Ankylotic mass can seen in the Anteroposterior direction.

2. Lateral Cephalogram:

Periodic radiographs taken can help to estimate growth of the jaw.

3. CT Scan:

Helpful as it gives an accurate picture of proximity of ankylotic mass to important structure,that cannot be seen in a radiograph.

CT Scan: Ankylosed TMJ

RADIOGRAPHIC FEATURES:

  • Decreased ramus height on the affected site.
  • Lack of joint space.
  • Normal joint space obliteration by bone/fibrous growth.
  • Elongation of coronoid process.
  • Deep antigonial notch.

REFERENCES:

  • Textbook of Oral & Maxillofacial Surgery, Chitra Chakravarthy (2nd Edition).
  • DentalHypothesis.com
  • Europe PMC
  • PocketDentistry.com
  • SciELO.com

INGLE’S RADIOGRAPHIC METHOD OF WORKING LENGTH DETERMINATION

Dr.Urusa InamdarLeave a comment

Written by : Dr. Urusa I Inamdar

Diagnostic radiograph of tooth used to estimate the working length by measuring the tooth from a stable occlusal reference point till radiographic apex

Subtract atleast 1 mm from this length as minor constriction is present short of the anatomic apex and compensation for radiographic image distortion.

This measurement is transferred to a diagnostic instrument with a silicon stop then placed in the root canal and working length radiograph is taken.

Now measure the difference between the end of the instrument and radiographic apex of the root , on the radiograph.

Tip of the instrument ends 0.5 mm – 1 mm from the radiographic root apex – working length established .

  • Short of the radiographic apex by more than 1.0 mm – then add this value to the earlier estimated length and adjust the stopper on diagnostic instrument accordingly.
  • Beyond the radiographic apex – reduce this value from the earlier estimated length and adjust the stopper on diagnostic instrument.

Retake the working length radiograph .

Weine’s modification:

  • If periapical bone resorption is evident in a radiograph , the working length should be reduced 1.5 mm short of the radiographic apex as the apical constriction would have been destroyed by the resorption .
  • If apical root resorption is seen , the working length is reduced to 2 mm short of the radiographic apex , in such an event , an apical stop is created short of the radiographic apex to prevent overinstrumentation and subsequent overfilling of the root canal .

https://youtu.be/fcKelPcZzds

Reference:

  • Grossman’s Endodontic Practice (13th edition)
  • Dental notes
  • Youtube.com

NON -CARIOUS CERVICAL LESIONS:

harshulsingh1 Comment
TYPES OF NON-CARIOUS CERVICAL LESION
  1. EROSION:
  • EROSION
  • EROSION

2. ABRASION:

ABRASION

3. ABFRACTION:

ABFRACTION

MANAGEMENT:

REFERENCES:

  • Clinical Operative Dentistry & Principles, Ramya Raghu(2nd Edition)
  • pocketdentistry.com
  • ResearchGate.com
  • Dr.Joe NT Nguyens DDS
  • DentalNews.com
  • Youtube.com
  • Healthline.com
  • DentalArcade.com
  • DentaGama.com

LAWS OF ACCESS OPENING

Dr.Urusa InamdarLeave a comment

Written by : Dr. Urusa I Inamdar

Krasner and Rankow’s Laws of Access Opening

  • Law of centrality : The floor of the pulp chamber is always located in the center of the tooth at the level of the CEJ .
  • Law of concentricity : The walls of the pulp chamber are always concentric to the external surface of the tooth at the level of the CEJ .
  • Law of the CEJ : The distance from the external surface of the clinical crown to the wall of the pulp chamber is the same throughout the circumference of the tooth at the level of CEJ .
  • Law of symmetry 1 : Except for maxillary molars , the orifices of the canals are equidistant from a line drawn in a mesiodistal direction through the pulp chamber floor .
  • Law of symmetry 2 : Except for maxillary molars , the orifices of the canals lie on a line perpendicular to a line drawn in a mesiodistal direction across the center of the floor of the pulp chamber .
  • Law of color change : The color of the pulp chamber floor is always darker than the walls .
  • Law of orifices location 1 : The orifices of the root canals are always located at the junction of the walls and the floor .
  • Law of orifices location 2 : The orifices of the root canals are located at angles in the floor – wall junction .
  • Law of orifices location 3 : The orifices of the root canals are located at the terminus of the root developmental fusion lines .
Law of Centrality
Law of concentricity
Law of symmetry
Orifice location

References:

  • Dental notes
  • Grossman’s Endodontic Practice (13th edition)
  • Google search

ADAMS CLASP

harshulsinghLeave a comment


• The Adams clasp was first described by Professor Phillip Adams.
• It is also known as Liverpool clasp, universal clasp and modified arrowhead clasp.
• When properly constructed this clasp offers maximum retention.
• The clasp is constructed using 0.7mm hard round stainless steel wire.

The Adams clasp is made of the following parts:
a) Two arrowheads
b) Bridge
c) Two retentive arms.
The two arrowheads engage the mesial and the distal proximal undercuts.
The arrow head are connected to each other by a bridge that is at 45° to the long axis of the tooth.

ADVANTAGES:
• It is rigid and offers excellent retention.
• It can be fabricated on deciduous as well as permanent teeth.
• TheyThey can be used on partially or fully erupted teeth.
• It can be used on molars, premolars and on incision.
• No specialized instrument is needed to fabricate the clasp.
• Young’s universal pliers that are used routinely for most wire bending can be used.

  • It is small and occupies minimum space.
  • The clasp can be modified in a number of ways.


MODIFICATIONS:
• The Adams clasp can be modified in a number of ways.
• These modification is permit additional uses or enhanced retention.
• The following are some of the modifications of Adams clasp:

Adams with single arrowhead:


• The Adams clasp cam be modified to have a single arrowhead.
• This type of clasp is indicated in a partially erupted tooth, which usually is the last erupted molar.
• The single arrowhead is made to engage the mesio – proximal undercut of the list erupted molar.
• The bridge is modified to encircle the tooth distally and ends on the palatal aspect as a retentive arrowhead.

Adams with J Hook:


• A Hook can be soldered on to the bridge of the Adams clasp.
• These hooks are useful in engaging elastics.
• Adams with incorporated helix: A helix can be inc porated into the bridge of the Adams clasp This helps in engaging elastics.
Adams with additional arrowhead:
• Adams clasp can be constructed with an additional arrowhead.
• The additional arrowhead engages the proximal undercut of the adjacent tooth and is soldered on to the bridge of the Adams.
• This type of clasp offers additional retention.

Adams with additional arrowhead:

  • Adams clasp can be constructed with an additional arrowhead.
  • The additional arrowhead engages the proximal undercut of the adjacent tooth and is soldered on to the bridge of the Adams.
  • This type of clasp offers additional retention.

Adams With Incorporated Helix:

  • A helix can be incor porated into the bridge of the Adams clasp.
  • This also helps in engaging elastics.

Adams with soldered buccal tube:


• A buccal tube can be soldered on to the bridge of the Adams clasp.
• This modification permits use of extra-oral anchorage using face bow- headgear assembly .
Adams with distal extension:
• The Adams clasp can be modified so that the distal arrowhead has a small extension incorporated distally.
• This distal extension helps in engaging elastics.

Adams With Distal Extension:

  • The Adams clasp can be modified so that the distal arrowhead has a small extension incorporated distally.
  • This distal extension helps in engaging elastics.

Adams on incisors and premolars:

• Adams clasp can be fabricated on the incisors and premolars when retention in those areas is required.
• They can be constructed to span a single tooth or two teeth.

DISADVANTAGES:
• Needs special arrowhead forming pliers the o fabricate.
• Occupies a large amount of space on buccal side.
• Arrowheads can injure interdental soft tissues.
• Difficult & time consuming to fabricate.


REFERENCES:
• Orthodontics: The Art & Science,SI Balajhi (7th Edition).
• SlideShare