Third Molar Impaction Extraction

# If impacted 3rd molar is to be extracted in patient planned for bilateral sagittal split osteotomy then extraction should be done:
a) 8-12 weeks after surgery
b) At the time of surgery
c) 1 month after surgery
d) 6 month before surgery

The correct answer is D. 6 months before surgery.

The poor split occurs more in cases where the last molar is removed at the time of surgery. Hence it is advised to have the last molar (if needed) to be removed about 6 months prior to surgery.

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Ecchymosis and Hematoma Treatment

# Ecchymosis and hematoma are treated with:
a) Intermittent ice pack
b) Continuous ice pack
c) Intermittent hot pack
d) Pressure and pack

The correct answer is: A. Intermittent ice pack

Management of ecchymosis consists of the immediate application of cold followed by heat. In severe cases, antibiotics are given along with proteolytic enzymes which causes break down of coagulated blood.

In the management of hematoma do not apply heat to the area for at least 4 to 6 hours after the incident.

Heat may be applied to the region beginning the next day. Although its benefits are debatable.

Ice may be applied to the region immediately on recognition of a developing hematoma. It acts as

both an analgesic and a vasoconstrictor, and it may aid in minimizing the size of hematoma.

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Jorgensen Technique of IV sedation

# In Jorgensen technique on IV sedation for dental procedure drugs used are:
a) Pentobarbital
b) Meperidine
c) Scopolamine
d) All the above

The correct answer is: D. All of the above.

Jorgenson technique includes intravenous administration of opioids. The drugs used in Jorgenson technique are:
a) Pentobarbital
b) Meperidine
c) Scopolamine (Hyoscine)
d) Pethidine, etc.

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Sublingual Space vs Submandibular Space

# Sublingual space is divided from submandibular space by:
a) Fibres of mylohyoid
b) Submandibular gland
c) Body of mandible
d) Geniohyoid

The correct answer is A. Fibres of Mylohyoid.

The mylohyoid muscle, which forms the floor of the oral cavity, is the key to the diagnosis and surgical management of the infections of the sublingual and submandibular spaces. The submandibular space is separated from the overlying sublingual space by the fibers of the mylohyoid muscle.

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Cavernous Sinus Thrombosis

# Cavernous sinus thrombosis following infection of anterior maxillary teeth most often from spread of infection along:
a) Facial artery
b) Angular artery
c) Ophthalmic vein
d) Pterygoid plexus

The correct answer is C. Ophthalmic vein.

Cavernous thrombosis (CST) is the infectious thrombosis of the cavernous sinus, which is a dural venous space present in the middle cranial fossa on either side of the sella turcica.

• It is a paired sinus, anterior and posterior. Infections to cavernous sinus may spread by two

pathways.

• The anterior route composed of ophthalmic veins and their anastomosis with the facial vein;

the angular vein; the infraorbital vein; and the inferior palpebral vein; readily allows the invasion of the cavernous sinus. Spread of infection by this pathway presents the classic picture of a fulminating cavernous .sin us thrombosis and CST through this route is more common than posterior route.

• The pterygoid venous plexus, which constitutes the posterior route, provide a connection between cavernous sinus and the retromandibular vein.

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Types of Maxillary Major Connectors

TYPE	IMPORTANT FEATURES
Single palatal bar	• Palatal connector component of less than 8mm in width is referred to as a bar • It is the least logical of all palatal connectors • To maintain rigidity it has to be made bulky • Derives least support from the palate .
Palatal strap	• It has suitable rigidity without excessive bulk • Its width should be increased as the edentulous span increases in length . • It is best suited for short span, tooth supported edentulous areas .
Anteroposterior Palatal Bar (double palatal bar)	• In comparison to the amount of soft tissue coverage, it is by far the most rigid palatal major connector • It is indicated in the presence of a torus that is not to be removed . • Anterior bar is narrower than the width of palatal strap. • Posterior bar is half oval; its width is equal to single palatal bar but less. bulky . • Derives least support from the bony palate • Not indicated in high narrow palatal vault and if the remaining teeth are periodontally weak
Anteroposterior Palatal Strap (Closed horse shoe)	• It is indicated in almost any maxillary partial denture design . • Structurally it is the rigid palatal major connector . • The anterior border should be located posteriorly in the valleys between the rugae crests . • Posterior border located at junction of hard and soft palates . • It is the best designed palatal major connector.
U shaped or Horse Shoe shaped	• Least desirable palatal major connector . • Poorest designed palatal major connector because it lacks rigidity • This is indicated only in cases of inoperable tori extending to the posterior limit of t he hard palate . • It lacks rigidity • This design leads to increased flexibility and movement at the open ends . • The wider the coverage, the more it resemble a complete palate (palatal plate)
Complete Palate (Palatal plate)	• It is the major connector that provides greatest retention . • Due to accuracy and stability of the cast metal, posterior palatal seal is not necessary. • The posterior border extends to the junction of the soft and hard palate . • It is indicated when anterior or posterior teeth are to be replaced bilaterally .

Stress breaker in Partial Dentures

# Disadvantage of using a stress breaker in partial dentures is:
a) The partial denture becomes cumbersome
b) Ridge resorption occurs
c) Its is not economical
d) No disadvantages present

The correct answer is B. Ridge resorption occurs.

Stress breaker or equalizer is a device that allows some movement between the denture base and the direct retainer. This type of design protects the vulnerable abutment teeth and concentrates more stresses on the residual ridge.

Its disadvantages are:

• Increased residual ridge resorption

• Difficulty to fabricate and repair

• Less tolerated by the patient

• The need for frequent relining

• High cost

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