COSMETIC DENTISTRY
ten years for the first dental patient to receive
What is Cosmetic Dentistry?  
 
Cosmetic dentistry is generally used to refer to
any dental work that improves the appearance of
teeth, gums and bite. It primarily focuses on
improvement in dental aesthetics in color, position,
shape, size, alignment and overall smile
appearance.  
 
Causes and Symptoms
Anyone who is unhappy with his or her smile is a
candidate for cosmetic dentistry. The reason might
be a general displeasure with the look of one's
teeth or a specific aesthetic dental concern. While
the reasons for improvement vary, the most
common causes are staining due to aging, tobacco
use, coffee intake, fluorosis, and tetracycline use.
Patients also often want to improve the shape and
position of their teeth. 
Diastema (spaces between teeth), slight rotations,
and malformation of the teeth (peg laterals, barrel
shape teeth) are common reasons for correcting
the shape and the position of the teeth.
HISTORY OF COSMETIC DENTISTRY 
The Early Years  The equipments and appliances during the early
There's not much documented regarding early
cosmetic dentistry practices, but we do know some
ancient civilizations used materials that resembled
teeth for replacements and restorations.  to focus in achieving natural-looking smiles and
700 BC
The Etruscans made dentures with ivory and bone,
and it was also common practice to construct
dentures from human or animal teeth. Teeth were
taken from the dead or extracted and sold by live
donors. Although the resulting dentures smelled
rotten and deteriorated quickly, this practice lasted
through the 1800s. 
200 AD
The Etruscans were using gold to make such
restorations as a dental crown and dental bridge,
although it may have been more for restorative
purposes than a fashion statement. Other cultures
that used cosmetic dentistry included the Ancient
Egyptians, who hammered seashells into their
gums as tooth replacements. Egyptians also made
toothpaste of pumice stone and vinegar to scrub
stains from their teeth, and early Romans used
toothpaste that contained urine.   • Tooth-colored restorations and fillings
The Age of Teeth Enlightenment 
Cosmetic dentistry became an experiment over the
next several centuries.  • Tooth bonding
1400s
Europeans caught on and started carving dentures
from bone or ivory. Unfortunately, these dentures
could be extremely uncomfortable.  that have mild to moderate amount
1700s
The first porcelain dentures were made but it took
them. Soon, dentists starting used a form of plaster
to make molds of their patient's mouths for better-
fitting dentures. 
1800s
Porcelain dentures were brought to the U.S.
and got very popular. 
1840s
The invention of Vulcanite, a rubber material used
as a base for false teeth that made wearing
dentures easier. The first dental lab to produce
prosthetic teeth was established a decade later.
Dentists continued to find ways to introduce
porcelain into tooth restorations. 
1900s
Dental labs switched to plastics and acrylics for
dentures. Acrylic is still the standard material for
modern dentures today.
1903
Charles Land created the "porcelain jacket crown,"
a substitute for amalgam and gold dental fillings.  
1938
DuPont made the first nylon toothbrush.
1990s
years of cosmetic dentistry weren't exactly efficient,
and procedures were said to have the tendency to
be extremely painful. Eventually, dentistry started
pain-free procedures. In the late 1990s, they saw a
major increase in aesthetic dentistry and hence
considered this as the start of the cosmetic
dentistry era.
Scope of Cosmetic Dentistry
Cosmetic Dentistry is a term which means for
majority of people as a surgical procedure that
involves revamping the dentals i.e. applying
veneers or whitening the teeth.
Cosmetic Dental Surgery is the method of
rejuvenating the lost self-esteem of a person by
fixing all of his dental problems.
Cosmetic dentistry involves replacing and restoring
damaged teeth, as well as a broad scope of other
aesthetic procedures.
Cosmetic dentists provide:
• Tooth whitening
• Porcelain veneers
• Orthodontics
• Dental implants
Procedures: 
1. Inlays and Onlays 
• Are restorations used to repair rear teeth
of decay. They are used to restore teeth
that are cracked or fractured if the damage
 is not severe enough to require a dental veneers and better mimic the light reflecting
crown  properties of natural teeth.  
• Also known as “Indirect fillings”   
Types of Problems that Dental Veneers fix: 
Inlays  • Teeth that are discoloured either because of
• Dental inlays are used to treat teeth that have root canal treatment; stains from
decay or damage lying within their indented tetracycline or other drugs, excessive
top surfaces, between the cusps of the fluoride or other causes; or the presence of
teeth.  large resin fillings that have discoloured the
tooth. 
• Inlay replacement is usually carried out over • Teeth that are worn down 
two appointments: 1. An impression off to a • Teeth that are chipped or broken 
dental lab, which will create the inlay to • Teeth that are misaligned, uneven, or
match your tooth’s specifications. 2. The irregularly shaped (for example: have
temporary inlay will be removed and the craters or bulges in them) 
permanent one will be placed carefully over
your tooth. 

Onlays  4. Teeth Whitening 

• They are used to treat decay that extends to • Lightens teeth and helps to remove stains
one or more of the cusps. It is placed in and discoloration. Whitening is among the
much same way as inlays.   most popular cosmetic dental procedures
• Onlay replacement is usually carried out two because it can greatly improve how your
appointments: 1. The impression is sent to teeth look. 
a lab, where a dental technician creates  
the onlay according to the What it’s Used for? 
tooth’s dimentions. 2. The temporary onlay is The outer layer of a tooth is called the enamel.
removed, and the permanent restoration is The color of natural teeth is created by the
placed on the tooth and securely bonded reflection and scattering of light off the enamel,
using high-strength dental resins.  combined with the color of the dentin under it.  
  The most common reasons for teeth to
2. Dental Bonding  get yellow or stained are: 
• A procedure in which a tooth- • Using tobacco 
colored composite material is applied to a • Drinking dark-colored liquids such as coffee,
tooth, sculpted into shape, hardened, and tea and red wine 
polished. • Not taking good care of your teeth 
• It is also used as a tooth-colored filling for   
small cavities because it’s more cosmetically 5. Implants 
appealing that silver fillings.  • A dental implant is a titanium (like a tooth
• Repair of decayed, damaged or discoloured root) that is surgically positioned into the
teeth using materials that resembles jawbone beneath the gum line that allows
the color of the tooth enamel.  your dentist to mount replacement teeth or
• First thing in able to make the bonding is bridge into that area.
the dentist will apply a gentle phosphoric • Dental Implants also benefit general oral
acid to the surface of your teeth, which health because they do not have to be
etches and roughens the surface to help the anchored to other teeth, like bridges.
bonding material stay in plave. 
American Dental Association considers two
types of dental implants to be safe for use: 
 
3. Dental Veneers  Endosteal Implants 
• It is a wafer-thin, custom-made shells of • These are the most common type of
tooth-colored materials designed to cover implant and are surgically placed direct into
the front surface of the teeth in able to the jawbone, they are also called root-form
improve you appearance. These shells are implants. These are typically shaped like
bonded to the front of the teeth changing small screws, cylinders or plates.
their color, shape, size, or length. 
    
• Dental Veneers can be made from porcelain Subperiosteal Implant
or from resin composite materials. Porcelain • This type of implant consists of a metal
veneers resist stains better than resin frame that is fitted onto the jawbone just
 under the gum tissue. As the gums heal,
the frame becomes fixed to the jawbone.
Posts, which are attached to the frame,
protrude through the gums. As with
the endosteal implants, artificial teeth are
then mounted to the posts.
CLASS III LESIONS: Involve the proximal surfaces of
the anterior teeth which may or may not involve the
lingual extension but DO NOT involve the incisal line
RESTORATIVE DENTISTRY angle.

Restorative dentistry is the study,

diagnosis and integrated management of diseases of
the teeth and their supporting structures and the
rehabilitation of the dentition to functional and
aesthetic requirements of the individual. Restorative
dentistry encompasses the dental specialties of
endodontics, periodontics and prosthodontics.a CLASS IV LESIONS: Involve all proximal surfaces of
Dental Restorations anterior teeth which also INVOLVE the incisal line
angle.
A dental restoration or dental filling is a
treatment to restore the function, integrity, and
morphology of missing tooth structure resulting from
caries or external trauma as well as to the
replacement of such structure supported by dental
implants. Tooth structure can be missing due to
decay, deterioration (weakening) of a previously
placed restoration, or fracture of a tooth. It has two CLASS V LESIONS: Involve the CERVICAL THIRD of
classifications, direct and indirect restoration. all teeth, including the proximal surface of posterior
teeth where the marginal ridge is not included in the
cavity preparation (Do not involve pit & fissure
CLASSIFICATIONS OF CARIES by Greene areas)
Vardiman Black

Greene Vardiman Black (1836-1915) - commonly

known as G.V. Black, is known as one of the
founders of modern dentistry in the United States.
He is also known as the father of operative dentistry.

G.V. Black’s Classification of dental caries

is the standard method used in identification of CLASS VI LESIONS: Involve the incisal edges of all
carious lesions according to its location on the tooth anterior teeth and the cusp tips of all posterior teeth.
surface. Black originally devised five classifications,
but a sixth was later added. These cavity
classifications are used when recording on the
patient’s chart the type of caries found on the teeth.

CLASS I LESIONS: All pit-and-fissure restorations

are Class I, and they involve the following 3 location
groups:
– the occlusal surfaces of molars and premolars
– the occlusal two thirds of the buccal and lingual
surfaces of molars
– the lingual surfaces of anterior teeth
DIRECT RESTORATIONS
This technique involves placing a soft or
malleable filling into the prepared tooth and building
up the tooth. The material is then set hard and the
tooth is restored. The advantage of direct
restorations is that they usually set quickly and can
be placed in a single procedure. The dentist has a
variety of different filling options to choose from.

FILLINGS

Fillings are the most common type of

CLASS II LESIONS: Involve the proximal surfaces
dental restoration. Teeth can be filled with gold,
(mesial and distal) of posterior teeth with access
silver amalgam, or tooth-colored plastic and glass
established from the occlusal tooth surface.
materials called composite resin fillings.

TYPES OF FILLINGS
AMALGAM
It is a mixture of silver, tin, zinc, copper and
mercury. Mercury is nearly 50% of the mixture.
Types: Traditional (non-bonded)
Used for: Fillings in posterior teeth
Lasts: At least 10 years, and usually lasts longer
Costs: The least expensive type of restorative
material
Advantages
❖ Amalgam fillings are strong. They can withstand
the forces of chewing.
❖ They are less costly than the alternatives.
❖ Amalgam fillings can be completed in one dental
visit.
❖ They are less sensitive to moisture during the
filling process than composite resin.
Disadvantages
❖ Amalgam doesn't match the color of your teeth.
❖ Amalgam fillings can corrode or tarnish over time.
This can cause discoloration where the filling
meets the tooth.
❖ A traditional (non-bonded) amalgam filling does
not bond (hold together) with your tooth.
❖ The cavity preparation (the "pocket" in your
tooth) developed by your dentist requires
undercuts or ledges to keep the filling in place.
Your dentist may have to remove more of the
tooth to create a secure pocket.
❖ Some people may be allergic to mercury or be
concerned about its effects. Research shows that
the amount of mercury exposure from fillings is
similar to what people get from other sources in
the environment.
COMPOSITE RESIN
It is a mixture of plastic and fine glass particles.
Types: Used in direct and indirect restoration
Direct fillings are placed by your dentist using a
bright blue light that hardens the soft material.
For indirect fillings, your dentist prepares the tooth
and takes an impression of it. A laboratory or the
dentist then will make the filling from the mold.
During a second visit, your dentist cements this
filling into place.
Used for: Small and large fillings, especially in front
teeth or the visible parts of teeth; also for inlays
Lasts: At least five years
Costs: More than amalgam, but less than gold
Advantages
❖ Your fillings or inlay will match the color of your
teeth.
❖ A filling can be completed in one dental visit. An
inlay may require two visits.
❖ Composite fillings can bond directly to the tooth.
This makes the tooth stronger than it would be
with an amalgam filling.
❖ Less drilling is involved than with amalgam
fillings. That's because your dentist does not have
to shape the space as much to hold the filling
securely. The bonding process holds the
composite resin in the tooth.
❖ Indirect composite fillings and inlays are heat-
cured. This step increases their strength.
❖ Composite resin can be used in combination with
other materials, such as glass ionomer, to provide
the benefits of both materials.
Disadvantages
❖ Composite resins cost more than amalgam
fillings.
❖ Although composite resins have become stronger
and more resistant to wear, it's not clear whether
they last as long as amalgam fillings under the
pressure of chewing.
❖ The composite may shrink when placed,
producing gaps between the tooth and the filling.
This can lead to more cavities in areas where the
filling is not making good contact with your tooth.
The shrinkage is reduced when your dentist
places this type of filling in thin layers.
❖ These fillings take more time to place. That's
because they are usually placed in layers. The
increased time and labor involved also contribute
to the higher cost.
❖ Indirect fillings and inlays take at least two visits
to complete if your dentist is not prepared to
make the inlay while you wait. Your dentist takes
impressions at the first visit and places the filling
or inlay at the second visit.
CAST GOLD
Made of: Gold alloy (gold mixed with other metals)
Used for: Inlays and onlays, crowns
Lasts: At least 15 years, usually longer
Costs: More than most other materials; 6 to 10 times
more expensive than amalgam.
Advantages
❖ Gold doesn't corrode.
❖ Some people like the gold color better than the
silver color of amalgam.
❖ Gold fillings are durable enough to withstand
chewing forces. They last longer than all other
filling materials.
Disadvantages
❖ You must visit the dentist at least twice to receive
a gold filling. At the first visit, the dentist makes
an impression of your tooth and places a
temporary filling. The gold filling is made from the
impression. It is placed at a second visit.
❖ The cost is high because of the high cost of gold
and the work involved.
❖ If gold and amalgam fillings are right next to each
other in your mouth, an electric current can result
from interactions between the metals and your
saliva. This can cause discomfort, called "galvanic
shock."
❖ Gold fillings are not tooth-colored.
CERAMICS
Made of: Porcelain, most commonly
Used for: Inlays and onlays, crowns, veneers,
implants, and orthodontic brackets
Lasts: More than seven years
Costs: More than composite and as much as or more
than gold, depending on the filling.
Advantages
❖ Ceramics are tooth-colored.
❖ Ceramics are more resistant to staining and
abrasion than composite resin.
Disadvantages
❖ Ceramics are more brittle than composite resin
and can break.
❖ A ceramic inlay or onlay needs to be large enough
to prevent it from breaking. This means that the
tooth must be reduced in size to make room for
the extra bulk.
GLASS IONOMER
Made of: Acrylic and a component of glass called
fluoroaluminosilicate
Types: In a traditional filling, the material sets
without a bright light. Resin-modified or hybrid
composite glass ionomer fillings are stronger than
traditional ones. A bright blue light is used to set the
material.
Used for : Glass ionomer is used most commonly as
cement for inlay fillings. It also is used for fillings in
front teeth, or around the necks of your teeth, or in
roots. As filling material, glass ionomer is typically
used in people with a lot of decay in the part of the
tooth that extends below the gum (root caries). It is
also used for filling baby teeth and as a liner for
other types of fillings.
Lasts: Five years or more
Costs: Comparable to composite resin
Advantages
❖ Glass ionomer matches the color of the teeth, but
not always as well as composite resin. Resin-
modified glass ionomer is usually a better match
than traditional glass ionomer.
❖ Glass ionomers release fluoride, which can help
protect the tooth from further decay.
❖ Glass ionomer restorations bond (stick) to the
tooth. This helps to prevent leakage around the
filling and further decay.
Disadvantages
❖ Traditional glass ionomer is significantly weaker
than composite resin. It is much more likely to
wear or fracture.
❖ Traditional glass ionomer does not match your
tooth color as precisely as composite resin.
❖ A resin-modified glass ionomer filling needs to be
applied in thin layers. Each layer must be cured,
or hardened, with a special bright blue light. Then
the next layer can be added. This makes the tooth
stronger, but can lengthen the time of the dental
appointment.
INDIRECT RESTORATIONS
In this technique the restoration is
fabricated outside of the mouth using the dental
impressions of the prepared tooth. Common indirect
restorations include inlays and onlays, crowns,
bridges, and veneers.
A dental technician fabricates the indirect
restoration from records the dentist has provided.
The finished restoration is usually bonded
permanently with dental cement. It is often done in
two separate visits to the dentist. Common indirect
restorations are done using gold or ceramics.
While the indirect restoration is being
prepared, a provisory/temporary restoration is
sometimes used to cover the prepared tooth to help
maintain the surrounding dental tissues. Removable
dental prostheses (mainly dentures) are sometimes
considered a form of indirect dental restoration, as
they are made to replace missing teeth.
INLAYS AND ONLAYS
Inlays and onlays are used in molars or
premolars, when the tooth has experienced too
much damage to support a basic filling, but not so
much damage that a crown is necessary. The key
comparison between them is the amount and part of
the tooth that they cover.
IMPLANTS
An inlay will incorporate the pits and
Implants are replacement tooth roots.
fissures of a tooth, mainly encompassing the
Implants are actually a small post made of metal
chewing surface between the cusps. An onlay will
(usually of titanium or a titanium mixture) that are
involve one or more cusps being covered. If all cusps
placed into the bone socket where teeth are missing.
and the entire surface of the tooth is covered this is
The implant may need an attachment called an
then known as a crown.
abutment that will act like a crown preparation. It is
Inlays are chosen when a portion of the then covered with a crown.
tooth needing to be restored is more extensive than
DENTURES
what can be remedied by a filling. It affects the
creviced area of the tooth and does not include the Dentures are a removable replacement for
outer cusp. missing teeth and surrounding tissues. They are
made of acrylic resin, sometimes combined with
Onlays are like inlays, but they
metal attachments. Complete dentures replace all
incorporate the outer cusp of the tooth because of
the teeth. Partial dentures are considered when
damage to the cusp. Onlays are done when the
some natural teeth remain, and are retained by
tooth becomes fractured on the cusp of the tooth or
metal clasps attached to the natural teeth.
is otherwise compromised. Onlays are also chosen if
the entire tooth does not need a crown.

ORAL AND MAXILLOFACIAL

CROWNS
Crowns are a tooth-shaped “cap” that is
placed over a tooth to restore its shape and size,
strength, appearance, to hold a bridge in place, or
to cover a dental implant. Teeth frequently need to
be reduced evenly around the tooth so that the
crown will perfectly restore the size and shape of the
tooth.
A dental crown is permanently cemented
to the tooth it has been made for. Once placed, the
tooth-crown unit functions, and is cared for, just like
a natural tooth. It restores and protects a weak
tooth from breaking or to hold together parts of a
cracked tooth
SURGERY
What is Oral and Maxillofacial
Surgery?
“It is the specialty of dentistry that includes the
diagnosis and surgical and adjunctive treatment of
disease, injuries and defect, including both the
functional and esthetic aspects of hard and soft
tissues of oral and maxillofacial region”
-Georgia Larry J. Peterson, DDS
“It is any surgery involving above the clavicle
(bone), to the frontal bone, excluding the brain”
- Donita Dyalram, DDS, MD, FACS
“It is treating high level problems such as head &
neck cancer, patients who need facial
reconstruction, also who require traumatic facial
injury reconstruction, pediatric patients, patients
with TMJ problems, children with cleft lip & palate,
and other cranial disorders”

-John Caccamese, Jr, DMD, MD, FACS

BRIDGE

Bridges are false teeth that are designed

to "bridge" the gap created by one or more missing
teeth. Bridges can be anchored on either side by
crowns and cemented permanently into place. The
dental bridge procedure is a restorative dental
treatment to replace missing teeth. The bridge fills
the gap in the mouth between healthy teeth or
dental implants on either side to restore both the
function and appearance of teeth.

ORIGIN OF ORAL AND MAXILLOFACIAL
SURGERY
The history of Oral surgery Began From
500 BC to 300 BC
The famous Greek physician Hippocrates,
described manually reducing dislocations of the
mandible, indicating the long history of this
discipline
1210, A guild of barbers was created in
France, Split into two groups; surgeons for more
complex operations, and surgeons for simpler
procedures
In 1575 Ambroise Pare ( The Father of
Surgery) published complete works. Carried
information on tooth extraction and jaw fractures.
In 1728, the oral surgeon Pierre Fauchard
wrote a treatise called “The Surgeon Dentist”.
The earliest man to be designated as an oral
surgeon was Simon P. Hullihen (1810-1857)
Chalmers J. Lyons established principles of
gentle surgery that advanced the specialty and
made extensive contributions to the oral surgery
literature. (1874-1935)
Matthew H. Cryper in 1901 he established
the first dental service at the Philadelphia hospital.
He also invented many instruments for the removal
of teeth and other surgical procedures
Robert H. Ivy was a great founder of oral
surgery and plastic surgery. The “Ivy Loop” was
the treatment for jaw fractures.
Father of Oral Surgery
James Edmund Garretson (1829-
1895)
Was known as the father of oral
surgery, because he named the
specialty
He also wrote a treatise on the
diseases and surgery of the mouth, jaws
and associate parts, first published in
1869, he helped to establish oral and
maxillofacial surgery as a specialty in
the United States.
He was also largely responsible for
the establishment of oral surgery as a
branch of medicine and dentistry,
though distinct from both. Thus, it was
the custom for several early generations
of oral surgeons to hold dual degrees.
SCOPE
• DENTOALVEOLAR SURGERY
It is the surgical procedure that oral and
maxillofacial surgeons perform most often.
These procedures are associated with the
dentate segment of the maxilla or mandible,
termed the alveolar ridge.
They include a variety of procedures,
including simple and difficult tooth extractions,
alveoplasty (recontouring of the alveolar bone),
surgery to remove impacted teeth , removal of
tori, bone grafting or preprosthetic surgery to
provide better anatomy for the placement of
implants, dentures, or other dental prostheses,
and extraction of impacted third molars. It
actually represent nearly 50% of all minor
surgeries completed
*SIDE NOTE*
EXTRACTIONS ARE DUE TO:
• Adjacent teeth having crowns or large fillings.
• A major nerve (dentoalveolar nerve) near the
tooth to be extracted.
• Roots that are large and curved, or that
penetrate deeply into the jaw bone or that have
been root filled.
An unerupted or impacted tooth, or a tooth
fused to the jaw bone (ankylosis).
TRANS-ORAL ROBOTIC SURGERY (TORS)
“It is the use of robotics to minimally invasive
surgical techniques to access tumors especially for
management of cancers of the oral cavity and oral
pharynx” -Joshua Lubek, DDS,MD,FACS
TORS is a minimally invasive procedure in
which a series of robotic arms are passed through
the mouth. It is as robotic surgery technique that
removes benign and malignant tumors of the
mouth and throat. It's most commonly used for
tumors in the throat, particularly tonsil and tongue
tumors. TORS uses the state-of-the-art da Vinci
Surgical system which allows the surgeon to access
areas of the throat that are difficult to reach with
traditional surgery. The robot consists of a high
definition 3-D camera attached to an endoscope for
precise, magnified visualization and robotic arms
equipped with small robotic instruments.
sinuses, pharynx, larynx, cervical esophagus,
thyroid, associated lymph nodes, soft tissues,
and bone. The diverse tissues in this anatomic
region give rise to a broad spectrum of tumors
and tumor-like conditions. Cancer of the head
and neck is the sixth most common malignancy
worldwide

TORS is a good option for treating head and

neck cancers not only because it's minimally
invasive, but also because it can reduce the need
for additional therapy. Patients who elect to
undergo TORS often find that they require a lower
dose of radiation --and some can even avoid
radiation and chemotherapy altogether.

• SOFT TISSUES TRAUMA

The soft tissues are often involved during

traumatic injuries to the orofacial area and
maybe bruised or lacerated by the impact of
teeth against the tissue. Usually application of
pressure with gauze to the injured site should
provide adequate hemostasis. If hemostasis
cannot be obtained or the laceration is so
• CYST , TUMORS AND HEAD AND NECK severe the edges are not well opposed, sutures
ONCOLOGY are recommended.

Jaw tumors and cysts are relatively rare
growths or lesions that develop in the jawbone
or the soft tissues in the mouth and face. Jaw
tumors and cysts, sometimes called
odontogenic tumors and cysts, can vary greatly
in size and severity. These growths are usually
noncancerous (benign), but they can be
aggressive and invade the surrounding bone
and tissue and may displace teeth.
Oral trauma may involve soft tissue, teeth,
and bone. Soft tissue injuries present different
and complex traumatic lesions. The most
common injuries to soft tissue are penetrating
wounds, lacerations, contusions, abrasions,
bruises, ecchymosis, traumatic ulcers, and
hematomas. Traumatized patients can sustain
one or more of these injuries simultaneously
when severe trauma occurs

Treatment options for jaw tumors and cysts
vary, depending on the type of growth or lesion
you have, the stage of growth, and your
symptoms. Mouth, jaw and face (oral and
maxillofacial) surgeons can treat your jaw
tumor or cyst usually by surgery, or in some
cases, by medical therapy or a combination of
surgery and medical therapy.
Lips often cushion the teeth during a fall,
bearing the brunt of the injury and resulting
in bruises and lacerations. If a laceration is
present, it should be carefully examined to
determine whether a foreign object such as
a tooth fragment or gravel has been
introduced into the wound.

Odontogenic jaw tumors and cysts originate

from cells and tissues that are involved in
normal tooth development. Other tumors that
affect the jaws can be nonodontogenic,
meaning that they can develop from other
tissues within the jaws that are not related to
the teeth. Generally, the cause of jaw tumors
and cysts is not known; however, some are
associated with genetic syndromes.

The region commonly referred to as the

"head and neck" includes the upper
aerodigestive tract (oral cavity, paranasal
 The maxillary labial frena may tear as a
result of a fall. This type of injury is
common during falls experienced while
learning to walk. However, such an injury
occurring in infants who do not walk or
crawl is probably due to an object being
forced into the child’s mouth and should be
investigated as a result of child abuse.
Trauma to the tongue can result in
laceration or puncture. Careful examination
of the injury is important since the necessity
for suturing is dependent on the extent of
injury.
Impalement of the soft palate is commonly
found in the child who falls while holding an
object in the mouth, i.e., a stick, pencil or
pen, straw or toothbrush. Most impalement
injuries heal spontaneously and do not
require treatment, however the area should
be thoroughly explored for foreign body
objects and a prophylactic antibiotic should
be prescribed to avoid infection
complications.
• CRANIOFACIAL ANOMALIES
Are a diverse group of deformities in the
growth of the head and facial bones. Anomaly
is a medical term meaning "irregularity" or
"different from normal." These abnormalities
are congenital (present at birth) and there are
numerous variations--some are mild and some
are severe and require surgery.
Craniofacial is a medical term that relates to
the bones of the skull and face. Craniofacial
abnormalities are birth defects of the face or
head. Some, like cleft lip and palate, are among
the most common of all birth defects. Others
are very rare. Most of them affect how a
person's face or head looks. These conditions
may also affect other parts of the body.
Treatment depends on the type of problem.
Plastic and reconstructive surgery may help the
person's appearance.
Different craniofacial malformations have different
symptoms. The most common craniofacial
malformations are:
Cleft lip or cleft palate forms in vitro when
tissue in the mouth or on the face fails to
connect properly.
Cleft lip. An abnormality in which the lip does not
completely form. The degree of the cleft lip can
vary greatly, from mild (notching of the lip) to
severe (large opening from the lip up through the
nose).
Cleft palate. Occurs when the roof of the mouth
does not completely close, leaving an opening that
can extend into the nasal cavity. The cleft may
involve either side of the palate. It can extend from
the front of the mouth (hard palate) to the throat
(soft palate). The cleft may also include the lip.
Craniosynostosis occurs when the skull’s
bony plates (called “sutures”) close too
early during infancy. It can affect your brain
and skull growth.
Crouzon syndrome happens when your skull
and facial bones are fused. It’s also called
craniofacial dysostosis.
 Hemangioma is a benign skin tumor that creates a
red birthmark – also called a port wine stain, a
strawberry mark or a salmon patch.

Deformational plagiocephaly is the medical term for

an asymmetrical or misshapen head. It’s also called
positional plagiocephaly.

Pierre Robin sequence is a U-shaped cleft in your

soft palate that causes your tongue to fall to the
back of your throat and makes it difficult to eat.

Encephaloceles happen when brain membranes

poke through openings in your skull and make a
groove between your forehead and nose or along
the back of your skull. Torticollis is when your head tilts to the side, often
because of an underlying bone or muscle problem.

Treacher Collins syndrome usually creates

underdeveloped cheekbones or jawbones, drooping
eyes or malformed ears.
Hemifacial microsomia occurs when the tissues on
one or both sides of your face are underdeveloped.
It usually affects your ear, mouth and jaw.

Vascular malformation is a birthmark or
blood vessel growth that can affect the way
your body functions. It’s also called
lymphangioma, arteriovenous
malformation and vascular gigantism.
CAUSES
❖ Combination of genes. A child may receive a
particular combination of gene(s) from one
or both parents, or there may be a change
in the genes at the time of conception,
which results in a craniofacial anomaly.
❖ Environmental. The effect of environmental
exposures on the development of
craniofacial abnormalities is not fully
understood. However, environmental
exposures may play a role, especially in
combination with genetic abnormalities.
❖ Folic acid deficiency. Folic acid is a B
vitamin found in orange juice, fortified
breakfast cereals, enriched grain products,
and green, leafy vegetables. Studies have
shown that women who do not take
sufficient folic acid during pregnancy, or
have a diet lacking in folic acid, may have a
higher risk of having a baby with certain
congenital anomalies, including cleft lip
and/or cleft palate.
• FACIAL PAIN
Facial pain is a catchall term for any type of
pain in the face. Facial pain can be either acute or
chronic.
Acute pain is pain that lasts less than six
months. Acute pain usually resolves either on its
own or with treatment. Examples are sinusitis,
infections of the mouth or gums, or injuries to the
face, such as a black eye or broken nose.
Chronic facial pain is pain that either lasts
continuously for over six months or occurs on a
fluctuating basis over a period of six months or
longer. Examples are trigeminal neuralgia and
temporomandibular joint disorder.
Chronic idiopathic orofacial pain is an ill
understood group of conditions, which may involve
the whole of the mouth and face. Unfortunately
descriptions of disorders and treatment tend to be
influenced by the background of the specialist
assessing the patient. Thus, patients who see
maxillofacial surgeons have symptoms described in
terms of clicking, sticking, and locking of the
temporomandibular joint and pain in the associated
musculature.
Types
1. Trigeminal neuralgia (TN) is a pain disorder
that affects the face, usually on one side.
The pain is related to the trigeminal nerve,
which runs from the brain to the side of the
face.
- There is no single cause of TN. Moreover,
the known possible causes are not clearly
defined. It is thought that compression of
the trigeminal nerve by an enlarged blood
vessel can cause it. It is also associated
with aging. Multiple sclerosis is also
sometimes associated with TN. Central
sensitization may also play a role in the
progression of TN.1, 2 Central sensitization is
a highly reactive state of the nervous
system, which amplifies pain. It can occur
with most any pain disorder.
2. Temporomandibular joint disorder (TMJ) is
a pain disorder that occurs in the joints of
the jaws, on either side of the face.
Specifically, it occurs in the joints located in
front of the ears, where the lower jaw joins
the face. The pain is usually described as a
tension-related ache, though in more
advanced stages, it can sometimes be a
sharp pain.
-The cause of pain is due to orthopedic
changes of the jaw from persistent wear
and tear. The wear and tear is usually
associated with stress-related clenching and
tension of the jaw muscles. It can also
sometimes start with a trauma to the jaw
joints.
PROCEDURES
Dental implants
• Because the human teeth has a huge
impact on a person’s everyday life, it is
unimaginable to survive a day without
having one or two. However, it is
inevitable that some people will fail to
take care of their teeth and this results to
damaged or missing teeth. Luckily, the
Oral and Maxillofacial covers the
procedure of making dental implants.
Dental implants are made to act as
perfect teeth replacements because they
look like the normal teeth of a human
being. Unlike dentures, dental implants
are permanent remedies for edentulism.
It works well in fixing the overall
appearance and capacity of the teeth and
it also helps in preserving the structure of
the face.

Wisdom tooth removal and general
tooth extraction
• In some cases when the wisdom tooth is
too infected or when it causes a lack of
space in the dental area, dentists may
suggest to extract it. This extraction is
handled by Oral and Maxillofacial
surgeons. These experts advise their
patients to abstain themselves from
eating and/or drinking 6 hours before the
surgery and they also recommend
bringing an escort adult during the
surgery because the patient may be too
groggy due to the anesthesia. After the
extraction, the patient may experience
swelling in the operated area as part of
the healing process.
• On the other hand, tooth extraction is the
removal of the tooth in its place in the
jawbone. This may be advised when the
tooth is too damaged and when it causes
intolerable pain. Moreover, a tooth may
be removed because it is already
nonfunctional in such a way that it does
not help in oral activities such as chewing
and talking. Also, like the wisdom tooth,
a tooth may be removed because it
causes poor alignment in the mouth.
Tooth extraction has two main types
namely the basic and the surgical. Basic
extractions are performed in teeth that is
clearly visible in the mouth while surgical
extractions are more complex in nature
because it involves removing teeth that
have not come out of the gums yet or
teeth that are on the gum line.
Bone grafting
• Usually when a tooth is removed, the
jawbone becomes weaker, especially if
the removed tooth is not replaced
immediately. Weak jawbones make it
harder for dental implants to be effective
and efficient. With this, dentists
recommend bone grafting in order to
make the extraction area ready for dental
implants and to maximize the potential of
dental implants. Bone grafting is a
process of making stronger jawbones to
further support dental implants.
Furthermore, it helps in preserving the
structure and the size of the jawbone. It
can be major where there are several
patch-ups made, or minor where little
procedures are executed. The bones that
will be added in the jaw will be coming
from the hip bone or lower leg bone
(tibia) of the patient.
Corrective jaw (orthognathic)
surgery
• Orthognathic surgery literally means
“surgery to create straight jaws.” This
kind of surgery usually uses a technique
named osteomy wherein parts of the jaw
are cut in order to make removable
pieces of bone. These slivers will be
utilized to create a straight jaw.
Dental alveolar surgery
• Dental alveolar surgery pertains to the
surgical cure of problems concerning the
teeth and the supporting tissues around
them. It involves but is not limited to:
• the removal of cyst in the jaw
• tooth extraction
• tooth transplantation (wherein a
buried or impacted tooth will be
removed and rearranged to fill the
space made by the lost tooth)
Aesthetic reconstruction and
surgery
• As a result of a traumatic accident, jaw,
facial bone, and facial tissue problems
may arise. Oral and Maxillofacial
surgeons handle treatments under this
matter. This kind of surgery helps in
replenishing the form and function of the
jaw, making it a better version of the old
one, if not as good as a new jaw. On the
other hand, cosmetic surgery can also be
done for unwanted facial features such
as signs of aging.
ENDODONTICS
What is Endodontics?
Endodontics a field of dentistry concerned with
the biology and pathology of the dental pulp and
root tissues of the tooth. It focuses on the
prevention, diagnosis, and treatment of
diseases and injuries of these tissues. Root
canal are a commonly performed endodontic
procedure. “Endo” is the Greek word for
“inside” and “odont” is Greek for “tooth”.
Taken together, these words mean study of the
inner part of the tooth or the dental pulp.

History of Endodontics
The history of endodontics begins in the 17th
century and since then many advances,
developments and research work has been
proceeded continuously.
Tough advances in endodontics have been
made, but especially after Pierre Fauchard, the
founder of modern dentistry, described in his
textbook "Le Chirugien Dentiste" (1728) the
method of access and removal of the offending
pulpal tissue with consequent lead fillings. This
Historic text of the 18th century truly marked
the beginning of endodontics. Later in 1725,
Lazare Riviere introduced the use of clove oil for
its sedative properties then in 1746, Pierre
Fauchard demonstrated the removal of pulp
tissue. Meanwhile, Leonard Koecher expanded
upon this idea in 1820 as he used a heated
instrument to effectively cauterize the infected
pulpal tissue and protect the remaining tissue
with lead foil.
Dr. Louis I. Grossman, the pioneer of
endodontics divided the evolution of
endodontics in four eras from 1776 to 1976,
each consisting of 50 years.
Evolution of Endodontics
1. Pre Science (1776 to 1826): In this era,
endodonic therapy mainly consisted of crude
modalities like abcesses were being treated
with poulitices or leeches and pulps were
being cauterized using hot cauteria.
2. Age of Discovery (1826 to 1876): there
occurred the development of anesthesia,
gutta-percha and barbed broaches. Also the
medications were created for treating pupal
infections and the cements and pastes were
discovered to fill them.
3. Dark Age (1876 to 1926): introduction of
X-rays and general anesthesia, extractions
was the choice of treatment then
endodontics in most of the cases of
damaged teeth because theory of the focal
infection was a main concern that time.
4. Renaissance (1926 to 1976):
endodontics was established as science and
therapy, forming its golden era. It showed
the improvement in anesthesia and
radiographs for better treatment results. The
theory of focal infection was also fading out,
resulting in more endodontics being
practiced and in 1943, because of growing
interest in endodontics, the AAE, the
American Association of Endodontics was
formed.
5. Innovation era: the period from 1977
onwards in which tremendous
advancements at very fast rate are being
introduced in the endodontics. The better
vision, the better techniques of
biomechanical preparations and obturation
are being developed resulting in the simpler,
easier and faster endodontics with more of
the successful results.
Scopes of Endodontics
• Vital pulp therapy - defined as a
treatment which aims to preserve and maintain
pulp tissue that has been compromised but not
destroyed by caries, trauma, or restorative
procedures in a healthy state. This is particularly
important in the young adult tooth with
incomplete apical root development.
• Diagnosis and differential diagnosis
of dental pain – Diagnosis is a personal and
cognitive experience; therefore, many of the
qualities of a good diagnostician are of an
interpersonal nature and based on knowledge,
experiences, and diagnostic tools. Diagnosing
orofacial disease is similar to medical diagnosis.
The pulp test, radiographs, percussion,
palpation, and other tests and procedures can
facilitate the diagnosing of facial disease.
• Root canal treatment with or
without periradicular pathology of pulpal
origin - Root canal treatment is based primarily
on the removal of microbial infection from the
complex root canal system. Periapical
periodontitis (AP) is an acute or chronic
inflammatory lesion around the apex of a tooth
root which is usually caused by bacterial
invasion of the pulp of the tooth.
• Surgical management or periapical
lesion resulting from pulpal pathosis - A
periapical abscess forms when inflammatory
cells accumulate at the apex of a non-vital tooth.
Frequently, the source of the infection is obvious
and is associated with a carious lesion or is the
result of a previous injury to the tooth and
pulpal tissue.
• Management of avulsed teeth
(replantation) - An avulsed permanent tooth
is one of the few real emergency situations in
dentistry. Dental avulsion is the complete
displacement of a tooth from its socket in
alveolar bone owing to trauma. The treatment
for permanent teeth consists of replantation,
immediately if possible.
• Endodontic implants - are artificial
metallic extension, which can safely extend out
through the apex of the tooth into sound bone.
• Root end resections, Hemisection,
Root resections - Root resection is the process
by which one or more roots of a tooth are
removed at the level of the furcation and leaves
the crown and remaining roots functional.
Hemisection is defined as removal or separation
of the tooth in half with its accompanying crown
portion (applies to mandibular molars).
• Retreatment of teeth previously
treated endodontically - With proper care,
you’ll keep teeth that have had root canal
treatment for a lifetime but it’s possible for
those teeth to heal improperly, becoming
painful or diseased months or even years after
treatment. If this happens to your treated teeth
you have a second chance to save the tooth with
retreatment. An additional procedure may be
able to diminish dental pain or discomfort and
promote healing.
• Bleaching of discolored teeth - Teeth
can become discolored for many reasons. Teeth
damaged by trauma (injury) can turn yellowish
as a consequence of excessive calcification.
(Internal bleaching, external bleaching and
micro abrasion)
Internal bleaching is the procedure used
by dentists to whiten teeth which have been
under an endodontic treatment or a root canal
treatment. The treatment consists in treating
the pulp or removing the infection and the nerve
tissue from the pulp of the tooth.
External bleaching procedures utilizing
highly concentrated 30-35% hydrogen peroxide
solutions or hydrogen peroxide releasing agents
can be used for tooth whitening.
Microabrasion is a quick and painless
solution for removing yellow, white, or brown
spots, stains, and discolorations on the teeth.
This procedure uses hydrochloric acid and
pumice to gently remove thin layers of tooth
enamel, removing the stains.
• Coronal restorations of teeth using
post and cores - The post and core complex
can be placed only after the endodontic
treatment has been successfully completed. It
must be securely in place before the crown
preparation can start. If the endodontic
procedure is not successful or not yet
comfortable for the patient, it does not make
sense to seal the endodontic access opening
with a post and core that obstructs further
endodontic intervention.
Procedures in Endodontics
1. Root Canal Treatment:
Also known as endodontic treatment, it is a
common procedure in modern dentistry, extract
inflamed or infected tissue inside the tooth. Pulp
can be seen beneath the enamel and dentin
layer of teeth, it is a type of soft tissue that
contains blood vessels, nerves and connective
tissue. It is also necessary for the growth and
development of a tooth.
The Root Canal Treatment involves in the
removal of pulp that is infected or inflamed.
Where the pulp chamber and root canal are
completely cleaned out and refilled to protect
the area from further damage. Also it is just
required if there’s a deep tooth decay, traumatic
dental injury, cracked tooth and elective (for
added retention of a crown).
It is also a good solution with many potential
benefits for patients who have significant
inflammation or infection in the pulp of a tooth.
Without the treatment, the infection may
develop to cause a significant pain or formation
of an abscess underneath the tooth, that could
influence the strength and function of the tooth.
In addition, in the importance of having a root
canal treatment it helps to maintain the function
of the teeth so that patients may continue to
chew effectively using normal biting force. It
also helps to maintain the natural aesthetic
appearance of the tooth, in contrast to
alternative options, such as dental implants.
Furthermore, root canal treatment can help to
protect other teeth in the mouth from excessive
strain and possible damage, as may occur if only
one side of the mouth is used.
2. Endodontic Retreatment:
Most of the time, root canal therapy is
successful at permanently alleviating tooth pain
and hesitating infection of the soft tissues deep
inside the teeth and gums. But sometimes,
relating in any medical procedure, “the body
may not heal as we expect it to”. After a period
of time, the patient may experience pain in the
damaged tooth again — or, if there’s no
symptoms, the infection may reveal by the
means of the result in x-rays that shows the
image of the infection near the tooth’s roots. In
that case, root canal retreatment is
recommended.
The procedure is usually attained by creating a
small opening into the inner part of the tooth,
removing filling material, and cleaning the pulp
chambers with tiny instruments.
3. Apicoectomy:
Also known as Root End Surgery. In this
procedure it is commonly performed with the
assistance of a microscope and other small
specialized tools, a type of endodontic
microsurgery. Most common type of root canal
surgery, that implies in extraction of a small
portion of apex (tip) of the tooth’s root, together
with the hard or soft tissue that may be infected.
Apicoectomy procedure is usually recommended
after one or more root canal treatments have
been attempt, and unsuccessful. Since a type of
problem generally occurs near the apex of the
root, apicoectomy procedure is the commonly
effective method to treat a persevering
infection.
DENTAL IMPLANT
Dental Implant is a metal posts or frames that
are surgically positioned into the jawbone
beneath the gums. It acts as an artificial tooth
root to support a crown, bridge or removable
denture.
History of Dental Implant
• 2000 BC – In ancient China, pegs carved
from bamboo were used as replacement
teeth.
• 1000 BC – Copper pegs were hammered
into the jawbone of an Egyptian king.
Experts believed that it was placed after
the death of the king since the procedure
of it was too painful.
• 600 AD – Seashells were used to replace
the missing teeth of a Malay. An
archaeologist named Amedeo Bobbio
discovered it on 1931.
The Development of Modern Dental
Implants
In 1952, Dr. Per-Ingvar Branemark,
an orthopedic surgeon, made an unexpected
discovery while doing his study about bone
healing and regeneration. He observed that
the bone had grown around the titanium
cylinder that he could not remove the rabbit.
The properties of titanium allow
osseointegration to take place (“osseo” –
bone; “integration” – fusion or joining with).
Dr. Branemark became the father of modern
dental implantology since his discovery
became the biological basis of modern
implants’ success.
In 1965, Dr. Branemark successfully
placed the first titanium dental implant in a
human volunteer. Due to its positive result,
it quickly led into more researches to
improve its techniques.
Dental Implant Surgery Procedures The current jawbone site for your implant
❖ Initial Evaluation may not be thick enough or it could be too
Several surgical procedures are required soft. Because your jaw creates so much
for dental implants, your dentist or oral pressure while chewing, the bone needs to
surgeon will do a full and thorough be extra strong to handle both the chewing
evaluation and protecting of the dental implant once it’s
o X-ray and teeth model evaluation been surgically added to the gum line.
o Condition of Jawbone - Evaluation of the jawbone site
o Planning process of teeth to be (thickness, structure)
implanted - Bone Grafting for implant base
o Evaluation on Medical Conditions - Check condition of jaw for
and Intakes (Prescription if there simultaneous task or not
is) - Temporary Dentures – kept and
o Surgical Anesthesia Options clean.
o Do’s and Don’t - Osseointegration in process
o Call A friend
❖ During the Surgery Placing the Abutment
Stages: - Osseointegration and Healing
o The damaged tooth is removed (if complete
it hasn’t already come out in some - Attachment of abutment (may be
other way). placed initially or 2nd procedure)
o The jawbone is prepped for - Heal for 1-2 weeks
surgery; this may include some
measure of bone grafting.
o Once the jawbone heals, the
implant is inserted into the gum
line.
o The jaw will be given time to heal
again, and then the surgeon
places the abutment (the piece
that screws into the implant) and Choosing your new Artificial Tooth

attaches the artificial tooth on top, - Gums healed and more impressions

completing the full implant. made

This process could take up to several - Choosing of artificial teeth (Fixed or

months to allow your jaw time to heal Removable)

and prepare for the final installation of - If you choose to get a fixed implant,

the implant. Without a strong jawbone in understand that the tooth cannot be

place, the implant won’t take, so it’s removed for cleaning or easy

important to be patient during the replacement. It’s either permanently

healing process. screwed on to the abutment or

cemented down. Should you have

Dental implant surgery and Bone Grafting several teeth that require implants
and money isn’t a concern, you can
 have all of them replaced in this
manner with each crown attached to
its own separate dental implant.
❖ After Surgery
Discomfort expectations:
o Swelling of face and gums
o Bruising of the gums or skin
o Pain at site of implant surgery
o Minor Bleeding
(If symptoms persist, consult your
dentist)
Fast recovery recommendation:
o Diet of soft foods
o Compressing of Ice Packs
o Patience
Preventions of complications:
o Avoid tobacco products
o Proper oral hygiene
o Regular dental visits
o Avoid bad oral habits
5 Types of Classification
1. Based on Implant Design
• Endosteal Implant
o A device which is placed on
the alveolar bone and/or basal
bone of the mandible or
maxilla
o Transect only one cortical
plate
a) Blade Implant
▪ Consist of thin plates in
the form of blade
embedded into bone
b) Ramus Frame Implant
▪ Horse shoe shaped
stainless steel device
▪ Inserted into the
mandible from one
retromolar pad to the
other
▪ Passes through the
anterior symphysis
area
c) Root Form Implant
▪ Designed to mimic the
shape of tooth
▪ For directional load
distribution
• Subperiosteal Implant
o Places directly beneath the
periosteum overlying the
bony cortex
• Transosteal Implant
o a.k.a Staple
Bone/Mandibular/Transma
ndibular Implant
o Combines the
subperiosteal and
endosteal components
o Penetrates both cortical
plates
• Intramucosal Implant
o Inserted into the oral
mucosa
o Mucosa is the attachment
site for the metal inserts
2. Based on Attachment Mechanism 4. Based on the surface of the implant

• Fibrointegration
• Smooth
o complete encapsulation of
• Machined
implant with soft tissues
• Textured
o Soft tissue interface could
• Coated
resemble the highly
5. Based on the type of Material
vascular periodontal fibers
• Metallic
of natural dentition
• Ceramic & Ceramic Coated
o Osseointegration
• Polymer
o Direct contact between
• Carbon Compound
bone and surface of
loaded implant
Scopes of Implant Dentistry
o Bio active material that
• For completely edentulous patients with
stimulate the formation of
bone can also be used
3. Based on Macroscopic Body Design

advanced residual ridge resorption

• For partially edentulous arches where
RPD may weaken the abutment teeth
• In patients with maxillofacial deformities
• Cylinder • For single tooth replacement where
• Thread fixed partial dentures cannot be placed
• Plateau • Presence of non-treated or
• Perforated unsuccessfully treated periodontal
• Solid disease
• Hollow/Vented

Discipline of Implant Dentistry

• The purpose of Implant Dentistry - The
Most Promising Discipline of Dentistry is
to present a comtemporary resource for
 dentists who want to replace missing MALOCCLUSION
of the teeth is a misalignment problem that
teeth with dental implants.
can lead to serious oral health complications.

ORTHODONTICS
- Orthodontics is a special branch of
dentistry.

- It describes the practice of straightening

misaligned teeth or malocclusions.

- Come from the two Greek words -

“ORTHOS" meaning STRAIGHT OR
CORRECT and “DONTICS" meaning TEETH.
- Dentists who has a specialization in
orthodontics can help manage abnormal
positioning of the teeth, jaws and face.
HISTORY OF ORTHODONTICS
The early Greeks appear to have at least
discussed tooth realignment, and the Etruscans
and early Romans of what it today.
TYPES OF MALOCCLUSION:
1) CROWDED TEETH /
OVERCROWDING is very common and
it’s often caused by a lack of space,
resulting in teeth that are crooked and
overlap. It’s the most common reason for

18TH CENTURY
- two dental practitioners, both French,
published short writings on tooth
straightening.

orthodontic treatment among adults.

MID 19TH CENTURY
- rudimentary braces appeared and medical
literature appeared that included the term
2) OVERJET
“orthodontia” for the first time.
is where your top teeth extend past your
- Progress was still rather slow, however,
bottom teeth horizontally (not to be
and the first school of orthodontics was not confused with an overbite). Protruding teeth
founded until 1901. can risk damage and cause problems with
eating and speech.
20TH CENTURY
- emphasis shift from merely straightening
teeth to treating malocclusion and utilizing
tooth extraction in addition to appliances.
- aided by more refined use of X-ray
imaging to better understand bone
development in the jaw.
- braces were usually made from metals
3) OVERBITE
(such as stainless steel) augmented by
while there should be some overlap of your
different forms of rubber.
lower front teeth, in some cases an
- more convenient and comfortable braces
increased overbite can cause your front
were developed. teeth to bite down onto your gums.
- first “invisible” braces.

21ST CENTURY
- growth of clear aligner removable braces,
advanced modeling based on computer
imaging and other techniques designed to
shorten treatment time and reduce
discomfort.
4.) CROSSBITE
is where your upper teeth bite inside your lower
teeth. In can happen on one or both sides of your
jaw and it can affect your front or back teeth
5.) ANTERIOR CROSSBITE / UNDERBITE
A crossbite that affects the front teeth is known as
an anterior crossbite, or perhaps more commonly
as an underbite.
6.) SPACING
can occur between two or more teeth. Some of the
causes can include missing teeth, small teeth,
tongue thrusting and thumb sucking.
7.) DIASTEMA
is a space between two teeth, usually the front
teeth. Madonna and model Lara Stone famously
both have diastemas.
8.) IMPACTED TOOTH
An impacted tooth is one that’s unable to erupt
through the gum normally. Possible treatments
include removing the tooth, or exposing it so that a
brace can be fitted.
9.) MISSING TOOTH
missing teeth, or hypodontia, can occur as a result
of teeth not developing properly or through
trauma.
10.) OPEN BITE
is where the front teeth don’t overlap the lower
teeth.
PROCEDURES
1. GET A PANORAMIC X-RAY
It covers a wider area than a conventional
intraoral x-ray and, as a result, provides
valuable information about the maxillary
sinuses, tooth positioning and other bone
abnormalities.
2. USE CHEEK RETRACTORS
It is used to make sure that the teeth
remain dry and visible throughout the
procedure to place dental braces.
3. CLEANING
Thoroughly clean the teeth to be bonded
with pumice in a rubber cup or bristle
brush. Take care to avoid irritating the
gingival tissue since slight
bleeding may cause contamination that
could affect the quality of the bond.
4. APPLICATION OF BRACKETS
Dental cement is used to hold the brackets
in place on the teeth, in the exact position
that was determined during the initial
examinations. Any excess dental cement
can then be removed, and the bonding of
the brackets to the teeth is strengthened
with a high-intensity light.
5. PUTTING OF DENTAL ARCH WIRES
AND ELASTICS
Once the dental braces are in place as
desired, the cheek retractor can be removed
 and dental arch wires and elastics can be
put in place.
TYPES OF BRACES
1. TRADITIONAL / METAL BRACES
They are made from a high-grade stainless steel
and have metal brackets that are attached to each
tooth using a type of cement.
2. CERAMIC BRACES
These work in the same way as traditional braces,
but the brackets are made from a clear,
transparent ceramic material. The braces are less
visible to others, which makes them a popular
choice for adults who need orthodontic treatment.
3. SELF-LIGATING / DAMON BRACES
It provides gentler treatment and requires fewer
dental visits. These braces produce faster results
because the teeth can move on their own without
needing to be adjusted.
4. LINGUAL BRACES
These are attached to the lingual (tongue) side of
your teeth. No one can see them, but they’ll be
hard at work straightening your teeth from the
inside. Your lingual brace will look and function just
like a fixed brace, using brackets and wires to
gradually move your teeth.
RETAINERS
Retainers aren’t braces. Instead of moving your
teeth, their job is to hold them in their new position
once your braces come off. They’re so important,
though, that we think they’re always worth a
mention.
TWO TYPES OF RETAINERS:
1. REMOVABLE RETAINERS consist of clear
vacuum-formed mouth guards that snugly fit your
teeth to hold them in position.
2. FIXED RETAINERS are thin stainless steel
wires that are permanently attached behind your
front teeth where they stop your teeth from moving
24 hours a day, seven days a week.
STEPS IN BRUSHING YOUR TEETH WITH
BRACES
STEP 1: Make sure your brush contacts and the
enamel of your teeth. This will require more
pressure than normal.
STEP 2: Brush vigorously in a circular motion to
achieve maximum contact with your teeth. Use a
soft brush to protect your gums. Be sure to brush
your gums to prevent swelling from lack of
stimulation.
STEP 3: Brush the outer, inner, and chewing
surfaces of each tooth systematically to avoid
missing any areas. We recommend you brush with
water first to visually remove all food and plaque.
Then brush with toothpaste with fluoride to protect
the enamel.
STEP 4: Use the tip of your brush for the inner
surface of your front teeth. Use your brush
vertically for difficult and crowded areas to make
sure your brush contacts the enamel surface.
STEPS IN FLOSSING YOUR TEETH WITH
BRACES
STEP 1: Using a piece of floss about 18 inches
long, carefully thread the end between braces and
wire. You may find a floss threader helpful.
STEP 2: Carefully floss around the braces.
STEP 3: Carefully floss around the gum areas.
STEP 4: Carefully floss around each tooth. If
flossing is too difficult in certain areas, use a proxy
brush instead. We will provide you with a sample at
the start of treatment.
PEDIATRIC DENTISTRY
What is Pediatric Dentistry?
Pediatric dentistry or pedodontics came
from the word pedo which means “of children”
and dontics which means “the study of the
tooth” so this discipline of dentistry simply
means that it deals with the oral health of the
children.
Pediatric dentists are the practitioners
who are responsible for taking care of the
approaches to help a child complete the needed
dental treatment and make a recommendation
or guidance for the child based on his/her health
history, special health care needs, dental needs,
type of treatment required. Being an effective
communicator, especially with the parents, is a
very important skill. This is why a minimum of
two years full time academic study leading to an
advanced degree in Pediatric Dentistry is
required.

What is the History behind Pediatric
Dentistry?
→ (1800 BC) Ancient Egypt- no caries
in children’s teeth
→ (1563-1564) Eustachius- described
and showed illustrations of both
primary and permanent dentition
→ (1737) Gerauldy writes about
theories regarding tooth eruption and
exfoliation
→ (1743) Robert Bunon, the “Father of
Pedodontics” and the one who
introduced serial extraction,
published his essay on the diseases of
the teeth, wherein for the first time
discussed the dental problems of a
child. It demonstrates that the
extraction of decayed teeth is not
dangerous.
→ (1763) Joseph Hurlock publishes the
first book on children’s dentistry
→ (1916) Minnie Evangeline Jordon
gave a lecture to the Los Angeles
County Nurses' Association on "The
Relation of the Teeth to the
Development of the Child"
→ (1921) Minnie Evangeline Jordon
presented a paper, "Relation of Food
to the Developing Teeth", at the 1921
meeting of the California State Dental
Association, where she recommended
fewer sweets and more milk, coarse
grains, eggs, and vegetables in
children's diets
→ (1924) Minnie Evangeline Jordon
publishes the first book on pediatric
dentistry in English
→ (1947) The American Academy of
Pedodontics was founded
→ (1950) Cities begin to fluoridate the
public water supply
→ (1960s) The US government created
the Pediatric Dentistry Training
Program with the purpose of teaching
how to treat the specific needs of
children.
→ (1960) Dental Sealants introduced to
help prevent cavities in children and
adolescents’ permanent teeth
→ (Mid-1980s) Caries in children drop
substantially across the population
What are the Common Problems that
Pediatric Dentists Encounter?
1. Tooth Decay/ Caries
Caries is a preventable disease. It doesn’t
endanger the child’s life directly but it may
negatively affect his or her quality of life. If not
promptly addressed, it could result to other
problems such as bad breath and weight loss.
Even the permanent teeth can get affected by
untreated tooth decay.
2. Bad Breath
It may be sometimes temporary due to
eating certain foods and can be simply solved
by prompt brushing and flossing. However, if it
persists, bad breath could be a sign of another
oral problem like gum disease or caries.
3. Early Tooth Loss
Children can lose teeth from injury or
decay and if baby teeth are lost before the
permanent teeth comes, the alignment of both
baby and permanent teeth can be messed up.
4. Tooth Grinding (Proxism)
This problem is common during childhood
development. By grinding the teeth, damage to
primary or permanent teeth can even cause
pain. This problem can be treated with a
custom night guard.
5. Orthodontic Problems
A malocclusion or a bite that does not
meet properly may be inherited or may be
caused by missing or extra teeth, crowded
teeth or misaligned jaws. It can also develop
because of prolonged oral habits such thumb–
or finger–sucking and tongue–thrusting.

What are the Common Procedures in
Pediatric Dentistry?
1. Dental Cleaning (Prophylaxis)
During a dental visit, the dental assistant or
hygienist will first review the child’s medical
history to ensure that they are updated on the
general health of the child so that they may review
any factors that may concern the child’s dental
health. Then the child’s mouth will be examined
for overall oral health. Next, the child’s teeth will
be thoroughly cleaned to remove plaque and
calculus (hard tarter deposits), which can cause
cavities and gum disease. After the cleaning,
fluoride will be applied to the teeth to help protect
and strengthen the weak areas against decay.
2. X-Rays (Radiographs)
Children need X-rays more often than
adults. Their mouths grow and change rapidly. X-
rays can often show weaknesses in the tooth
structure (such as demineralization) that may not
be visible with the naked eye. Radiographs (X-
Rays) are a vital and necessary part of your child’s
dental diagnostic process. Without them, certain
dental conditions can and will be missed.
3. Tooth Colored Fillings (Composite
Resin)
Tooth colored fillings are used to restore front
or back teeth or where cosmetic appearance is
important. Composites are used to repair
fractured teeth and/or areas of decay. The shade
of the composite restorative material is matched
as closely as possible to the color of the natural
teeth.
4. Stainless Steel Crowns (SSCs)
Stainless steel crowns are used to restore back
teeth that are too badly decayed to hold white
fillings. These prefabricated sliver-colored crowns
are fit; then cemented onto the primary (baby)
teeth to prevent further damage until these teeth
are naturally lost. When tooth decay on back teeth
has been left untreated, teeth may have extensive
damage to the enamel, dentin and sometimes the
nerve (pulp). In such cases, tooth-colored fillings
are not a viable option, and stainless steel crowns
necessary.
5. Early (Interceptive) Orthodontic Care
Early interceptive orthodontic treatment has
proven to be extremely beneficial for the overall
oral health, development and desired result for a
straight, beautiful smile that can last a lifetime.
This preventive evaluation, prior to a child’s
permanent teeth erupting allows the opportunity
for early action and treatment. It is the guidance
of teeth eruption and correction of malocclusion
(abnormal bite) by early intervention in order to
improve future outcome(s). This is usually
achieved by simple fixed or removable appliances.
6. Extractions (Tooth Removal)
Extractions are done only as a last resort in the
case of severe tooth decay. If a primary molar is
removed prematurely, a space maintainer will be
placed. Some extractions are needed for
orthodontic reasons to help facilitate tooth
alignment when crowded teeth are
present. Primary teeth are essential in
maintaining the correct spacing in your child’s jaw
for the permanent teeth.
7. Pulp Treatment (Pulpotomy)
Pulp therapy (pulpotomy) is the treatment of
infected nerves and blood vessels in teeth. Pulp
therapy generally becomes necessary for two
reasons: either as a result of extensive tooth
decay (dental cavities) or as the result of tooth
injury. Failure to provide the necessary pulp
therapy could result in your child experiencing
pain, infection, swelling, or loss of the tooth.
8. Sealants
Sealants are thin, white plastic coatings that are
applied to the tops or chewing surfaces of back teeth
and are highly effective in preventing tooth
decay. The naturally occurring pits and grooves on
the chewing surfaces of teeth can often collect
plaque
9. Space Maintainers
Space maintainers are used when a primary
tooth has been prematurely lost (or extracted)
to hold space for the developing permanent
tooth. If space is not maintained, teeth on either
side of the extraction site can drift into the space
and prevent the permanent tooth from erupting
into its proper position. The space maintainer
will be removed from your child’s mouth once
his/her permanent tooth replacing the extracted
tooth comes in

10. Fluoride Treatment
The fluoride treatment is effective in
preventing caries and plaque from building up
and hardening on the tooth’s surface.
Depending on the child’s doctor, this treatment
may be required every three, six, or twelve
months.
TMJ SPECIALIZATION
TMJ Specialization is the discipline in Dentistry
which includes the assessment, diagnosis and
treatment of patients with jaw behavior dysfunction
and disorder.
TMJ or temporomandibular joint is a hinge that
connects your jaw to the temporal bones of your
skull, which are in front of each ear. It lets you
move your jaw up and down and side to side, so
you can talk,chew, and yawn.
TMJ Anatomy
Articular Disk
The articular disk is the most important anatomic
structure of the TMJ. It is a biconcave
fibrocartilaginous structure located between the
mandibular condyle and the temporal bone
component of the joint. Its functions to
accommodate a hinging action as well as the
gliding actions between the temporal and
mandibular articular bone.
Temporal Bone
The temporal bones are situated at the sides and
base of the skull, and lateral to the temporal lobes
of the cerebral cortex. The temporal bones are
overlaid by the sides of the head known as the
temples, and house the structures of the ears. The
lower seven cranial nerves and the major vessels to
and from the brain traverse the temporal bone.
Condyle
The part of the mandible which mates to the
under-surface of the disc and the part of the
temporal bone which mates to the upper surface of
the disk is the articular fossa or glenoid fossa or
mandibular fossa.
Nerve
Sensory innervation of the temporomandibular joint
is derived from the auriculotemporal and
masseteric branches of V3 or mandibular branch of
the trigeminal nerve. These are only sensory
innervation. Recall that motor is to the muscles.
Ligaments
There are three ligaments associated with the
temporomandibular joints: one major and two
minor ligaments. These ligaments are important in
that they define the border movements, or in other
words, the farthest extents of movements, of the
mandible. Movements of the mandible made past
the extents functionally allowed by the muscular
attachments will result in painful stimuli, and thus,
movements past these more limited borders are
rarely achieved in normal function.
The major ligament, the temporomandibular
ligament, is actually the thickened lateral portion
of the capsule, and it has two parts: an outer
oblique portion (OOP) and an inner horizontal
portion (IHP). The base of this triangular ligament
is attached to the zygomatic process of the
temporal bone and the articular tubercle; its apex
is fixed to the lateral side of the neck of the
mandible. This ligament prevents the excessive
retraction or moving backward of the mandible, a
situation that might lead to problems with the joint.
The two minor ligaments, the stylomandibular
and sphenomandibular ligaments are
accessory and are not directly attached to any part
of the joint.
The stylomandibular ligament separates the
infratemporal region (anterior) from the parotid
region (posterior), and runs from the styloid
process to the angle of the mandible; it separates
the parotid and submandibular salivary glands. It
also becomes taut when the mandible is protruded.
The sphenomandibular ligament runs from the
spine of the sphenoid bone to the lingula of
mandible. The inferior alveolar nerve descends
between the sphenomandibular ligament and the
ramus of the mandible to gain access to the
mandibular foramen. The sphenomandibular
ligament, because of its attachment to the lingula,
overlaps the opening of the foramen. It is a vestige
of the embryonic lower jaw, Meckel cartilage. The
ligament becomes accentuated and taut when the
mandible is protruded.
HISTORY:
In 1934, Costen, an otoraryngologist, described a
conplex of symptoms presuned caused by disorder
of the TMJ. After Zimmerman’s exhaustive critique
of the proposed mechanisms for the symptoms in
1951, the term Costen’s syndrome gradually fell
fron favor. However, until recently, the concept of
a rather consistent symptom complex caused by a
variety of TMJ and/or masticatory muscle disorders
has persisted, and many syndrome names and
features have appeared in the literature. This has
resulted in considerable diagnostic confusion.
During the past 20 years, significant progress has
been made in our understanding of TMJ and
masticatory muscle disorders, particullarly
intracapsular joint disorders and interpretation of
joint sounds. This has resulted in the current
emphasis on diagnosis of specific muscle and joint
conditions rather than a single syndrome.
TMD (TEMPOROMANDIBULAR DISORDER):
Problems with your jaw and the muscles in your
face that control it are known as
temporomandibular disorders (TMD).
Temporomandibular joint disorder embrace a
wide spectrum of specific and non-specific
disorders that produce symptoms of pain and
dysfunction of the muscles of mystification and
temporomandibular joints.
SYMPTOMS:
Symptoms arising from TMJ and its associated
muscles are common and include:
• Pain – probably the most common
symptom resulting in patients
seeking help. Pain may arise from
joint capsule, “retro-discal” tissues
or associated muscles such as the
lateral pterygoid or masseter.
SIGNS:
These are elicited on clinical examination.
• Joint Noises – these are usually
experienced as clicking or grating.
They can occur in otherwise
asymptotic joints
• Limitation of mouth opening – it
is important to draw a distinction
between limitation of movement
resulting from some kind of
obstruction within the joint and that
caused by muscle spasm.
Example of trismus, opening less than 40
mm.
• Deviation on mouth opening – normal
mouth opening should be symmetrical and
pain free; intercisal shoulf approach 40 mm.
Deviation may result from mechanical
interference or pain.
• Clicking – A soft cartilage disk
cushions the two bone surfaces. In
people with TMD, the disk often is
out of its normal position. When the
mouth is opened, the disk snaps
back into its normal location,
causing a click; when the mouth is
closed, it becomes displaced again,
causing another click.
• Locking – jaws that gets “stuck” or
“lock” in the open- or closed- mouth
positions.
TMD (TEMPOROMANDIBULAR DISORDER):
Problems with your jaw and the muscles in your
face that control it are known as
temporomandibular disorders (TMD).
Temporomandibular joint disorder embrace a
wide spectrum of specific and non-specific
disorders that produce symptoms of pain and
dysfunction of the muscles of mystification and
temporomandibular joints.
COMMON DISORDERS:
1. TMJ pain dysfunction syndrome
Temporomandibular joint pain dysfunction
syndrome is a descriptive term relating to
pain arising from the joint itself and the
muscles of mastication. It is also known as
facial arthromyalgia and myofacial pain.
2. Internal Derangement
Internal derangements of the
temporomandibular joint are conditions in
which the articular disc has become
displaced from its original position the
condylar head.
3. Fractures and dislocations
Temporomandibular Joint (TMJ) fracture
(jaw fracture) is the second most common
fracture to the bones of the face. Only the
bones of the nose are broken more
frequently. This facture occurs when the
mandible and/or temporal bone is broken
near or through the TMJ, the joint
connecting the jaw bone to the skull.
UNCOMMON DISORDERS:
1. Degenerative joint disease
 Also known as Ostreoarthrosis, which is the
most common type of arthritis. It is
associated with a breakdown of cartilage in
joints and can occur in almost any joint in
the body. It most commonly occurs in the
weight-bearing joints of the hips, knees,
and spine.
2. Inflammatory joint disease
Inflammatory arthritis is known to be
caused by an increase of cytokines which
leads to degradation of articular cartilage
and a decrease of growth factors which
induce chondrogenesis.
3. Ankylosis
An abnormal union acrossed the joints.
This may be either fibrous or bony in origin.
Commonly Anklylosis, is seen in the larger
joints.
4. Condylar hyperplasia or hypoplasia
Condylar hyperplasia of mandible is
overdevelopment of condyle, unilaterally or
bilaterally, leading to facial asymmetry,
mandibular deviation, malocclusion and
articular dysfunction.
Idiophatic condylar resorption
Idiopathic condylar resorption (ICR) is a specific
condition that affects the jaw joints
(temporomandibular joints or TMJs) and most
commonly occurs in teenage girls. It sometimes has
been referred to as “cheerleader’s syndrome,”
because it frequently occurs in teenage girls
participating in sports activities which, through
minor or major trauma to the jaws, can initiate or
exacerbate the condition.
RARE DISORDERS:
1. Infective arthritis
It has become rare since the advent of
antibiotics. Most cases are arouse from the
spread of infection from the ear (otitis
externa, otitis media), which is now much
better diagnosed and treated. However
infective athrbfdghsa is pontentially very
severe condition because it may spread into
the middle Cranial Fossa and result in
intracranial sepsis.
2. Tumours of the TMJ
Tumors and pseudotumors in the
mandibular joint area refer to the
occurrence of neoplasms in the component
parts of the temporomandibular joint.
TREATMENT:
MEDICATIONS:
➢ Pain relievers and anti-inflammatories.
If over-the-counter pain medications aren't
enough to relieve TMJ pain, your doctor or
dentist may prescribe stronger pain
relievers for a limited time, such as
prescription strength ibuprofen.
➢ Tricyclic antidepressants. These
medications, such as amitriptyline, are used
mostly for depression, but in low doses,
they're sometimes used for pain relief,
bruxism control and sleeplessness.
➢ Muscle relaxants. These types of drugs
are sometimes used for a few days or
weeks to help relieve pain caused by TMJ
disorders created by muscle spasms.
THERAPIES:
Nondrug therapies for TMJ disorders include:
➢ Oral splints or mouth guards (occlusal
appliances). Often, people with jaw pain
will benefit from wearing a soft or firm
device inserted over their teeth, but the
reasons why these devices are beneficial
are not well-understood.
➢ Physical therapy. Along with exercises to
stretch and strengthen jaw muscles,
treatments might include ultrasound, moist
heat and ice.
➢ Counseling. Education and counseling can
help you understand the factors and
behaviors that may aggravate your pain, so
you can avoid them. Examples include teeth
clenching or grinding, leaning on your chin,
or biting fingernails.
SURGICAL OR OTHER PROCEDURES:
➢ Arthrocentesis. Arthrocentesis (ahr-
throe-sen-TEE-sis) is a minimally invasive
procedure that involves the insertion of
small needles into the joint so that fluid can
be irrigated through the joint to remove
debris and inflammatory byproducts.
➢ Injections. In some people, corticosteroid
injections into the joint may be helpful.
Infrequently, injecting botulinum toxin type
A (Botox, others) into the jaw muscles used
for chewing may relieve pain associated
with TMJ disorders.
➢ TMJ arthroscopy. In some cases,
arthroscopic surgery can be as effective for
treating various types of TMJ disorders as
open-joint surgery. A small thin tube
(cannula) is placed into the joint space, an
arthroscope is then inserted and small
surgical instruments are used for surgery.
TMJ arthroscopy has fewer risks and
complications than open-joint surgery does,
but it has some limitations as well.
➢ Modified condylotomy. Modified
condylotomy (kon-dih-LOT-uh-mee)
addresses the TMJ indirectly, with surgery
on the mandible, but not in the joint itself.
 It may be helpful for treatment of pain and
if locking is experienced.
➢ Open-joint surgery. If your jaw pain does
not resolve with more-conservative
treatments and it appears to be caused by a
structural problem in the joint, your doctor
or dentist may suggest open-joint surgery
(arthrotomy) to repair or replace the joint.
However, open-joint surgery involves more
risks than other procedures do and should
be considered very carefully, after
discussing the pros and cons.
ORAL AND MAXILLOFACIAL
RADIOLOGY
WHAT IS ORAL MAXILLOFACIAL
RADIOLOGY?
Oral and maxillofacial radiology, also
known as dental and maxillofacial
radiology, is that specialty of dentistry
concerned with performance and interpretation
of diagnostic imaging used for examining the
craniofacial, dental and adjacent structures.
Maxillofacial - of, relating to, or treating the
maxilla (upper jaw) and the face
Radiology- concerned with the use of radiant
energy (such as X-rays) or radioactive material
in the diagnosis and treatment of disease.
Oral and maxillofacial imaging includes cone
beam CT, multislice CT, MRI, PET, ultrasound
scan, dental panoramic radiology,
cephalometric imaging, intra-oral imaging.
HISTORY
• 1895 X rays discovered by Wilhelm
Conrad Roentgen
• 1896 First dental radiograph were made.
The early pioneers of dental radiology
used glass photographic plates or roll film
to capture the images. The plates were
cut down by the dentist, wrapped in
black paper, and then enclosed in rubber
dam material. The glass plates were
extremely fragile and were
uncomfortable for the patient.
• Friedrich Otto Walkhoff (1860-
1934)- Fritz Giesel, Walkhoffs’ close
friend and professor, made a
radiographic image of Walkhoff’s molars
with an exposure time of 25 minutes.
Otto Walkhoff and Fritz Giesel
established the first dental
roentgenologic laboratory in the world.
In April 1898, Walkhoff succeeded in
making extraoral radiographic images
with an exposure time of 30 minutes.
• 1903 Kells opens first dental x-ray lab in
United States
SCOPE
Conditions Requiring Oral Maxillofacial
Radiology
Your dentist may refer you to an OMR specialist
for any of the following reasons:
• Surgical planning for impacted and
wisdom teeth, tooth extraction and other
types of oral surgery that may require
sedation or general anesthesia
• Facial pain (including problems related to
TMJ abnormalities and disorders)
• Oral cancer diagnosis/treatment planning
ADVANTAGES:
An X-ray may reveal:
- small areas of decay between the
teeth or below
- existing fillings
- infections in the bone
- periodontal disease aka gingivitis
- abscesses or cysts
- developmental abnormalities
- some types of tumors aka oral
cancer
DISADVANTAGES:
- no simple or definitive answer to
how much radiation is enough or
too much
- unborn children are at highest risk
from radiation
- radiation effects take years to
develop, people have a longer
time to experience possible
negative effects
Oral and Maxillofacial Radiology
Procedures
Extraoral Radiographs
- These can be considered the "big
picture" X-rays. It is less detailed
than intraoral X-rays. For this
 reason, they are usually not used
for detecting cavities or flaws in
individual teeth. They show teeth,
but they also provide information
on the jaw and skull. Extraoral
radiographs are used to:
▪ Keep track of growth and
development
▪ Look at the status of
impacted teeth
▪ Examine the relationships
between teeth and jaws
▪ Examine the bones of the
face
• A CT scan or computed tomography
scan makes use of computer-processed
combinations of many X-
ray measurements taken from different
angles to produce cross-sectional images
of specific areas of a scanned object,
allowing the user to see inside the object
without cutting.
• Panoramic Radiograph
- Panoramic radiography is the
most commonly used exta-buccal
radiographic technique in
dentistry, it provides broad vision
of the dental - buccal - maxillary -
facial complex. Calcifications
located at the soft tissue can also
be observed when examined.
• Panoramic X-rays
- It shows the entire mouth on a
single X-ray. They include all teeth
on both upper and lower jaws.
The process is very safe. It often
uses less radiation than intraoral
X-rays.
• Magnetic Resonance Imaging
(MRI): Used to evaluate and treat TMJ,
trauma, disease or abnormal conditions
like oral cancer, an MRI is a radiology
technique that uses magnetism, radio
waves and a computer to produce highly
detailed images of body structures.
• Ultrasound (US): Ultrasound imaging,
also known as ultrasound scanning or
sonography, obtains images from inside
the human body using high frequency
sound waves. Intraoral USG is also used
in dentistry for examining the salivary
glands and ducts, as well as the mouth
floor, the buccal, labial, and palatal
mucosa, the tongue, periodontal tissues,
and periapical lesions. The main purpose
of this review is to provide detailed
information about intraoral USG
applications in dentistry.
• Cephalometric projections
- They are X-rays taken of the entire
side of the head. They are used to
look at the teeth in relation to the
jaw and the person's profile.
Orthodontists use cephalometric
projections to determine the best
type of orthodontic treatment.
• Standard computed tomography
(CT)
- It is usually done in a radiologist's
office or a hospital. Typically, you
will lie down while the image is
taken. Dental computed
tomography (CT) scanners are a
significant addition to the imaging
armamentarium available for the
investigation of dental patients.
• Digital Radiographs
- Digital radiographs are one of the
newest X-ray techniques. The
image goes into a computer,
where it can be viewed on a
screen, stored or printed out.
Digital X-rays use about half the
radiation of conventional film.
Intraoral Radiographs
Intraoral X-rays are the most common type.
They give a high level of detail. These X-rays
allow dentists to:
• Find cavities
• Look at the tooth roots
• Check the health of the bony area around the
tooth
• See the status of developing teeth
• Otherwise monitor good tooth health
The various types of intraoral X-rays show
different aspects of the teeth:
• Bite-wing X-rays
• highlight the crowns of the back teeth.
Dentists take one or two bite-wing X-
rays on each side of the mouth. Each X-
ray shows the upper and lower molars
(back teeth) and bicuspids (teeth in
front of the molars). These X-rays are
called "bite-wings" because you bite
 down on a wing-shaped device that
holds the film in place while the X-ray is
taken. These X-rays help dentists find
decay between back teeth.
• Periapical X-rays
highlight only one or two teeth at a
time. A periapical X-ray looks similar to
a bite-wing X-ray. However, it shows
the entire length of each tooth, from
crown to root. Depending on your oral
health and dental history your dentist
may recommend a full-mouth
radiographic surveya, or FMX. This
includes every tooth, from crown to root
to supporting structures. They are X-
rayed using both bitewing and periapical
radiographs.
• Occlusal X-rays (right)
are larger than most X-rays. They
highlight tooth development and
placement in children. Each X-ray shows
nearly the full arch of teeth in either the
upper or lower jaw.
PROSTHETIC DENTISTRY
Dental Prosthetics
Dental prosthetics are the branch of dentistry that
deals with the reconstruction of damaged teeth or
the replacement of missing teeth.
Discipline of Prosthetic Dentistry
The discipline in dentistry concerning itself with the
diagnosis, prevention and treatment of problems
caused by tooth loss. Dental prosthetic is concerned
with the functional and aesthetic rehabilitation of the
teeth by artificial replacement of missing teeth and
associated tissues. There are several ways of
repairing a tooth or teeth such as artificial crowns,
dentures, bridges, obturators and surgical
prostheses. Dental prosthetic aims to provide dental
care for missing tooth or teeth therefore, there must
be a deep understanding of the patient’s issue or
concern.
History of Dental Prosthetics
• 2500 B.C
First Dental Prosthesis Constructed in Egypt
• 700 B.C
Archaeologic findings of Etruscans’ dentistry
having a collection
of ancient dental prosthesis of antiquity such
as fixed partial
dentures made up of soft or rolled golds
• 1st century
earliest use of gold crowns by the Roman
• 2nd , 4th and 6th century
writings of Talmud, “a book of rabbinical laws
of the Hebrews”
• 1829-1892
discovery of Dr. Renan and Dr. Galliardt
in necropolis of sidon
• 1927
Hermann Junker found a specimen of
the restoration consisted of a eft third molar with
resorbed root that was linked to a left second molar
by a gold wire woven around the gingival margins
from the Egyptian mummies
• Early Dental Prosthesis Steps:
1. loose teeth were ligated by means of
gold or silver wire
2. grass fiber, gold, or silver wire was
passed through holes drilled in
natural or animal teeth, and they
were ligated to the teeth in the mouth
3. detached natural teeth were replaced
4. fixed partial dentures were made of
soft gold and appliances of gold wire
or ribbon were used to support loose
teeth
5. gold fixed partial dentures were
constructed to with teeth secured to
the framework by rivets
6. fixed partial dentures that contained
teeth incorporated by means of
solder were constructed
7. fixed partial dentures that contained
gold shell crowns were soldered to
supporting loops of gold ribbon
8. crowns were attached to abutment
teeth by means of a supporting wire
Modern Dentistry
Pierre Fauchard
• founder of modern dentistry and the
father of modern dental prosthesis
• wrote a book entitled "Le Chirurgien
Dentiste" in 1723
• first to use what he called as "tenons"
which were, in reality, dowels
or pivots screwed into the roots of
the teeth to retain
 fixed partial dentures
• idea of mineral teeth was also
credited to Fauchard
Claude Moulton
• published a book written exclusively
on prosthetic dentistry in 1746
the retention of removable partial
dentures by spring clasps made
up of round gold wire and the use of
the gold shell crown are
being described first time in the book
he wrote
Scope of Prosthetic Dentistry
Fixed Prosthetic
- Crowns and temporary crowns
- Bridges and temporary bridges
- Veneers
- Inlays
Removable Prosthetic
- Acrylic Dentures
- Chrome Dentures
- Immediate Replacement Dentures
Fixed Prosthetic
1. Crowns
- Crowns are made to entirely cover a
damaged tooth. It strengthens and improves
the appearance of the tooth at the same
time. Gold, metal alloys, acrylic, ceramic and
Porcelain are the most common materials
used in making crowns.
Crowns are recommended when
- Protecting a weak tooth from further damage
- A tooth is filled with root and has a tendency
to be weaker after time
- In aesthetic reasons when tooth is not
pleasant to see
2. Bridges
- Bridges are made up of two or more crowns
and a false tooth in between them. The
crowns supporting crowns are called the
abutment teeth and the false tooth is the
pontic. Gold, alloys and porcelains are the
common materials used in making dental
bridges.
Bridges are recommended when
- Restoring the smile of an individual
- Distributing the forces of biting to each teeth
by replacing missing tooth
Types of Bridges
- Traditional bridges – maximizes the use of
two or more teeth attached to the pontic
- Cantilever bridges – uses only one adjacent
tooth to the pontic
- Maryland bonded bridges – a false tooth with
wings to be attached to adjacent teeth.
3. Veneers
- Veneers are thin shells that are used in
covering the front surface of the tooth. They
are used to improve the appearance of the
tooth.
Veneers are recommended when
- Tooth is discolored
- Tooth is worn down
- Teeth with noticeable gaps in between
4. Inlays
- Inlays are pre molded fillings that are
attached to a damage tooth. It is used when
the damage has not yet reached the cusp
area of the tooth. The help of the laboratory
is needed as the dentist will send an
impression to the technician.
Inlays are recommended when
- The tooth is not damage up to the cusp area
- There is no more reasonable structural
support to place a crown instead
- It is extensive enough that a simple dental
filling is not enough.
Removable Prosthetic
1. Acrylic Dentures
- Acrylic Dentures are made up of plastic. It is
used as substitute for missing teeth. It is
easier to mold and is more convenient as it
is easier to adjust as time passes by. It is
anchored to the gingiva of the person.
Dentures are often made in laboratory and
impressions of the dentist are their guide.
2. Chrome Dentures
- Chrome Dentures are also used for
replacement of missing teeth. Unlike acrylic
dentures, chrome dentures have a thinner
metal framework that clasps to natural teeth
thus making it more comfortable and secure
at the same time.
3. Immediate Replacement Dentures
- Immediate replacement dentures are placed
immediately after the extraction of a tooth.
This helps control bleeding and helps shape
the tissue in the arc.