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Haemorrhage Shock And Blood Transfusion Short Question and Answer

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Question 1. Types of shock.

Answer:

Various Types Of Shock Are As Follows:

Haemorrhage Shock And Blood Transfusion Types Of Shock

Question 2. Septic shock.

Answer:

Aetiology:

  • Release of endotoxin by gram-negative organisms.
  • Severe septicaemia.
  • Peritonitis.
  • Meningitis

Haemorrhage shock and blood transfusion Q&A

Question 3. Neurogenic shock.

Answer:

Neurogenic Shock Causes:

  • Paraplegia, quadriplegia.
  • Trauma to the spinal cord.
  • Spinal anaesthesia.

Neurogenic Shock Clinical Features:

  • Skin remains warm, pink and well-perfused.
  • Urinary output – normal.
  • Heart rate is rapid.
  • Blood pressure is decreased.

Question 4. Cardiogenic shock.

Answer:

Cardiogenic Shock Causes:

  • Injury to the heart
  • Myocardial infarction.
  • Cardiac arrhythmia.
  • Congestive cardiac failure.

Cardiogenic Shock Clinical Features:

  • Initially
    • Skin is pale and cool.
    • Urine output reduced.
  • Later
    • Rapid pulse.
    • Hypotension
    • Distended neck veins.
    • The liver is enlarged.
    • The heart becomes enlarged.

Read And Learn More: General Surgery Question and Answers

Question 5. Hypovolaemic shock.

Answer:

Hypovolaemic Shock Causes:

  • Blood and plasma loss
  • Electrolyte loss.

Question 6. Crush Syndrome.

Answer:

Crush Syndrome

It is a symptom complex in which a portion of the body becomes crushed due to a heavy weight falling on that portion and is kept there for some time to crush all the tissues in that portion.

Crush Syndrome Causes:

  • Earthquakes
  • Mine injuries
  • Air raids
  • Collapse of the building.
  • Use of a tourniquet for a longer period.

Crush Syndrome Clinical Features:

  • Extravasation of blood into muscles.
  • Muscles are crushed and swollen.
  • Acute renal tubular necrosis.
  • Reduced urinary output.
  • Tense and painful extremities.

Crush Syndrome Treatment:

  • Application of a tourniquet.
  • Parallel incisions are made to relieve tension.
  • Administration of intravenous fluid.
  • Catheterisation of the bladder.
  • Hemodialysis is a severe condition.

Short questions on haemorrhage and shock

Question 7. Hypokalaemia.

Answer:

Hypokalaemia

Potassium deficiency in the diet is called hypokalemia.

Hypokalaemia Causes:

  • Following trauma.
    • Starvation
    • Loss of gastrointestinal secretion.

Hypokalaemia Clinical features:

  • Gradual onset of drowsiness.
  • Slow and slurred speech.
  • Irritability.
  • Muscular hypotonia and weakness.
  • Absence of deep reflexes.
  • Slow pulse rate.
  • Diminished intestinal motility.
  • Low BP.
  • Skin remains warm and dry.

Hypokalaemia Treatment:

  • Replacement of potassium deficit.

Question 8. Acidosis.

Answer:

Acidosis

An increase in pH leads to acidosis.

Acidosis Types:

  1. Metabolic acidosis.
    • In it, there is a gain or retention of fixed acids or a loss of base.
    • Cause:
      • Diabetic acidosis.
      • Lactic acidosis.
      • Renal insufficiency.
      • Rapid transfusion of bank blood.
      • Diarrhoea.
    • Clinical Features:
      • Increase in rate and depth of breathing.
      • Rapid and noisy respiration.
      • Raised pulse rate and blood pressure.
      • Urine becomes strongly acidic.
    • Treatment:
      • Administration of Ringer’s lactate solution.
  2. Respiratory acidosis.
    • Causes:
      • Lung disorders.
      • Peritonitis
      • Crush injury.
      • Depressed respiratory centre.
      • Airway obstruction.

Acidosis Clinical Features:

  • Slow rise in BP.
  • Abnormal respiration.
  • Restlessness.
  • Hypertension
  • Tachycardia.

Acidosis Treatment:

  • Mechanical ventilation
  • Endotracheal intubation.
  • Avoid over-sedation and over-use of muscle relaxants.

Question 9. Haemorrhage.

Answer:

Haemorrhage

Haemorrhage is defined as the escape of blood from blood vessels.

Haemorrhage Classification:

  1. Based on the bleeding haemorrhage.
    • External and internal.
    • Arterial, venous or capillary.
  2. Based on the time of appearance.
    • Primary – Secondary – Reactionary.

Blood transfusion questions and answers

Question 10. Secondary Haemorrhage.

Answer:

Secondary Haemorrhage

Secondary Haemorrhage is a bleeding that usually occurs after 7-14 days of injury.

Secondary Haemorrhage Causes:

  • Infection.
  • Sloughing part of the arterial wall.

Secondary Haemorrhage Clinical features:

  • Preceded by a warning, haemorrhage staining the dressings.
  • Followed by moderate to severe haemorrhages.

Secondary Haemorrhage Types:

  • Externally – example: at the operation site of haemorrhoids- tomy.
  • Internally, Example: haematemesis following peptic ulcer operation.

Question 11. Hemophilia.

Answer:

Hemophilia

Haemophilia is an X-linked recessive disorder of coagulation factors.

Haemophilia Types:

  1. Haemophilia A-classic haemophilia – due to factor 8 deficiency.
  2. Haemophilia Christmas disease -due to factor 9 deficiency.
  3. Von Willebrand’s disease is due to a deficiency of von Willebrand factor.

Haemophilia Clinical features:

  • Easy bruising
  • Prolonged bleeding.
  • Spontaneous bleeding into subcutaneous tissue.
  • GIT bleeding.
  • Hypotaxis.
  • Recurrent haemarthrosis.
  • Hematuria.
  • Intracranial haemorrhage.

Question 12. Disseminated intravascular coagulation (DIC)

Answer:

Disseminated intravascular coagulation (DIC)

Disseminated intravascular coagulation is a complex thrombo-hemorrhagic disorder occurring as a secondary complication in some systemic diseases.

Pathogenesis:

  • Includes
  1. Activation of coagulation
  2. Thrombotic phase
  3. Consumption phase.
  4. Secondary fibrinolysis.

Question 13. Blood groups.

Answer:

Blood groups

Blood groups are classified based on the presence or absence of specific agglutinogen or antigen on the surface of RBC.

Major blood groups are:

1. ABO system

Haemorrhage Shock And Blood Transfusion Blood Groups

2. Rh blood group.

    • Rh factor is an antigen present in RBC.
    • Persons having the D antigen are called Rh-positive.

Question 14. Rh factor.

Answer:

Rh Factor

  • Rh factor is an antigen present in RBCs.
  • Rh factor was first discovered by Landsteiner and Weiner in rhesus monkey.
  • Rh factor is detected only in RBCs
  • Rh factor is inherited from both parents as homozygous positive DD, heterozygous negative Dd or homozygous negative dd.
  • Rh Antibody is absent in plasma.
  • But its production can be evoked by.
    • Transfusion with Rh-positive blood.
    • The entrance of Rh-positive blood from the foetus into the circulation of the Rh-negative mother.

Types of shock short answer questions

Question 15. Blood Transfusion.

Answer:

Blood Transfusion

Blood Transfusion is a process of transferring blood or blood-based products from one person into the circulatory system of another.

Blood Transfusion Types:

  1. Typical stored CPD blood from the blood bank.
  2. Filtered blood filtered through a membrane with 40 |im pores.
  3. Warm blood is used in cardiopulmonary operations.
  4. Autotransfusion – preserving and then transfusing one’s blood.
  5. Replacement transfusion – used in newborns.

Haemorrhage Shock And Blood Transfusion

Question 16. Indications of blood transfusion.

Answer:

Acute Haemorrhage.

  • During operations, preoperatively and postoperatively.
  • Anaemia.
  • Malnutrition.
  • In severe burns.
  • In coagulation disorders.
  • In erythroblastosis fetalis.
  • During chemotherapy.

Question 17. Complications of blood transfusion.

Answer:

Complications Of Blood Transfusion

  1. Transfusion reactions
    • Incompatibility
    • Pyrexia reactions
    • Allergic reactions
    • Sensitisation to leucocytes and platelets
  2. Transmission of diseases
    • Serum hepatitis
    • AIDS
  3. Reactions caused by massive transfusion.
    • Acid-base imbalance.
    • Hyperkalaemia.
    • Citrate toxicity.
    • Hypothermia.
    • Failure of coagulation.
  4. Complications of over-transfusion.
    • Congestive cardiac failure.
  5. Other complications.
    • Thrombophlebitis
    • Air embolism.

Question 18. Types of haemorrhage

Answer:

Types of Haemorrhage

  1. According to the source
    • External haemorrhage – seen externally
    • Internal haemorrhage – not seen externally
  2. According to the vessels involved
    • Arterial haemorrhage – haemorrhage coming out of the artery
    • Venous haemorrhage – haemorrhage coming out of a vein
    • Capillary haemorrhage – haemorrhage coming out of the capillary
  3. According to the time of appearance
    • Primary haemorrhage – at the time of injury
    • Reactionary haemorrhage – within 24 hours of injury
    • Secondary haemorrhage – after 7-14 days of injury

MCQs on haemorrhage and shock

Question 19. Reactions to blood transfusion

Answer:

Reactions To Blood Transfusion

Haemorrhage Shock And Blood Transfusion Reactions To Bllod Transfusion

Haemorrhage Shock And Blood Transfusion Long Essays

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Haemorrhage Shock And Blood Transfusion Long Essays

Question 1. Classify shock. Describe the pathophysiology, clinical features and management of shocks.

Answer:

Shock:

  • Shock is a condition in which circulation fails to meet the nutritional needs of the cells and fails to remove the metabolic waste products.
  • It is characterised by hypoperfusion and severe dysfunction of vital organs.

Shock Classification:

  1. Haematogenic or hypovolaemic shock.
    • Occurs due to loss of blood, plasma or body water and electrolytes.
    • Caused by haemorrhage, vomiting, diarrhoea, dehydration, etc.
  2. Traumatic shock.
    • Caused by major fractures, crush injuries, burns, extensive soft tissue injuries and intraabdominal injuries.
  3. Neurogenic shock.
    • Caused by paraplegia, quadriplegia, trauma to the spinal cord and spinal anaesthesia.
  4. Cardiogenic shock.
    • Caused by injury to the heart, myocardial infarction or congestive cardiac failure.
  5. Septic shock.
    • Occurs due to gram-negative septicaemia.
  6. Miscellaneous types – includes:
    • Anaphylactic shock.

Physiology: It can be described as 2 processes.

  1. Reduced effective circulating volume.
    • May result in either.
      • By actual loss of blood volume or
      • By decreased cardiac output.
  2. Tissue anoxia.

Haemorrhage shock and blood transfusion long essay

Haemorrhage Shock And Blood Transfusion Reduction In effective Circulating Blood Volume

Shock Clinical features:

Haemorrhage Shock And Blood Transfusion Shock Clinical Features

Management: AIMS:

  • To increase cardiac output.
  • To improve tissue perfusion to vital organs.

Shock Treatment:

  1. Maintenance.
    • Maintain a patent airway and oxygen.
    • Head position – At a low position with the face turned to one side
  2. Control of haemorrhage.
    • Done by elevation, compression bandages or by ligation of blood vessels.
  3. Extracellular fluid replacement.
    • Nonsugar, nonprotein crystalloid is preferred.
    • Normal saline or Ringer’s lactate should be started first.
  4. Correct acid-base disturbance.
  5. Drugs.

Haemorrhage Shock And Blood Transfusion Shock Treatment

Long essay on types of shock and management

Question 2. Describe the pathophysiology, clinical features and treatment of septic shock.

Answer:

Septic Shock:

  • Septic shock is caused by to release of endotoxin in blood, mostly by Gram-negative organisms.
  • Occurs in cases of severe septicaemia, peritonitis or meningitis.
  • Pathophysiology.

Read And Learn More: General Surgery Question and Answers

Presence of gram-positive and gram-negative organisms
↓
Local inflammation occurs
↓
Release of endotoxins from the organism
↓
Activation of neutrophils, monocytes & macrophages.
↓
Release of inflammatory mediators.
↓
Cellular chemotaxis.
↓
Endothelial injury
↓
Activation of the coagulation cascade
↓
Massive fluid loss
↓
Septic shock

Septic Shock Clinical Features:

  • Initially, chills and fever above 100 °C occur.

Septic Shock Types:

  1. Early warm shock.
    • There is cutaneous vasodilation.
    • Body temperature increases
    • Cutaneous vasodilatation occurs.
    • Arterial blood pressure falls.
    • Cardiac output increases.
    • Skin remains warm, pink and well-perfused.
    • Pulse rate increases
  2. Late cold shock.
    • There is increased vascular permeability
    • Cardiac output is decreasing.
    • Hypovolemia occurs.

Septic Shock Treatment:

  • Removal of septic focus.
    • Drainage of pus under anaesthesia.
    • Closure of perforation.
    • Resection of gangrene.
  • Antibiotics.
    • Administered after antibiotic sensitivity tests.
    • Initial antibiotics are
      • Cephalothin – 6 – 8 gm/day IV in 4 – 6 divided doses.
      • Gentamicin – 5 mg/kg/day.
      • Clindamycin
  • Fluid replacement.
    • Crystalloids such as isotonic saline as Ringer’s lactate, may be used.
    • Blood transfusion – to maintain haemoglobin level at 10 mg%.
  • Supportive care.
    • Oxygenation.
    • Mechanical ventilation.
    • Endotracheal intubation.
  • Steroids.
    • Short-term, high-dose steroid therapy is used.
    • An initial dose of 15 – 30 mg/ kg body weight of methylprednisolone is given.
    • Same dose repeated within 4 hours.
    • Vasoactive drugs.
  • Vasodilators such as phenoxybenzamine are used along with fluid replacement.
    • Inotropic agents such as isoproterenol are used to restore adequate circulation.
    • It produces mild peripheral vasodilation.
    • There is a slight fall in BP.

Blood transfusion long answer question

Question 3. Describe the pathophysiology, clinical features and management of haemorrhage or hypovolaemic shock.

Answer:

Haemorrhage shock/Hypovolaemic shock: Such shock occurs due to sudden loss of blood volume or loss of fluid from the vascular space.

Pathophysiology:

Haemorrhage
↓
Loss of blood
↓
Decreased filling of the right heart.
↓
Decreased filling of the pulmonary vasculature
↓
Decreased filling of the left atrium and ventricle
↓
Decrease in stroke volume.
↓
Drop in arterial blood pressure

Hypovolaemic Shock Clinical Features:

  • Depending on the degree of blood loss it can be described into three types.

Haemorrhage Shock And Blood Transfusion Haemorrhage Or Hypovolaemic Shock

Hypovolaemic Shock Management:

  1. Resuscitation.
    • Maintain airway with adequate ventilation and oxygenation.
    • Lower the head with jaw support.
  2. Immediate control of bleeding.
    • Raise the foot end of the bed.
    • Use of compression bandages.
  3. Extracellular fluid replacement.
    • Ringer’s lactate, Ringer’s acetate or normal saline supplemented with 1-2 ampules of sodium bicarbonate is used.
    • 1000 – 2000 ml solution is given intravenously within 45 minutes.
    • Blood transfusion was done if required.

Question 4. Describe neurogenic shock and its management.

Answer:

Neurogenic Shock Causes:

  • Paraplegia.
  • Quadriplegia.
  • Trauma to spinal cord
  • Spinal anaesthesia.

Pathophysiology:

Blockade of the sympathetic nervous system
↓
Loss of arterial and venous tone
↓
Peripheral pooling of blood.
↓
Decrease in cardiac filling
i
Decrease in stroke volume.
↓
Decrease in pulmonary blood volume.
↓
Decrease in cardiac output.
↓
Shock

Neurogenic Shock Clinical Features:

  • Skin remains warm, pink and well-perfused.
  • Urinary output – normal.
  • Heart rate is rapid.
  • Blood pressure – decreased

Neurogenic Shock Management:

  1. Elevation of the legs to correct peripheral pooling of blood.
  2. Fluid administration to increase cardiac output.
  3. Use of a vasoconstrictor drug.
    • It increases BP and myocardial activity.

Classification and management of haemorrhage essay

Question 5. Classify haemorrhage and its management, and describe the causes and clinical features. How will you manage a case of primary haemorrhage after a dental extraction?.

Answer:

Haemorrhage: Haemorrhage is defined as the escape of blood from blood vessels.

Haemorrhage Classification:

  1. According To The Source:
    • External haemorrhage.
      • Seen externally.
    • Internal haemorrhage.
      • Not seen externally, it is hidden,
      • Example: GIT bleeding.
    • Arterial haemorrhage.
      • It is a haemorrhage coming out of the artery.
      • It is bright red in colour.
    • Venous haemorrhage.
      • It is a haemorrhage coming out of a vein.
      • It is dark red in colour.
    • Capillary haemorrhage.
      • It is a haemorrhage coming out of a capillary
      • It is bright red in color, and it oozes out
  2. According To The Time Of Appearance:
    • Primary haemorrhage.
      • Occurs at the time of injury.
    • Reactionary haemorrhage.
      • Occurs within 24 hours of injury.
      • Secondary haemorrhage.
    • Occurs after 7-14 days of injury.

Haemorrhage Management: To Stop Blood Loss.

  1. Rest.
    • Use of sedatives and analgesics.
    • Morphine is administered IM/IV.
    • Inj. Pethidine is better than morphine.
  2. Position of the patient.
    • The head end of the bed is raised in haemorrhage oc- curing after thyroidectomy.
    • The foot end of the bed is raised in case of haemorrhage from varicose veins.
  3. Pressure and packing.
    • Use of sterile gauze pieces and pressure bandage.
    • At home, it can be done with clean linen cloth.
  4. Operative methods.
    • Haemorrhage can be controlled by.
      • Use of artery forceps.
      • Ligation of blood vessels.
      • Smaller vessels are coagulated with diathermy.
      • Bigger vessels are sutured
      • In case of oozing blood-following is used
        • Oxycel or gelatine sponge.
        • Gauze soaked in adrenaline (1:1000)
        • Bone wax for bleeding occurring from the bone.

Haemorrhage Causes:

  • Bleeding disorders.
  • Low platelet count
  • Anticoagulant medication.
  • Broken or ruptured blood vessels.
  • Severe trauma
  • After surgery.
  • After childbirth.

Haemorrhage Clinical Features:

  • Blood loss
  • Increased pulse rate
  • Thready pulse
  • Low blood pressure
  • Pallor Restlessness
  • Deep respiration
  • Cold and calmmy extremities
  • Empty veins
  • Low urinary output.

Management Of Primary Haemorrhage:

1. Post-Extraction Bleeding.

Removal of clots with gauze
↓
Placement of gauze pad or tea bag over socket.
↓
Patient is instructed to bite over it for 1 hour
↓
Repeated 2-3 times.
↓
Prevent disruption of clot

2. If Bleeding Continues.

Anaesthetise the area
↓
Curette the socket
↓
Remove the existing clot and freshen the bone
↓
Irrigate with normal saline
↓
Place a local haemostatic agent into the socket
↓
Suture under gentle tension

Pathophysiology of shock long essay

Question 6. Describe the indications and complications of blood transfusion.

Answer:

Blood Transfusion: It is the process of transferring blood or blood-based products from one person into the circulatory system of another.

Blood Transfusion Indications:

  • Acute haemorrhage – external or internal.
  • Certain major operations, like a radical mastectomy.
  • In deep burns.
  • Preopera is lively in anaemic patients.
  • Postoperatively in septicaemia.
  • In anaemia.
  • In severe malnutrition.
  • In coagulation disorders like haemophilia.
  • In the treatment of erythroblastosis foetal.
  • During chemotherapy for malignant diseases.

Blood Transfusion Complications:

  1. Transfusion Reactions:
    • Incompatibility
      • Incompatibility Causes:
        • Incompatible transfusion.
        • Transfusion of hemolyzed blood.
        • Transfusion of old blood.
      • Incompatibility Clinical features:
        • Fever, rigour.
        • Headache.
        • Nausea, vomiting.
        • Pain in the loins.
        • Tingling sensation in the extremities.
        • The feeling of tightness in the chest
        • Dyspnea.
        • Diminished urinary output.
        • Haemoglobinuria.
        • Jaundice
      • Incompatibility Treatment:
        • Stop the transfusion immediately.
        • Administration of 4 fluids.
        • Alkalization of blood with 10 ml of isotonic solution of sodium lactate and simultaneously 10 ml of saturated solution of sodium bicarbonate 4.
        • Use of 80 -120 mg furosemide IV to provoke diuresis.
        • Antihistamine and hydrocortisone may be prescribed.
    • Pyrexia Reactions.
      • Pyrexia Causes:
        • Lack of sterilisation
        • Infected donor’s apparatus
        • Infected blood transfusion,
        • Rapid transfusion,
        • Presence of sulphur compounds in rubber tubing.
      • Pyrexia Clinical Features:
        • Pyrexia.
        • Rigour, chills.
        • Restlessness.
        • Headache.
        • Increased pulse rate.
        • Nausea and vomiting.
      • Pyrexia Treatment:
        • Stop the transfusion immediately.
        • Cover the patient with a blanket.
        • Antipyretic and antihistaminic drugs are injected.
    • Allergic Reaction:
      • Allergic Cause:
        • Allergic reaction to plasma product
      • Allergic Features:
        • Mild tachycardia.
        • Urticarial rash.
        • Fever
        • Dyspnea
        • Circulatory collapse.
      • Allergic Treatment:
        • Stop transfusion
        • Administer 10 mg of chlorpheniramine.
    • Sensitization To Leucocytes And Platelets:
      • Use of antipyretics, antihistamines and steroids.
  2. Transmission Of Diseases:
    • Diseases transmitted are.
      • Serum hepatitis
      • AIDS
      • Bacterial infections.
  3. Reactions Caused By Massive Transfusion:
    • Acid-base imbalance – alkalosis.
    • Hyperkalaemia.
    • Citrate toxicity.
    • Hypothermia.
    • Failure of coagulation.
  4. Complications Of Over-Transfusion:
    • Congestive cardiac failure occurs.
  5. Other Complications:
    • Thrombophlebitis
    • Air embolism.

Blood transfusion indications and complications essay

Question 7. Define shock. Describe the pathophysiology and classification of shock. Discuss management of hypovolaemic shock

Answer:

Shock Definition: Shock is a condition in which circulation fails to meet the nutritional needs of the cells and fails to remove the metabolic waste products

Pathophysiology

  • Reduced effective volume
    • It may result either
      • By actual loss of blood volume or
      • By decreased cardiac output
  • Tissue anoxia
    • Reduction in effective circulating blood volume
    • Reduced venous return
    • Decreased cardiac output
    • Decreased oxygen supply
    • Tissue anoxia
    • Cellular injury
    • Release of inflammatory mediators
    • Results in shock

Shock Classification

  • Haematogenic or hypovolaemic shock
  • Traumatic shock
  • Neurogenic shock
  • Cardiogenic shock
  • Septic shock
  • Miscellaneous
    • Anaphylactic shock

Management Of Hypovolemic Shock

  • Resuscitation
    • Maintain airway with adequate ventilation and oxygenation
    • Lower the head with jaw support
  • Immediate control of bleeding
    • Raise the foot end of the bed
    • Use of compression bandages
  • Extracellular fluid replacement
    • Ringer’s lactate, Ringer’s acetate or normal saline supplemented with 1-2 ampules of sodium bicarbonate is used
    • 1000-2000 ml solution is given within 45 min intravenously
    • Blood transfusion done if required

Principles of transfusion medicine long essay

Question 8. What are blood components? Write in detail about the indications, contraindications and complications of blood transfusion.

Answer:

Blood Components

  • There are four main components of blood
    • Plasma
    • Red blood cells or erythrocytes
    • White blood cells or leukocytes
    • Platelets

Blood Transfusion

  • Indications
    • Acute haemorrhage
    • Major surgery
    • Deep burns
    • Pre-operative and post-operative in anaemia
    • In malnutrition
    • In coagulation disorders
    • In erythroblastosis fetalis
    • During chemotherapy in malignant diseases
  • Contraindications
    • Infections
    • Aortic stenosis
    • Angina
    • Significant cardiac or pulmonary disease
    • Coronary heart disease
    • Cyanotic heart disease
    • Uncontrolled hypertension
  • Complications
    • Transfusion reactions
      • Incompatibility
      • Pyrexia reactions
      • Allergic reactions.
    • Transmission of diseases
    • Reactions caused by massive transfusion
      • Acid-base imbalance
      • Hyperkalaemia
      • Citrate toxicity
      • Hypothermia
      • Failure of coagulation
  • Complications of over-transfusion
    • Congestive cardiac failure
  • Other complications
    • Thrombophlebitis
    • Air embolism

Normal Periodontium Short Essays

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Question 1. Enzymes in the gingiva.
Answer:

Normal Periodontium Enzymes in gingiva.

Question 2. Cells of Periodontal Ligaments.
Answer:

1. Synthetic Cells:

Osteoblasts:

  • Covers the periodontal surface of the alveolar bone
  • It actively synthesizes ribosomes
  • Contains a largely open nucleus containing prominent nucleoli

Read And Learn More: Periodontics Question and Answers

2. Fibroblasts, spindle-shaped cells:

  • Most prominent cell
  • Synthesizes chondroitin sulfates, heparin sulfate, and hyaluronan sulfate
  • Synthesizes connective tissue matrix

Fibroblasts, spindle-shaped cells Produces:

  • Collagen fibers
  • Reticulin fibers
  • Oxytalan fibers
  • Elastin fibers

1. Cementoblast:

  • Seen lining cementum
  • Lay down cementum

2. Resorptive cells:

  • Osteoclast:
    • Multinucleated giant cell
    • Lies adjacent to the bone
    • Undergoes resorption of bone
    • Formed by monocytes
  • Fibroblast:
    • Contain fragments of collagen
    • These undergoes digestion
    • Results in resorption of bone
  • Cementoclast:
    • Located in Howships Lacunae
    • Causes resorption of cementum

3. Progenitor cells:

  • Formed in the basal cell layer
  • Basal cells have the ability to divide
  • One of the divided cells migrates to the superficial layer and the other remains as a progenitor cell

4. Epithelial cell rests of Malassez:

  • Remnants of Hertwig’s epithelial root sheath
  • Present near and parallel to root surfaces Attached to one another by desmosomes
  • During disease conditions, they undergo proliferation
  • Persists as a network strand, island, or tubule
  • Exhibits tonofilaments

5. Mast Cell:

  • Small, round, or oval cell
  • Contains cytoplasmic granules
  • Contains heparin and histamine
  • During an inflammatory response, these releases of histamine cause antigen-antibody formation

6. Macrophages:

  • Capable of phagocytosis

Question 3. Functions of Periodontal ligament.
Answer:

1. Physical Functions of Periodontal ligament:

  • Provide soft tissue casing
  • Protect nerves and vessels from injury
  • Transmit occlusal forces to the bone
    • By stretching of oblique fibers of PDL
    • Transmits tensional force to the bone
    • Results in bone formation
  • Attaches tooth to the bone
  • Maintains architecture of gingival tissue
  • Shock absorbent

2. Formative and Remodelling function:

  • Synthesis and resorption of cementum, PDL, and al-alveolar bone
  • Old cells and fibers are replaced by a new one

3. Nutritional and Sensory function:

  • Nutrition – Through blood supply
  • Sensory – Transmits sensation of touch, pressure, and pain to CNS

Neural Transmission Functions of Periodontal ligament :

  • Apical area – Ruffini
  • Apex Pressure and vibration endings
  • Mid root – Meissners corpuscles

Question 5. Define alveolar bone and describe its composition.
Answer:

Alveolar Bone is that portion of the maxilla and mandible that forms and supports the tooth socket

Alveolar Bone Composition:

Cells:

1. Osteoblast: Cuboidal cells

Osteoblast Contains:

  • Rough endoplasmic reticulum
  • Large Golgi apparatus
  • Secretory vesicles

Osteoblast Functions:

  • Synthesize osteoid, collage
  • Regulate mineralization

Osteoblast Precursor: Progenitor cells

2. Osteoclasts: Multinucleated giant cells

Osteoclasts Precursor: blood-borne monocytes

Osteoclasts Functions: Resorptive cell, Secretes hydrolytic en-zymes

3. Osteocytes: These extend processes from lacunae to canaliculi

Osteocytes Function: Canaliculi bring oxygen and nutrients to osteocytes

4. Extracellular Matrix:

Extracellular Matrix Inorganic:

  • Calcium, Hydroxyl
  • Phosphate, Carbonate
  • Citrate, Sodium
  • Magnesium, Fluorine

Extracellular Matrix Organic:

  • Osteocalcin
  • Osteonectin
  • BMP
  • Proteoglycans
  • Glycoproteins

Question 6. Dentogingival junction.
Answer:

  • The junctional epithelium and the gingival fibers are together considered a dentogingival unit

Dentogingival Junction:

  • The Dentogingival Junction represents a unique anatomic feature concerned with the attachment of the gingiva to the tooth
  • The Dentogingival Junction comprises an epithelial portion and a connective tissue portion

1. Epithelial portion It can be divided into

  • Gingival epithelium
  • Sulcular epithelium
  • Junctional epithelium

Normal Periodontium Portion and Features.

2. The connective tissue component contains densely packed collagen fiber bundles.

  1. Dentogingival fibers
    • Extends from cementum into free and at-attached gingiva
  2. Alveologingival fibres
    • Extends from the alveolar crest into free and at-attached gingiva
  3. Circular fibers
    • Wrap around the tooth
  4. Dentoperiosteal fibres
    • Run from cementum, over the alveolar crest, and insert into the alveolar process
  5. Transseptal fibers
    • Runs interdentally from cementum to one tooth to the adjacent tooth

Question 7. Sulcular Epithelium.
Answer:

  • Sulcular epithelium is the epithelium lining the gingival sulcus
  • Sulcular epithelium is a thin,non-keratinized stratified squamous epithelium without recipes
  • Sulcular epithelium extends from the coronal limit of the junctional epithelium to the crest of the gingival margin
  • Sulcular epithelium usually shows many cells with hydropic degeneration
  • Sulcular epithelium lacks granulosum and corneum strata
  • Enzymes present have a lower degree of activity
  • Sulcular epithelium has the potential to keratinize if
    1. It is exposed to the oral cavity or
    2. The bacterial flora of the sulcus is totally eliminated

Sulcular Epithelium Importance:

  • Sulcular epithelium may act as a semipermeable membrane through which injurious bacterial products pass into the gingival and tissue fluid from the gingiva seeps into the sulcus

Question 8. Fenestrations and Dehiscences.
Answer:

Fenestration:

  • These are isolated areas in which the root surface is covered only by the periosteum and gingiva
  • Marginal bone is intact

Dehiscence:

  • Defect involving denudation of marginal bone

Etiology:

  • Root prominence
  • Malposition
  • Teeth in labial version

Common location:

  • Site – Facial bone
  • Teeth involve – Anterior

Importance:

  • Affect the outcome of surgical treatment

Question 9. Define and classify cementum. (or) Schroeder’s classification of cementum
Answer:

Cementum:

  • It is a calcified avascular mesenchymal tissue that forms the outer covering of the anatomic root

Cementum Classification:

1. Acellular fibrillar cementum:

  • Contains a mineralized ground substance
  • Does not contain fibres or cells

Acellular fibrillar cementum Site: On enamel near CEJ

2. Acellular extrinsic fiber cementum:

  • Contains Sharpey’s fibers
  • Does not contain cells

Acellular extrinsic fiber cementum Site: Coronal half of root surface

3. Cellular mixed stratified cementum:

  • Contains cells and fibres

Cellular mixed stratified cementum Site: Apical third of root, apices, and furcation areas

4. Cellular Intrinsic Fiber cementum:

  • Contains fibers but not cells

Cellular Intrinsic Fiber cementum Site: Resorption lacunae

5. Intermediate Cementum:

Intermediate Cementum Site: Apical 1/3rd of root

Intermediate Cementum Function: Attaches cementum to dentin

  • This is removed during root planning

Question 10. Junctional epithelium.
Answer:

  • Junctional Epithelium is the tissue that joins to the tooth on one side and the oral sulcular epithelium and connective tissue on the other
  • Junctional Epithelium forms the base of the sulcus

Junctional epithelium Attachment:

  • Attach to the tooth surface
    • By internal basal lamina
    • Reinforced by the gingival fibers
    • Consists of lamina dens and lamina lucida
  • Attach to gingival connective tissue
    • By external basal lamina

Junctional epithelium Features:

  • Consists of non-keratinizing epithelium
  • Thickness
    • Early life- 3-4 layers
    • Later- Increases
  • Length- 0.25-1.35 mm

Junctional epithelium Structure:

  • Consists of basal and suprabasal layer
  • Zones present are
    • Apical- germination
    • Middle- adhesion
    • Coronal-permeable
  • Cells present are
    • Basal cells- cuboidal/flattened
    • Suprabasal cells
    • Complex microvilli formation and interdigitation
    • Presence of leukocytes and lymphocytes
    • Desmosomes interconnect the cells

Question 11. Oxytalan fibers.
Answer:

  • The periodontal ligament contains two immature forms of fibers
  • Oxytalan fibers are xylan and cleaning fibers
  • The xylan fibers run parallel to the root surface in a vertical direction and bend to attach to the cementum. in the cervical third of the root
  • Oxytalan fibers are associated with blood vessels and nerves of the periodontal ligament
  • Oxytalan fibers regulate the vascular flow
  • An elastic meshwork in the periodontal ligament is composed of many elastic lamellae with peripheral oxy- talan fibers and cleaning fibers
  • Oxytalan fibers develop de novo in the regenerated periodontal ligament

Question 12. Describe the mechanism by which ligament periodontal resists occlusal forces.
Answer:

1. Tensional theory:

  • Tensional Theory states that the principal fibers of the periodontal ligament are major factors in supporting the tooth and transmitting forces to the underlying bone
  • When a force is applied to the crown, the principal fibers first unfold and straighten and then transmit forces to the alveolar bone
  • When the alveolar bone has reached its limit, the load is transmitted to the basal bone

2. Viscoelastic theory:

  • Viscoelastic Theory states that the displacement of the tooth is controlled by fluid movements with fibers having only a secondary role
  • When forces are transmitted to the tooth, the ex-intracellular fluid passes from the periodontal ligament into the marrow spaces of bone through fo- the lamina

3. Thixotropic theory:

  • According to this theory, the periodontal ligament has rheological behavior of thixotropic gel

Question 13. Significance of width of attached gingiva
Answer:

  • The width of the attached gingiva is the distance between the mucogingival junction and the projection on the external surface of the bottom of the gingival sulcus or periodontal pocket

Normal Periodontium Significance of width of attached gingiva.

  • The width of the attached gingiva increases with age 4 and in supra-erupted teeth
  • On the lingual aspect of the mandible, the attached gingiva terminates at the junction of the lingual alveolar mucosa which is continuous with the mucous membrane lining the floor of the mouth

Normal Periodontium Long Essays

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Periodontics Normal Periodontium Long Essays

Question 1. Define Gingiva. Describe the microscopic and macroscopic features of the gingiva. Add a note on the importance of GCF.
Answer:

Gingiva: Gingiva is a part of oral mucosa that covers the alveolar process of the jaws and surrounds the neck of the teeth

Macroscopic: Gingiva is divided into

1. Marginal Gingiva:

  • Border of the gingiva surrounding the teeth in the collar-like fashion
  • Demarcated apically by a shallow depression called “free gingival groove”

Read And Learn More: Periodontics Question and Answers

2. Attached Gingiva:

  • Part of the gingiva that is firm, resilient, and tightly bound to the underlying periosteum of the alveolar bone
  • The width of the attached gingiva is the distance between the mucogingival junction and the projection on the external surface of the bottom of the gingival sulcus or periodontal pocket

3. Interdental Gingiva:

  • Occupies gingival embrasure

Parts: Facial papilla, lingual papilla and col

  • Lateral borders and tips of interdental papilla are formed by continuation of marginal gingiva.
  • In diastema, interdental papilla is absent

Normal Periodontium Anatomic land marks of gingiva.

Microscopic Features:

1. Oral/Outer Epithelium Layers:

  1. Outer Epithelium Basal layer:
    • Cells are cylindrical/cuboidal
    • Attach to the basement membrane
    • Cells have the ability to divide
    • Stratum Spinosum:
    • Large cells with short processes called spines
    • Cells have a prickled appearance
    • Cells are attached to one another with the help of desmosomes
    • Stratum Granulosum:
    • Keratohyalin granules are seen
    • Stratum Corneum:
    • The cytoplasm of cells in this layer is filled with keratin
    • It can be
    • Orthokeratinized – In this cells are devoid of a nucleus
    • Parakeratinized – In this cells contains the pinpoint nucleus
  2. Sulcular epithelium:
    • Extends from the gingival margin to the junctional epithelium
    • Made up of basal and prickle cell layer
  3.  Junctional epithelium:
    • It is the tissue that joins to the tooth on one side and to sul- color epithelium and connective tissue on the other
    • It is attached to the tooth surface by the internal basal lamina and to the gingival connective tissue by an external basal lamina

Outer Epithelium Connective tissue:

  • Termed as lamina propria
  • Superficial papillary layer:
  • Contains epithelial ridges
  • Deeper Reticular layer:
  • Contains collagen fibers

Outer Epithelium Cells:

  • Fibroblast
  • Mast cells
  • Macrophages
  • Inflammatory cells

Outer Epithelium Fibers present:

  • Collagen fibers
  • Reticulin fibers
  • Oxytalan fibers
  • Elastin fibers

Normal Periodontium Non-keratinized epithelium

Normal Periodontium The principal group of fibers.

Importance Of Gingival Crevicular Fluid:

1. Cicardian periodicity:

  • There is a gradual increase in a gingival fluid amount from 6:00 am to 10:00 pm and decreases afterward
  • This is called Cicardian periodicity

2. Sex hormones:

  • Female sex hormones increase flow
  • Pregnancy, ovulation, and hormonal contraceptives increase gingival fluid

3. Smoking:

  • Causes an immediate transient increase in flow

4. Periodontal therapy:

  • An increase in gingival fluid occurs during the healing period

Question 2. Define gingiva. Describe morphological, histological, and functional features of normal gingiva.
Answer:

Gingiva is a part of oral mucosa that covers the alveolar process of the jaws and surrounds the neck of the teeth.

Morphological Features: Gingiva is divided into

  1. Marginal gingiva:
    • Marginal gingiva is border of the gingiva surrounding the teeth in col- lar like fashion
    • Marginal gingiva is demarcated apically by a shallow depression called a “free gingival groove”
  2. Attached Gingiva:
    • Attached Gingiva is part of the gingiva that is firm, resilient, and tightly bound to the underlying periosteum of the alveolar hone
    • The width of the attached gingiva is the distance between the mucogingival junction and the projection on the external surface of the bottom of the gingival sulcus or periodontal pocket
  3. Interdental gingiva:
    • Interdental Gingiva occupies gingival embrasure
    • Interdental Gingiva parts are facial papilla, lingual papilla, and col
    • Lateral borders and tips of interdental papilla are formed by the continuation of the marginal gingiva
    • In diastema, interdental papilla is absent

Normal Periodontium Anatomic land marks of gingiva.

Gingiva Histological Features:

1. Epithelium Layers:

  1. Basal layer:
    • Cells are cylindrical/cuboidal
    • Attach to the basement membrane
    • Cells have the ability to divide
    • One of the divided cells migrates to the superficial layer
    • Basal cells are separated from connective tissue by a basement membrane
    • Beneath the basal cell, the electro-lucent zone can be seen called lamina lucida
    • Beneath it, there is a dense zone called lamina densa
    • Hemidesmosomes attach epithelium to the connective tissue.
  2. Stratum Spinosum:
    • Large cells with short processes called spines
    • Cells have a prickled appearance
    • Cells are attached to one another with the help of desmosomes
  3. Stratum Granulosum:
    • Keratohyalin granules are seen
  4. Stratum Corneum:
    • The cytoplasm of cells in this layer are filled with keratin
    • It can be
    • Orthokeratinized – In this cells are devoid of a nucleus
    • Parakeratinized – In this cells contains pinpoint nucleus

2. Sulcular epithelium:

  • Extends from the gingival margin to the junctional epithelium
  • Made up of basal and prickle cell layer

3. Junctional epithelium:

  • It is the tissue that joins to the tooth on one side and to sul- color epithelium and connective tissue on the other
  • It is attached to the tooth surface by an internal basal lamina and to the gingival connective tissue by an external basal lamina

Connective tissue:

  • Termed as lamina propria
  • Superficial papillary layer:
    • Contains epithelial ridges
  • Deeper Reticular layer:

Cells:

  • Contains collagen fibers
  • Fibroblast
  • Mast cells
  • Macrophages
  • Inflammatory cells

Fibers Present:

  • Collagen fibers
  • Reticulin fibers
  • Oxytalan fibers
  • Elastin fibers

Importance Of Gingival Crevicular Fluid:

1. Cicardian periodicity:

  • There is a gradual increase in gingival fluid amount from 6:00 am to 10:00 pm and decreases afterward
  • This is called Cicardian periodicity

2. Sex hormones:

  • Female sex hormones increase flow
  • Pregnancy, ovulation, and hormonal contraceptives increase gingival fluid

3. Smoking:

  • Causes an immediate transient increase in flow

4. Periodontal therapy:

  • An increase in gingival fluid occurs during the healing period

Gingival Crevicular Fluid Functions:

1. Attached gingival:

  • Attached gingival braces marginal gingiva
  • Attached gingival allows for proper deflection of food
  • Attached gingival provides room for proper placement of toothbrush
  • Attached gingival is important for the overall maintenance of gingival health

2. Gingival crevicular fluid:

  • Gingival Crevicular Fluid cleanses material from the sulcus
  • Gingival Crevicular Fluid improves the adhesion of the epithelium to the tooth by plasma proteins
  • Gingival Crevicular Fluid possesses antimicrobial properties
  • Gingival Crevicular Fluid exerts antibody activity to defend gingiva
  • Gingival Crevicular Fluid transports a variety of molecules

3. Gingival fibers:

  • Provides support to the gingiva and attaches it to the bone
  • It anchors the tooth to the bone
  • Maintains relationship of adjacent teeth
  • Secures alignment of teeth in the arch

Question 3. Define PDL. Write in detail about its structure and function. (or) Enumerate principal groups of periodontal ligament fibers. Add a note on the cellular elements and functions of PDL. Principal Fibres of PDL. (Extracellular components)
Answer:

Periodontal Ligaments are the connective tissue that surrounds the root and connects it with the bone

Periodontal Ligaments Structure:

Cells:

1. Synthetic Cells:

  • Osteoblasts:
    • Covers the periodontal surface of alveolar bone
    • It actively synthesizes ribosomes
    • Contains a largely open nucleus containing prominent nucleoli
  • Fibroblasts, spindle-shaped cells:
    • Most prominent cell
    • Synthesizes chondroitin sulfates, heparin sulfate and hyaluronan sulfate
    • Synthesizes connective tissue matrix
  • Produces:
    • Collagen fibers
    • Reticulin fibers
    • Oxytalan fibers
    • Elastin fibers
  • Cementoblast:
    • Seen lining cementum
    • Lay down cementum

2. Resorptive cells:

  • Osteoclast:
    • Multinucleated giant cell
    • Lies adjacent to the bone
    • Undergoes resorption of bone – Formed by monocytes
  • Fibroblast:
    • Contain fragments of collagen – These undergo digestion
    • Results in resorption of bone
  • Cementoclast:
    • Located in Howships Lacunae
    • Causes resorption of cementum

3. Progenitor cells:

  • Formed in the basal cell layer
  • Basal cells have the ability to divide
  • One of the divided cells migrates to the superficial layer and the other remains as a progenitor cell

4. Epithelial cell rests of Malassez:

  • Remnants of Hertwig’s epithelial root sheath are Present near and parallel to root surfaces
  • Attached to one another by desmosomes
  • During disease condition, they undergo proliferation
  • Persists as a network strand, island, or tubule
  • Exhibits tonofilaments

5. Mast Cell:

  • Small, round, or oval cell
  • Contains cytoplasmic granules
  • Contains heparin and histamine
  • During an inflammatory response, these releases- time causes antigen- antibody formation

6. Macrophages:

  • Capable of phagocytosis

Extracellular Components

1. Fibres:

  • Collagen:
    • Synthesized by fibroblasts, chondroblasts, os
    • neoblasts, odontoblast, and other cells
    • Type 1,3 and 4 are common
  • Oxytalin:
    • Provide elastic properties to PDL

Principal Fibres:

  1. Trans-septal group:
    • Connects cementum of one tooth with that of other
  2. Alveolar crest:
    • Extends from cementum to alveolar crest Function: Retains tooth in the socket, Retains lateral tooth movement
  3. Horizontal group:
    • Extends from cementum to alveolar bone
  4. Oblique group:
    • Extends coronally from the cementum to bone Function: Resist axially directed forces
  5. Apical group:
    • From cementum to the bone of alveolar fundus Function: Prevents tipping movement, Resists luxation
  6. Inter-radicular fibers:
    • Presents between cementum of a multi-rooted tooth.
    • Function: Resists luxation, Resists tipping and torquing

Normal Periodontium Functions of periodontal ligament.

2. Ground substance:

  • Glycosaminoglycan – hyaluronic acid, proteoglycan- cane
  • Glycoproteins – fibronectin and laminin

Principal Fibres Functions:

1. Physical:

  • Provide soft tissue casing
  • Protect nerves and vessels from injury
  • Transmit occlusal forces to the bone
    • By stretching of oblique fibers of PDL
    • Transmits tensional force to the bone
  • Results in bone formation Attach tooth to the bone
  • Maintains architecture of gingival tissue
  • Shock absorbent

2. Formative and Remodelling function:

  • Synthesis and resorption of cementum, PDL, and al- alveolar bone
  • Old cells and fibers are replaced by a new one

3. Nutritional and Sensory function:

  • Nutrition – Through blood supply
  • Sensory Transmits sensation of touch, pressure, and pain to CNS

Neural Transmission

  • Apical area – Ruffini
  • Apex Pressure and vibration endings
  • Mid root – Meissners corpuscles

Question 4. Discuss the role of alveolar bone in health and periodontal diseases.
Answer:

Alveolar Bone In Health:

  • Alveolar Bone In Health is that portion of the maxilla and mandible that forms and supports the tooth socket
  • The alveolar process is a thickened ridge of bone that contains tooth sockets that bear teeth
  • The alveolar bone proper is the thin layer that provides attachment to principal fibers of the periodontal ligament Alveolar bone is perforated with numerous openings for intra-alveolar nerves and blood vessels
  • Alveolar Bone In Health consists of:

1. Cells:

  1. Osteoblast:
    • Cuboidal cell
    • Contains
    • Rough endoplasmic reticulum
    • Large Golgi apparatus
    • Secretory vesicles
    • Functions:
    • Synthesizes osteoid and collagen
    • Regulates mineralization
    • Precursor:
    • Progenitor cell
  2. Osteoclasts:
    • Multinucleated giant cells
    • Precursor- Blood-borne monocytes
    • Functions:
    • Resorption of bone
    • Secretes hydrolytic enzymes
  3. Osteocytes:
    • These extend processes from lacunae to canaliculi
    • Functions:
    • Canaliculi bring oxygen and nutrients to osteocytes

2. Extracellular matrix:

  • Inorganic:
    • Calcium
    • Hydroxyl
    • Phosphate
    • Carbonate
    • Citrate
    • Sodium
    • Magnesium
    • Fluorine
  • Organic:
    • Osteocalcin
    • Osteonectin
    • BMP
    • Proteoglycans
    • Glycoproteins
    • Parathyroid hormone regulates bone removal- selling by both bone formation and bone resorption

Alveolar Bone In Disease:

  • Fenestration and dehiscence are seen during disease in relation to alveolar bone

Bone-In Disease Fenestration:

  • These are isolated areas in which the root surface is covered only by the periosteum and the gingiva Marginal bone is intact

Dehiscence:

  • It is a defect involving the denudation of marginal bone

Bone-In Disease Etiology:

  • Root prominence
  • Malposition
  • Teeth in labial version

Bone-In Disease Common Location:

  • Site- Facial bone
  • Teeth commonly involved- Anterior

Bone-In Disease Importance:

  • Affects the outcome of surgical treatment

Intraoral Radiographic Techniques Short Essays

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Intraoral Radiographic Techniques Short Essays

Question 1. Paralleling technique/Long cone technique.
Answer.

Paralleling technique

  • In this technique the X-ray film is placed parallel to the long axis of the tooth and the central ray of the X-ray beam is directed at right angles to the tooth and film
  • The film must be placed away from the tooth and towards the middle of the oral cavity
  • The object film distance must be increased
  • It is also referred to as the long-cone technique

Long Cone Technique Target Film Distance:

  • The target film distance is large
  • This results in less image magnification and better definition

Long Cone Technique  Film Holders:

  • This technique requires filmholders

Long Cone Technique  Film:

  • Ideally, the size of the film used will depend upon the teeth being radiographed
    • Size 1: used for interiors
    • Size 2: used for posteriors

Long Cone Technique  Film Placement:

  • The white side of the film always faces the teeth
  • For interiors, the film is placed vertically
  • For posteriors, the film is placed horizontally
  • The identification dot on the film is always placed toward the occlusal surface
  • Always place the film away from the teeth and towards the middle of the oral cavity
  • The film must be positioned to cover the prescribed area of the teeth to be examined

Read And Learn More: Oral Radiology Question and Answers

Long Cone Technique  Patient Position:

  • Explain the procedure to the patient
  • Position the patient comfortably on the chair
  • Adjust the patient’s head such that the occlusal place of the upper arch is parallel to the floor
  • Mid sagittal plane is perpendicular to the floor
  • Secure lead apron and thyroid collar
  • Remove all objects from the mouth that may interfere with the film exposure

Long Cone Technique  Basic Rules:

  • Film placement film must cover the prescribed area of the teeth to be examined
  • Film position the film must be placed parallel to the long axis of the tooth
  • The holder is rotated so that the teeth to be examined are touching the block
  • The correct focal spot to film distance is determined
    • In vertical angulation, the central ray of the X-ray beam is directed perpendicular to the film, and the long axis of the tooth
    • In horizontal angulation, the central ray of the X-ray beam is directed through the contact areas of the film are exposed
    • Film exposure the X-ray beam must be centered on the film to ensure that all areas of the film are exposed
  • Exposure is made

Oral Radiology Intraoral Radiographic Techniques Positions of the film tooth and the central ray of the x ray beam

Oral Radiology Intraoral Radiographic Techniques The film is placed closed to the tooth and is not parallel to the long axis of the tooth

Oral Radiology Intraoral Radiographic Techniques Increased object film distance the film is placed

Oral Radiology Intraoral Radiographic Techniques In this diagram the x rays pass through the contact areas

Long Cone Technique  Advantages:

  • This technique produces an image that has dimensional accuracy
  • It is simple and easy to learn and use
  • It is easy to standardize and can be accurately duplicated or repeated
  • Facial screens can be used
  • There is decreased secondary radiation
  • The shadow of the Zygomatic bone appears above the apices of the molar teeth
  • The periodontal levels are well represented
  • There is minimal foreshortening or elongation
  • Good detection of interproximal caries
  • Useful in handicapped and compromised patients as the relative position of the film packet, teeth, and X-ray beam are always maintained

Long Cone Technique  Disadvantages:

  • The film-holding device is difficult to place in children and patients with shallow palate
  • The film-holding device causes discomfort to the patient
  • Object film distance is increased
  • There is an increase in the exposure time
  • It is more space-consuming
  • Sometimes the apices of the teeth are very close to the edge of the film and so not well appreciated
  • The holders need to be autoclaved

Question 2. Principles of projection geometry.
Answer.

Principles of projection geometry

  • The basic principles of projection geometry are as follows:
    • The focal spot should be as small as possible
    • The focal spot object distance should be as long as possible
    • The object film distance should be as small as possible
    • The long axis of the object and the film planes should be paralleling
    • The X-ray beam should strike the object and the film planes at tight angles
    • There should be no movement of the tube, film, or patient during exposure

Oral Radiology Intraoral Radiographic Techniques The smaller the focal spot area

Oral Radiology Intraoral Radiographic Techniques A longer PID and target film

Oral Radiology Intraoral Radiographic Techniques To limit distortion the central ray

Oral Radiology Intraoral Radiographic Techniques Illustrating the influence of motion

Question 3. Bitewing radiograph
Answer.

Bitewing radiograph

  • It is also called Short Cone Technique
  • It is based on the principle known as “Ciesenzky’s rule of isometry”
  • It states that the two triangles at equal if they have two equal angles and share a common side
  • The X-ray beam should bisect the imaginary bisector that bisects the angle formed by the film and the long axis of the tooth
  • When the rule is strictly followed, the resultant image obtained is accurate

Oral Radiology Intraoral Radiographic Techniques Angle A is bisected by line AC

Oral Radiology Intraoral Radiographic Techniques The image on the film is equal to the length of the tooth

Bitewing Radiograph Guidelines:

  • The white side of the film always faces the teeth
  • Anterior films are always placed vertically
  • Posterior films are always placed horizontally
  • The incisal or occlusal edge of the film must extend approximately 1/8th inch beyond the incisal or occlusal surface of the tooth
  • Always center the film over the area to be examined
  • If the patient’s finger is used for stabilization, instruct the patient to gently push the film against the lingual/palatal surface of the tooth

Bitewing Radiograph Basic Rules:

  • Film placement film must cover the prescribed area of the teeth to be examined
  • Film position the film must be placed parallel to the long axis of the tooth
  • In vertical angulation, the central ray of the X-ray beam is directed perpendicular to the film and the long axis of the tooth
  • In horizontal angulation, the central ray of the X-ray beam is directed through the contact areas of the film are exposed
  • Film exposure the X-ray beam must be centered on the film to ensure that all areas of the film are exposed

Bitewing Radiograph Advantages:

  • It can be used in patients with shallow palate, bony growth
  • It is quick and comfortable
  • Decreased exposure time required
  • Short PID is used
  • If angulations are correct, the image obtained is of the same size
  • No sterilization of holders is required as they are not used

Bitewing Radiograph Disadvantages:

  • Image distortion may occur due to the use of short PID
  • By using a film holder it becomes difficult to visualize the imaginary bisector
  • Incorrect horizontal angulation results in overlapping
  • Incorrect vertical angulation leads to elongation or foreshortening
  • If the patient’s finger is used for stabilization, the patient may shift the film before or during exposure
  • The patient’s hand is exposed unnecessarily
  • The periodontal tissues are poorly represented
  • Overlapping of shadows of Zygomatic bone occurs
  • The Buccal roots of premolars and molars are foreshortened
  • The crowns of the teeth are often distorted.

Intraoral Radiographic Techniques.

Oral Medicine Tumours Short Essays

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Oral Medicine Tumours Short Essays

Question 1. Hemangioma

Answer:

Hemangioma

  • They are relatively common benign proliferative lesions of vascular tissue origin

Hemangioma Clinical Features:

  • Age And sex: Early-age females are commonly affected
  • Site: Intraorally over
    • Tongue
    • Lip
    • Buccal mucosa
    • Palate
    • Within jawbones
    • Within salivary gland
  • Hemangioma Presentation
    • They are usually raised, multinodular, red or purple lesions
    • When a hemangioma is compressed with the help of a slide it blanches
    • Once the pressure is released, its reddish appearance returns due to the refilling of the tumor cells with blood
    • It is soft and compressible
    • The size of the lesion varies from time to time
    • Port wine stain is often seen over the face
    •  Jawbones involvement
      • Mandible is more commonly affected
      • It produces slow enlarging, painful, expansile jaw swelling
      • It may cause erosion of the bone
      • Loosening of the teeth
      • Anesthesia or paraesthesia of the skin and oral mucosa

Hemangioma  Differential Diagnosis:

  • Pyogenic granuloma
  • Mucoceles
  • Kaposi’s sarcoma
  • Salivary gland neoplasm

Read And Learn More: Oral Medicine Question and Answers

Hemangioma  Management:

  • Local excision for smaller lesions
  • Larger lesions are treated by excision after pretreat¬ment of the lesion with sclerosing agents to reduce the size of the lesion

Question 2. AOT

Answer:

AOT Origin: reduced enamel epithelium

AOT Clinical Features:

  • Age: Young age
  • Sex: Female
  • Site: Maxillary anterior region

AOT Presentation:

  • Slow enlarging, small, bony hard swelling
  • Elevation of the upper lip
  • Displacement of teeth
  • Expansion of cortical plates
  • Asymptomatic
  • Nodular swelling over gingiva

AOT Radiographic Features:

  • Well-defined, unilocular, radiolucent area
  • Interior small radiopaque foci

AOT Treatment:

Surgical enucleation

Question 3. Ossifying fibroma

Answer:

Ossifying Fibroma

Oral Medicine Tumours Ossifying fibroma

Question 4. Malignant melanoma.

Answer:

Malignant Melanoma

  • Malignant Melanoma is a malignant neoplasm arising from melanocytes of the skin and mucous membrane

Malignant Melanoma Clinical Features:

  • Age And sex: It affects older aged people
  • Sites:
    • Hardpalte
    • Maxillary alveolar ridge
    • Less frequently,
      • Lower jaw
      • The floor of the mouth
      • Tongue
      • Buccal mucosa
      • Parotid gland

Malignant Melanoma Presentation

  • It initiates as a macular pigmented lesion
  • Some of them appear as inflamed area
  • The pigmented lesions are dark brown or bluish-black
  • Initially, they are rapidly growing, large painful dif¬fuse mass
  • Surface ulceration may occur It may be secondarily infected
  • It spreads rapidly and destroys the involved bone
  • It leads to the loosening and exfoliation of teeth
  • There may be a metastasis of the tumor cells to distant sites.

Oral Medicine Tumours

Malignant Melanoma Management:

Radical surgery with prophylactic neck dissection is done

Question 5. Kaposi sarcoma.

Answer:

Kaposi Sarcoma

  • Kaposi Sarcoma is a malignant neoplasm arising from the endothelial cells of the blood capillaries

Kaposi Sarcoma Etiology:

  • Genetic predisposition
  • HIV
  • Immunosuppression
  • Environmental factors

Kaposi Sarcoma Clinical Features:

  • Sites: Maxillary gingival, tongue
  • Clinical stages:

1. Patch Stage:

  • Patch Stage is the initial stage of the disease and during this, a pink, red, or purple macule appears over the oral mucosa

2. Plaque Stage:

  • Plaque Stage continues into the plaque stage with time and during this stage, the lesion appears as a large, raised plaque

3. Nodular Stage:

  • The nodular Stage is the last stage of the disease
  • The nodular Stage is characterized by the occurrence of multiple nodular lesions on the skin or the mucosa

Kaposi Sarcoma Differential Diagnosis:

  • Pyogenic granuloma
  • Hemangioma
  • Angiosarcoma

Kaposi Sarcoma Management:

  • Radiotherapy
  • Chemotherapy.

Essential Laboratory Procedures Prior to Try-In: Short Questions And Answers

by

Introduction to Laboratory Procedures

Laboratory procedures before try-in are critical for ensuring successful outcomes in dental prosthetics. This guide provides essential questions and answers regarding these procedures.

Complete Denture Wax Try-In Procedure

Laboratory Procedures Before Try In Short Answers

Question 1. Pre-Extraction Guides In The Selection Of Teeth.
Answer:

  • The diagnostic cast is prepared before the extraction of teeth
    • It provides 3 3-dimensional views.
  • Photographs – Showing frontal and lateral views
    • Limitation: Anterior teeth should be seen in the photograph.
  • Radiographs: Accurate measurements are not obtained
    • They provide only a 2-dimensional view
  • Close relatives- If other methods fail
  • Extracted teeth- Best method
    • But all the extracted teeth are preserved.

Read And Learn More: Prosthodontics Question And Answers

Question 2. Compensatory curves.
Answer:

The anteroposterior and lateral curvatures in the alignment of the occluding surfaces and incisal edges of artificial teeth are used to develop balanced occlusion

  • Steep compensatory curves for steep condylar path
  • Shallow curves for loss of balancing molar contacts

Laboratory Procedures Prior To Try In Posterior Separation And Incorporating Curve

  • Thus balance must be present between all five factors
  • The effect of incisal and condylar guidance must counteract the effect of the other three factors
  • If the balance is lost, balanced occlusion cannot be achieved

Pre-Try-In Lab Procedures in Prosthodontics

Question 3. Color selection of teeth.
Answer:

Color For Anterior Teeth:

Age:

  • Young people have lighter teeth
  • Old people have Dark teeth
  • More shiny
  • Brownish tinge
  • Habits Smoker’s porcelain teeth
  • Complexion teeth selected in harmony with

Question 4. Factors in denture design affecting speech.
Answer:

  • Denture wearers have shallow pronunciation In dentulous patients, rugae enhance speech
    • In a denture wearer speech is affected due to the absence of rugae
    • The use of metal dentures improves speech
    • Injury to the external laryngeal nerve
    • Presence of tongue tie

Essential Laboratory Procedures Prior to Try-In

Production Of Various Sounds:

  1. Bilabial-b, p, m
  2. Labiodental-f, v
  3. Linguodental- th
  4. Linguoalveolar-t, d, s, z, v, 1
  5. ‘s’ sound is controlled by the anterior part of the palatal plate of the denture base

Laboratory Procedures Prior To Try In Position of the Tounge In Relation To Maxillary Anterior

Question 5. Neutral zone.
Answer:

  • Neutral Zone is the potential space between the lips and cheeks on one side and the tongue on the other side
  • An area or position where the forces between the tongue and cheek or lips are equal
  • If the teeth are placed buccally, it leads to cheek-biting

If the teeth are placed lingually, it leads to encroachment into the tongue space

Laboratory Procedures Prior To Try In Posterior Teeth And Co Relation Of The Ridge And Improper Relation Tooth Of The Ridge

Essential Lab Steps Before Denture Try-In

Question 6. Shortcomings of the plane line articulator.
Answer:

  • An articulator is a single hinge joint
  • No lateral or sliding movement is possible
  • No guide for mounting the cast
  • Single-use
  • Difficult for prosthetic work as the metallic frame must be held together with the cast
  • Removal of the cast is by breaking, which leads to loss of integrity of the cast and loss of strength of the articulator

Question 7. Incisal guidance.
Answer:

The influence of the contacting surfaces of the mandibular and maxillary anterior teeth on mandibular movements

  • The second factor of occlusion
  • Customized
  • If overjet increases, it decreases. If overbite increases, it increases
  • If incisal guidance is steep, steep cusps, a steep occlusal plane, and steep compensatory curves are required
  • Incisal Guidance must be as flat as possible

Question 8. Condylar guidance.
Answer:

  • Condylar Guidance is the first factor of occlusion to be considered
  • Measured using protrusive registration
  • Increased condylar guidance increases jaw separation
  • Condylar Guidance cannot be modified

Question 9. Hinge axis
Answer:

  • The Hinge Axis is also known as the transverse axis
  • The hinge axis is the axis that runs horizontally from the right side of the mandible to the left
  • Rotation around it is seen during protrusive movement. It varies during different phases of protrusive movements
    • During the initial mouth opening, the hinge axis passes through the head of the condyle
    • During later stages, the axis passes through the mandibular foramen

Question 10. Posterior teeth form.
Answer:

Factors Affecting Posterior Teeth Form:

  • Condylar inclination
  • Height of the residual ridge
  • Patient’s age
  • Ridge relationship
  • Hanau’s quint

Wax Try-In in Complete Dentures – FAQ

1. Cusp Teeth:

  • They have cusps and fossae-like natural teeth
    • Anatomic teeth
      1. Resemble normal, newly erupted teeth
      2. Have the best aesthetics
      3. Havea  30-degree cuspal angulation
    • Semi-anatomic teeth
      1. Have 20 or 10-degree cuspal angulation
      2. They are more flexible than anatomic teeth

2. Cuspless Teeth:

  • Have no cuspal angulation
  • Very flexible to set

Question 11. Anatomic teeth.
Answer:

Teeth that have prominent pointed or rounded cusps on the masticatory surfaces and which are designed to occlude with the teeth of the opposing denture or natural dentition

Advantages of Anatomic teeth.:

  • Efficient cutting
  • Balanced occlusion is obtained
  • Guide the mandible in centric occlusion
  • Aesthetic
  • More resembles natural dentition

The Disadvantage Of Anatomic Teeth.:

Difficulty In Teeth Arrangement

Laboratory Procedures Prior To Try In Difficulty In Teeth Arrangements

  • (a) Incisoe
  • (b) Canine
  • (c) Premolar
  • (d) Molar

Question 12. Advantages of an adjustable articulator.
Answer:

  • Capable of adjustability in all directions
  • Have numerous adjustable readings
  • Customized for each patient
  • Have receptacles in which acrylic dough is contoured to form customized condylar and incisal guidance

Record Base and Wax Rim Preparation

Question 13. Buccolingual width of posterior teeth in the complete denture.
Answer:

  • The buccolingual width of posterior teeth should be decreased to provide a proper path of escapement of food
  • It should be such that the forces from the tongue neutralize the forces from the cheek
  • If the buccolingual width increases, the rate of ridge resorption also increases
  • Teeth with broader dimensions interfere with the tongue, leading to instability of the denture
  • If the teeth are broader buccally, it may lead to cheek biting.

Question 14. Bilabial sounds.
Answer:

  • Bilabial sounds are b, p, and m
  • These are controlled by the lip support
  • These become defective in the absence of lip support or with alteration in the vertical dimension at occlusion

Question 15. Hanau articulator.
Answer:

  • Hanau Articulator is a semi-adjustable articulator
  • Hanau Articulator accepts face bow transfer
  • Hanau Articulator is capable of hinge and lateral movements

Hanau Articulator Parts:

  1. Upper Member:
    • It is T-shaped
    • The vertical arm runs anteroposteriorly, and the horizontal arm runs transversely
  2. Lower Member:
    • It is L L-shaped structure
    • The horizontal arm is a rectangular strip
    • It has a dowel for attachment of the mounting ring
    • The incisal guide table is located at the anterior end of the horizontal arm
    • The vertical arm is sloping
    • It contains a roll pin
  3. Condylar Guidance:
    • It is attached to the upper member of the articulator
    • It represents the glenoid fossa of the TMJ
  4.  Incisal Guide Table:
    • It is customized
  5.  Incisal Pin:
    • It is a double-sided pin.
    • One end is sharp but chisel-like, with a flat edge
    • The other end tapers to a pointed tip

Laboratory Procedures Prior To Try In Upper Member Of A Hanau Wide Vue Articulator

Laboratory Procedures Prior To Try In Hanau Wide Articulator

Laboratory Procedures Prior To Try In Condylar Guidence In Upper Member

Laboratory Procedures Prior To Try In Lateral View Of The Incisal Guidance

Question 16. Beyron’s point.
Answer:

  • The first step in placing a face bow is to locate the hinge axis on the skin on each side of the face
  • One frequently recommended method is to position condylar rods on a line extending from the outer canthus of the eye to the tragus, approximately 13 mm in front of the external auditory meatus
  • This is called Beyron’s point
  • The placement generally locates the rods within 5 mm of the true center of the opening axis of the jaw
  • The imaginary line joining two Beyron’s points is approx. hinge axis
  • The posterior reference point is 10 mm in front of the external auditory meatus.
  • 7 mm below Frankfort’s horizontal plane
  • The anterior reference point is
  • 7 mm from orbitale
  • 25 mm from nasion
  • 18 mm from the inner canthus of the eye
  • 43 mm superior to the tip of the central incisors

Essential Laboratory Procedures Before Try-In Conclusion

Understanding laboratory procedures before try-in is vital for dental professionals. This question and format provides quick insights into best practices in the field.

Laboratory Procedures Prior To Try In Long Essays

by

Laboratory Procedures Before Trying Long Essays

Question 1. Define articulator. Give classification, uses, and discuss semi-adjustable articulators.
Answer:

Articulator Definition:

“A mechanical device which represents the temporomandibular joints & the jaw members to which maxillary & mandibular casts may be attached to stimulate jaw movements”.

Laboratory Procedures Before Wax Try-In

Articulator Classification:

1. Based On Theories:

  • Bonwill theory articulator
  • Conical theory articulator
  • Spherical theory articulator

Read And Learn More: Prosthodontics Question And Answers

Laboratory Procedures Prior To Try In Spherical Articulator

 

Laboratory Procedures Prior To Try In Spherical Articulator And Glabella
2. Based On The Type Of Occlusal Record Used:

  • Interocclusal record adjustment
  • Graphic record adjustment

3. Based On The Ability To Stimulate Jaw Movements:

  • Class 1
  • Class 2
  • Class 3
  • Class 4

4. Based On Adjustability:

  • Nonadjustable
  • Semi adjustable
  • Fully adjustable

Articulator Uses:

  • Diagnose the state of occlusion
  • Planning of dental procedures
  • Fabrication of restoration
  • Correction of restoration
  • Arrangement of artificial teeth

Complete Denture Wax Try-In Preparation

Semi-Adjustable Articulator:

They have adjustable horizontal condylar paths, adjustable lateral condylar paths, adjustable incisal guide tables & adjustable intercondylar distances

Laboratory Procedures Prior To Try In Long Essays

Types Of Articulators:

  •  Arcon Articulator:
    • In this type condylar element is attached to the lower member of the articulator & the condylar guidance is attached to the upper member
    • This resembles the TMJ.
  • Advantages of Articulator: All relations are preserved even when the articulator is open or closed
  • Examples: Whip mix articulator:

Laboratory Procedures Prior To Try In Systamatic Whip Mix Articulator

  • Non-Arcon Articulator:
    • This articulator has a condylar element attached to the upper member
    • The condylar guidance is attached to the lower member
    • It is the reverse of TMJ
  • Examples: Hanau H series

Laboratory Procedures Prior To Try In Systamatic Hanau H Series

Question 2. Discuss in detail the anterior teeth selection for edentulous patients. Add a note ketogenic concept.
Answer:

Anterior Teeth Selection:

Size: Methods:

  • Pre-Extraction Records:
    • Diagnostic cast- prepared before the extraction of teeth
    • Photographs- showing frontal and lateral views
    • Radiographs- Accurate measurements not obtained
    • Close relatives- If other methods fail
    • Extracted teeth- Best method
  •  Anthropological Measurements:
    • Cephalic Index: Total width of upper anteriors= Bizygomatic width/3.36
    • The total width of the lower anterior: 4/5 of the width of the upper anterior. By H. Pound

Laboratory Procedures Prior To Try In Bizygomatic Width

Record Base and Wax Rims in Complete Dentures

  • By Sears: Width of upper central incisor, Circumference of head/13

Laboratory Procedures Prior To Try In Measuring The Circumference Of The Head

Anatomical Landmarks:

1. Size Of Maxillary Arch:

  • Distance between the incisive papilla and the hamular notch on one side.
  • Distance between the two hamuli notches.
  • Total width of all anterior and posterior

Laboratory Procedures Prior To Try In Sum Of The Posterior And Anterior Teeth

  • Canine Eminence: Distance between two canine eminences combined width ofthe  anterior teeth

2. Buccal Frenal Attachments: Distance between two frena = total widths of maxillary anterior

 

Laboratory Procedures Prior To Try In Combined Width Of Maxillary Anteriors

3. Corners Of The Mouth: Distance between them = total width of anterior

Laboratory Procedures Prior To Try In Corners Of Mouth

4. Theoretical Concepts:

  • Winkler’s Concept:
    • Physiological: Evaluate the perioral tissues and arrange the teeth
    • Psychological: Camper’s line is used for it
      1. Raised by happy people
      2. Depressed downward in depressed people
    • Biomechanical: Placement of teeth in the neutral zone
      Laboratory Procedures Prior To Try In Raised Campers Line Patient
  • Typal Form Theory (Leon Williams): The shape of teeth inverse the shape of the face

Laboratory Procedures Prior To Try In Leon Williams Concept

  • Temperamental Theory:
    • People based on mental, functional, and physical characteristics contain teeth
  • Concept Of Harmony:
    • The size of the  teeth corresponds to the size of the head

5. Others:

  • Size of face
  • Interarch distance
  • Lip length

6. Color:

  • Age
  • Young people have lighter teeth
  • Old people – dark teeth
  • More shiny
  • Brownish tinge
  • Habits – smokers’ porcelain teeth
  • Complexion- teeth selected in harmony with the complexion
  • The colour of the eyes color of iris, is considered

7. Form:

  • Patient’s face (Leon William’s concept)
  • Facial form can be ovoid, tapering, or square Teeth are selected according to it
  • Form Example: Oval teeth for oval face
    1. (a) Square
    2. (b) Oval
    3. (c) Tapering
    4. (d) combination

Custom Tray Fabrication in Complete Dentures

Laboratory Procedures Prior To Try In Facial Form And Tooth Shape

  • Patient’s profile
  • It can be convex, concave, or straight
  • The labial form of the anterior is selected according to it
  • Example: Straight labial form for straight profile

Laboratory Procedures Prior To Try In Facial Profile And Labial Convexity

8. Dentogenic concept (SPA concept):

  • Sex:
    • Females: Rounded incisal edges
      1. Less angular teeth
      2. Incisal edges follow the plane of the curve of the lower lip
      3. Rotated distal surfaces of central
      4. The visible mesial third of canines
      5. Exposure to more interiors while smiling
    • Males: More angular teeth
      1. Incisal edges are above the plane of occlusion
      2. The mesial end of the laterals is hidden by the central
      3. The middle 2/3rd of the canine is visible
      4. Prominent cervical regions

Laboratory Procedures Prior To Try In Arrangement Of Maxillary Laterals In Males

Laboratory Procedures Prior To Try In Arrangement Of Maxillary Laterals In Females

Laboratory Procedures Prior To Try In Arrangement Of Maxillary Anteriors Of Lower Lip In Males

Laboratory Procedures Prior To Try In Arrangement Of Maxillary Anteriors Of Lower Lip In Females

  • Personality:
    • Squarish-vigorous people
    • Flat: Executives

Laboratory Procedures Prior To Try In Small Teeth For Executives

  • Age:
    • Increased horizontal overlapping of posteriors
    • Reduced interarch distance
    • Reproduce abrasion and gingival recession in teeth as present in an old individual

Question 3.Given its functions and requirements of an articulator.
Or
Requirements of the articulator
Answer:

Functions Of Articulator :

  • Holds maxillary and mandibular casts in a determined fixed relationship
  • Stimulates jaw movements like opening and closing
  • Produces border and intraborder movements of the teeth similar to those in the mouth

Requirements of Articulator: Requirements of Articulator

  1. Minimal Requirements:
    • The articulator should hold casts in the correct horizontal relationship
    • The articulatorshould hold casts in the correct vertical relationship
    • The casts should be easily removable and re-attachable
    • The articulator should provide a positive anterior vertical stop
    • The articulator should accept the face bow transfer record using an anterior reference point
    • Articulator should open and close in a hinge movement
    • Articulator should be made of non-corrosive and rigid materials that resist wear and tear
    • Articulator should not be bulky or heavy
    • There should be adequate space present between upper and lower members
    • The moving parts should move freely without any friction
    • The nonmoving parts should be of a rigid construction
  2. Additional Requirements:
    1. Condylar guides should allow protrusive and lateral jaw motion
    2. The condylar guide should be adjustable in a horizontal direction
    3. The articulator should be adjustable to accept and alter
    4. Bennett movement
    5. The incisal guide table should be customized

Question 4. Selection of posterior teeth in complete denture
Or
Criteria For Posterior Teeth Selection
Or
Posterior Teeth Selection
Answer:

Posterior Teeth Size:

  • Buccolingual Width: Such that it
  • Provide escape of food
  • Neutralizes forces from cheeks
  • Prevent cheek biting

Laboratory Procedures Prior To Try In Placement Of Posterior teeth The Neutral Zone

  • Mesiodistal length: Such that
  • The combined length of all posteriors doesn’t exceed the distance between canine and retromolar pad

Laboratory Procedures Prior To Try In Mesiodistal Length of Endentulous Ridge

  • Occlusogingival height
  • The occlusal plane should be at the midpoint of the interocclusal distance

Laboratory Procedures Prior To Try In Good Inter Arch Space To Place Teeth With high Occluso Gingival Height

Steps Before Wax Try-In in Prosthodontics

2. Form:

  • High cuspal height for steep condylar guidance
  • Shallow cusps for shallow ridge
  • Monoplane teeth for posterior crossbite

Laboratory Procedures Prior To Try In Shallow Cusped Teeth Should Be Used Over Shallow Ridges

Maxillomandibular Relations Long Essays

by

Maxillomandibular Relations Long Essays

Question 1. Define vertical jaw relation. Enumerate the different methods to register the vertical jaw relation. Describe any one method in detail.
(or)
Question 1. Define jaw relation and explain various methods involved in recording vertical jaw relation.
(or)
Question 1. Discuss various methods of determining vertical dimension in edentulous patients. Describe anyone.
(or)
Question 1. Define vertical jaw relation. Explain in detail the various techniques of recording it.
Or
Methods of recording vertical dimension.
Answer:

Maxillomandibular Relations Long Essays

Maxillomandibular Relations Definition:

  1. Jaw Relation: Any relation of the mandible to the maxilla
  2. Vertical Jaw Relation:
    1. The length of the face as determined by the amount of separation of the jaws
    2. Methods for recording vertical jaw relation

Read And Learn More: Prosthodontics Question And Answers

Methods Of Recording Of Vertical Jaw Relations:

1. Methods To Measure Vertical Jaw Relation At Rest:

  • Facial Measurements:
    • Two reference points are marked
    • One on the nose and other over the chin
    • The patient is asked to perform various functions Distance between the two reference points is measured
    • This gives a measurement of the physiological rest position of the mandible.

Maxillomandibular Relations Reference Points For Vertical Jaw

  •  Facial Expression:
    • The patient is asked to relax
    • Various expressions are viewed
  • Anatomical Landmarks:
    • Distance between:
    • Pupil of the eye and corners of the mouth
    • Anterior nasal spine and lower border of the mandible
    • Anatomical Landmarks is measured
    • If they are equal, jaws are at rest

 

Maxillomandibular Relations Anatomical Land Marks

  • Tactile Sensation:
    • The patient is asked to open the mouth wide
    • Then close his mouth slowly till the muscles are relaxed
    • Distance between two reference points is measured
  • Speech:
    • The patient is asked to repeat the letter ‘m’
    • Distance between two reference points is measured as soon as the patient stops repeating

Centric Relation in Complete Dentures Essay

2. Vertical Jaw Relations At Occlusion:

  • Ridge Relation:
    • Distance between incisive papilla to mandibular incisors is measured distance be-tween incisive papilla & maxillary incisors is 6 mm
      1. Overbite is 2 mm
      2. Thus, the distance between the incisive papilla & mandibular incisors is 4 mm
    • Ridge Parallelism: Mandible is parallel to maxilla only at occlusion

Maxillomandibular Relations Distance Between Incisive Papilla And Incisal Edge

  • Pre-extraction Records:
    1. Profile photographs
    2. Profile silhouettes
    3. Radiography
    4. Articulated cast
    5. Facial measurements
  • Measurements from former dentures:

3. Physiological Methods:

  • PowerPoint: By Boos
    1. A metal central bearing plate is attached to the upper base
    2. Bimeter attached to lower base
    3. Inserted in patient’s mouth & asked to bite
    4. Pressure reading in bimeter is recorded

Maxillomandibular Relations Boos Power Point Method

  • Using Wax Occlusal Rims:
    1. Measure vertical relation at rest
    2. Estimate vertical relation to be 2-5 mm less of it
    3. Coat occlusal surface of maxillary rim with petrolatum
    4. Place triangular sectioned occlusal rim over the mandibular rim
    5. Soften the wax
    6. Ask the patient to bite over it
    7. Remove it and articulate

Maxillomandibular Relations Adding A Tringular Cross Section Of Modeing Wax

  • Physiological Rest Position (Niswonger And Thomson): 
    1. Seat the patient
    2. Ask him to swallow and relax
    3. Part the lips slightly
    4. Space exists between the upper and lower rims
    5. This space is called “Freeway space”
    6. It should be 2-4 mm
    7. By it, vertical dimensions at occlusion is calculated from the formula
    8. VD at rest =VD at occlusion + freeway space

Maxillomandibular Relations Free Way Space

Vertical Dimension of Occlusion in Prosthodontics

Then a+b+c. The vertical dimension at rest is equal to the sum of the vertical dimension at occurrence and free way space

Maxillomandibular Relations The Vertical Dimension At Rest To Equal

  • Phonetics:
    • Silverman’s closest speaking space:
    • Sounds like ch, s, j results in the closest relation of upper and lower rim without contacting each other
    • This indicates the vertical dimension of the patient

Maxillomandibular Relations Silvermans closest Residula Ridge Resorption

  • Aesthetics:
    • The size of teeth assessed from the residual ridge resorption
  • Swallowing Threshold:
    • The conical rim is placed over the lower rim
    • Insert both the record bases
    • Ask the patient to swallow
    • By this height of the lower rim is reduced
  • Tactile Sensation:
    • Occlusal rims with a central bearing plate & screw are inserted in the patient’s mouth,
    • Tighten the screw till the patient feels discomfort

Maxillomandibular Relations tactile Sense method And central Bearing And Central Bearibearing Plate

    • A –  Tactile sense method of determining vertical jaw relation vertical jaw relation
    • B –  Central bearing point
    • C – Central bearing plate
  • Patient’s Perception:
    • Occlusal rims with excessive height is inserted in the patient’s mouth
    • Stepwise reduction is carried out till the patient feels comfortable

Long Essay on Jaw Relations in Complete Dentures

Question 2. Define balanced occlusion. Discuss in detail the factors affecting balanced occlusion in complete dentures.
Or
Define balanced occlusion. Write in detail about various factors affecting it.
(or)
Define balanced occlusion. Explain its significance. Write in detail about various factors affecting it.
Or
Factors affecting balanced occlusion.
Answer:

Balanced Occlusion Definition:

“The simultaneous contacting of the maxillary & mandibular teeth on the right & left & in the anterior & posterior occlusal areas in centric & eccentric positions, developed to lessen or limit tipping or rotating of the denture bases concerning the supporting structures

Maxillomandibular Relations Long Essays

Factors Affecting Balanced Occlusion:

1. Condylar Guidance:

  • The first factor of occlusion to be considered
  • Measured using protrusive registration
  • Increased condylar guidance increases jaw separation
  • It cannot be modified

Maxillomandibular Relations Posterior Slope Of The Articular Eminence

2. Incisal Guidance:

  • “The influence of the contacting surfaces of the mandibular & maxillary anterior teeth on mandibular movements”
  • The second factor of occlusion
  • Customized
  • If overjet increases, it decreases
  • If overbite increases, it increases
  • If incisal guidance is steep, steep cusps, steep occlusal plane & steep compensatory curves are required
  • It must be as flat as possible

Maxillomandibular Relations Incisal Guidence

3. Occlusal Plane:

  • “An imaginary surface which is related anatomically to the cranium & which theoretically touches the incisal edges of the incisors & the tips of occluding surfaces of posteriors”
  • Height of the lower canine should coincide with a measure of the mouth
  • It should not be altered beyond 10°
  • A posterior plane parallel to the Camper’s line 10°

Maxillomandibular Relations The Plane Of Occlusion

4. Cuspal Angulation:

  • “The angle made by the average slope of a cusp with the cusp plane measured mesiodistally or buccolingually”
  • Reduced cuspal height in shallow overbite High cuspal angle in deep bite

Maxillomandibular Relations Cuspal Angulation

5. Compensatory Curves:

  • “The anteroposterior & lateral curvatures in the alignment of the occluding surfaces & incisal edges of artificial teeth which are used to develop balanced occlusion
  • Steep compensatory curves for steep condylar path
  • Shallow curves for loss of balancing molar contacts
    Maxillomandibular Relations Posterior Separation And Incorplorating Curve
  • Thus balance must be present between all the five factors
  • Effect of incisal & condylar guidance must counter-act by the effect of other three factors
  • If the balance is lost, balanced occlusion cannot be achieved

Question 3. Define Centric relation. Classify jaw relation. Write in detail on any one technique of determining jaw relation.
Or
Define centric jaw relation. Classify different methods & explain any one method for recording jaw relation.
Or
Methods of centric jaw relation.
Answer:

Centric Jaw Relation:

The maxilla mandibular relation in which the condyles articulate with the thinnest avascular portion of their respective disc with the complex in the anterior-superior position against the slopes of the articular eminence

Jaw Relations And Methods To Record Them:

Orientation jaw relation: by face bow: Vertical jaw relation:

  1. Vertical jaw relation at rest:
    • Facial measurement
    • Tactile sense
    • Measurement of anatomical landmarks
    • Speech
    • Facial expression
  2.  Vertical Jaw Relation At Occlusion:
    • Mechanical methods:
        • Ridge relation
          1. Ridge parallelism
          2. Distance of incisive papilla to mandibular Incisors
    • Pre-extraction records
  3. Physiological Methods: [PATUS]:
    • Powerpoint
    • Physiological rest
    • Phonetics
    • Patient’s perception
    • Aesthetics
    • Tactile sense
    • Using wax records Swallowing threshold
  4.  Horizontal Jaw Relation: 
    • Physiological methods –
      1. Tactile method
      2. Pressureless method
      3. Pressure method
    • Functional method:
      1. Needlehouse method
      2. Patterson method
    • Graphic method:
      1. Intraoral
      2. Extraoral
    • Radiographic method

Pressureless Method [Nick And Notch]:

Seat the patient in an upright position
↓
Retrude his mandible
↓
Remove up to 3 mm of wax from either side of the mandibular rim
↓
Cut 1-2 notch on the corresponding area of the maxillary rim
↓
Make a nick anterior to it [notch-prevent anterioposterior movement Nick-lateral movement]
↓
Add aluwax upto 4.5 mm in mandibular rim & insert in patient’s mouth Teach the patient to close mouth in centric relation
↓
Remove the rims & place it in cold water
↓
Check for any errors
↓
Articulate it.

Maxillomandibular Relations Notch In Maxillary Occlusal Rim

Maxillomandibular Relations Trought In Maxillary Occlusal Rim

Maxillomandibular Relations Nick In Maxillary Occlusal Rim

Maxillomandibular Relations The Excess Aluwax Scrapped And Wax Carver

Question 4. Classify Jaw and Centric relation. Explain its significance. What are the methods for recording it.
Or
Classification Of Jaw Relation
Answer:

Jaw Relations:

Any relation of the mandible to the maxilla

Jaw Relation Classification:

  1. Orientation Jaw Relation:
    • The jaw relation when the mandible is kept in its most posterior position, it can rotate in the sagittal plane around an imaginary transverse axis passing through or near the condyles’
  2. Verticle Jaw Relations: The length of the face as determined by the amount of separation of the jaws
    • Vertical Relation At Rest:
      • The length of the face when the mandible is in rest position
    • Vertical Relation At Occlusion:
      • The length of the face when the teeth are in contact & the mandible is in centric relation or the teeth are in centric relation
  3. Horizontal Jaw Relation: It is the relationship of the mandible to the maxilla in the horizontal plane

Prosthodontics Essay on Maxillomandibular Relations

Centric Jaw Relation:

The maxillomandibular relation in which the condyles articulate with the thinnest avascular portion of their respective disc with the complex in the anterior-superior position against the slopes of the articular eminence

Centric Jaw Relation Significance:

  • Proprioceptive impulses guide the mandible during various movements
  • In edentulous patients, it is possible from the impulses of PDL
  • But in edentulous patients, it is not possible
  • In such cases, impulses are received from our transferred to TMJ
  • Centric relation acts as a center for such impulses
  • It guides the mandible during such movements

Centric Jaw Relation Methods Of Recording It:

1. Physiological Methods:

  • Tactile Method:
    • Ask the patient to retrude the mandible
    • Tentative jaw relation is recorded
    • Based on it casts are articulated
    • Teeth arrangement is done
  • Pressureless Method:
    • Occlusal rims are fabricated
    • Denture base along with occlusal rim is inserted in the patient’s mouth
    • Ask the patient to close in a centric relation
    • Occlusal rims are sealed in this position
  • Pressure Method:
    • Upper occlusal rim is inserted into the patient’s mouth
    • The lower rim is fabricated with excess material
    • It is thoroughly softened and inserted in the mouth
    • Ask the patient to close in centric relation over softened wax

2. Centric Jaw Relation Functional Method:

  • Centric Jaw Relation utilizes the functional movements of the jaw to record centric relation
    • Needlehouse method
    • Patterson method

3. Centric Jaw Relation Graphic method:

  • Centric Jaw Relation involves tracing to record centric jaw relation
  • Intraoral
  • Extraoral

4. Centric Jaw Relation  Radiographic Method

Question 5. Define balanced occlusion. Give in detail its various functional objectives in complete dentures.
Answer:

Balanced Occlusion Definition:

The simultaneous contacting of the maxillary & mandibular teeth on the right & left & in the anterior &posterior occlusal areas in centric & eccentric positions, developed to lessen or limit tipping or rotating of the denture bases in relation to the supporting structures

Balanced Occlusion Functional Objectives:

  • The smaller the area of the occlusal surface, the lesser the transmission of forces to the supporting structures
  • A tilted occlusal surface causes, nonvertical forces on the denture
  • Tilted tissue support causes nonvertical forces on the denture
  • Vertical forces on resilient tissues cause lever forces on the denture
  • Vertical forces outside the ridge cause tipping of the denture
  • The stability of the denture must be present in both centric & eccentric relation
  • Balanced occlusal contacts during eccentric movements Unlocking of cusps to settle the denture
  • Reduced cuspal height to resist horizontal forces Efficient mastication efficiency
  • Minimal tooth contact during mastication
  • Absence of sharp ridges & cusps
  • Wide & large ridges
  • Teeth arranged close to ridge Narrow ridge rest on ridge
  • Arrangement of teeth slight lingually Forces of occlusion should be centered

Maxillomandibular Relations Aluwax Placed On The Mandibular Trough

Question 6. Discuss the importance & validity of centric relation.
Or
Significance of centric relation.
Answer:

Centric Relation Importance:

  • Proprioceptive impulses guide the mandible during various movements In edentulous patients it is possible from the impulses of PDL
  • But in edentulous patients, it is not possible In such cases, impulses received from the ridge are transferred to TMJ
  • Centric relation acts as a center for such impulses
  • Centric Relation guides the mandible during such movements

Maxillomandibular Relations Proprioceptive Impulses From Teeth And temporomandibular Joint

Centric Relation Validity:

  • Learnable
  • Repeatable
  • All functional movements are possible from this position
  • The arrangement of muscles is such that they move the mandible from a centric position
  • Helps in the mounting of casts
  • Adjustment of condylar guidance in articulator is done according to it
  • Definite
  • Recordable
  • During any movement of the mandible, it has passed from this position first

Question 7.  Mention the significance of physiologic rest position
Or
Physiologic rest position and Discuss effects of increased & decreased vertical jaw relations.
Answer:

1. Significance Of Physiological Rest Position:

  • “The mandibular position assumed when the head is in an upright position & the involved muscles, particularly the elevator & depressor groups, are in equilibrium in tonic contraction, and the condyles are in a neutral, unstrained position”
  • During rest position, space exists between the upper & lower rims
  • This is called freeway space
  • It should be 2-4 mm
  • If it increases, the vertical dimension at occlusion re- duces & becomes inefficient
  • If this space decreases, then the vertical dimension at occlusion increases to a greater extent
  • This increases lower facial height of the patient

2. Effects of Increased Vertical Dimensions:

  • Increased trauma to the denture-bearing area
  • Increased lower facial height
  • Cheek biting
  • Difficulty in swallowing & speech
  • Pain & clicking in TMJ
  • Stretching of facial muscles
  • Increased space of the oral cavity

3. Effects Of Decreased Vertical Dimensions:

  • Decreased trauma to the denture-bearing area
  • Decreased lower facial height
  • Angular cheilitis
  • Difficulty in swallowing
  • Pain, clicking & discomfort in TMJ
  • Loss of lip fullness
  • Loss of muscle tone
  • Dropping down of corner of the mouth
  • Thinning of vermillion borders of lip
  • Decreased space of the oral cavity

Maxillomandibular Relations Short Essays

by

Maxillomandibular Relations Short Essays

Question 1. Define face bow. Explain the parts of the face bow
Answer:

Definition Of Face Bow:

A caliper-like device is used to record the relationship of the jaws to the temporomandibular joints & to orient the casts on the articulator to the relationship of the opening axis of the temporomandibular joint

Parts Of Face Bow:

1. U-Shaped Frame:

  • Fce bow is a U-shaped metallic bar that forms the main frame of the face bow
  • All other components are attached to it
  • Face bow records the plane of the cranium

Read And Learn More: Prosthodontics Questions And Answers

2. Condylar Rods:

  • Condylar rods are two small metallic rods on either side of the free end of the U-shaped frame
  • Helps to locate the hinge axis
  • Transfer the hinge axis of the TMJ by attaching it to the condylar shaft in the articulator

3. Bite Fork:

Bite Fork is U U-shaped plate that is attached to the occlusal rims while recording the orientation relation It is attached to the frame with the help of a stem

Bite Fork should be inserted about 3 mm below the occlusal surface within the occlusal rim

Prosthodontics Notes on Jaw Relations

4. Locking Device:

  • The locking Device helps to attach the bite fork to the U-shaped frame
  • The locking Device supports the face bow and occlusal rim, and is cast during articulation
  • The locking Device consists of a transfer rod and a transverse rod. The U-shaped frame is attached to the vertical transfer rod
  • A transverse rod connects the transfer rod with the stem of the bite fork

Maxillomandibular Relations Short Essays

5. Orbital Pointer:

  • Orbital Pointer marks the anterior reference point
  • Present only in the arbitrary face bow

Question 2. Balanced Occlusion.
Answer:

Balanced Occlusion Definition:

“The simultaneous compacting of the maxillary & mandibular teeth on the right & left & in the anterior & posterior occlusal areas in centric & eccentric positions, developed to lessen or limit tipping or rotating of the denture bases concerning the supporting structures”.

Types Of Balanced Occlusion:

  • Unilateral balanced occlusion
  • Bilateral balanced occlusion
  • Protrusive balanced occlusion
  • Lateral balanced occlusion

Laws Of Balanced Articulation:

  • Condylar guidance
  • Incisal guidance
  • Compensatory curves
  • Relative cusp height
  • The plane of the orientation of the occlusal plane

Factors Influencing Balanced Occlusion:

  • Condylar guidance
  • Incisal guidance
  • Orientation of occlusal plane
  • Cuspal angulation
  • Compensatory curves

Complete Denture Maxillomandibular Relations

How Balance Is Achieved:

  • The incisal and condylar guidance produces an increase in posterior separation
    While other three factors i.e., occlusal plane, cervical angulation, and compensatory curves, cause a decrease in posterior separation.
  • The effect of incisal and condylar guidance should counteract the other three factors to obtain a balanced occlusion

Question 3. Unbalanced occlusion.
Answer:

Unbalanced Occlusion is an arrangement of teeth with a Form or purpose

Unbalanced Occlusion General Considerations:

  • Opposing artificial teeth should not contact in eccentric relation
  • Tooth contact should occur only when the mandible is in centric occlusion
  • Repeat the mandibular movements till the comfort of the patient in centric relation

Unbalanced Occlusion Concepts:

1. Pound’s Concept:

  • Proposed importance of phonetics & aesthetics for anterior teeth
  • While posterior teeth should have a sharp upper lingual cusp & wide lower central fossa
  • Lingualized occlusion
  • A triangle is formed between the mesial end of the canine & the two sides of the retromolar pad

Maxillomandibular Relations Pounds Concept Of Tooth Arrangement

2. Hardy’s Concept: Proposed a flat occlusal plane with non-anatomical teeth for complete denture

3. Kurth’s Concept: Flat posterior teeth in a horizontal plane without any balancing ramps. It is an arrangement of teeth with form or purpose

Maxillomandibular Relations Philip M Jones Concept Of Non Balanced Occlusion

Question 4. Orientation relation in the complete denture, And Write Face bow
Answer:

Orientation Jaw Relation:

  • “The jaw relation when the mandible is kept in its most posterior position, it can rotate in the sagittal plane around an imaginary transverse axis passing through or near the condyles”.
  • It can be recorded with the help of a face bow

Centric Relation in Complete Dentures

Face Bow:

A caliper-like device that is used to record the relationship of the jaws to the temporomandibular joints & to orient the casts on the articulator to the relationship of the opening axis of the temporomandibular joint

Face Bow Parts:

  • U-shaped frame
  • Condylar rods
  • Bite fork
  • Locking device
  • Orbital pointer

Face Bow Types:

  1. Arbitrary Face Bow:
    • Facia type
    • Earpiece type
    • Hanau face bow
    • Systematic
    • Twirl bow
    • Whipmix
  2. Kinematic Face Bow:

Maxillomandibular Relations U Shaped Frame of A Face Bow

Maxillomandibular Relations Orbital Pointer

  • Aluwax is softened
  • The bite fork is embedded into this wax. A thin layer of petroleum jelly is applied over both the rims
  • Both the rims are inserted into the patient’s mouth
  • The bite fork is also inserted into the patient’s mouth. Ask the patient to close their mouth
  • The stem of the bite fork is locked to the transverse rod
  • The orbital pointer is made to touch the infraorbital notch
  • The entire face bow, along with the rims is removed and articulated

Maxillomandibular Relations Face Bow Along With Rims Removed And Articulated

Maxillomandibular Relations Preparing The Occlusion Rim Receive To Bite Fork

Maxillomandibular Relations The Bite Fork To Occlusion Rim Using Alu Wax

Maxillomandibular Relations The Looking stem Of The Bite Forjk To Tranverse Rod

Maxillomandibular Relations Positioning And Looking The Orbital Pointer

Vertical Dimension of Occlusion Essays

Question 4. Occlusal rims.
Answer:

Occlusal Rims Definition:

Occluding surfaces built on temporary or permanent denture bases for the purpose of making maxillo-mandibular relation records & arranging teeth

Occlusal Rims Factors Controlling It:

1. Relationship Of Natural Teeth To The Bone:

  • Rims should be parallel to the long axis of the teeth to be replaced
  • The maxillary anterior is labially inclined, and the posteriors are vertically placed

2. Relationship Of Occlusal Rims To Edentulous Ridge:

  • The midline of the occlusal plane should pass through the apex of the edentulous ridge

3. Standard Dimensions:

  • Maxillary rims
  • Height: 22 mm
  • Width: 4-6 mm in the anterior region
  • Width: 8-12 mm in the posterior region

Maxillomandibular Relations Ideal Measurements Required For Maxillary Occlusal Rim

  • Mandibular rims
  • Height: 6-8 mm
  • Width: 4-6 mm in the anterior region
  • Width: 8-12 mm in the posterior region

Maxillomandibular Relations Ideal Measurements Required For A Mandibular Occlusal Rim

4. Clinical Guidelines:

  • Maxillary anterior edge 0-2 mm below the upper lip
  • Maxillary posterior occlusal plane 1/4th inch below the opening of Stenson’s duct
  • Mandibular incisal edge at the level of the lower lip
  • Canine eminence at the corner of the mouth

Maxillomandibular Relations Clinical Guide Lines For Cheking To Occlusal Rims

5. Techniques For Fabrications:

Maxillomandibular Relations tecniques For Fabrications And Rolled wax Tecnique

  • Rolled Wax technique
  • Metal occlusal rim former
  • Pre-formed Occlusal rim