
SUTURING TECHNIQUES

The following is a list of techniques used for gingival augmentation coronal to the recession (root coverage):
Indication:
Adjacent to the denuded root surface, the donor connective tissue is sandwiched between the split flap as shown in the figure.
Step 1. Raise a partial-thickness flap with a horizontal incision 2 mm away from the tip of the papilla and two vertical incisions 1 to 2 mm away from the gingival margin of the adjoining teeth.
Step 2. Thoroughly plane the root, reducing its convexity.
Step 3. Obtain a connective tissue graft from the palate by means of a horizontal incision 5 to 6 mm from the gingival margin of molar and premolars. The connective tissue is carefully removed along with all adipose and glandular tissue. The palatal wound is sutured in a primary closure.
Step 4. Place the connective tissue on the denuded root. Suture it with resorbable sutured to the periosteum.
Step 5. Cover the graft with the outer portion of the partial-thickness flap and suture it interdentally.
Step 6. Cover the area with dry foil and surgical pack.
After 7 days, the dressing and sutures are removed. The esthetics are favorable with this technique since the donor tissue is connective tissue.
Dentowesome|@drmehnaz
Source: Carranzaβs Clinical Periodontolgy, 10th Ed
Periodic Dental Check-ups: You can say good riddance to tartar, plaque, cavities and gum disease…..
Here’s an overview of various treatment options for drugs known to cause Gum disease/Gingival Enlargement.π
To discover more w.r.t this topic head on to βπ» – https://dentowesome.in/2020/07/03/gingival-enlargement/
Presentation Tipπ‘: Try to present your answers with flowcharts & diagrams rather than long paragraphs!! It will definitely have more impact & help you score well in exams..πππ»
Source: Carranza’s Clinical Periodontolgy, 10th Ed
Dentowesome|@drmehnazπ
PA radiolucencies identification made easy! Happy learning..ππ
When formulating radiological differential diagnosis, features should be evaluated carefully, such as
β’ Location: With periapical inflammatory lesions, which are pathological conditions of the pulp, the epicenter typically is located at the apex of a tooth.
β’ Periphery: Ill defined
β’ Effects on surrounding structures: Periapical lesions cause widening of PDL space at apical region of the root.
PERIAPICAL RADIOLUCENCIES
Developmental
Lateral periodontal cyst
Inflammatory Lesions
Apical periodontitis, periapical abscess
Cystic Lesions
Periapical (radicular) cyst
Odontogenic keratocyst
Glandular odontogenic cyst
Benign Tumors
Ameloblastoma
Malignant Tumors
Ameloblastic carcinoma
Dentowesome|@drmehnazπ
References:
A swelling is a value term that denotes only enlargement or protuberance in body due to any cause.
According to the cause a swelling may be congenital, traumatic, inflammatory, Neoplastic or miscellaneous.
Examination of a swelling should be accompanied by a complete history of the patient. Following points should be noted:
β’ Duration: The clinician may ask βwhen was the swelling first
noticedβ? Swellings that are painful and of shorter duration are mostly inflammatory (acute), whereas those with longer duration and without pain are chronic, e.g. a chronic periapical abscess.
β’ Mode of onset: The clinician may ask βhow did the swelling startβ? The history of any injury or trauma or any inflammation may contribute to the diagnosis and nature of the swelling.
β’ Progression: The clinician should ask βhas the lump changed in size since it was first noticed? Benign growths such as bony swellings grow in size very slowly and may remain static for a long period of time. If the swelling decreases in size, this suggests of an inflammatory lesion.
β’ Site of swelling: The original site where it started must be assessed.
β’ Other symptoms: Pain, fever, difficulty in swallowing, difficulty in respiration, disfigurement, bleeding or pus discharge are the common symptoms associated with swellings in the orofacial region.
β’ Recurrence of the swelling: many swellings do recur after removal of the tissue, indicating the presence of precipitating factor, e.g. ranula.
(A) Inspection
(B) Palpation
Surface: Can beππ»
β’ Smooth (cystic swellings)
β’ Lobular with smooth lumps (lipoma)
β’ Nodular (multinodular goitre)
β’ Matted (lymph nodes)
β’ Irregular (carcinoma)
Margins: Well defined/indistinctππ»
β’ Malignant growth - irregular margin
β’ Acute inflammatory swelling - ill defined margin
β’ Benign tumor - swelling slips & is indistinct
Edgeππ»
β’ Well defined & regular-Benign Neoplasms
β’ Well defined & irregular-Malignant Neoplasms
β’ Ill defined & diffuse - Inflammatory swellings
Consistency: ππ»
β’ Soft - lipoma
β’ Cystic - Cyst or chronic abscesses
β’ Firm - Fibroma
β’ Hard - Chondroma
β’ Bony hard - Osteoma
β’ Stony hard - Carcinoma
β’ Variable consistency - Malignancy
An ulcer is break in continuity of epithelium, skin or mucous membrane. A proper
history must be taken in case of an ulcer:
β’ Mode of onset: The clinician may ask βhow has the ulcer developedβ? The patient may provide significant information about the nature and etiology of the ulcer such as any trauma or spontaneously.
β’ Duration: The clinician may ask βhow long is the ulcer present hereβ? It determines the chronicity of the ulcer. For example, traumatic ulcers in oral cavity are acute (occurring for a short period), but if the agent persists; it may become a chronic ulcer.
β’ Pain: The clinician may ask βis the ulcer painfulβ? Most of the ulcers, being inflammatory in nature, produce pain. Painless ulcers usually suggest nerve diseases (such as peripheral neuritis, syphilis, etc).
β’ Discharge: Any blood, pus or serum discharge must be noted.
β’ Associated disease: Any associated generalized systemic problem may be associated with the ulcers of oral cavity (such as
tuberculosis, squamous cell carcinoma, etc).
(A) Inspection
Size & Shape:
β’ Tuberculous ulcer - oval with irregular border
β’ Varicose ulcer - vertical & oval in shape
β’ Carcinomatous ulcer - irregular
Number: Tuberculous, inflammatory ulcer may be more than one in number
Position:
β’ Arterial ulcer: Tip of the toes, dorsum of the foot
β’ Varicose ulcer: lower limb
β’ Perforating ulcers: over the sole at pressure points
β’ Non-healing ulcers: over the shin
β’ Rodent ulcer: upper part of face
Edge: An area between margin & floor. In spreading ulcer, edge is inflamed. Undermined edges destroy subcutaneous tissue faster than skin.
Floor: This is the part of the ulcer which is exposed or seen.
β’ Red granulation tissue - Healing ulcer
β’ Necrotic tissue, slough - spreading ulcer
β’ Pale, scanty granulation tissue - tuberculous ulcer
β’ Wash-leather slough - Gummatous ulcer
Discharge:
β’ Serous discharge - Healing ulcer
β’ Purulent discharge - Spreading ulcer
β’ Bloody discharge - Malignant ulcer
β’ Discharge with bony spicules - Osteomyelitis
β’ Greenish diacharge - Pseudomonas infection
(B) Palpation
Tenderness: Characteristic of infected ulcers and arterial ulcers.
Induration: The edge, base and the surrounding area should be examined for induration
β’ Maximum induration - Squamous cell carcinoma
β’ Minimal induration - Malignant melanoma
β’ Brawny induration - Abscess
β’ Cyanotic induration - Chronic venous congestion as in varicose ulcer
Mobility: Malignant ulcers are usually fixed, benign ulcers are not.
Bleeding: Malignant ulcer is friable like a cauliflower. On gentle palpation, it bleeds. Granulation tissue as in a healing ulcer also causes bleeding.
Surrounding Area:
Relevant Clinical Examination:
Dentowesome|@drmehnazπ
References:
Steroids are a group of hormones produced naturally in the body.
The adrenal cortex consists of 3 zones:
β’ Glucocorticoid secretion is regulated by ACTH produced in the anterior pituitary. Cortisol has a -ve feedback on ACTH production.
β’ In Addison diseases, Glucocorticoid secretion impaired & ACTH is β¬οΈ
Stress
β¬οΈ
Release of cytokines (IL-1)
β¬οΈ
β¬οΈ cortisol levels
The substrate for steroid production is cholesterol. It is mobilized from the outer to the inner mitochondrial membrane by the steroidogenic acute regulatory (StAR) protein.
β’ Action: Anti-allergy, anti-inflammatory
β’ Therapeutic Uses:
Action: Fibrinolytic,Anti-allergic, anti-inflammatory*
It causes β¬οΈ fibroblastic production & deposition of collagen*
β’ Trade Name: CORTEF, ORABASE-HCA
β’ Preparation:
β’ Hydrocortisone acetate 25-50 mg/mL for soft tissue suspensions
β’ Hydrocortisone sodium phosphate: 50mg/mL IV, IM, SC
β’ Uses:
β’ Action: Anti-allergic, anti-inflammatory, immunosuppressive
β’ Uses:
β’ Trade name: DELTA-CORTEF, PRELONE
β’ Uses:
β’ Trade name: Kenolog cream
β’ Uses:
ππ»Mainly used for adrenal cortical suppression
β’ Trade name: DECADRON
β’ Action: Anti-allergy, anti-inflammatory
β’ Uses: Lichen planus, pemphigus, Aphthae ulcer
Dr. Mehnaz Memonπ
References: Self Notes, Image chart source: Classification of Drugs with DOC by Vikas Seth (Third Edition)
πAnalgesic is a drug that selectively relieves pain by acting in the CNS or on the peripheral pain mechanisms without significantly altering consciousness.
πThey are divided into 2 groups:
Dr. Mehnaz Memonπ
References:
π€Clinical Features:
This is the most dangerous of the malarias and patients are either ‘killed or cured’. The onset is often insidious, with malaise, headache and vomiting. Cough and mild diarrhoea are also common. The fever has no particular pattern.
π¦Neurological
π¦Optic fundi
π¦Respiratory
π¦Cardiovascular
π¦Renal
π¦Abdomen
π¦Blood
Dentowesome 2020
@dr.mehnazπ
References: Davidsonβs Principles and Practice of Medicine Textbook; Image source: ResearchGate, Quizlet
Dr. Mehnaz Memonπ
References: Davidsonβs Principles and Practice of Medicine Textbook