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Below are the highlighted topics:
Braces treatment (Orthodontic treatment) is used to correct the teeth alignment prior to jaw surgery (Orthognathic surgery) for patients with discrepancy in his jaw relationship. This procedure requires close collaboration between orthodontist (dentist who does braces treatment) and maxillofacial surgeon (dentist who does jaw surgery). The objective of braces treatment before jaw surgery is to prepare the patient for surgery by placing the teeth in correct position in relative to their respective jaw bone without concern for the bite and aesthetic of patient. During this phase, patient might have compromised aesthetic and bitting ability until the jaw surgery is done. After jaw surgery, short duration of braces treatment is required to refine the final occlusion.
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An articulator is a mechanical device used in dentistry which represents the anatomy of temporomandibular joint (the joint connecting lower jaw to the skull), upper jaw and lower jaw of patient to which upper teeth cast and lower teeth cast are fixed to the articulator in order to reproduce patient’s jaw movements.
By nature, the purpose of these articulators can only be achieved when the position of the maxilla is duplicated with respect to the skull. The upper teeth cast should be mounted on a semi-adjustable articulator using a face bow. The closer the articulator matches the patient’s anatomy, the better the treatment outcome will be, hence shorter dental treatment time is required.
It is a complex articulator which almost imitates the anatomy of the temporomandibular joint and follows the movement of your lower jaw. Therefore, it can be used in the fabrication of complex crowns, long span bridges and full mouth rehabilitation. This articulator is also used for jaw surgery (orthognathic) planning.
Semi-adjustable articulator is adjustable in certain areas but not all. They have adjustable horizontal condylar paths, adjustable lateral condylar paths, adjustable incisal guide tables, and adjustable intercondylar distances. Nevertheless, this articulator is adequate for most of the cases.
Uses of articulators
Advantages of articulator
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Oral cysts and tumors may develop in the jawbone or soft tissues in the mouth and face.
Oral cyst is an abnormal cavity within bone or soft tissues which may contain fluid. There are many different types of cysts in the mouth.
Reason to remove oral cyst:
Oral tumor is a solid or semi-solid mass in the bone or soft tissue that is made of unusual cells. Oral tumor can be benign tumor (not cancerous) or malignant tumor (cancerous). This can be confirmed by using biopsy test (a surgery that removes part of your tumor to examine it under a microscope). Biopsy is needed to diagnose the tumor before starting any treatment.
When should I suspect that I have an oral cyst or tumor?
Most of the oral lesions do not have any symptoms. Oral cyst may cause swelling, bone expansion, displacement or loosening teeth and pain (if infected). Oral tumor may present as a non-painful bump, lump, or ulcer. After your oral and maxillofacial surgeon examines the cyst or tumor, he will often recommend an X-ray to determine what kind of treatment you need.
Type of common treatments for oral tumors and cysts – Treatment options depends on the location and the type of lesion and your symptoms.
The post was prepared by Dr. Jean
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Multiple dental extraction is defined as removal of more than one tooth in a single dental visit. This procedue usually will be done under general anaesthesia (GA) in the hospital setup. Dental extraction under GA also can be performed on children who is anxious, uncooperative or having medical condition such as cerebral palsy or hyperactive child. In some cases, dental extraction under GA is done on children with badly decay teeth which needed multiple dental visit for extraction. It is therefore, better to have it done under general anaesthesia.
The indications of dental extractions under general anesthesia are:
Dental extraction under GA di performed in the hospital setup as day-care (no hospitalization). The patient (or the child) is usually health (ASA I) and fasting since midnight. The anesthesiologist will assess the child and written consent is taken before the procedure started.
In the operating room, the anesthesiologist will put a tube in patient’s throat to administer ‘sleeping’ gas allowing patient to ‘sleep’ during the whole procedure. The oral surgeon will come in to perform the dental extraction. After the procedure, the tube with be removed from the patient’s throat, and he will placed in the recovery room. He will be allowed to discharge from the hospital when fully conscious and ambulated.
Upon the procedure, a minor bleeding in extraction site, swollen tongue/lip/chin/cheek, temporary mouth opening limitation are the sequelae or conditions to be expected.
Advantage of extraction under GA
Disadvantage of extraction under GA
In intravenous sedation, a cannula is placed into a vein and a drug is administered directly into the patient’s blood stream with the patient in supine position.
A cannula (thin plastic tube) will be put into a vein in the back of one of your hands.
The primary goal of IV sedation is to reduce your anxiety, make you feel relaxed and less aware of the dental procedure.
The use of intravenous sedation is indicated in the management of patients with high level of dental anxiety or patients that unable to tolerate stress (epileptic, stroke patient).
During the procedure, adequately sedated patient is demonstrated by expressionless face, drowsiness, and slow speech but they will still be able to understand and respond to verbal contact. However, this patient may not be able to recall events that occurred during the procedure after the treatment.
The major side effect with midazolam sedation is respiratory depression. Thus, the use of a pulse oximeter (device attached to your finger to measure oxygen level and heart rate) is mandatory to monitor patient from this potentially dangerous side effect during the procedure.
Patient who is allergy to benzodiazepines is an absolute contraindication but is extremely rare. IV sedation should be aware in pregnant patient, patient with kidney, liver and heart disease, elderly patient, and children.
Before intravenous sedation
After intravenous sedation
When compared to general anaesthesia, intravenous sedation is simpler, easier to administer, faster onset with fewer complications and contraindications, patient remains conscious and can breathe on their own throughout procedure.
In general anesthesia (GA), drugs are administered by intravenous or inhalation routes which makes the person to be unconscious and do not feel or remember anything during the surgery. This patient is not wakened even by painful stimulation. General anaesthesia currently can only be performed in the operating room under the hospital setup where the sleep doctor (anaesthesiologist) will be the one to make the patient sleep.
GA is recommended for:
Advantages
Disadvantages
Procedures
The uses for general anesthesia in dentistry have decreased over the years as other less invasive sedation techniques have evolved. Nevertheless, there are still many situations that require the use of GA.
Minor oral surgery is a field in dentistry that involves surgical treatment that performed within the mouth. This surgery can be done under local anaesthesia with or without sedation. In most situations, it requires only a relatively short recovery period. 
Types of Minor Oral Surgery
Removable appliance is an appliance that is not fixed to teeth but can be removed by the patient. It usually contains spring, screws, clasps and acrylic base plate. This appliance is often used in situation whereby simple teeth movement are needed only and it can allow patients to perform better oral hygiene by removing it. However, this appliance requires compliance from the patient to wear it.
Fixed appliance is probably the most common type of orthodontic appliances in use today. They consist of small brackets that are attached onto the front surface of the teeth and a thin wire which is often held in place by elastic loops.This appliance allows multiple tooth movements simultaneously and more effectively as compared to removable appliance. The treatment usually lasts from 6 months to 30 months depending upon the severity of the problem. It is very important to maintain an excellent oral hygiene and dental health throughout the orthodontic treatment
This procedure is conducted to remove excess gum tissue that may be overgrown on the teeth to provide a better aesthetic result and a better area to clean the teeth.
Several reasons why there is an overgrowth of gum:
All these gum overgrowth can be corrected by reduce the cause factors or gum surgery (gingivectomy)
A young lady complained that she didn’t have great smile. On examination, we found out that she had a very short teeth. Oral hygiene just moderate.
Dental scaling was done to improve oral hygiene
After taken radiograh to determain the bone height and biological width, surgical excision of 2mm of gum tissue above the gingiva margin.
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