GD 3 Study Guide PDF

Craniofacial Growth and Development (Pt 1, 2, 3) ​ Key concepts: ○​ Well-documented norms for many aspects of craniofacial growth ○​ Growth is variable ○​ Growth can hinder or help treatment ○​ Growth is lifelong ​ Growth: increase in size ​ Developme...

Craniofacial Growth and Development (Pt 1, 2, 3) ​ Key concepts: ○​ Well-documented norms for many aspects of craniofacial growth ○​ Growth is variable ○​ Growth can hinder or help treatment ○​ Growth is lifelong ​ Growth: increase in size ​ Development: increase in complexity of structure and function ​ Wolff’s law: form follows function ​ Define hyperplasia, hypertrophy, displacement, remodeling, deposition, resorption ○​ Hyperplasia: physiological increase in number of cells (ex: glandular tissue, cartilage AND bone) ​ Bone ONLY goes under hyperplasia ​ Cartilage ​ Increased production of extracellular matrix ○​ Hypertrophy: physiological increase in size of the cells (ex: muscle and chondrocytes) ​ Cartilage ○​ Remodeling: changes in shape due to patterned zones of resorption and deposition ○​ Displacement: relative movement of a bony structure due to resorption on one surface and deposition on the opposite surface ○​ Deposition: bone formation via osteoblastic activity ○​ Resoprtion: bone removal via osteoclastic activity ○​ Endochondral: pre-existing cartilage model ​ Ex: mandibular condyle ○​ Intra-membranous: pre-existing connective tissue ​ Ex: cranial vault, maxilla, most mandible ○​ Interstitial growth: from within ○​ Appositional growth: at surfaces ○​ Cartilage can grow interstitially and appositionally ○​ Bone can only grow appositionally ​ Describe overall timing and patterns of growth of maxilla, mandible, cranial base ○​ Cranial base: finishes growth early in child’s life so can be used as plane of reference for changes in other structures ​ Midline structures are endochondral in origin with very complex resorptive and appositional patterns ​ Lateral structures are intra-membranous and have moderately complex remodeling features ​ Cranial vault entirely intra-membranous with simple remodeling patterns ​ ​  ​ ○​ Maxilla: downward and forward relative to the cranial base ​ Bone added in tuberosity area and at the posterior & superior structures ​ Resorption at the anterior surfaces of the maxilla ○​ Mandible: downward and forward relative to the cranial base ​ Longest, Largest, Last ​ Grows more and longer than maxilla ​ Shows more variation in growth than the maxilla ​ Remodeling leads to posterior relocation of the ramus and resorption causes formation of the chin ​ Condyles grow up and back to allow mandible to move down and forward ​  ​ ​ Understand relationship between statural growth and craniofacial growth ○​ Newborn: neurocranium is half and face is the other half ○​ Adult: neurocranium is ⅓ and face is ⅔ ○​ Eyes get smaller and the jaw gets bigger ○​ Stature: ​ Boys peak: 13-14 y/o ​ Girls peak: 11-12 y/o ​ Peak mandibular growth usually 6 months behind ​ Be able to interpret growth chart data, and to articulate why growth chart data is useful to clinicians ○​ Sometimes dentist sees child more than primary care so speak up when you see something ○​ Best time to intervene is when the bone is most actively growing ○​ Development of Pediatric Occlusion (Pt 1, 2, 3) ​ Know eruption times and characteristics of the primary dentition ○​ Issues in primary dentition can impact the final occlusion ○​ Primary dentition = foundation for permanent dentition ○​ Succendaneous teeth develop from the same lamina as precursor  ○​ First tooth is mandibular central incisor at about 6 mo. ○​ Last tooth is maxillary 2nd molar at 2 years ○​ ○​ Sequence of eruption is more important than chronological age ​ Know the ages of the early mixed and late dentition stages and what teeth erupt during each ○​ Early mixed dentition stage: after eruption of first molars and incisors ​ Age 6-9 ○​ Late mixed dentition stage: follows eruption of permanent canines and premolars ​ Age 9-12 ​ Permanent maxillary canine travels a long distance so erupt later and more likely to be impacted ​ Canines, premolars, second molar ​ Be able to compare and contrast early and late mesial shifts ○​ Early mesial shift: teeth shift towards the midline ​ Permanent first molars come in behind deciduous molars → mesial push → primate space closed ○​ Late mesial shift: cause permanent molars to move into leeway space, closes leeway space ​ Be able to define: interdental spaces; canine spaces; incisor liability ○​ Interdental spacing: space expected and desired in primary dentition, especially in the anterior teeth ​ Makes crowding of permanent incisors less likely ○​ Incisor liability: the discrepancy between the amount of space available in the dental arch and the space required to accommodate the larger permanent incisors when they replace the smaller primary incisors ○​ Primate space: mesial to maxillary canine and distal to mandibular canine  ​ Closed by early mesial shift ​ Allows intercuspation ○​ Leeway space: deciduous molars and canines wider than permanent premolars and canines ​ ~3mm total space in maxillary arch ​ ~7mm total space in mandibular arch ​ Lost with premature loss of deciduous molars ○​ ○​ ​ Age 0-2: ​ Increase in intercanine distance due to eruption of incisors ​ Increase in arch length due to eruption of molars ​ Age 6: ​ Decrease in arch length due to early mesial shift ​ Increase in intercanine distance with eruption of permanent incisors ​ Increase in arch length in maxilla due to labial inclination of the incisors ​ Age 12:  ​ Decrease in arch length due to using leeway space and late mesial shift ​ No change in intercanine distance ​ Know how to classify primary molar occlusion, as well as likely outcomes for permanent molar occlusion based upon primary molar presentation ○​ Based on distal surfaces of second primary molars ○​ ○​  ○​ ○​ Radiology 3 ​ Bening tumor = new uncontrolled growth that spreads by direct extension and not by metastases ​ What is the most common benign odontogenic tumor? The odontOMA ○​ Surrounded by zone of radiolucency ​ No malignant cementoblastoma ​ ​ ​ Fibro-osseous lesions ○​ Periapical Cemental Dysplasia ​ Common ​ Middle aged (42 y/o) ​ Mandibular anterior teeth ​ 95% African-American or Asian-American women ​ Phase 1: refer to endodontist ​ Phase 2: cementoblastic —-- “target-like” appearance  ​ Phase 3: only harm coming from dentist performing root canal ​ Don’t die from PCD, die with PCD ○​ Florid Osseous Dysplasia ​ Common ​ Middle aged ​ Posterior mandibular teeth ​ Asian-American and African-American women ​ Can spread anteriorly ○​ Fibrous Dysplasia ​ Teenagers ​ Posterior maxilla ​ Slow growing, painless ​ Enlargement of alveolar process ​ Swelling, facial asymmetry ​ Growth ceases after adolescence ○​ Paget’s Disease ​ Abnormal resorption and apposition of osseous tissue ​ May involve many bones (maxilla more common than mandible) ​ 65+ ​ Bone enlargement and deformity ​ May see movement of teeth causing malocclusion, sometimes neurologic pain ​ Confirm with blood tests ​ Trabecular pattern “stretched out” ○​ Cherubism ​ Bilateral swellings at mandibular angles during childhood ​ Posterior mandible ​ Expansion/thinning of cortices ​ Uncommon perforation ​ Tooth displacement, resorption ​ Eyes look up due to built up pressure ​ Can be genetic  ○​ ​ ​ Sialoliths laid down in rings ○​ Starts in the middle and moves out ​ Calcified stylohyoid ligament: ligament runs from stylohyoid to hyoid and closes jaw ○​ Eagle’s Syndrome if pain in the ear ​ Maxillary sinus membrane ○​ Ciliated columnar epithelial cells ○​ Mucous glands on bottom → mucous to throat ○​ Antroliths: calcification within maxillary sinus ​ Could interfere with mucociliary clearance ​ Intraoral imaging ○​ Traditional (film): better resolution than digital ○​ Digital direct (hard sensor): diagnostic equivalent to film, wired  ○​ Digital indirect (imaging plates): no wires Radiology 4 ​ Cyst: fluid-filled pathologic space lined by epithelium ​ Hard sensor for direct instantaneous images ​ Soft sensor for indirect delayed images ​ ​ Digital Image Processing: any operation that acts to improve, correct, analyze, or improve a digital image ○​ Goal: improve diagnostic yield ​ Increasing conspicuity of relevant features ​ Improving accuracy, precision and reliability ​ Obtaining quantitative information ​ Tomography ○​ Computed (computer) – CT or CAT ​ Laying down ​ Takes multiple slices in region of interest ​ Uses x-rays ​ Uses different views: sagittal, coronal, transverse ​ Issues: ​ Takes a longer time ​ High dose ​ Point of service ​ $$$$ ○​ Volumetric (ConeBeam) – CBCT ​ Greater field of view compared to CT  ​ Issues: ​ Doesn’t give you soft tissue ​ ​ ○​ MRI ​ Electromagnetic radiation ​ Can get MRI and CBCT in the same day because different radiation types ​ Best imaging system for soft tissue ​ Not good with bone Emergency Exit ​ Increase in disasters: ○​ Globalization ○​ Increasing population ○​ Development ○​ Climate change ○​ War ○​ Humans ​ Homeland Security Presidential Directive (HSPD) ○​ 4 components: ​ Bio-surveillance ​ Countermeasure stockpiling and distribution ​ Mass casualty care ​ Community resilience ​ NIMS: provides template enabling government, private-sector, and nongovernmental organization to work together to prevent, prepare for, respond to, and recover from domestic incidents ​ Dental professionals train in what skills? ○​ Medical surge capacity ​ inoculation/prophylaxis ​ Walking wounded ​ Worried well ​ With appropriate training ○​ Local supply capacity ​ Alternative treatment site (chairs = beds) ​ Medical supplies (through MOU w/LHD) ​ ​ Needs > resources = disaster ​ Risk = hazard + vulnerability ​ ​ ​ ​ Disaster classifications ○​ Natural: ​ Time-limited, direct deaths ​ May become public health emergency ○​ Human systems failure (technological) ​ Time-limited, causing direct deaths ​ Environmental contamination ○​ Conflict  ​ Prolonged war ​ Terrorism ○​ Severe storm most prevalent in the US ○​  ○​ ○​ Esthetic Parameters ​ Esthetic: proportion, harmony, and unity ​ Beauty: characteristics that provide a perceptual experience of pleasure, meaning, or satisfaction ○​ In the eye of the beholder ○​ Dependent on culture, society or time period, matter of individual subjective preference ​ ​ Facial analysis: ○​ Frontal view: ​ Horizontal reference lines ​ Vertical reference lines ​ Facial thirds ○​ Lateral view: ​ Facial profile ​ Lip position ○​ ○​ ○​ ○​ ○​ ○​ ○​  ○​ ○​ Less teeth seen at rest if you have bigger lips ​ Whites: 2.43 mm ​ Asians: 1.86 mm ​ Black: 1.57 mm ​ Aging decreases amount of maxillary teeth exposure and increases mandibular teeth exposure ​ ​ ​ ​ ​ ​ Gummy smile:  ○​ Altered passive eruption ○​ Short or hyperactive upper lip ○​ Anterior dentoalveolar extrusion ○​ Vertical maxillary excess ​ ​ ​ ​ ​ ​ Dental analysis: ○​ Goal: natural esthetic restoration ○​ Key elements: maxillary anterior teeth ○​ Challenge: establish harmonious distribution of teeth shapes, sizes and proportions ​ ​ Phonetics: “F, V, Th” sounds ​ ​ Golden proportion rarely seen in natural teeth and only preferable for tall teeth ​ ​  ​ ​ ​ Diagnostic tools: ○​ Clinical examinations ○​ Radiographs ○​ Diagnostic wax up ○​ Intraoral mockup ○​ Provisional restorations ○​ Digital photography Psychomotor Skills ​ Review terminology related to cavity preparation ○​ External walls: surrounding walls of a cavity prep take the name of tooth surfaces adjacent to that wall  ○​ Cavosurface angle: angle formed by junction of prepared wall and external surface of the tooth ○​ Cavosurface margin: the margin/edge of the preparation ○​ Outline form: ​ Internal outline form: shape of internal walls ​ External outline form: shape or form of cavosurface margin ○​ Convergence: coming together (buccal and lingual walls) ○​ Divergence: spreading away from each other (mesial & distal walls) ​ Review preparation internal walls ○​ Internal walls: prepared surface that does not extend to external tooth surface ​ Pulpal floor is adjacent to the pulp chamber in the occlusal and incisal cavity preparations ​ Axial wall is adjacent to the pulp in preparations made in the axial surfaces (mesial, distal, facial, lingual) of teeth ​ Review line angles and point angles ○​ Line angle: junction of two walls ○​ Point angle: junction of 3 or more walls ​ Nomenclature: ​ Drop the last two letters of walls except the name of the last-named wall and substitute the letter “O” ​ Ex: distopulpal line angle instead of distalpulpal line angle ○​ If first letter of next word is “o” use a hyphen (ex: axiomesio-occlusal) ​ Introduce evaluation criteria ○​ ​ Discuss handpieces ○​ Tools: periodontal probe, Thompson condenser, high-speed handpiece, #329MW (pear) and #1169 (tapered)  ○​ Class 1 Occlusaal Amalgam Preparation ​ Restoration is when a lesion has caused damage to the tooth structure and is not reversible due to the extent ​ Prep types: ○​ Conventional: ​ Specific wall forms, depth, margin design ​ Due to restorative material properties (ex: amalgam, metal and ceramic restorations) ○​ Modified: ​ ONLY the removal of the defect ​ No specific wall design, depth, marginal form, or additional retentive features are needed ​ Bc of resin composite and bonding systems (ex: resin composite) ○​ GV black steps to cavity prep: ​ Establish outline form ​ Obtain resistance form ​ Obtain retention form ​ Obtain convenience form ​ Remove remaining infected dentin or prior restorative material ​ Finish enamel walls and the cavosurface margins ​ Clean the prep ○​ WE DO NOT PRACTICE EXTENSION FOR PREVENTION IN MODERN TIMES ○​ WE DO PRACTICE MINIMALLY INVASIVE RESTORATIVE DENTISTRY WHENEVER POSSIBLE ○​ Our steps: ​ Initial prep: ​ Outline form and initial depth ​ Resistance form ​ Retention form ​ Convenience form ​ Final prep: ​ Remove remaining infected dentin and/or prior restorative material ​ Pulp protection ​ Refine enamel walls and cavosurface margins ​ Clean and inspect ○​ Establishing outline form: ​ Carious structure should be removed, influenced by groove pattern  ​ Margins should be placed on sound tooth structure ​ Also based on properties of amalgam ○​ Clinical depth: 0.25-0.5 mm into dentin (no enamel can remain on pulpal floor) ○​ Pre-clinic depth: 1.5-2 mm ○​ Resistance form: shape and placement of preparation walls that best enable the restoration to withstand masticatory forces delivered principally in the long axis of the tooth (prevent fracture of tooth or restoration) ​ 1.5 mm marginal ridge maintained ​ Mesial and distal walls divergent ​ Narrow isthmus ​ Flat pulpal floor ​ Rounded internal line angles ​ Sufficient depth ○​ Retention form: the shape of the prepared cavity that resists displacement or removal of the restoration from tipping or lifting forces (prevents dislodgement) ​ Convergent buccal and lingual walls ​ Dovetails to prevent lateral displacement ○​ Convenience form: the shape or form of the cavity that provides for adequate observation, accessibility, and ease of operation in preparing and restoring a cavity (access to all areas and restore prep) EBD Levels of Evidence ​ 5 steps of EBD ○​ Formulating searchable question ○​ Searching the literature efficiently ○​ Appraising the literature CRITICALLY ​ Study design and level of evidence ​ Summary of methods and materials ​ Conclusion ​ Strengths and limitations ○​ Applying the result to clinical practice and patient ○​ Evaluating the outcomes of the applied evidence in your practice or patient ​ ​ Editorials, expert opinion ○​ Little to no evidence to substantiate position ○​ What you often get in consultations, articles, CE courses ○​ Poses questions that could lead to meaningful study ​ Case study report/study ○​ Usually single individual or specific group ○​ Usually involves: ​ Interesting diagnosis ​ Unusual presentation or outcomes ​ Unique intervention ​ atypical/abnormal developments ​ Emerging disease/condition ​ Case series: multiple case reports ○​ Report on a series of patients with an outcome of interest, no control group involved ○​ Relatively weak evidence of study types, since they describe a relatively small number of patients, and no experimental intervention is involved ○​ Basis for future research using stronger evidence study designs ​ Case-Control Studies ○​ Observational, retrospective study ○​ Identify patients who have the outcome of interest and control patients without the same outcome ○​ Looks back to see if they had the exposure of interest ○​ Relying on people’s memories or incomplete records, making them prone to error, and difficult to measure the exact amount of exposure in the past ​ Cohort Studies ○​ ○​ Observational. prospective/retrospective study ○​ Involves identification of two groups/cohorts of patients, one that received the exposure of interest, and one did not  ○​ Follows cohort forwards for outcome of interest ○​ Similar to randomized control trial but differs in one very significant way: the researchers do not assign the exposure or randomize the groups in any way. RCT is experimental and cohort studies are observational ○​ ​ Randomized Control Trials ○​ Experimental, prospective study ○​ Participants are randomly assigned into experimental group or a control group ○​ Follows subjects over time for variables or outcomes of interest ○​ Study participantsare randomly assigned to ensure that each participant has an equal chance of being assigned to an experimental or control group ​ Lots of drug trials ​ Systemic reviews (meta-analysis) ○​ Summary or medical literature that uses explicit methods to perform a comprehensive literature search and critical appraisal of individual studies ○​ Literature is selected based on well-defined inclusion data ○​ Attempt to find all research on a topic, published and unpublished and combine the research into a single analysis ○​ “Systemic reviews” hone in on specific topic/question ○​ “Review” articles provide a broad overview on a topic to answer background questions does not attempt to find all existing knowledge on a topic ​ Other study designs ○​ Cross-sectional studies: the observation of a population as a single moment in time  ○​ Animal research studies: conducted using animal subjects instead of people ○​ In vitro: in test tube/controlled environment ​ ​ Internal validity: refers to how well an experiment is designed and performed ○​ Less confounding variables with well-executed experiment ○​ High internal validity = reader more confident with results, LOW bias, well-designed experiment ​ Cause = effect relationship ○​ ○​ ○​ Randomized control trials minimize bias THE MOST  ​ External validity: how well data translates to other settings, environment, and larger population ○​ High external validity = relates well to different populations ○​ EBD CAT ​ 5 steps of EBD ○​ Formulating searchable question ​ P: population/problem/patient ​ I: intervention (new) ​ C: comparison (positive/negative control) ​ O: outcome (specific & quantifiable) ○​ Searching the literature efficiently ○​ Appraising the literature CRITICALLY ○​ Applying the result to clinical practice and patient ○​ Evaluating the outcomes of the applied evidence in your practice or patient ​ A MeSH term is a Medical Subject Heading ​ ​