All are features of Keratocystic odontogenic tumor EXCEPT:

# All are features of Keratocystic odontogenic tumor EXCEPT:

A. Most common location is the posterior body of the mandible

B. Shows evidence of a cortical border, when not secondarily infected

C. Internal structure is most commonly radiopaque

D. Curved internal septa may be present

The correct answer is C. Internal structure is most commonly radioopaque.

Keratocystic odontogenic tumors (KCOTs) are benign but locally aggressive lesions. Their radiographic appearance is typically:

Radiolucent: KCOTs appear as dark areas on radiographs, indicating that they are less dense than the surrounding bone.

Well-defined borders: They usually have clear and distinct margins.

Unilocular or multilocular: They can be single-chambered (unilocular) or multi-chambered (multilocular).

Scalloped borders: The edges of the lesion may have a wavy or scalloped appearance.

Curved septa: If multilocular, the internal septa may appear curved.

Reference:

Odontogenic keratocyst | Radiology Reference Article | Radiopaedia.org: https://radiopaedia.org/articles/odontogenic-keratocyst

# Soldering and welding is not possible in:

 # Soldering and welding is not possible in:

Stainless steel wire

Elgiloy

Nitinol

TMA

The correct answer is C. Nitinol.

Limitations of NiTi wires

NiTi wires have very low formability in the clinical setting. These wires cannot be welded or soldered due to the passivating nature of titanium dioxide which is strongly adhered to the metal surface. The frictional forces in the nitinol wire are very high due to high Ti content, and therefore these wires are unsuitable for sliding tooth movements such as retraction on the wire.

NiTi wires have highest nickel content among the appliances used in orthodontics which is 55%. Although they are greatly biocompatible, however, high nickel content could be disadvantageous by causing hypersensitive reactions.

Reference: Orthodontics: Diagnosis and management of malocclusion and dentofacial deformities, OP Kharbanda, 2020

STOP USING DABUR LAL DANT MANJAN ! Why you should not use Dabur Lal Dant Manjan?

 Dabur Lal Dant Manjan is not fluoridated. It is an Ayurvedic toothpaste made with traditional herbs and ingredients. While it's popular in many countries, including India, its legal sale in the USA might be limited due to the lack of fluoride, which is a standard ingredient in toothpaste for cavity prevention.

Here's why it's still sold legally in many countries:

Cultural Preference: Ayurvedic practices are deeply ingrained in many cultures, and people trust and prefer traditional remedies like Dabur Lal Dant Manjan.

Alternative Ingredients: While not containing fluoride, Dabur Lal Dant Manjan includes ingredients like clove and other herbs that are believed to have antibacterial and oral health benefits.

Focus on Gum Health: Some users believe that the toothpaste is effective in maintaining gum health and preventing gum diseases.

Lack of Awareness: In some regions, there might be a lack of awareness about the importance of fluoride in preventing tooth decay.

Important Note: The American Dental Association (ADA) recommends using toothpaste with fluoride for effective cavity prevention. If you're concerned about tooth decay, consult your dentist for advice on the most suitable toothpaste for your oral health needs.

A 17 year old male, who has been using Dabur Lal Dant Manjan since his early childhood and has never used fluoridated toothpaste has developed dental caries as depicted in the image below. Though there could be many other contributory factors like poor oral hygiene, low salivary flow, mouth breathing habit, use of drugs causing xerostomia, radiation-induced salivary gland aplasia or some unknown factors, use of fluoridated toothpaste could have reduced the severity of the decay.

The contour of the incisal edges of the maxillary anterior teeth relative to the curvature of the lower lip during a social smile is called:

# The contour of the incisal edges of the maxillary anterior teeth relative to the curvature of the lower lip during a social smile is called:

Line of occlusion

b. Curve of Spee

c. Curve of Monson

d. Smile arc

The correct answer is D. Smile arc.

The smile arc is defined as the contour of the incisal edges of the maxillary anterior teeth relative to the curvature of the lower lip during a social smile. For best appearance, the contour of the incisal edges of these teeth should parallel the curvature of the lower lip. If the lip and dental contours match, they are said to be consonant.

A flattened (non-consonant) smile arc can pose either or both of two problems: It is less attractive, and it tends to make you look older (because older individuals often have wear of the incisors that tends to flatten the arc of the teeth). The characteristics of the smile arc must be monitored during orthodontic treatment because it is surprisingly easy to flatten it in the pursuit of other treatment objectives. The data indicate that the most important factor in smile esthetics, the only one that can change the rating of a smile from acceptable to unesthetic, is the smile arc.

Ref: Contemporary Orthodontics, William R. Proffit, 6th Edition.

# Concept of cortical anchorage given by:

# Concept of cortical anchorage given by:

a. Angle 

b. Kingsley 

c. Ricketts 

d. Newton 

The correct answer is C. Ricketts. 

Rickets technique by intentionally bringing the buccal roots of the anchor teeth into contact with the cortical plates of bone thus increasing the anchorage value of such teeth. It should be appreciated that this process should be carried out with great care and precision since overzealous torque can produce root resorption or in extreme cases cortical perforation. (Brezniak& Wasserstein, 2008)

One of the following procedures falls under high bacteremia risk for infective endocarditis:

 

# One of the following procedures falls under high bacteremia risk for infective endocarditis: 

a. Post-operative suture removal 

b. Intraligamentary and intra-osseous local anesthetics injections 

c. Intracanal endodontic treatment 

d. Placement/ removal of removable orthodontic appliances 

The correct answer is B. Intraligamentary and intra-osseous local anesthetics injections.

All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa are the procedures for which endocarditis prophylaxis is reasonable.

The following procedures and events do not need prophylaxis: 

• routine anesthetic injections through noninfected tissue,  
• taking dental radiographs, 
• placement of removable prosthodontic or orthodontic appliances, 
• adjustment of orthodontic appliances, 
• placement of orthodontic brackets, 
• shedding of deciduous teeth, 
• and bleeding from trauma to the lips or oral mucosa. 

Fenestration as an adverse effect of Fixed Orthodontic Treatment

 Fenestration is a notable adverse effect associated with fixed orthodontic treatment. It refers to the formation of a window-like defect in the alveolar bone, where the root of a tooth becomes partially exposed due to the bone's resorption. This condition can occur when excessive or improperly directed orthodontic forces are applied, causing the tooth to move outside the limits of the alveolar bone housing.

The main factors contributing to fenestration include:

Excessive Force Application: Applying too much force during orthodontic treatment can lead to undue stress on the bone, resulting in resorption and fenestration.

Unfavorable Tooth Movement: Moving teeth in directions that extend beyond the anatomical boundaries of the alveolar bone can cause this adverse effect.

Pre-existing Bone Deficits: Patients with naturally thin or compromised alveolar bone are more susceptible to fenestration when undergoing orthodontic treatment.

Fenestration above left maxillary canine in a female patient undergoing fixed orthodontic treatment

The clinical implications of fenestration include increased risk of periodontal problems, potential tooth sensitivity, and aesthetic concerns. Early detection and careful planning of orthodontic forces are crucial to minimize the risk of fenestration. Regular monitoring through clinical and radiographic evaluations can help in identifying early signs of this adverse effect, allowing for timely intervention to prevent further complications.

Detecting fenestration clinically involves a combination of visual examination, palpation, and radiographic assessment. Here are the primary methods used:

1. Visual Examination

Gingival Recession: Look for areas where the gum line appears lower than usual, which may indicate underlying bone loss.

Tooth Root Visibility: In severe cases, the root of the tooth might be visible through the gum tissue.

2. Palpation

Probing: Gently probing the gum tissue around the suspected area can help identify soft spots or depressions that suggest bone loss.

Tactile Sensation: Feeling for irregularities in the bone contour by gently pressing the gingiva around the suspected area.

3. Radiographic Assessment

Intraoral Periapical Radiographs: These provide detailed images of the tooth and surrounding bone, which can help identify areas of bone loss.

Cone Beam Computed Tomography (CBCT): Offers a three-dimensional view of the alveolar bone, making it easier to detect fenestration accurately.

Panoramic Radiographs: These can be used for a broader view, though they are less detailed compared to periapical radiographs and CBCT.

4. Additional Diagnostic Tools

Periodontal Probing Depths: Increased probing depths around a tooth can indicate bone loss.

Bone Scanning: In some cases, advanced imaging techniques like bone scans might be used for a more detailed assessment.

Clinical Signs to Watch For

Localized Inflammation: Swelling or redness around the affected area.

Pain or Discomfort: Patients may report unusual sensitivity or pain in the area, especially when pressure is applied.

Changes in Tooth Position: Shifts in tooth alignment may also indicate underlying bone issues.

Regular follow-up appointments and careful monitoring are essential for early detection and management of fenestration during orthodontic treatment.