Termination of skeletal maturity - Indicator

 # Which of the following bone indicates the termination of skeletal maturity?

A. Presence of Sesamoid

B. Appearance of pisiformis

C. Appearance of calcification of hook of hamate

D. Union of diaphysis and epiphysis on radius

The correct answer is D. Union of diaphysis and epiphysis on radius.

Some other important tips:

 * Absence of hamate and pisiform - Still 1 year for prepubertal growth spurt

* Presence of hamular process of the hamate, pisiform and sesamoid- Beginning of  growth spurt

* Initial ossification of  sesamoid - Peak pubertal growth spurt

* The epiphysis and diaphysis fusion/ ossification of sesamoid completed - Prepubertal growth spurt completed

* The epiphysis and diaphysis fusion on radius and ulna- Active growth completed

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Fishman’s index is used in relation with:

 # Fishman’s index is used in relation with:

A. Population

B. Hand-wrist radiographs

C. Cephalograms 

D. Periodontal diseases

The correct answer is B. Hand-wrist radiographs.

The following are the most commonly used methods for determination of skeletal maturity through hand-wrist xrays: 

- Atlas method by Greulich and Pyle

- Bjork Grave and Brown method

- Singer's method of assessment

- Fishman's skeletal maturity indicators

- Hagg and Taranger method

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Carpal radiograph is used for assessment of:

 # Carpal radiograph is used for assessment of:

A. Bone condition

B. Chronological age

C. Treatment plan

D. Skeletal maturation

The correct answer is: D. Skeletal Maturation.

There are different methods to assess the skeletal maturity of an indivudual which include:

1. Use of hand wrist radiographs

2. Evaluation of skeletal maturation using cervical vertebrae

3. Assessment of maturity by clinical and radiographic examination of different stages of tooth (Lower third molar)

Hand wrist radiograph is the most reliable among all these. 

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Vestibuloplasty procedure

 # A vestibuloplasty procedure is performed by:

A. Reducing buccal bone from the alveolar ridge with a barrel bur and a handpiece

B. Apically repositioning the muscular and mucosal attachments of the mandible

C. Reflecting the gingiva and using Rongeurs to remove bone from the alveolar crest

D. Using a bone file to smooth rough bony projections

E. Grafting harvested iliac or rib bone onto the alveolar process

The correct answer is B. Apically repositioning the muscular and mucosal attachments of the mandible

Vestibuloplasty is a procedure performed to lengthen the residual ridge and deepen the oral vestibule.

A vestibuloplasty can only be achieved by relocating or repositioning the muscle attachments and mucous membrane covering it into a deeper or more apical position. 

Vestibuloplasties are also accompanied with the use of a mucosal graft or a skin graft. 

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Most ideal finish line configuration for a porcelain veneer:

 # The most ideal finish line configuration for a porcelain veneer is:

A. Feather

B. Chamfer

C. Shoulder

D. Chisel

The correct answer is: C. Shoulder.

#Shoulder Finish Line

Indications: • All ceramic crowns • PFM crowns • Injectable porcelains 

Advantages:  • Good crown contours • Esthetics  • Less distortion • Provides adequate bulk

Disadvantages: • Least conservative • Inferior marginal adaptation

# Shoulder with bevel Finish Line

Indications: • Proximal boxes of onlays and inlays • Labial finish line of metal ceramics • Occlusal shoulder of onlays 

Advantages:  • Superior marginal adaptation • Resists distortion • Facilitates removal of unsupported enamel rods

Disadvantages: • Requires subgingival extension • Detection of post cementation caries is difficult

# Chamfer Finish Line

Indications: • Cast metal restorations • Lingual aspect of metal ceramics

Advantages:  • Conservative • Good marginal adaptation • Provides bulk

Disadvantages: • Improper fabrication may result in an unsupported tip

# Knife edge Finish Line

Indications: • Young patients • MOD onlay • Inaccessible areas • Finish lines in cementum

Advantages:  • Conservative • Ideal for marginal adaptation 

Disadvantages: • Does not provide a distinct finish line • Waxing, polishing and casting becomes critical • Overcontoured restoration in an attempt to obtain bulk

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Preferred gingival finish line for veneer metal restoration

 # The preferred gingival finish line for veneer metal restoration is:

a) Shoulder 

b) Chamfer

c) Shoulder with bevel 

d) Radial shoulder

The correct answer is B. Chamfer.

#Shoulder Finish Line

Indications: • All ceramic crowns • PFM crowns • Injectable porcelains 

Advantages:  • Good crown contours • Esthetics  • Less distortion • Provides adequate bulk

Disadvantages: • Least conservative • Inferior marginal adaptation

# Shoulder with bevel Finish Line

Indications: • Proximal boxes of onlays and inlays • Labial finish line of metal ceramics • Occlusal shoulder of onlays 

Advantages:  • Superior marginal adaptation • Resists distortion • Facilitates removal of unsupported enamel rods

Disadvantages: • Requires subgingival extension • Detection of post cementation caries is difficult

# Chamfer Finish Line

Indications: • Cast metal restorations • Lingual aspect of metal ceramics

Advantages:  • Conservative • Good marginal adaptation • Provides bulk

Disadvantages: • Improper fabrication may result in an unsupported tip

# Knife edge Finish Line

Indications: • Young patients • MOD onlay • Inaccessible areas • Finish lines in cementum

Advantages:  • Conservative • Ideal for marginal adaptation 

Disadvantages: • Does not provide a distinct finish line • Waxing, polishing and casting becomes critical • Overcontoured restoration in an attempt to obtain bulk

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Partial veneer crown is contraindicated in:

 # Partial veneer crown is contraindicated in:

a) Long teeth 

b) Short teeth

c) Tipped teeth 

d) Tapered teeth

The correct answer is B. Short Teeth.

Indications for partial veneer crown:

• Intact or minimally restored teeth .

• Teeth with normal anatomic crown form i.e., without excessive cervical constriction.

• Teeth with adequate crown Length.

Contraindications for partial veneer crown:

• High caries rate.

• Short teeth.

• Bell shaped teeth.

• Teeth with insufficient buccolingual width.

• Excessively restored teeth.

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