mfd part2 final revision booklet

volume 1
station 1
this is the tongue appearance of 32 years old patient
what is the name of the condition? Geographic
tongue
mention 2 other names? Benign migratory glossitis,
erythema migrans
differential diagnosis- acute erythematous
candidiasis, lichen planus, lichenoid drug reaction,
strawberry tongue due to nutritional deficiencies,
leukoplakia.
causes (3 points)- familial/hereditary, idiopathic,
associated with systemic diseases like psoriasis.
Treatment- symptomatic relief- 0.15% benzadymine
mouthrinse used three times daily for the burning
sensation, avoid smoking, alcohol and hot and spicy
food. The lesion is self limiting. Corticosteroid topical
like 0.1% triamcinolone acetonide applied to the
lesion also provides some benefit.
station 2
describe the radiograph? This is an DPT showing the
upper and the lower teeth and surrounding hard and
soft tissues. There is a large well defined
radiolucency in the right lower 46,47 region. The
lesion is well corticated it is in close approximation
to the root of 45 and mild resorption is visible in the
root apex. The lesion is extending to the alveolus. All
teeth distal to 45 are missing. Tooth 45 has a large
distal radiolucency in the cervical area of crown
extending into the pulp.
differential diagnosis? Radicular cyst, residual cyst,
unicystic ameloblastoma, odontogenic keratocyst
what medical syndrome is correlated to this
condition? Gorlin Goltz syndrome
mention 2 other features we may see in this
syndrome? Calcification of the falx cerebri, multiple
basal cell carcinomas.
this type of this cyst has high recurrence rate why (3
points) - presence of daughter cells and very thin
epithelial lining which is resistant to complete
curettage.

station 3
describe what you can see? There is a clinical
photograph showing the 11 and 21 with a large
diastema between them. The 22 appears rotated.
The lower anterior teeth from 42 to 31 exhibit
significant gingival recession with interdental bone
loss. The roots of the teeth are exposed. There is
moderate gingival inflammation evident in the lower
anterior region. The radiograph, showing the lower
anterior teeth from 43 to 34 shows upto 80%
horizontal bone loss including the interdental bone.
classify this according to miller classification? Class 4
what are the possible causes (5 points)- Local factors
– plaque , calculus and poor oral hygiene, premature
loss of upper and lower posterior teeth, trauma due
to anterior closure, thin gingival biotype, familial
tendency such as in aggressive periodontitis,
systemic diseases like uncontrolled diabetes mellitus
and smoking.
what may be the patient complain(3 points)-
sensitivity, food impaction and inability to keep the
area clean, mobility of teeth and inability to chew.
Poor esthetics.
describe your management- identify the cause.
Clinical examination with 6 point pocket charting. -
Non surgical periodontal therapy is initiated to
remove local factors and prevent further
deterioration of the condition. Medical consultation
on possible systemic involvement in also taken.
Teeth with poor prognosis may need extraction.
Refer to specialist for surgical management of
recession or in condition with aggressive
periodontitis. Plan for future prosthetic
management in consultation with periodontist.
station 4
• what is the name of this appliance? Herbst
appliance which is a fixed functional appliance
• what type of mal occlusion it treats best? Class II
malocclusions.
• what is the main advantage of this appliance in
comparison to others? It is less bulkier and
patients find it easy to talk and eat with this
appliance. Because it is fixed, patient
compliance is not a problem.
• what group of patients will get use of this
appliance most? Growing child and non
compliant patient with class II malocclusions.
• Drawbacks- breakage and increased cost
station 5
this is a photo after a trauma to an 8 years old child
1-what is the best treatment for this condition?
Partial pulpotomy.
2- what materials can be used in managing this
case (3 examples)- calcium hydroxide, MTA,
biodentine
what is the name of the process? Apexogenesis.
3- which one of them you prefer best and why?(3
points) calcium hydroxide- long term proven results
available from previous research, alkaline ph,
antimicrobial properties, ability to stimulate
reparative dentin formation, ability to stimulate root
development.
4-what important points you have to ask regarding
the history of trauma?(5 points) – time and duration
of trauma, clean /dirty area, unconsciousness or
vomiting after trauma, any bleeding from nose, ear
or any other area, is there associated pain or
tenderness, do you have the fractured segment, last
tetanus prophylaxis, did you take any medication or
visit a dentist?

station 6
• describe the process you can see? Mini plates
used for reduction and fixation of fracture in the
body of the mandible
• what signs and symptoms we may notice with
this patient? Derangement of occlusion, pain,
haematoma, trismus, deviation on opening or
closing the mouth, step deformity on palpation,
pain and mobility of the teeth, nerve injury
ecchymosis at the floor of the mouth.
 • what are the possible complications(3 points)
malunion , delayed union , non union, infection,
wound dehiscence.
•

station 7
this photo for your 33 years old patient ,with no
history of trauma, he suffer from diarrhea and
abdominal pain lately
1-what is the most likely condition-Crohn’s disease
2-what other oral complication we can see in this
case (3 points)- oro facial granulomatosis, cobble
stone appearance of oral mucosa, mucosal
ulcerations, angular cheilitis ,hyperplasia and
erythematous gingiva, recurrent aphthous
stomatitis.
3-what medication is used to treat this
condition(mention drug name)-
immunomodulators, steroids, anti inflammatory
drugs

station 8
• What is the Kennedys classification? Class I
• Draw a design “what is the system that you used
on the right and left 4 called? RPI
• What is the main function of this system?
Horizontal stability, distribute forces between
the teeth and the edentulous arch, provide
support with mesial rest, Guideplanes with
minor connector provide frictional retention,
prevents extraction of the distal abutment.
• Name 2 techniques to improve the retention
and stability
 Functional impression and altered case
technique.
Maximum coverage of denture base
Lingual plate major connector.
•

station 9
• What type of injury can u notice? Intrusive
luxation of teeth 21
• what necessary examinations are you going to
perform? Intra oral periapical or occlusal
radiographs depending on patient co-operation,
pulp sensibility test, pain/ dull sound on
percussion , palpation, mobility
• what are the possible treatment options?
Allow spontaneous extrusion of the tooth
 If tooth does not extrude within 3-4 weeks
spontaneously, orthodontic extrusion is
attempted by specialist.
Root canal treatment should be initiated within
3-4 weeks to prevent root resorption.
• What does the prognosis depend on?
With/without concomitant alveolar fracture,
depth of intrusion, stage of root development,
pulpal and periapical status of the tooth.

• station 10
• this appearance of your discolored teeth which
have been previously root filled
• 1-describe procedure of internal bleaching- local
anesthesia and rubber damn isolation. Remove
 the coronal restoration and 2mm of GP below
the CEJ. 2mm of thick glass ionomer cement to
be placed as barrier above the GP. The pulp
chamber is etched with 30% orthophosphoric
acid, washed and dried. The bleaching agent
which may contain 10% carbamide peroxide or
10-30 % hydrogen peroxide is applied. The
cavity is sealed cotton pellet and resin
composite. Patient is recalled after a week.
• 2-name 3 chemicals used in internal bleaching.
Carbamide peroxide, hydrogen peroxide,
sodium perborate
• 3-what warning should be patient given before
starting internal bleaching? There can be
sensitivity of teeth. There can be gingival
irritation or itching. Please report if there are
signs of allergy. There can be external cervical
resorption that might occur later.
• 4-what is the advantage of application of heat to
process of internal bleaching, what is its
disadvantage?? Heat accelerates the reaction
 and breaks down hydrogen peroxide in oxygen.
The risk of teeth sensitivity is higher.
• 5-other than pulp necrosis what else can cause
tooth discoloration? Endodontic materials, pulp
left behind during pulp extirpation, intra pulpal
hemorrhage, trauma, enamel hypoplasia.

station 11
this photograph show an area of gingival recession
affecting lower central incisor
1-what are indications of treatment of gingival
recession? 3 points- poor aesthetics, tooth sensitivity
, risk of root caries.
2-this area can be managed by free gingival graft or
connective tissue graft ,donor site is usually taken
from palate ,which area in palate is preferred?-
palatal mucosa closer to the molar premolar area.
3-which anatomical structures needed to be avoided
? greater and lesser palatine nerves and greater
palatine artery.
4-name other 2 surgical techniques can be used to
treat the defect? Double pedicle flap, coronally,
repositioned flap, free gingival grafting.
5-mention 2 factors may influence success of
surgery?- oral hygiene, gingival biotype, presence or
absence of interferences and mandibular
displacement related to the teeth.

station 12
this photograph show a tooth wear treated by gold
veneers
1-why gold is a good material here?- less tooth
preparation required compared to ceramics, can be
advantages when there is less clearance because it
can be made thinner, increased strength and wear
resistant
2-what are disadvantages of using gold?- esthetically
unacceptable because the color may be seen
through. , cannot be used in cases that require
incisal overlapping, expensive.
3-non precious materials can be used in this purpose
,what is the disadvantages of non-precious metals in
comparison to gold? Difficulty to finish and polish.
Cannot be burnished to thin margins.
4-what alternative materials can be used here
instead of gold? Zirconia, lithium disilicate reinforced
ceramics.
5-what techniques are used here to bond gold
veneers to tooth structure.? Sandblasting and
cement using reinforced glass ionomer cement.
• station 13
• this is 48 years patient gave a history of sore
,bleeding gums, he has history of eczema but
taking no prescribed medication
• 1-descrice what can you see in the photo- this is
a clinical photograph of the lower anterior teeth
and the gingiva from 33 to 43. There is crowding
of teeth evident with interdental calculus. The
gingiva appears red and desquamated involving
the marginal and attached gingiva as well.
• 2-most likely explanation is desqumative
gingvitis
• what conditions may associated with?(5 points)-
lichen planus(atrophic), mucous membrane
pemphigoid, pemphigus, lichenoid drug
reaction, graft versus host disease.
• 3-what are important investigations needed to
this patient- incisional biopsy ,
 immunofluroscence, presence of antibodies
against the basement membrane.
• 4-describe your management in brief- identify
the cause, avoid spicy and hot food, smoking
and alcohol, use SLS free tooth paste,
symptomatic relied with 0.15% benzadymine
hydrochloride mouth rinse three times daily for
10 days. Topical corticosteroid- 0.1%
triamcinolone acetonide or topical tacrolimus.
Mucosal protectants and oral hygiene
instructions with non surgical periodontal
therapy to remove local irritants. Low dose
systemic steroids and referral if not recalcitrant.
•