Radiographic Interpretation of Ameloblastoma 4m*** 2m**

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    1. Slow growing = identified late 
    2. Initially, pt has asymptomatic symptoms
    3. Later develops swelling due to buccolingual expansion and come to dentist 
    4. Unilateral
    5. Mandible = posterior = Ramus/body = mc 
    6. If it occurs in anterior region = desmoplastic type = aggressive and resembles fibro osseous lesion
    7. 20% of cases seen in maxilla = can involve sinus 
    8. Epicenter = odontogenic in origin = above IAC
    9. Size = large, diffuse
    10. Borders = well defined 
    11. Internal structure =
      1. Multilocular
      2. septa are small and round = honeycomb appearance 
      3. Septa are large and round = soap bubble appearance
      4. Septa are curved and round
    12. Displace IAC inferiorly 
    13. Root resorption = Knife edge resorption
    14. Lower border of mandible = thin egg shell appearance due to aggressive expansion

RADIOLUCENT LESIONS OF JAWS #9M #NTRUHS

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  1. Acute periapical abscess
    1. Swelling
    2. Vertical pain = tenderness on percussion
    3. Vestibular tenderness and obliteration = pathognomonic sign
    4. Widening of PDL = Only feature. It takes time for r/g features to develop, by that time acute has been converted into chronic
  2. Chronic Periapical abscess
    1. Carious tooth 
    2. Sinus tract = pus will come out
    3. Hence, there will be a breach in the continuity of lamina dura
    4. Diffuse, ill-defined radiolucency surrounding root apex
  3. Periapical Granuloma
    1. Granuloma is made up of granulation tissue. It is formed due to new vascularizations.
    2. May or maynot be corticated
    3. Size is less than 1.5 cm in diameter
    4. Well defined
  4. Periapical cyst
    1. Well defined 
    2. Surrounding corticated or sclerotic border
    3. Size is more than 1.5 cm 
  5. Infected Cyst
    1. Partially well defined 
    2. Corticated border = evident only in few areas
  6. PERIAPICAL CEMENTAL DYSPLASIA 2M*
    2. Site = mandibular anteriors
    3. Teeth = vital
    4. Multifocal 
    5. Appearing as periapical radiolucency
    6. RL = initial stage
    7. Mixed = intermediate stage
    8. RO = mature stage
  7. Phoenix abscess
    1. Acute exacerbated phases of chronic periapical abscess
    2. Pt complains that Every 6 months, swelling and pain
    3. Pulp is non vital
  8. Lateral periodontal Cyst

Ortho Case 4.2

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An 11-year-old female presented with a class II division 1 malocclusion on a moderate skeletal class II pattern with reduced vertical dimensions complicated by an increased overjet (11mm), increased overbite, generalized spacing and bi-maxillary proclination.

The aetiology of this malocclusion is multi-factorial.

The moderate skeletal class II discrepancy resulted in an increased overjet and class II molar relationship. The overjet was exacerbated by the presence of a lower lip trap. The generalized spacing was a result of an underlying dento-alveolar disproportion. This was compounded by bi-maxillary proclination, which arose due to resting soft tissue pressures and dento-alveolar compensation.

TREATMENT PLAN

• Integration of twin block functional and sectional lower fixed Herbst appliancee
• Continuation of functional appliance wear at night
only
• Use of headgear
• Inter-arch class II elastic traction following fixed
appliance placement

The prognosis for long-term stability of class II correction is good in this case, as the new maxillary incisor position will be controlled by the lower lip following the achievement of lip competence.

Ortho Case 4.1

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A 12-year-old female presented with a class II division 1 malocclusion on a moderate skeletal class II pattern, with increased vertical dimensions complicated by an increased overjet (12mm), crowding of both dental arches and teasing in relation to her dento-facial appearance.

What is treatment plan?

TREATMENT PLAN

1) Functional appliance like Dynamax or Twin block (more preffered as overjet reduction is more effective) = maxillary retroclination, mandibular incisor proclination, guides the eruption of posterior dentition.

2) Need of Headgear with torqueing spurs = restricts maxillary forward growth and tipping of maxillary incisors.

3) Extraction of four second premolars followed by edge to edge appliances for stability of class II correction.

Picture based diagnosis case 1

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Study the two radiographs which are of the same
patient at (a) 19 years and (b) 34 years of age.

1 . What is the most likely periodontal diagnosis at 34
years of age?

Generalised aggressive periodontitis. The severity
of bone resorption and the radiographic absence of
signs of resorption at 19 years preclude a diagnosis of
chronic periodontitis.

2 . What does the initial phase of treatment involve?

Initially conventional cause-related treatment
is instigated: instruction in toothbrushing and
use of adjunctive aids for interproximal and
subgingival cleaning, RSI, prophylaxis. Ultimately,
treatments such as surgery and the adjunctive use of
antimicrobials might be indicated, but conventional
treatment is first in line.

3 . The patient has a sister who is aged 29 years. What
advice might you offer?

Periodontal screening and radiographic examination.
There is evidence that certain subjects are at high risk
from developing aggressive periodontitis and this
risk may be under genetic control. Siblings should
be screened and affected individuals with children
warned that early signs may develop from around
puberty onwards

Case History 4 in Diseases of bone and the maxillary sinus

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A 35-year-old man presents with gross loosening of both his lower left premolar teeth. The gingiva around them looks swollen and is purple–brown in colour. A radiograph shows irregular bone destruction to the apices. Incisional biopsy shows multinucleated osteoclast-like giant cells in a haemorrhagic fibrous stroma.

  1. Which investigations should now be performed?
    The serum calcium level should be measured and radiographs reviewed to exclude hyperparathyroidism.
  2. If these prove negative, what treatment should be undertaken?
    The lesion should be treated by local removal with curettage.
  3. Which other lesions in the jaws contain multinucleate giant cells of this type?
    Osteoclast-like giant cells are found in
    1. giant-cell granuloma
    2. brown tumour of hyperparathyroidism
    3. PagetĘĽs disease of bone
    4. aneurysmal bone cyst
    5. some fibro-osseous lesions, particularly cherubism. 

INTRODUCTION Over the ages, oral health care has been delivered to the community in different ways. The horseback dentistry of olden days has evolved into the most modern painless dental procedures. In India, about 70% of the population live in rural areas whereas 70% of the dentists practice in urban areas. We seldom find certain dental offices and few government establishments in rural areas, which lack the required infrastructure.WHAT ARE MOBILE DENTALCLINICS? A mobile dental clinic is used primarily when oral health care is be delivered to small pockets of patients that are scattered over a specific geographic area. The mobile clinic generally is parked at a facility such as a school, residential facility or community center.SALIENT FEATURES:- •Useful life is shorter than a fixed facility. •Requirement of water and waste disposal methods. •Dental equipment can be a traditional or a portable one. •Requirement of a generator on board to provide electricity.TARGETED POPULATIONS FOR MOBILE DENTAL SERVICES:- •Low-income individuals or families. •Isolated or very rural rural populations. •Persons in residential care facilities. •People who are “ homebound”, bedridden, very frail or receiving hospital services at home. •Persons with a variety of special health care needs. •Migrant and seasonal workers. •People who are homeless or temporarily displaced.WHY MOBILE CLINICS ARE PREFERRED OVER USUAL ONES? •Moderate start up costs. •It addresses the problem of transportation to the clinics. •It decreases missed appointments when run in conjunction with schools. •Services can be made available at multiple sites. •Services are made available to the needy population.   Even though mobile clinics are preferred over the usual ones, but they do have certain disadvantages. Let’s have a look at certain “disadvantages” of it:- •High maintenance costs may occur. •Difficult to access and store patient record. •Provides limited services and follow up may be difficult. •Requires permission for site use. •Difficult to use during monsoon. ESSENTIALS OF MOBILE DENTAL CLINIC:- The mobile dental clinic should be equipped with 2 dental chairs with all attachments and seating space for 15-20 people. 1.PORTABLE DENTAL UNIT:-•Dental chair should be portable and easy to handle. It should be able to be folded for easy transportation.  All the parts  should be detachable type and well balanced and sturdy. •Mobile suitcase unit: Fitted with aerotar and micromotor hand piece. •Scaler with 3 scaling tips. •Control box with transparent, regulated water tank and foot control.2.OPERATING LIGHT:- Two, intensity fixed with hinge on the top of the van. 3.DENTAL X-RAY UNIT:-  X-ray unit with digital arm timer and day light manual developer. 4.AUTOCLAVE:-  High speed automatic instrument autoclave. 5.METAL CABINETS WITH WASH BASIN 6.WATER TANK: 400 litres capacity. 7.HEALTH EDUCATION MODELSPARTNERSHIPS IN PROVIDING MOBILE DENTAL SERVICES:-Some of the group or  Individuals who could potentially be partners are:- •GOVERNMENT:-State/ Local, Health Department, Department of Social Service. •COMMUNITY:- Local community, Business Leaders, Foundations. •PUBLIC:- Patient Care  Advocate, Organizations that promote health. •POLICY:- Local and Community Policy Makers. •HIGHER/ PROFESSIONAL EDUCATION:- Medical schools ,Dental schools and Allied Health Schools.CONCLUSION A fully-equipped mobile dental clinic is to provide effective dental care at the doorsteps of underprivileged, rural population is the need of the hour. The key to a successful dental practice is a cohesive dental team, which will create an atmosphere of co-operation resulting in the achievement of the goals of oral health in the coming up years.REFERENCE Essentials of public health dentistry-Soben Peter

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