Preserve ridge for anterior implants
Bone grafting - repair (GBR), rebuild (fenestration, dehiscence), restore
Medications such as bisphosphonates stop osteoclastic activity, affect succes rate of grafting
soft tissue grafting - if interdental papilla is of gd height, gd chance of success
narrow defect better chance to restore
V shape better than U shape
healing - revascularisation 3-11 days, tissue maturation 11-42 days, 30% shrinkage, therefore usually over contour
Monday, April 27, 2009
pfm vs full porcelain -wkm
anterior full porcelain - 100% success rate
posterior full porcelain - 95%
Posterior - bruxism better to use metal esp 2nd molar, if porcelain must have enough reduction
anterior zirconia base - 0.4mm, posterior 0.6mm
to have sufficient space for papilla, there should be 5mm from crown contact pt to bone(bone sounding)
empress I is good for anterior, except discoloured teeth, can try bleaching agents under temp crown
procera strongest, 5 year warranty
cementing for gd tooth structure, use cr, if sclerotic dentine, use rmgic (luting agent)
when using retraction cord, min. put on for 4mins
to trim sub G prep, trim to gingiva, put retraction cord then trim again to prevent gg past biological width
cerac is good for inlay/onlay only, poor strength
pfm definitely no for anterior aesthetic zone, blocks light
if papilla shrink due to poor proV, recreate the space in final crowns and papilla will grow back, DO NOT add porcelain to cover the space as the papilla will be compressed.
its ok for zirconia base to be exposed, white so no need to over prep
posterior full porcelain - 95%
Posterior - bruxism better to use metal esp 2nd molar, if porcelain must have enough reduction
anterior zirconia base - 0.4mm, posterior 0.6mm
to have sufficient space for papilla, there should be 5mm from crown contact pt to bone(bone sounding)
empress I is good for anterior, except discoloured teeth, can try bleaching agents under temp crown
procera strongest, 5 year warranty
cementing for gd tooth structure, use cr, if sclerotic dentine, use rmgic (luting agent)
when using retraction cord, min. put on for 4mins
to trim sub G prep, trim to gingiva, put retraction cord then trim again to prevent gg past biological width
cerac is good for inlay/onlay only, poor strength
pfm definitely no for anterior aesthetic zone, blocks light
if papilla shrink due to poor proV, recreate the space in final crowns and papilla will grow back, DO NOT add porcelain to cover the space as the papilla will be compressed.
its ok for zirconia base to be exposed, white so no need to over prep
Monday, February 9, 2009
Other causes of Pain (feel free to add)
Pain
1) Dentin pain - brief, sharp twinge
2) Pulpal pain - deep, demanding, radiating pain precipitated by thermal shock to an inflamed pulp. pain may be spontaneous
3) Periodontal pain - The aggravating throbbing of a sore tooth.
Crack Tooth Syndrome
s/s: pain on biting, TTP, Wedge test +ve(not always), sensitive to cold air/water/sweets, , may be pulpitic
tx: molar band may be used to confirm diagnosis followed by crown or rct + crown
Sinusitis
s/s: TTP(upper molars), history of runny nose, morning sinusitis, pain when walking down stairs
x-ray - cloudy sinus on affected side, apex of molar root near or into sinus space
tx: exlude all other causes of pain, referral to ent or
acute: prescribe antibiotics (augmentin useful), antihistamines/decongestants, review, kiv rct/exo
chronic: nasal irrigation
Trigeminal Neuralgia
s/s: intense pain(burning or shock-like) on touch(skin) or movement, one sided. lasts anywhere from a few seconds to as long as 2 minutes per episode
tx:
1)Medication - Anticonvulsant medicines (carbamazepine), Tricyclic antidepressants (amitriptyline)
2)neurosurgical procedures.
-A rhizotomy is a procedure in which select nerve fibers are destroyed to block pain. A rhizotomy for TN causes some degree of permanent sensory loss and facial numbness.
1) Dentin pain - brief, sharp twinge
2) Pulpal pain - deep, demanding, radiating pain precipitated by thermal shock to an inflamed pulp. pain may be spontaneous
3) Periodontal pain - The aggravating throbbing of a sore tooth.
Crack Tooth Syndrome
s/s: pain on biting, TTP, Wedge test +ve(not always), sensitive to cold air/water/sweets, , may be pulpitic
tx: molar band may be used to confirm diagnosis followed by crown or rct + crown
Sinusitis
s/s: TTP(upper molars), history of runny nose, morning sinusitis, pain when walking down stairs
x-ray - cloudy sinus on affected side, apex of molar root near or into sinus space
tx: exlude all other causes of pain, referral to ent or
acute: prescribe antibiotics (augmentin useful), antihistamines/decongestants, review, kiv rct/exo
chronic: nasal irrigation
Trigeminal Neuralgia
s/s: intense pain(burning or shock-like) on touch(skin) or movement, one sided. lasts anywhere from a few seconds to as long as 2 minutes per episode
tx:
1)Medication - Anticonvulsant medicines (carbamazepine), Tricyclic antidepressants (amitriptyline)
2)neurosurgical procedures.
-A rhizotomy is a procedure in which select nerve fibers are destroyed to block pain. A rhizotomy for TN causes some degree of permanent sensory loss and facial numbness.
- Balloon compression
- Glycerol injection
- Radiofrequency thermal lesioning
- Stereotactic radiosurgery
Sunday, February 8, 2009
Reduced OVD
Signs and symptoms:
- overclosure
- angular cheilitis
- cheek biting
- poor aesthetics, facial profile not supported
- less biting force
Causes:
- generalised attrition of teeth due to old age
- loss of posterior occlusal stops( posterior teeth) over a long period of time.
Tx options:
- Full mouth rehab (full mouth crowns)
- overlay partial dentures.
Note: the posterior occlusal stops of the overlay partial dentures not to be in acrylic, in case of fracture.
- overclosure
- angular cheilitis
- cheek biting
- poor aesthetics, facial profile not supported
- less biting force
Causes:
- generalised attrition of teeth due to old age
- loss of posterior occlusal stops( posterior teeth) over a long period of time.
Tx options:
- Full mouth rehab (full mouth crowns)
- overlay partial dentures.
Note: the posterior occlusal stops of the overlay partial dentures not to be in acrylic, in case of fracture.
Gummy Smile
Treatment options:
1) ortho + orthognathic surgery.
- to determine incisal show at rest. If originally, the incisal show at rest is 3-4mm. (normal) After orthognathic surgery, incisal show at rest will be approx nil. (which gives pt an aged look)
- to discuss with pt on the above and manage pt's expectations.
2) gingivectomy, kiv Crown lengthening.
1) ortho + orthognathic surgery.
- to determine incisal show at rest. If originally, the incisal show at rest is 3-4mm. (normal) After orthognathic surgery, incisal show at rest will be approx nil. (which gives pt an aged look)
- to discuss with pt on the above and manage pt's expectations.
2) gingivectomy, kiv Crown lengthening.
Friday, February 6, 2009
Drugs
Antibiotics
Amoxycillin 500mg tds x5/7
Amoxycillin (125mg/5ml) susp 5ml tds x 5/7 (PEDO)
Co-Trimoxazole Tab (Adult) BP 400mg bd x5/7
Clindamycin 150mg tds x5/7
Erythromycin 400mg bd x 5/7
EES 400 400mg bd x5/7
Clarithromycin 500mg bd x5/7
Metronidazole 400mg tds x7/5
Tetracycline 3% ointment bd prn
AntiFungals
Nystatin oral suspension 100,000 u/ml 1ml qds x1week (continue 48hrs after s/s disappear)
Miconazole oral gel 2% bd prn
Painkillers
Paracetamol 1000mg tds x 5/7
Paracetamol syrup (120mg/5ml) 5ml tds x 5/7(<6yrs)>10yrs)
Anarex 2 tabs tds x 5/7
Mefenamic acid (Ponstan) 500mg tds x 5/7
Ibuprofen 400mg tds x5/7
Diclofenac Sodium 25mg tds x5/7
Codeine Phosphate 30mg tds x5/7
Panadeine 2 tabs tds x5/7
Tramadol 50mg tds x5/7
Anxiolytic & TMD
Diazepam 2mg bd x3/7
Trigeminal Neuralgia
Carbamazepine CR(Tegretol) 200mg bd x3/7
Anti-Emetic
Stemetil 10mg bd x3/7
Anti-Histamines
Chlorpheniramine 4mg tds x3/7
Mouthwash
Chlorhexidine 0.2% 15ml bd x5/7
Difflam mouth gel tds
Difflam Solution 15ml tds
Topical
Triamcinolone oral paste 0.1% tds prn
Kenalog in Orabase bd prn
Oracort E bd prn
Others
Famotidine 20mg bd x5/7
Antacid 1 tab tds prn
Solcoseryl Dental Adhesive paste B79 prn
Danzen 5mg tds x5/7
Dequalinium Lozenges 1loz tds prn
Thursday, February 5, 2009
Heparin Pts (dialysis)
LMW heparins
-surgical procedures can be done 12 hours after administration of last dose
-slow metabolism may occur in presence of significant renal failure
-surgical procedures can be done 12 hours after administration of last dose
-slow metabolism may occur in presence of significant renal failure
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