1 Stem cells - **: An undifferentiated cell of a multi-cellular organism that is capable of giving rise to indefinitely more cells of the

cells of the same

definition type, and from which certain other kinds of cell arise by differentiation reference?
*******************************************
**: I remember someone mentioning that differentiating between totipotency and pluripotency was part of the answer.
Totipotency is the ability of a single cell to divide and produce all the differentiated cells in an organism, including
extraembryonic tissues.[2] Totipotent cells include spores and zygotes. [3] In cell biology, pluripotency refers to a stem cell
that has the potential to differentiate into any of the three germ layers: endoderm (interior stomach lining, gastrointestinal
tract, the lungs), mesoderm (muscle, bone, blood, urogenital), or ectoderm (epidermal tissues and nervous system).[5]
**: Also characteristic of Stem Cells: Self renewal: the ability to undergo many cycles of cell division without losing their
differentiated state

2 Evaluate grafts done **: Preorthodontic Gingival Surgery (Source: Managing Treatment for the Orthodontic Patient with Periodontal Problems)
in relation to Gingiva grafting (teeth less than 2 mm attached gingiva)

impacted canines I. Grafting for cosmetic reasons --> perform after ortho treatment

II. If area has recession --> may perform before or during ortho treatment

Based on the clinical observation that recession may occur during orthodontic therapy involving sites which have an
"insufficient" zone of gingiva, it has been suggested that a grafting procedure to increase the gingival dimensions should
precede the initiation of orthodontic therapy in such areas (Boyd 1978, Hall 1981, Maynard 1987). Pg 583 Clinical
Periodontology and Implant Dentistry

**:Check with Kleio, check rules for grafting/exposure techniques Kokich

3 1st brachial arch **: Derivatives of the first arch:
bone derivitives Skeletal elements:
● Malleus & Incus of the middle ear
● maxilla & mandible
● spine of sphenoid bone
● Sphenomandibular ligament
● palatine bone
● squamous part of temporal bone
● Anterior ligament of malleus
Muscles
● Muscles of mastication
○ Masseter
○ medial & lateral pterygoid muscles
○ Temporalis muscles
● Mylohyoid muscle
● Anterior Digastric muscle
● Tensor palati muscle
● Tensor tympani muscle
Nmenonic for muscles: MOM and MATT (mom= muscles of mastication)
Other derivatives: Mucous membrane and glands of the anterior two thirds of the tongue are derived from ectoderm and
endoderm of the arch.
Nerve supply: mandibular and maxillary branches of the trigeminal nerve (CN V)
Blood supply: The artery of the first arch is the first aortic arch, which partially persists as the maxillary artery.
**: 1st arch: Meckel’s cartilage
**: 2nd arch: Styloid process, stapes, lesser cornu of hyoid, sup. part of body of hyoid. Known as Reichert cartilage.

4 Marfan Syndrome- **: Fibrillin 1 (FBN1), Autosomal Dominate inheritance pattern (but 25% caused but a new mutation)
associated gene Mutations in the FBN1 gene cause Marfan syndrome. The FBN1 gene provides instructions for making a protein called
fibrillin-1. Fibrillin-1 attaches (binds) to other fibrillin-1 proteins and other molecules to form threadlike filaments called
microfibrils. Microfibrils become part of the fibers that provide strength and flexibility to connective tissue. Additionally,
microfibrils store molecules called growth factors and release them at various times to control the growth and repair of
tissues and organs throughout the body. A mutation in the FBN1 gene can reduce the amount of functional fibrillin-1 that is
available to form microfibrils, which leads to decreased microfibril formation. As a result, excess growth factors are
released and elasticity in many tissues is decreased, leading to overgrowth and instability of tissues.

5 Effects of **: vasoconstriction, pupil dilation

amphetamines Amphetamine exerts its behavioral effects by modulating several key neurotransmitters in the brain, including dopamine,
serotonin, and norepinephrine.
6 Spinal cord photo **:

1. spinal nerve
2. Dorsal Root Ganglion
3. Dorsal Root (sensory)
4. Ventral Root (motor)
5. Central Canal
6. Grey matter
7. White Matter

**: Mnemonic: SAME DAVE: Sensory Afferent, Motor Efferent; Dorsal Afferent Ventral Efferent
7 Sphenopalatine **: The sphenopalatine artery is a branch of the maxillary artery which passes through the sphenopalatine foramen into
artery the cavity of the nose, at the back part of the superior meatus. Here it gives off its posterior lateral nasal branches.
Crossing the under surface of the sphenoid, the sphenopalatine artery ends on the nasal septum as the posterior septal
branches. Here it will anastomose with the branches of the greater palatine artery.
Clinical significance: The sphenopalatine artery is the artery responsible for the most serious, posterior nosebleeds (also
known as as epistaxis). It can be ligated surgically to control such nosebleeds.
8 Procerus m ID **:
Origin: From fascia over the lower of the nasal bone; Insertion: Into the skin of the lower part of the forehead between the
eyebrows; Artery: facial artery; Nerve: Buccal branch of the facial nerve; Actions: Draws down the medial angle of the
eyebrow giving expressions of frowning

D. is procerus
9 Anterior diagstric m **:
ID Origin: anterior belly - digastric fossa (mandible); posterior belly - mastoid process of temporal bone
Insertion: Intermediate tendon (hyoid bone)
Artery: anterior belly - Submental branch of facial artery; posterior belly - occipital artery
Nerve: anterior belly - mandibular division (V3) of the trigeminal (CN V) via the mylohyoid nerve; posterior belly - facial
nerve (CN VII)
Actions: Opens the jaw when the masseter and the temporalis are relaxed.
1 Palatoglossus ID **:
0 Origin: palatine aponeurosis
Insertion: tongue
Artery:
Nerve: Vagus nerve (via pharyngeal branch to pharyngeal plexus)
Actions: raising the back part of the tongue
1 Superior capitis ID **:
1 Origin: lateral mass of atlas; Insertion: lateral half of the inferior nuchal line
Artery ; Nerve: suboccipital nerve; Actions: Acts at atlanto-occipital joint to extend the head and flex head to ipsilateral side
Muscle highlighted in red in image below
1 Jugular foramen ID **: The anterior compartment transmits the inferior petrosal sinus. The intermediate transmits the glossopharyngeal,
2 vagus, and accessory nerves (aka cranial nerves IX, X, and XI respectively). The posterior transmits the sigmoid sinus
(becoming the internal jugular vein) and meningeal branches from the occipital and ascending pharyngeal arteries.
**: Position on bone: between the petrous part of temporal & occipital. Base of skull view: behind carotid canal.
1 Internal acoustic **: is a canal in the petrous part of the temporal bone of the skull that carries nerves from inside the skull towards the
3 meatus ID middle and inner ear, namely cranial nerve VII and cranial nerve VIII.

**:
1 Sphenoid sinus ID
4 from lateral ceph
1 Adenoid pad ID from **:
5 lateral ceph

IT Inferior turbinate, SP soft palate, NPAT Adenoid pad

1 NSAIDS mechanism **: NSAIDS acts inhibiting PG production (T). They increase pain threshold of the pain producing fiber (F).
6 of action
Most NSAIDs act as nonselective inhibitors of the enzyme cyclooxygenase (COX), inhibiting both the cyclooxygenase-1
(COX-1) and cyclooxygenase-2 (COX-2) isoenzymes. This inhibition is competitively reversible (at varying degrees of
reversibility), as opposed to the mechanism of aspirin, which is irreversible inhibition. COX catalyzes the formation of
prostaglandins and thromboxane from arachidonic acid. Prostaglandins act (among other things) as messenger molecules
in the process of inflammation.
Although they are classified as mild analgesics, NSAIDs have a more significant effect on pain resulting from the increased
peripheral sensitization that occurs during inflammation and leads nociceptors to respond to stimuli that are normally
painless. In particular, it is believed that inflammation leads to a lowering of the response threshold of polymodal
nociceptors. This is why the second statement is false – NSAIDs do not directly affect the neurons.
http://www.med.nyu.edu/pmr/residency/resources/PMR%20clinics%20NA/PMR%20clinics%20NA_pain/NSAIDS.pdf

**: Also see board article #8: Medication effects on the rate of orthodontic tooth movement: A systematic literature review
**: saw a question which asked the opposite, lowering the pain threshold. It seems that ….Inflammation lowers the
threshold, not NSAIDS....

1 CBCT: structures ** Detect hard and soft tissues, not muscle attachments
7 visualized http://endoexperience.com/userfiles/file/unnamed/New_PDFs/cbCT/CBCT_how_does_it_work_Scarfe_et_al_2008.pdf
CBCT is able to distinguish between soft tissue and air spaces, but not different soft tissue densities.
1 CBCT: Ability to True
8 detect intracapsular **: I was surprised by what I found when I looked in to this…Role of different imaging modalities in assessment of
disorders better than temporomandibular joint erosions and osteophytes: a systematic review. AM Hussain
conventional CT Dentomaxillofacial Radiology (2008) 37, 63–71. doi: 10.1259/dmfr/16932758
MRI: use to see the disk
CBCT: use to see hard tissues (intracapsular)
Arthrography: use to see perforation
**: Research all TMJ imaging modalities for diagnosing various pathologies

1 TADs: most reliable place TAD distal to the canine? TAD is more stable with a pilot hole?
9 way to protract a **: Implants: A systematic review (Am J Orthod Dentofacial Orthop 2009;135:284-91) Chen
molar “the proper width of the pilot drill should be 0.2 to 0.5 mm less than the implant diameter, and the depth should be less to
obtain proper initial mechanical stability; this was the most important factor for successful immediate and early loading.”
14 of the 16 papers reviewed used the self tapping screws (pilot hole) vs self drilling (no pilot hole)
**: #7: Critical factors for the success of orthodontic mini-implants: A systematic review
Self-tapping method: Use of pilot hole in the most important factor for successful immediate and early loading.
Self drilling: success varied and may be due to clinical experience
? If the question is speaking about the self-tapping screws but doesnt say it directly the TAD is more stable with a pilot hole. Not sure re: second
part of Q... ?
**: From Temple Doc: Pilot drill increase TADs stability (T/F): Consensus is true, per Chen systematic review
2 TMJ cartilage type Hyaline; distinct feature of TM joint
0 **: No hyaline cartilage in TMJ‐this is what makes it different from other joints of
body. Fibrocartilage disk and condylar cartilage. “Condylar cartilage is a unique tissue, which is distinctively different in
composition and mechanics compared to hyaline cartilages, knee meniscus or growth plate (Wang et al., 2008).”
**: however in Treacher Collins, Condyle is covered with Hyaline.

M. Singh, M.S. Detamore / Journal of Biomechanics 42 (2009) 405–417 http://dx.doi.org/10.1016/j.jbiomech.2008.12.012

2 CBCT: magnification Does increasing voxels increase magnification? resolution? True/False
1 and resolution **: increase in voxel increases magnification; An increase in voxel increases resolution. T or F (I am not sure of the first one,
the second one is false); Decreased voxel size would increase resolution. Increase in voxel may increase magnification
since resolution is lower and the object appears to be taking up more space?

**: if you have smaller (i.e. more) voxels, you can magnify an image more and maintain the quality.

From During a CBCT scan, the scanner (x-ray source and a rigidly coupled sensor) rotates, usually 360 degrees, around the
head to obtain multiple images (ranging from approximately 150 to 599 unique radiographic views). The scanning software
collects the raw image data and reconstructs them into viewable formats. The scan time can range between five and 40
seconds, depending on the unit and protocol setting. The x-ray source emits a low milliampere and a shaped or divergent
beam. The beam size is constrained by a circular or rectangular collimator to match the sensor size, but in some cases it can
be constrained (collimated) further to match the anatomical region of interest. After the scan, the resultant image set or
raw data are subjected to a reconstruction process that results in the production of a digital volume (a cylindrical or
spherical shape that is composed of volume elements called “voxels” that are stacked in rows and columns) of anatomical
data that can be visualized with specialized software. Voxels are the smallest subunit of a digital volume. CBCT voxels
generally are isotropic (that is, X, Y and Z dimensions are equal) and range in size from approximately 0.07 to 0.40
millimeters per side. Each voxel is assigned a gray-scale value that approximates the attenuation value of the represented
tissue or space. The latest generation of CBCT units produces 12- or 14-bit images in which 12 bits is 212 (4,096) shades of
gray and 14 bits is 214 (16,384) shades of gray. Computer monitors used to visualize the 12- or 14-bit digital or voxel
volume can display only eight bits (256 shades) of gray at a time. The software uses a technique called “windowing and
leveling” that allows the operator to access and visualize all of the data. Windowing allows the data to be scrolled through,
thus visualizing eight bits at a time with air and soft tissues (low-attenuation structures) at one end of the spectrum and
bone and teeth (high-attenuation structures) at the other end of the spectrum. Once the optimum window level has been
achieved, the contrast and brightness (leveling) are adjusted by the clinician for optimal viewing. The small isotropic voxel
size along with the large number of gray levels have contributed to accuracy and precision when clinicians measure the
dimensions of anatomical structures and visualize anatomical form.1–4
2 Maxillary Down Growth continues after a down fracture
2 Fracture and Growth **: Depends on how the question is worded – “Maxillary hypoplasia is defined as deficient maxillary development in the
AP, transverse, and/or vertical dimensions. Because the cause of this deformity is deficient maxillary growth, normal
growth cannot be expected after surgery. Correction of AP or vertical deficiencies during growth will result in recurrence of
the Class III skeletal relationship as the mandible continues to grow normally. Earlier surgery may be indicated if significant
functional, esthetic, and psychosocial impairments exist. When treating these cases during growth, the surgeon may
choose to overcorrect the maxilla and allow the growing mandible to develop into it. If surgery is performed during growth,
the patient and parents must be informed that future surgery will probably be necessary.
Le Fort I maxillary osteotomy - The Le Fort I osteotomy, when performed during growth, effectively inhibits further
anterior growth of the maxilla.9,10 Vertical maxillary growth, however, can be expected to continue postoperatively at the
same rate as before surgery. 10-13. Horseshoe maxillary osteotomy (dentoalveolar osteotomy). With the horseshoe
maxillary osteotomy procedure (Fig 2), the nasal septum remains attached to the stable palate, and only the dentoalveolar
structures are mobilized.14 Thus, some AP maxillary growth may be expected to occur postoperatively. The overall growth
rate, however, will remain deficient and result in the redevelopment of a skeletal Class III deformity. No studies are
available on growth after maxillary dentoalveolar osteotomies for this type of deformity. The maxillary dentoalveolar
osteotomy is technically much more difficult to perform in this patient type.
 Considerations for orthognathic surgery during growth, Part 2: Maxillary deformities Larry M. Wolford, DMDa, Spiro C.
Karras, DDSb, Pushkar Mehra, DMDc (Am J Orthod Dentofacial Orthop 2001;119:102-5)
http://dx.doi.org/10.1067/mod.2001.111400

2 TMD: causes Primary cause is parafunction

3 **: The primary cause is muscular hyper- or parafunction, as in the case of bruxism, with secondary effects on the oral
musculoskeletal system, like various types of displacement of the disc in the temporomandibular joint. The disorder and
resultant dysfunction can result in significant pain, which is the most common TMD symptom, combined with impairment
of function.

2 Treacher Collins Not maxillary hyperplasia

4 **: Treacher Collins syndrome or mandibulofacial dysostosis is a rare autosomal dominant congenital disorder
symptoms characterized by craniofacial deformities, such as absent cheekbones. The typical physical features include downward
slanting eyes, micrognathia, conductive hearing loss, underdeveloped zygoma, drooping part of the lateral lower eyelids,
and malformed or absent ears.
**: cleft palate in some, ant open bite, macrostomia

2 Endo-Ortho: Can do ortho right away without any concerns

5 Apexification **: During apexification procedures with Ca(OH)2 orthodontic tooth movement may be initiated prior to completion of the
calcific bridge formation. Separate study recommends waiting 6 months prior to ortho movement if periapical lesion is
present
**: Also article #87: Orthodontic-Endodontic Treatment Planning of Traumatized Teeth

2 Endo-Ortho: Tooth is not more susceptible to root resorption during orthodontic movement
6 Apexification NF: tooth is not more susceptible to root resorption while being moved orthodontically
Endo/Ortho Powerpoint: http://endoexperience.com/documents/endoorthopresentationpdf.pdf
**: Also article #87: Orthodontic-Endodontic Treatment Planning of Traumatized Teeth

2 Perio-Ortho: ligation Steel ties are better because bacteria grows less on them than alastic ties
7
2 Standard of Care Determined by courts
8 **: In legal terms, the level at which an ordinary, prudent professional having the same training and experience in good
standing in a same or similar community would practice under the same or similar circumstances. An "average" standard
would not apply because in that case at least half of any group of practitioners would not qualify. The medical malpractice
plaintiff must establish the appropriate standard of care and demonstrate that the standard of care has been breached,
with expert testimony.
Courts or professionals?
**: Review from Peter indicates: “Court cases, Dr. Briss has mentioned this many times.”

Standards of care are set by each state, through the corresponding state’s Dental Act, as well as the cumulative common-
law decisions made by various state and federal courts, which create a body of precedent
Source:Inside Dentisty October 2008, Volume 4, Issue 9

2 Bone: Woven< composite< lamellar

9 structure/organizatio NF: Woven bone is characterized by haphazard organization of collagen fibers and is mechanically weak Lamellar bone has
n a regular parallel alignment of collagen into sheets (lamellae) and is mechanically strong
SG: (Graber, Pg. 240-2)
Woven bone: A bone that is crucial in wound healing because of its ability to fill voids rapidly. It is weak, disorganized, and poorly mineralized. It is the first type of bone
formed in response to orthodontic loading.

Composite bone: A bone that is a mixture of woven and lamellar bone. It is the fastest way to create strong bone. It involves the process of depositing
lamellar bone in a woven bone matrix known as cancellous compaction. This is an important bone in orthodontic loading and is the principal bone tissue during
retention. The initial composite of woven and lamellar bone is known as primary osteon formation. As the composite remodels and further mineralizes, secondary
osteons are formed.

Lamellar bone: A bone that is very strong, very well mineralized, and highly organized tissue. This bone makes up 99% of the human skeleton and is not present until 1
year after completion of orthodontic treatment. The strength of the bone increases as it matures and mineralizes. New lamellar bone is weaker than mature lamellar
bone. In this mineralization process, osteoblasts are responsible for depositing the initial hydroxyapatite, which gives initial strength to the bone. Further mineralization
occurs throughout the maturation of the bone.

Bundle bone: A type of lamellar bone that is functionally specialized because it is the tissue that attaches to tendons and ligaments including Sharpey’s Fibers in the PDL.
This is the mechanism of ligament and tendon attachment throughout the body and is found in the bone adjacent to the PDL space.
Bone biology

3 Adult treatment: Maxillary orthopedic expansion

0 Gingival Clefting NF: Small fissures extending apically from the midline of the gingival margin in teeth subjected to trauma. Although these
causes clefts may be found in traumatism, they are not necessarily diagnostic of occlusal trauma; a cleft of the marginal gingiva;
may be caused by many factors, such as incorrect toothbrushing, a breakthrough to the surface of pocket formation, or
faulty tooth positions, and may resemble a V-shaped notch. Also known as Stillmans clefts
3 Gardener’s NF: Gardner syndrome also known as familial colorectal polyposis, is an autosomal dominant form of polyposis
1 Syndrome: characterized by the presence of multiple polyps in the colon together with tumors outside the colon. The extracolonic
characteristics tumors may include osteomas of the skull, thyroid cancer, epidermoid cysts, fibromas and sebaceous cysts,[4] as well as
the occurrence of desmoid tumors in approximately 15% of affected individuals. Oral findings include multiple impacted
and supernumerary teeth, multiple jaw osteomas which give a "cotton-wool" appearance to the jaws, as well as multiple
odontomas

3 White spot lesions Gorlick found 50% of patients have decals/white spots; Gorlick recommended waiting 2-3 months after debond before
2 applying fluoride

**: First statement: true.

Second statement: None of the articles by Gorelick discuss post treatment fluoride use to correct white spots. He does
recommend 0.05% NaF rinse during treatment to help decrease the development of white spots.
Incidence of white spot formation after bonding and banding. Gorelick wt al. AJODO.1982:81(2)
**: Graber
50% of patients do have decals. Gorlick found highest incidence of decal to be in the maxillary incisors, particularly the
laterals. Recommends daily rinsing with dilute (.05%) sodium flouride solution throughout treatment and during a period of
retention. Flouride enhances the degree of remineralization and reduces the time required for remineralization to occur.
Visible white spots that develop during ortho treatment should NOT be treated with concentrated flouride immediately
after debonding, because this procedure will arrest the lesion and prevent complete repair. Recommends a period of 2-3
months of good oral hygiene without flouride supplements after debonding.

3 TMD-ortho: tx Avoid Class III elastics

3 management

3 Lip bumper therapy What percentage of expansion is complete in the first 100 days of lip bumper tx
4 **: 50% of the total expansion (premolar area) occurs in the first 100 days, and 90% of the total expansion occurs within
about the first 300 days.
Murphy et al. A Longitudinal study of incremental expansion using a mandibular lip bumper. Angle Orthod. 2003:73;396-
400
3 Finishing: reasons for Axial angulation of canines
5 not achieving class I
(Angle) CR: Andrews LF. The six keys to normal occlusion. AJODO. 1972;62(3)

- Angulation: Distal tip of all teeth especially the anterior teeth as they have the longest crown (plus reading)
- Inclination: All posterior teeth have lingual inclination; anteriors must be properly inclined to allow their contacts to be
positioned more distally.
- Molar relationship: Distobuccal cusp of upper molar contacts mesiobuccal cusp of lower second molar
- Rotations: No Rotations
- Spaces: No Spaces
- Occlusal Plane: Flat

AIM NoR NoS NoC: Angulation Inclination Molars; No Rotations No Spaces No Curve

From Temple doc

155. What prevents attaining an ideal Angle Cl I posterior occlusion?
a. Axial inclination of the canine
b. Excessive mandibular lingual torque
c. Excessive maxillary buccal torque
d. Steep premolar cusps
e. Procumbent maxillary incisors

3 Leveling: relapse **: The notes we were giving stated levelling of curve of spee. However, according to Andrews there is a natural tendency
6 for the curve of spee to deepen with time due to the lower jaw growing downward and forward sometimes faster and
longer then the upper jaw leading to the extrusion of the lower incisors. This also subsequently leads to crowded lower
anteriors and deepening of the bite. This recurrence is why we end treatment with a flat or even reverse curve of spee so
as to anticipate this relapse.

From Temple Doc:

Which correction is most stable/ has least relapse potential?
a. Class II *
b. Leveling curve of spee
c. Rotation
d. Incisor alignment
e. Expansion
Refer to Little article, Graber chapter
**This question is very debateable…different sources point to different answers
3 Mandibular growth: Are implants or lateral ceph superimpositions better ways to measure growth, historically?
7 measurement **: Implant studies
Skieller et al. Prediction of mandibular growth rotation evaluated from a longitudinal implant sample. Am J Orthod.
1984;86(5):359-370.

3 Superimpositions: Cranial base: planum sphenoidale, lesser wing sella, ociput.

8 landmarks and ABO **: Craniofacial Superimpositions: register on Sella with the best fit on the anterior cranial base bony structures (Planum
requirements Sphenodium, Cribiform Plate, Greater Wings of the Sphenoid) and Occiput. Allows assessment of overall growth and tx
changes.

Maxillary Superimpositions: Register on the vertical leg of the key ridges (anterior and posterior contours of the zygomatic
arches); align the key ridges both horizontally and vertically and the best fit of the internal structures of the maxillary bony
complex.

Mandibular Superimpositions: Register on the internal cortical outline of the symphysis with the best fit on the mandibular
canal to assess mandibular tooth movement and incremental growth of the mandible.

Black = initial; Blue = progress/interim; Red = final

3 Lateral ceph: midline structure: opisthion
9 anatomy **: Opisthion - Midpoint on the posterior margin of the foramen magnum on the occipital bone.

4 PA ceph: anatomy midline structure: menton

0

4 NSAIDS + THYROXINE **: Thryroxin (T4) is a prohormone utilized to produce tri-iodothyronine (T3). It influences cellular activity and metabolism
1 and is important in development and growth. It also effects intestinal calcium absorption and therefore indirectly bone
turnover. Hyperthyroidism or thyroxine medication can lead to osteoporosis. In rats, incresed thyroxin leads to increased
rate of orthodontic tooth movement

NSAID is the most important class of protanoidsythesis inhibitors. Analgesis, antipyretic, and anti-inflammatory effect. Rx
for rheumatoid arthritis, osteroarthritis, gout, dysmenorrhea, headache, migraine, post-operative pain, prevention of
cardiovascular diseases and colorectal cancer. All NSAID suppress the producation of all prostanoids (thrombanes,
prostacyclins, and prostoglandins) due to the inhibition of Cox-1 and Cox-2. NSAIDs decrease the number of osteoclasts
because prostoglandins are either directly or indirectly involved in the osteoclast differentation or activity stimulation.
Whether this lead to a reduction in the rate of orthodontic tooth movement is unclear.
 Bartzel et al. Medication effects on the rate of orthodontic tooth movement: A systematic literature review. Am J Orthod
Dentofacial Orthop. 2009;135:16-26.

4 Bisphosphonates: do not decrease osteoblasts

2 mechanism of action **: Bisphosphonates: Inhibit bone resorption. Used for osteoporosis, Paget’s disease, bone metastases, and bone pain
from some types of cancer. Bisphosphonates are incorporated into the bone matrix and have a half-life of 10+ years. There
is a dose dependent decrease in the rate of orthodontic tooth movement.

Bartzel et al. Medication effects on the rate of orthodontic tooth movement: A systematic literature review. Am J Orthod
Dentofacial Orthop. 2009;135:16-26.

Bisphosphonates decreases bone resorption by inhibiting osteoclastic activity which decreases bone turnover. Sever
adverse side effect is osteonecrosis of the jaw however occurence is low but is higher when extractions have occurred (for
oral doses 0.01-0.04% vs 0.09-0.34% when exo have occurred; for iv dose risk increases to 6.67-9.1%). Decreased
orthodontic tooth movement has been found in mice and rates that have been administered bisphosphonates. Prevalence
of women over 45 taking bisphosphanates is 10%. The ADA now recommends that conservative treatment be used when
possible in patients who have a history of bisphosphonate use.

In a study comparing treatment of 50 year old women taking bisphosphonates, it was was found that pt taking
bisphosophonates had longer treatment times for extraction cases (38 months vs 28 months), less root parallelism (44%
completed treatment with roots more than 20 degress from the ideal vesus 1.9% in control group), and more likely to have
at least 1 open contacts upon treatment completion if they initially started with treatment spaces or had extraction (20% vs
1.9%). The was no difference between treatment time in non-extraction cases nor was there a difference in lower incisor
alignment. The difference in treatment times for extraction and non-extraction treatment for patients taking
bisphosphonates is due to bisphosphonates having higher affinity for areas of high bone turn over such as extraction sites.

Lotwala et al. Bisphosphonates as a risk factor for adverse orthodontic outcomes: A retrospective cohort study. Am J
Orthod Dentofacial Orthop. 2012;142:625-34

Steroids impact on tooth movement; prednisone no effect, methyl prednisone increased tooth movement; glucocorticoids
inhibits COX 1 and 2 so inhibits PG syn so tooth movement decreases, cortisone increases tooth movement Article #8
4 Primary Failure of Primary Failure of eruption does not occur more in the anterior region; teeth in PFE do not become ankylosed until
3 Eruption extrusive force is placed on them
**: Proffit WR, Vig KWL. Primary failure of eruption: a possible cause of posterior open bite. Am J Orthod. 1981;80:173-190

PFE is a condition where nonankylosed teeth fail to erupt fully or partially because of malfunction of the eruption
mechanism. This occurs even if there seems to be no barrier to eruption.

Suri et al. Delayed tooth eruption: Pathogenesis, diagnosis, and treatment. Am J Orthod Dentofacial Orthop.
2004;126(4):432-45.

Primary failure of eruption is a syndrome where affected posterior teeth fail to erupt, presumably because of a defect in
the eruption mechanism. In these individuals, bone resorption apparently proceeds normally but the teeth involved simply
do not follow the path that has been cleared. These teeth do not respond to orthodontic force and cannot be moved into
position.

WR Proffit, HW Fields, and DM Sarver. Contemporary Orthodontics. 4th Ed. Mosby -Elsevier; 2007: St. Louis, MO.
**: Per Dr. Suri most common U6’s and 7’s

Temple Doc: PFE occurs more in the anterior region, and the teeth in PFE do not become ankylosed until extrusive force is
placed on them. - False, true

4 DI score does not include FMA

4 **: The cephalometric values taken into consideration for the DI score are:
ANB ≥ 6° or ≤ -2°
SN-MP ≥ 38° or ≤ 26°
L1 to MP ≥ 99°

4 Maxillary impaction look at the lips at rest

5 evaluation **: Patients with vertical maxillary excess and require surgical correction with maxillary impaction have an upper lip of
normal length however it appears short in repose as the upper anterior teeth are excessively exposed when the teeth are
in repose.

Fish et al. Surgical orthodontic correction of vertical maxillary excess. Am J Orthod Dentofacial Orthop. 1978;73(3):241-
257.
4 Open bite: skeletal in skeletal open bite, the incisal edges are 2mm below the upper lip
6 vs. dental **: I couldn’t find support for the answer given about. In the ABO articles the following article discusses skeletal vs dental
according to skeletal measurements.

Cangialosi TJ. Skeletal morphologic features of anterior open bite. Am J Orthod Dentofacial Orthop. 1984;85(1):28-36.

BC TCH: skeletal open bite, U1 where is it to lip

above
below*
at

habitual open bite, U1 is above lip, in skeletal open bite, U1 is in normal position.

4 Primary Herpetic symptoms: fever, lymphadenopathy, gingival lesions

7 Gingivostomatitis **: Primary Herpetic Gingivostomatitis: Most frequent acute viral infection of the oral mucosa. Mainly affects children and
young adults. Due to contact with HSV-1. Characterized by: high temperature, malaise, irritability, headache, and pain in
the mouth, followed within 1-3 days by the eruptive phase. The oral mucosa is read and edematous, with numerous
coalescing vesicles. Within 24h the vesicles rupture, leaving painful small, round, shallow ulcers covered by a yellowish-gray
pseudomembrane and surrounded by an erythematous halo. Heal in 10-14 days without scarring. Bilateral painful regional
lymphadenopathy is a constant feature of the disease. Lesions almost always on the gingiva and may also be seen on the
buccal mucosa, tongue, lips and palate.

Laskaris G. Color Atlas of Oral Diseases.

4 Positive TB test Person has been exposed or had the vaccine

8 **: Person has been infected with TB bacteria (either latent or active disease) or has had vaccine (bacill Calmette-Guerin
vaccine).

http://www.cdc.gov/tb/topic/testing/default.htm

4 Functional appliance significance of functional appliance--> long term insignificant?

9 **: Twin-block treatment when a child is 8-9 years old has no advantages over treatment stated at an average age of 12.4
years. However, the cost of early treatment to the patient in terms of attendance and length of appliance wear is
increased.

O’Brien et al. Early treatment for Class II Division 1 malocclusion with the Twin-block appliance: A multi-center,
randomized, controlled trial. Am J Orthod Dentofacial Orthop. 2009;135:573-9.
5 Autotransplantation most likely cause of loss of a tooth after autotransplantation: external root resorption
0 **: External Root Resorption??? Can’t find a reference. Multiple causes are cited in the literature - inflammation of
surrounding tissue, root resorption, insufficient bone...

5 Root resorption Intrusion and lingual root torque cause the most root resorption (RR)
1 **:
- Continuous forced produces more RR than discontinuous force **: Study had a high risk of bias
- Heavy force > Thermoplastic appliance > light force (9x vs 6x vs 5x more RR than controls)
- Heavy continuous force produces greater RR than light forces or controls
- Intrusive forces caused a 4x greater RR than controls or extrusive force; extrusive force and controls had similar RR
- No difference in RR based on archwire sequence
- In patients who endured RR during first 6 months of treatment, RR was significantly less in those whould paused
treatment then those who treated with continuous force without a pause.
- No difference between amount of RR and Angle classification, trauma history, extraction treatment, time with
rectangular archwire, time with Class II elastics, or total treatment time
- No difference in prevalence or severity of RR in patients treated with fully programmed edgewise appliance (FPA) and
partly programmed edgewise appliance (PPA)
- No statistically significant correlations between RR and trauma history
- Teeth with roots having unusual morphology before treatment were not significantly more likely to have moderate to
severe RR than those with more normal root forms.
- Odds of a tooth experiencing severe RR were greater with a large reduction in OJ during phase 2
- Mandibular incisor RR is no different between self ligating and conventional brackets
- Torquing of maxillary incisor apices towards the lingual is strongly correlated with RR
Weltman et al. Root resorption associated with orthodontic tooth movement: A systematic review. Am J Orthod
Dentofacial Orthop. 2010;137:462-76.
**:?? I always thought we were told trauma -> increased root resorption. Am I mistaken?? I know the article says
otherwise.
5 VTO: accurate for yes
2 extraction cases? **: Cephalometric VTO and video image predictions in this study were found to be accurate in simulating the soft tissue
outcomes of adult four-premolar-extraction treatment.

Le et al. The role of computerized video imaging in predicting adult extraction treatment outcomes. Angle Orthod.
1998;68(5):391-400.

VTO are reasonably accurate in the AP plane compared to hand tracing, while the vertical plane is slight poorer but is still
acceptable. Treatment of high angle, Class II, non-extraction cases, the VTOs showed to be accurate in predicting effects of
growth and treatment on maxillary position and rotation, mandibular length, upper face height, and incisor position. It was
inaccurate in predicting the effects of growth and treatment on maxillary length, mandibular rotation, lower anterior and
posterior face heights, the horizontal and vertical positions of the molars and over 50% of the soft-tissue parameters.

Grubb et al. Clinical and scientific applications/advances in video imaging. Angle Orthod. 1996;66(6):407-416.

5 Posselt diagram: last hinge

3 movement **: Im not sure if this is how the question is was actually worded because there is no specific order to the movements on
the posselt diagram. The hinge movement is from C-R on the diagram.

**:

This links to a good presentation on the subject:

http://student.ahc.umn.edu/dental/coursearchives/FormerClasses/Occlusion/Mechanical_Characteristics_HO.pdf
and this is From Kaplan:
5 Tongue thrust 10 year old with minimal OJ/OB and no speech problems--> no tx indicated
4 **: Nothing???
**: From Peter’s review..not sure what source was used: There are two modern viewpoints regarding tongue thrust in
children. 1). A tongue thrust in younger children with normal occlusion is merely a transitional stage in normal physiologic
maturation. The mature adult swallow pattern occurs as early as age 3, but is not present in the majority until age 6. Ten
to 15% of the population never develops an adult swallowing pattern. Only brain damaged children will retain a truly
infantile swallow where the posterior part of the tongue has little or no role in swallowing. 2). A tongue thrust is an
adaptation in anterior open bite patients. It is considered a result and not a cause of anterior open bites. Correcting the
anterior open bite will cause a change in swallowing pattern.

Anterior tongue thrust is not an etiologic factor in anterior open bites as it does not have the required duration for the
equilibrium theory to be upset. However, forward tongue posture can upset the equilibrium and contribute to anterior
open bite pattern.

5 Bruxism: causes occlusal interferences, stress

5 **: Habits, posture, emotional stress, occlusal interferences
Okeson JP. Management of temporomandibular disorders and occlusion. 6th ed.
5 Scaphocephaly sagittal suture
6 **: Form of craniosynostosis where there is premature closure of the saggital suture. Most common form of
craniosyntostosis (50%). A long narrow head shape is secondary. Usually isolated and not associated with syndromes. It is
often occurs in premature infants. No growth in the skull bones along the saggital sutures, however growth continues and
the coronal and lambdoid sutures causing the elongation of the skull as the frontal and occipital bones compensate for the
restricted lateral growth of the parietal bones (Elongated in AP, contricted in transverse)

http://www.skullbaseinstitute.com/craniosynostosis-craniofacial/craniosynostosis-scaphocephaly.html

**: Is this related to the question: age of max width of cranium?

The infant's skull consists of the metopic suture, coronal sutures, sagittal suture, and lambdoid sutures. The metopic suture
is supposed to close between three to nine months of age.The lambdoid, sagittal and coronal sutures are supposed to close

between 22 to 39 months of age.

5 Buccal corridors Can lay people detect small differences in buccal corridors? Yes
7 **: TRUE

The results indicate that both laypersons and orthodontists prefer smiles in which the smile arc parallels the lower lip and
buccal corridors are minimal. Significantly lower attractiveness ratings were found for smiles with flat smile arcs and
excessive buccal corridors. Flattening of the smile arc overwhelms the deleterious effects of excessive buccal corridors on
attractiveness ratings.
Parekh et al. Attractiveness of variations in the smile arc and buccal corridor space a judged by orthodontists and laymen.
Angle Orthod. 2006;76:557-563.
Recent studies have indicated that lay persons can detect differences in buccal corridor width, and that they tend to prefer
wider dental arches and narrower buccal corridors even though wide corridors often are judged acceptable.
WR Proffit, HW Fields, and DM Sarver. Contemporary Orthodontics. 4th Ed. Mosby -Elsevier; 2007: St. Louis, MO. p.187
5 Cleft lip and palate there’s a special ruler to measure deficiency
8 **: I couldn’t find this anywhere.
From Temple Review: Cleft Palate J. 1987 Oct;24(4):314-22. The Goslon Yardstick: a new system of assessing dental arch
relationships in children with unilateral clefts of the lip and palate. Mars M, Plint DA, Houston WJ, Bergland O, Semb G.

Abstract
The Goslon (Great Ormond Street, London and Oslo) Yardstick is a clinical tool that allows categorization of the dental
relationships in the late mixed and or early permanent dentition stage into five discrete categories. Cases are allocated to
these categories on a value judgment basis by reference to the anchor groups of the Goslon Yardstick. The categorization
was sufficiently sensitive to distinguish the treatment results at different centers in this study. It is proposed that the
Goslon Yardstick should facilitate cross-center studies.

**: link to the full article: http://digital.library.pitt.edu/c/cleftpalate/pdf/e20986v24n4.08.pdf

5 Calcium uptake kidney

9 regulation **: Devi has told us Kidney in her lit review. Graber says: Bone is primary calcium reservoir. Serum calcium to be
maintained at 10 mg/dl. Kidney is the primary calcium conservation organ. Excretes excess phosphate while minimizing
loss of calcium. Kidney disease can result in poor bone quality. Absorption from the small intestine is the primary source
of exogenous calcium. Absorption from the gut is Vit D dependent and only 30% efficient. If less than 300 mg/day is
absorbed in the intestine -> serum calcium drops -> PTH secretion -> calcium removed from bones.
6 Muscles of facial obicularis oris
0 expression: least **: Obicularis oris - Encircles the lips, involved in playing brass instruments. This muscle closes the mouth and puckers the
involved in smiling lips when it contracts.
Muscles involved in smiling: 12 muscles Zygomaticus major and minor (4), obicularis oculi- raises the cheek (2), levator labii
superioris (2), levator anguli oris (2) risorius - retracts corners of lip(2)

**:

6 Somatic growth: 0-2 years

1 most active time **: Profitt: The general pattern of physical development after birth is a continuation of the late fetal period. Rapid growth
continues, with a relatively steady increase in height and weight, although the rate of growth declines as a percentage of
the previous body size. Extremely rapid growth in early infancy with a progressive slowing after the first 6 months.

6 Elastics and loss of within 24 hrs, 50% loss, apparently something in Nanda states this?
2 elasticity **:

6 Lasers: diode laser ablation

3 mechanism **: Graber: wavelengths 810-980 nm. Diode lasers deliver laser energy to the working area by a fiberoptic cable or
disposable fiberoptic tip, in light contact with the target tissue for ablating procedures. All diode laser wavelengths are
absorbed primarily by tissue pigment (melanin) and hemoglobin.
6 Lip bumper therapy 50% of expansion is complete within the first 100 days
4 **: Article: A longitudinal study of incremental expansion using a mandibular lip bumper. 90% of expansion within 300
days. Don't use for longer than 300 days. 50% in 100 days.

6 Finishing: CR-CO shift in finishing, if 2mm shift exists, what should you do?
5 **: “An important consideration in dealing with midline discrepancies is the possibility of a mandibular shift contributing
to the discrepancy. This can arise easily if a slight discrepancy in the transverse position of posterior teeth is present. For
instance, a slightly narrow maxillary right posterior segment can lead to a shift of the mandible to the left on final closure,
creating the midline discrepancy. The correction in this instance, obviously, must include some force system (usually careful
coordination of the maxillary and mandibular archwires, perhaps reinforced by a posterior cross-elastic) to alter the
transverse arch relationships. Occasionally, the entire maxillary arch is slightly displaced transversely relative to the
mandibular arch so that with the teeth in occlusion, relationships are excellent, but there is a lateral shift to reach that
position. Correction again would involve posterior cross-elastics, but in a parallel pattern as shown in Figure 16-8.” Proffit,
Contemporary Orthodontics 4th ed, p 609.

RP: Look into occlusal equilibration

6 Arch intercanine intercanine width increases slightly (less than 2mm) during transition from primary to permanent dentition
6 width changes: **: Think it is intercanine width (not arch length) that changes by increasing slightly (less than 2 mm) from primary to
mixed dentition permanent dentition.
6 Asymmetry: causes most common cause: trauma
7 of mandibular **:
asymmetry

Chia M et al, The Aetiology, Diagnosis and Management of Mandibular Asymmetry, Ortho Update 2008 1:44-52

“An old condylar fracture is the most likely cause of asymmetric mandibular deficiency in a child, but other destructive
processes that involve the temporomandibular joint such as rheumatoid arthritis (Figure 5-5), or a congenital absence f
tissues in hemifacial microsomia (see Chapter 3), also can produce this problem.” Proffit, Contempory Orthodontics, 4th
ed, pp 133-134

6 Anatomy: hyoid **: Superior

8 bone attachments •Middle pharyngeal constrictor muscle
•Hyoglossus muscle
•Digastric muscle
•Stylohyoid muscle
•Geniohyoid muscle
•Mylohyoid muscle
Inferior
•Thyrohyoid muscle
•Omohyoid muscle
•Sternohyoid muscle
6 Metabolism: effect depolarization of nerve fibers and convulsions, has effect on nerves and muscles
9 of low serum Ca2+ **: hypocalcaemia is the presence of low serum calcium levels in the blood, usually taken as less than 2.1 mmol/L or 9
mg/dl or an ionized calcium level of less than 1.1 mmol/L or 4.5 mg/dL. In the blood, about half of all calcium is bound to
proteins such as serum albumin, but it is the unbound, or ionized, calcium that the body regulates. Hypocalcemia is a
symptom of a parathyroid hormone [PTH] deficiency/malfunction, a Vitamin D deficiency, or unusually high magnesium
levels or low magnesium levels.
Symptoms:
The neuromuscular symptoms of hypocalcemia are caused by a positive bathmotropic effect due to the decreased
interaction of calcium with sodium channels. Since calcium blocks sodium channels and inhibits depolarization of nerve and
muscle fibers, diminished calcium lowers the threshold for depolarization[1]. The symptoms can be recalled by the
mnemonic "CATS go numb"- Convulsions, Arrhythmias, Tetany and numbness/parasthesias in hands, feet, around mouth
and lips.
● Petechiae
● Oral, perioral and acral paresthesias, tingling or 'pins and needles'
● Carpopedal and generalized tetany (unrelieved and strong contractions of the hands, and in the large muscles of
the rest of the body)
● Latent tetany
● Tendon reflexes are hyperactive
● Life threatening complications: Laryngospasm, Cardiac arrhythmias
● Intermittent QT prolongation

7 TMD: symptoms disc displacement is not a primary symptom

0 **: symptoms refer to a subjective event experienced and reported by the patient (pain, loss of function/range of motion);
a sign is discovered by the physician during examination or via objective tests. Disc displacement would not be considered
a symptom
7 Growth and chin remodels via apposition on the lingual of the symphysis (poor question)
1 Development: chin **: Profitt pg 46—“as a growth site, the chin is almost inactive. It is translated downward and forward, as the actual
remodeling growth occurs at the condyle and along the posterior boder of the ramus.”
I would assume there is a little resorption on the facial surface and some apposition on the lingual surface?
**: Essentials of facial growth-Enlow and Hans: periosteal resorption on the labial bony cortex, deposition on the alveolar
surface of the labial cortex, resorption on the alveolar surface of the lingual cortex, deposition on the lingual side of the
lingual cortex. -> deposition/apposition on the lingual of either cortex, and resorption on the labial of either cortex
**: from Enlow:Apposition on posterior surface and inferior border which leads to increase in thickness and height of the
symphysis
7 Growth and maxilla and mandible
2 Development: 1st **:
brachial arch
derivatives

7 Imaging: best method to see disc perforation

3 arthrography **: Arthography
7 Functional effect: opens the bite
4 appliances: Herbst **: Profitt pg 293: herbst, though it depresses upper molars, is effective in treating deep bite class II patients with short
face

Reference: Pancherz board article comparing late vs early Herbst treatment

Herbst and FORSUS disoccludes posterior teeth, therefore allowing posterior eruption and bite opening

7 Retention if pt started with significant lower crowding, removal of retention causes decrease in arch length and perimeter
5 **: Arch length and arch perimeter decreases

7 Cephalometrics: 7 degrees
6 Frankfurt Horizontal **: Profitt pg 207— Frankfort plane: extends from anatomic porion to orbitale. 2 disadvantages:
· Both landmarks can be difficult to discern on a radiograph
· Individuals can show significant differences in true horizontal (up to 10 degrees) from the horizontal established by
the Frankfort plane.
Alternative: Sella-Nasion (oriented, on average, 6-7 degrees upward anteriorly to the Frankfort plane.)

Showfety et al, Angle ,ASsociation between the Postural Orientation of Sella-Nasion and Skeletodenal Morphology, Angle
April 1987
7 DI Class III both sides
7 **: Full cusp class II/III- 4 points per side
End on/half cusp class II/III- 2 points per side
**: From Dr. Briss’ email
Supernumerary teeth- one (1) point each, Other: Ankylosis of permanent teeth two (2) points per tooth, Anomalous
Morphology of tooth size and shape (e.g. peg lateral), Impactions (2)points(eg. Canine), Non congenitally missing teeth
(except third molars) are one (1) point per tooth. Congenitally missing teeth are two (2) points per tooth, For generalized
spacing per arch not related to missing teeth, there must be at least 4 mm of spacing occurring within the arch. Score two
(2) points per arch, Tooth transposition- two (2) points for each event or iatrogenic)- two (2) points per occurrence, Skeletal
asymmetry (treated non-surgically) yields three (3) points, ectopic eruption (2)points.

Additional tx complexity: Significant Bolton Discrepancy (3 mm or greater), 2. Multiple areas of shorten roots, 3. Deep
Curve of Spee, 4. Associated traumatic injury to multiple teeth, 5. Periodontally labile condition, 6. Severely angulated
roots, 7. Severe bi-maxillary protrusion (critical anchorage case)
7 DI complexity of which? Case or treatment?
8 shows complexity of case
**: from ABO website and also Article #7
1 The Discrepancy Index (DI) is a measure of the complexity of an orthodontic case on the pre-treatment dental
casts. It is used by the Board in determining the criteria for case submission. For an overview see Discrepancy Index
Scoring System (pdf).
2 The Cast/Radiograph Evaluation (C-R Eval) is a measure of the results of treatment on the final dental casts and
intraoral radiographs. For an instructional manual of the grading system for Cast Evaluation, see Grading System
for Dental Casts and Panoramic Radiographs (pdf).
3 The Case Management Form (CMF) is a measure of the changes in the skeletal, dental and facial aspects of the
case.
Article 7: The DI was initially developed in 1998. A criterion for determining the acceptability of a case submitted for the
American Board of Orthodontics (ABO) Phase III clinical examination is case complexity. Case complexity is defined as “a
combination of factors, symptoms, or signs of a disease or disorder which forms a syndrome.”1 Therefore, the ABO has
devised the Discrepancy Index (DI) to provide an objective evaluation of complexity that
might lead to a better understanding of difficulty

7 Elastics Class II elastics

9 **: Steepen mandibular plane
BC TCH ABK: short class two elastic center of resistance on Max. Distal to mand center. rotates mand. Occ. plane clockwise.

8 Growth and fusion of mandible is shortly after birth

0 Development: **: From Case reports: http://www.almeidabuco.com.br/artigos/artigo_05.pdf
Embryologically, the mandible develops from the cartilage of the first pharyngeal arch, the mandibular process, known as
Meckel’s cartilage. The mandible is derived from ossification of an osteogenic membrane formed from ectomesenchymal
condensation at 36 to 38 days of development. In the mental region, on either side of the symphysis, 1 or 2 small cartilages
appear, and endochondral ossification commences in the seventh month in utero to form a number of mental ossicles.
These ossicles become incorporated into the intramembranous bone when the symphysis menti is converted from a
syndesmosis to a synostosis during the first postnatal year. Most authors presume that failure of fusion of the mandible is
probably due to a lack of mesodermal penetration into the midline structures of the mandibular portion of the first
branchial arch. This failure may be a deficiency or delayed growth of the mesenchyme.
8 Cleft lip: problem in **: Visualize: http://www.indiana.edu/~anat550/hnanim/animations/yes_consent/face/face.html
1 fusion of max and 2 major groups:
medial nasal 1)clefts involving the upper lip and anterior part of the maxilla
processes 2)clefts involving the hard and soft plate

Also divided as ant/posterior. Anterior clefts are embriogically different from posterior clefts. Ant clefts: caused by
defective development of primary palate resulting from mesoderm deficiencies in the maxillary prominences and
intermaxillary segments. Posterior clefts are caused by defective development of the secondary palate resulting from
abnormal growth and or improper fusion of the horizontally positioned palatal shelves.

Hare lip: extremely rare midline cleft of upper lip resulting from improper fusion of labial components of the intermaxillary
segment. This cleft is restricted to the lip b/c underlying mesoderm provides adequate material for formation of alveolar
bone.
8 Statistics: Predicting ANB, SNA, SNB, Wits: ANOVA
2 mandibular growth **: Anova: In its simplest form, ANOVA provides a statistical test of whether or not the means of several groups are all
what analysis would equal, and therefore generalizes t-test to more than two groups. Doing multiple two-sample t-tests would result in an
be used? tTest chi, increased chance of committing a type I error. For this reason, ANOVAs are useful in comparing two, three, or more means.
analysis of variance
T test: It can be used to determine if two sets of data are significantly different from each other
**: Chi square test: more than one group. Testing whether the %’s are = to each other. Each variable can have more than
2 categories. (ie. wore helmet/not -> injury/not). Association: between 2 binary variables.
One sample t-test: compares mean of a continuous variable to a number
Paired t test: compare means of 2 groups to each other - matched
Independent sample t-test: compare the means of 2 groups to each other - not matched
ANOVA: compare the means of more than 2 groups in terms of a continuous variable (ie. means of oral health for pts at 3
schools)
Z test: tests whether %’s are = to a certain value
Correlation: association between 2 continuous variables

P value: greater than .05 -> dont reject the null -> evidence of association is not stat. sig.
P value: less than .05 -> reject null -> evidence of assoc. is stat. sig.
8 micro severts. **: The sievert (symbol: Sv) is the International System of Units (SI) derived unit of equivalent radiation dose, effective
3 effective dose vs. dose, and committed dose. Quantities that are measured in sieverts are designed to represent the stochastic biological
Equivalent dose. effects of ionizing radiation. The sievert should not be used to express the unmodified absorbed dose of radiation energy,
Micro grays?? which is a clear physical quantity measured in grays. To enable consideration of biological effects, further calculations
must be performed to convert absorbed dose into effective dose, the details of which depend on the biological context.

**: Equivalent dose: It is adequate for assessing risk due to external radiation fields that penetrate uniformly through the
whole body, but needs further corrections when the field is applied only to part(s) of the body or when it is due to an
internal source. A further quantity called effective dose can be calculated if the fractionation of radiation to different parts
of the body is known, to take into account the varying sensitivity of different organs to radiation.

RR: See Jacobson Pg. 244, 246.

The Equivalent dose (Ht) is mean tissue-absorbed dose in micrograys times the radiation weighting factor; it is used to
compare the effects of different types of radiation on tissues and organs Ht= Wr x Dt (absorbed dose in grays), Wr is 1, r is
radiation weighting factor.

The effective dose estimates damage from radiation to an exposed population as well as type, quantity, sensitivity, and
carciogenic potential of irradiated tissues. E = Wt x Ht (Wt is tissue/organ weighting factor)

Effective absorbed Radiation doses

Pan: 3-11 uSv
Lat or PA Ceph: 5-7 uSv
FMX 30-80 uSv
TMJ series 20-30 usv
CBCT 40-135 uSV

**: Equivalent dose = Radiation weighting factor x average absorbed dose (specific tissue)
Mean tissue absorbed dose = micrograys
Equivalent dose = microsevert
Effective dose = microsevert

8 correction of class II **:

4 div 1 twin block Article #6 Conclusions
during phase one. - Early tx with twin block then fixed appliances does not result in long term differences when compared with one course of
25, 55, 75, 90. tx started in late mixed or early permanent dentition
● Definite disadvantages to two phase approach -> more visits, costs, inc length of tx, inferior final result
● Early tx for Class II not normally justified
8 most common cause maxilla hyper?
5 of class II mandibular hypo?
combination?
unsure?
**: #26: Long-term follow-up of Class II adults treated with orthodontic camouflage: A comparison with orthognathic
surgery outcomes
Intro: ⅔ of patients mandibular deficiency is the problem

8 most active time of 0-3 years?

6 somatic growth 3-6?
9-12?
**: Copy of prior question. 0-3 years

8 buccal crown torque up?

7 on molar where does down?
wire go on opposite level?
side **: #46: Biomechanics of orthodontic correction of dental asymmetries
Buccal root torque placed in TPA on side not in cross bite. When engaged, force creates buccal tipping of molar in
crossbite. Question is asking the opposite....so buccal crown torque on molar->opposite side buccal root torque->wire
down. (Someone please verify)

If wire and upper molar = up

8 superimposing over SN ON SELLA.

8 10 years **: Possible copy of prior question.
Craniofacial Superimpositions: register on Sella with the best fit on the anterior cranial base bony structures (Planum
Sphenodium, Cribiform Plate, Greater Wings of the Sphenoid) and Occiput. Allows assessment of overall growth and tx
changes.

Maxillary Superimpositions: Register on the vertical leg of the key ridges (anterior and posterior contours of the sygomatic
arches); align the key ridges both horizontally and vertically and the best fit of the internal structures of the maxillary bony
complex.

Mandibular Superimpositions: Register on the internal cortical outline of the symphysis with the best fit on the mandibular
canal to assess mandibular tooth movement and incremental growth of the mandible.

Black = initial; Blue = progress/interim; Red = final

8 pt with class IIi facemask
9 missing laterals, 16 distalbuccal rotation of max molar***
years want canine extrude max centrals.
substitution (stupid) **: Not sure what the question is asking. I think it is asking...given a pt who is missing U2’s and wants canine substituion,
what don't you want and is Class III.....What dont you want to do if you are using Class III elastics? You wouldn’t want to bend disto-buccal
to rotation in the wire for the U6’s. The elastics will have this force so would want if anything to do the opposite.
class III elastics Facemask would help protract the maxillary dentition.
Extruding maxillary centrals....I assume you do this to maintain overbite and prevent anterior crossbite. Not sure what that
has to do with Class 3 elastics.

9 female with condylar wait to 22 years?

0 hyperplasia case high condylar shaving?
extract lower premolars?
ivro?
**: #33: Considerations for orthognathic surgery during growth, Part 1: Mandibular deformities
Inc in mand growth rate almost always occurs in condyles (condylar hyperplasia)
Cause elongation of condylar neck and mandibular body -> dental compensation
Growth can be accelerated unilaterally or bilaterally; horizontal or vertical
High condylectomy
Surgically remove superior 3-5 mm of condylar head -> will stop AP and vertical growth
Should defer procedure until normal max and mand growth closer to completion (14 for girls, 16 for boys)
no mand growth, but max growth -> max and mand complex -> down and back
Inverted L osteotomy (ILO) and vertical ramus osteotomy (VRO)
condylar position is inexact
any age
Amount of setback with VRO limited by temporalis muscle and coronoid process

So based on what I can assume this question is asking....I think they forgot to include what age the patient is.
Three options regarding timing of surgery relative to growth:
Defer surgery until growth complete
Not indicated because fully manifested growth may lead to non ideal final result
Perform surgery to posteriorly position mandible during growth with overcorrection
Additional surgery may be necessary if overcorrection insufficient or excessive
If you do this, should wait until after majority of maxillary growth complete (girls 14 boys 17)
Surgically eliminate further growth with high condylectomy and simultaneously correct jaw deformity Fig 4
Remove active growth centers and prevent mandibular growth
9 transposition related genetics?
1 to tooth agenesis?
crowding?
**: Elevated tooth agensis in patients with transposition. (Not sure if that answers the question?)

9 what does a fixed open bite?

2 functional do? minimal lower inclination?
deepen bite?
**: prior question ->open the bite

9 chose following 10% for 3rds?

3 agenesis that is not 3.5% for mand 2nd premolars?
true 3rds missing 13x more likely?
other agenisis?
a. Agenesis of third molar 10% (should be 20%)
b. Agenesis of unilateral 2nd premolar 3%
c. Agenesis of third molar associated with 13x chance of missing other teeth
d. Agenesis of third molar not related to crown shape of lateral and premolar
**:
Incidence of permanent tooth agenesis: 1.6-9.6% (excluding 3rd molars)
Incidence of primary dentition agenesis: 0.5-0.9%
Severe tooth agenesis (absence 4 or more teeth beside 3rd molars): 0.25%
Third molar agenesis is most common (20%)
If 3rd molar absent: Agenesis of remaining teeth is 13x more likely
9 lots of scammon
4 curve questions

**: -Scammon with Max and mand: From Proffit

•Neural growth complete by age 6, unaffected by adolescence
• Jaw growth is intermediate between the neural and general body curves
•Correlation between general body growth and jaw growth is not perfect
–Juvenile acceleration in jaw growth in some individuals occur 1 to 2 years before adolescent growth spurt.
–Sexual development really begins much earlier than previously thought: Adrenarche
Likely that juvenile acceleration in growth is related to intensity of adrenarche
9 all parts of the anterior?
5 maxilla has superior?
deposition except inferior?
posterior?
anterior and superior?
**:
•As maxilla grows downward and forward, its front surfaces are remodeled and bone is removed from anterior surface.
However, in general, remodeling does not always oppose direction of translation.
•Growth occurs by :
–1) Apposition of bone at sutures that connect maxilla to cranium and cranial base
–2) Surface remodeling
–3) In addition maxilla is pushed forward by cranial base growth until age 6. Failure of cranial base to move forward results
in midface deficiency
–After age 7, sutural growth is the primary mechanism
–Bone is added to free posterior border in the tuberosity region , which allows for permanent molar eruption at age 6 and
12 yrs.

****in case they ask about other areas, I included figures from Enlow.
9 medial nasal process phitrum?
6 helps develop? columella of nose?
ala of nose?
**: Philtrum and columella are formed by the medial nasal and maxillary processes

Lateral nasal prominences form the alae of nose

9 pt has ADD (anterior **:

7 disc displacement) MRI: use to see the disk
WITHOUT reduction CBCT: use to see hard tissues (intracapsular)
how to get better Arthrography: use to see perforation
view of tissue?

9 hemifacial
8 microsomia begins in
first trimester, **: Hemifacial microsomia: From gestation to childhood
occasionally can be Hemifacial microsomia is a variable, complex malformation that is most strictly defined as asymmetric hypoplasia of the
bilateral? face and ear. However, the defect is best described in terms of its embryologic development -- that is hypoplasia of
t/f for each structures derived from the first and second branchial arches during the first six weeks of gestation
sentence.
SK: YES, it can happen bilateral
SG: Wikipedia: Hemifacial microsomia is a congenital disorder that affects the development of the lower half of the face, most
commonly the ears, the mouth and the mandible. It can occur on one side of the face or both.
1 What is the average mandibular movement for adolescent?
a. 40mm vertical and 7mm lateral
b. 50mm vertical and 12mm lateral
c. 60mm and 10mm
d. there is no “average” mandibular movement for adolescent* (the other answer choices didn’t make much sense.
Average move from most reviews says it’s 55m vertical and 7mm lateral)
**:
One study age 10-17 the mean +/- standard deviation for maximum opening was 50.6 +/- 6.4 mm, for laterotrusion to the
right was 10.2 +/- 2.2 mm, for laterotrusion to the left was 10.6 +/- 2.3 mm, and for protrusion was 8.2 +/- 2.5 mm.
Bivariable (t-test) and multivariable (linear regression) analyses showed that normative values for jaw opening capacity
were influenced by age and gender.

Graber: The normal range of mouth opening when measured interincisally is between 53-58mm. Even a 6 year old can
normally open a maximum of 40 mm or more.
A lateral movement less than 8 mm is recorded as a restricted movement.

Profitt: In the mandible moves normally its function is not impaired... “vice versa”....most important single indicator of joint
function is the amount of maximum opening....important to note limitation of opening.... (No values given)

Craniorehab: So men can usually open wider than women, taller people more than shorter people. In studies, MMO for
adults has generally been around 50 mm, with a range from 32mm to 77mm. Men can open to about 50-60, and women to
45-55mm.

Okesson: re-iterated Graber exactly

George: said minimally you should eb able to open 40 and have a lateral movement of 7. We searched options..and he said
it may seem best to select that there is no average.

It seems to be that as long as you have the minimum of 40 and 7 you are Ok. We can discuss this one.

2 2. what happens to ANB when you rotate the mandible clockwise?

a. Increase* (Jacobson article about Wits)
b. Decrease
c. Stay the same
**: CCW rotation of jaw-> reduces ANB, and CW rotation ->increases ANB

3 3. according to an article on “seminars of orthodontics” what increases stability?

a. Maintaining intermolar and intercanine width*
b. No more than 3mm expansion etc.
4 4. which of the following about arch form is not true.
a. Brader arch is based on mathematical model
b. Cantenary curve based on chain suspended from 2 points
c. B—arch based on ellipse
d. mandibular arch is based on maxillary arch* (b/c mand arch is treatment arch.)
**:
Profitt: Catenary: shape that a loop chain would take if it were suspended from two hooks. The length of the chain and the width
between the supports determine the precise shape of the curve. When the width across the first molars is used to establish the
posterior attachments a catenary curve fits the dental arch form of the premolar-canine-incisor segment of the arch very nicely for
most individuals. For all pts., the fit is not as good if the catenary curve is extended posteriorly, because the dental arch normally
curves slightly lingually in the 2nd and 3rd molar region. Most preformed archwires are based on the catenary curve, with average
intermolar dimensions.

Another mathematical model of dental arch form, Brader arch, is based on a trifocal ellipse. The anterior segment of the trifocal ellipse
closely approximates the anterior segment of the catenary curve, but the trifocal ellipse gradually constricts posteriorly in a way the
catenary curve does not. the Brader arch form, therefore, will more closely approximate the normal position of the 2nd and 3rd
molars. It also differs from a catenary curve in producing somewhat greater width across the premolars.

No mention of B-arch. If means Brader arch, it is based on ellipse (see above)

5 DUPLICATE Q 5. what happens to intercanine width during transition dentition?

a. I picked increase less than 2mm

6 DUPLICATE Q 6. without fixed retention after ortho Tx, what happens?

a. It is more stable with serial extraction
b. It is more stable with treatment during mixed dentition
c. Decrease in arch length and intercanine width *
7 7. What limits expansion using SARPE?
a. Coronoid process
b. Zygometic buttress* (Suri article – make sure to review a lot of questions on SARPE)
**: Zygomatic buttress and pterygomaxillary junction are critical areas of resistance #12: Surgically assisted rapid palatal
expansion: A literature review - only speaks about the zygomatic buttress. Although I know I have talked about this with
Shar, who remembered the coronoid process limits expansion, I researched it and couldn’t find anything on the coronoid
process limiting expansion.....everything indicates the buttress. ANYONE’S THOUGHTS????
I am told that Dr. Briss has said coronoid process a few times in case presentations.
**: I have heard faculty mention it. Depends if the question is asking anatomical limit Vs. resistance as a limiting factor.
zygomaxillary buttress is definitely what resists expansion especially in the beginning of expansion. third molars and
second molars are anatomically positioned medial to coronoid, such that in maximum opening, extraction of thirds
becomes difficult.

8 8. Know that SARPE is more stable on non-growing pt than orthopedic expansion

a. (2008 article) The relapse rates for SARPE vary from 5% to 25%. These rates are significantly lower than the relapse
rate of OME, which can be as high as 63%.
**: #12: Surgically assisted rapid palatal expansion: A literature review
Relapse rate for SARPE: 5-25% (OME can be 63%). Non-growing pt. -> SARPE more stable
9 9. When do molars mineralize?
a. At birth
**: At Birth, see table below

Secondary Tooth Development - Key Timing

1 10. When do mandibular symphysis fuse?
0 a. 3 month after birth
**: Shortly after birth (first 3 months)

1 11. When can you start use superimpose on anterior cranial base?
1 a. 5
b. 7*
c. 10
**: 7
Synchondroses fused at ~:
Intrasphenoid: birth
Spheno-ethmoidal: 3-5 y.o.
Spheno-occipital: 9-10 y.o.

1 12. When does the cranium get maximum width

2 a. 5
b. 7* (I picked 7 but it could be 5. Double check)
c. 11
**: Graber: By 4 years of age, the brain and the associated cranial vault will have achieved 80% of adult size; by age 10, the
brain and cranial vault have attained 95% of their size.
Fundamentals of craniofacial growth: The growth in neurocranial breadth and length follows the rapid growth gradient of
neural tissues and most of the maximal head width and length is established at the age 4 to 6 years old.
Checked Enlow and Profitt....nothing to add?
Manual of dental assisting: Growth cranial vault complete by 6
Handbook of growth: 4.5 yrs. -> 91-93% growth of adult cranial vault
Textbook of craniofacial growth:Cranial vault completes growth before the base. Midsagittal suture patent till 3rd decade
of life
Answer -> 11 yearsSomeone ask Dr. Briss jewish joke.
1 13. Which of the following doesn’t affect gingival response and fibroblasts?
3 a. IL-1
b. Interferen gamma
c. TNF-beta
d. Neocytokine * (I picked this one. Look these up)
TNF-beta, IL-1, IL-gamma are proinflammatory cytokine released during bone destruction, cytokine markers for bone
resorption --?
**: The Interleukin 1 family (IL-1 family) is a group of 11 cytokines, which plays a central role in the regulation of immune
and inflammatory responses to infections or sterile insults.

Interferon gamma: Produced by lymphocytes activated by specific antigens or mitogens. IFN-gamma, in addition to having
antiviral activity, has important immunoregulatory functions. It is a potent activator of macrophages, it has antiproliferative
effects on transformed cells and it can potentiate the antiviral and antitumor effects of the type I interferons.

Tumor necrosis factors (or the TNF-family) refer to a group of cytokines whose family can cause cell death (apoptosis)

The only information I could locate on Neocytokine says this “we show that a chemically synthesized fragment of the IL-2
sequence can fold into a molecule mimicking the quaternary structure of a hemopoietin. Indeed, peptide p1–30 (containing
amino acids 1–30, covering the entire α helix A of IL-2) spontaneously folds into an α-helical homotetramer and stimulates
the growth of T cell lines expressing human IL-2Rβ, whereas shorter versions of the peptide lack helical structure and are
inactive. We also demonstrate that this neocytokine interacts with a previously undescribed dimeric form of IL-2Rβ”.......I
thought maybe the term Neo - Cytokine refers to a new-cytokine (prefix neo = new). Thus the word doesn’t describe an
actual cytokine, just any “new” cytokine.

1
4 14. If pt has skeletal anterior openbite where is UI in relation to stomion superiorus?
a. Below * ( I picked this one. There is a paper that says distance between stomion superius and upper incisal edge
increase with hyperdivergence)
b. Above
c. At the same level
**: Skeletal anterior open bite, teeth in normal relationship to lip, open bite exists -> teeth below upper lip . Dental open
bite, teeth not in normal relationship to lip.
1 15. Springback is related to?
5 a. the ability of the wire to maintain it’s stiffness
b. the ability of the wire to remain flexible
c. the ability to be activated beyond yield point * (Springback allows you to activate loop even if the AW is past
proportional limit.)

**: Yield strength is the stress at which a specified amount of permanent deformation of a material occurs.
When we apply stress to a material, it deforms. Some of the deformation is plastic and the material can recover when the
stress is relieved. But some deformation is permanent and the material cannot recover from it. As we apply more stress,
there is more deformation. This plots on a curve in a somewhat linear, or proportional, way. But at some point, a bit more
stress results in a lot more deformation, and this is the proportional limit of the material. Stress applied beyond this causes
an increasing rate of deformation until the maximum or ultimate strength of the material is reached. (Beyond that it will
fail completely.) Somewhere between the proportional limit and the ultimate strength of the material is the yield strength.
Look at page 360 Profitt

**: Article 71: Springback is defined as the extent to which the range recovers upon deactivation of an activated archwire.
Range is defined as the distance an archwire can be activated by a specific force. This distance is termed the “working
range”, when an orthodontist defines the limit of activation. With regard to elastic property ratios, one measure of the
range is the distance that an archwire can be activated elastically which terminates at its proportional limit.

RP: Spring is also referred to as maximum elastic deflection, maximum flexibility, range of activation, range of activation,
range of deflection, or working range. Spring back is related to the ratio of yield strength to the modulus of elasticity of the
material (YS/E). Higher springback values provide the ability to apply large activations with a resultant increase in working
time of the appliance-->fewer arch wire changes. Springback is also a measure of how far a wire can be deflected without
causing permanent deformation or exceeding the limits of the material.
 Stiffness or load deflection rate: the force magnitude delivered by an appliance; proportional to the modulus of elasticity;
low stiffness = lower force, more constant force over time as appliance deactivates, greater easy and accuracy in applying a
given force.
Formability: ability to bend a wire without fracturing
Resilience: work available to move teeth, the area under the line describing the elastic deformation of the wire

Ref: Kapila and Sachdeva, Mechanical properties and clinical applications of orthodontic wires AJODO, 1989: 96: 100-9

1
6 16. What is Jugular?
a. It is PA landmark where maxillary tuberosity intersects zygomatic arch
**: Jugale (J), at the jugal process, the intersection of the outline of the maxillary tuberosity and the zygomatic but- tress.
1 DUPLICATE Q 17. Which of the following is not a bilateral structure on a ceph?
7 a. Point A
b. Opisthion *

**: DONT MIX WITH Prosthion! prosthion - craniometric point that is the most anterior point in the midline on the
alveolar process of the maxilla.

1 18. Which of the following is not a bilateral structure on aceph?

8 a. Point A
b. Menton
**: Menton is not bilateral. Point A is bilateral.

1 19. You want to use a superelastic wire to maintains low forces along a range of strains because…
9 a. Phase transformation*
b. Load deformation
**: Profitt: NiTi can exist in more than one form or crystal structure. The martensite form exists at lower temperatures,
the austenite form at higher temperatures. For steel and almost all other metals, the phase change occurs at a transition
temperature of hundreds of degrees. Both shape memory and superelasticity are related to phase transitions within the
NiTi alloy between the martensitic and austenitic forms that occur at a relatively low transition temperature.
2 20. Pt had a BSSO and ended up with altered sensation on lower lip. What nerve was damaged?
0 a. Auricular temporal
b. IAN
c. Mental *
d. Long buccal
e. lingual
**:
IAN damaged, mental provides sensation to lip. Can mental get damaged as well?
Mental nerve is a general somatic afferent (sensory) nerve which provides sensation to the anterior aspects of the chin and
lower lip as well as the buccal gingivae of the mandibular anterior teeth and the premolars. It is a branch of the posterior
trunk of the inferior alveolar nerve, which is itself a branch of the mandibular division of the trigeminal nerve (CN V3). The
nerve emerges at the mental foramen in the mandible.

2 21. Articulation between C1 and this (arrow pointing to C2) allow head to rotate. The combination of C1 and C2 is called
1 odontoid process. (T/F – odontoid process is just C2)
**: The atlas (C1) is the topmost vertebra, and – along with the Axis (C2) – forms the joint connecting the skull and spine.
The atlas and axis are specialized to allow a greater range of motion than normal vertebrae. They are responsible for the
nodding and rotation movements of the head.
The atlanto-occipital joint (articulation between the atlas and the occipital bone - is a synovial joint) allows the head to nod
up and down on the vertebral column. The dens (also odontoid process or odontoid peg) is a protuberance of the axis
(second cervical vertebra). The dens acts as a pivot that allows the atlas and attached head to rotate on the axis, side to
side.
First statement is true, second statement is false.
2 22. Origin CNV?
2 a. Pons
**: A number of cranial nerve nuclei are present in the pons:
● mid-pons: the 'chief' or 'pontine' nucleus of the trigeminal nerve sensory nucleus (V)
● mid-pons: the motor nucleus for the trigeminal nerve (V)
● lower down in the pons: abducens nucleus (VI)
● lower down in the pons: facial nerve nucleus (VII)
● lower down in the pons: vestibulocochlear nuclei (vestibular nuclei and cochlear nuclei) (VIII)

2 23. Semilunar ganglion associated with what nerve?

3 a. CN5 - Aka trigeminal ganglion
**: The trigeminal ganglion (or Gasserian ganglion, or semilunar ganglion, or Gasser's ganglion) is a sensory ganglion of the
trigeminal nerve(CN V) that occupies a cavity (Meckel's cave) in the dura mater, covering the trigeminal impression near
the apex of the petrous part of the temporal bone. It leaves the skull through the foramen ovale. The ophthalmic (V1) and
maxillary (V2) consist exclusively of sensory fibers; the mandibular (V3) is motor and sensory.
2 24. Pterygomaxillary fissure seperates maxillary to ___ posteriorly?
4 a. Sphenoid*
b. Temporal bone
**: The pterygomaxillary fissure is a fissure of the human skull. It is vertical, and descends at right angles from the medial
end of the inferior orbital fissure; it is a triangular interval, formed by the divergence of the maxilla from the pterygoid
process of the sphenoid.
It connects the infratemporal with the pterygopalatine fossa, and transmits the terminal part of the maxillary artery.
Alveolar branches of the maxillary nerve go from the pterygopalatine fossa to the infratemporal region via this fissure.
In older texts, the pterygomaxillary fissure is sometimes called the pterygopalatine fissure.

2 DUPLICATE Q 25. On lat Ceph, where is adenoid pad closest. (the arrow was pointing at basion and soft palate. Adenoid was literally
5 right in the middle. I picked soft palate)
a.
b. SP (soft palate)=velum, NPAT=adenoid, IT=inferior turbinate,
2 DUPLICATE Q 26. How does diode laser works?
6 Aww yeah! kicking a. Ablation * ( some old exams said this or vaporization is the answer. Look it up)
things off with a b. Heat
winner! ablation c. Vaporization
baby! d. Carbonization
e. Protein denaturation

2 27. How do you sterilize heat sensitive instrument?

7 a. Phenol
b. Autoclave
c. Ethyl alcohol * (?? Ethylene oxide was not a choice)
d. Dry heat

**: If these items are heat resistant, the recommended sterilization process is steam sterilization, because it has the
largest margin of safety due to its reliability, consistency, and lethality. However, reprocessing heat- and moisture-
sensitive items requires use of a low-temperature sterilization technology (e.g., ethylene oxide, hydrogen peroxide gas
plasma, peracetic acid)
http://www.cdc.gov/hicpac/disinfection_sterilization/13_0sterilization.html

Ethyl alcohol – disinfectant

There is no good answer to this question!!

2 28. If you want to flatten curve of Wilson what do you want to do?
8 a. Buccal root torque
b. buccal crown torque*

**: curve of wilson defined as--the curve, as viewed from the front, that contacts the buccal and lingual cusps of the
mandibular molars, which is lower near the midline to the lingual inclination of lower molars. (uprighting the molars, via
buccal crown torque, would therefore flatten that curve. )
http://www.ptcdental.com/dentaldictionary/c/curve-of-wilson/
2 29. You need to premedicate patient with mitral valve prolapsed with regurgitation when banding. If the patient is allergic
9 to penn, use Clindamycin 600mg
a. (F, T) I think you no longer have to premedicate mitral valve prolapsed. Look up.

**: Antibiotic prophylaxis with dental procedures is reasonable only for patients with cardiac conditions associated with
the highest risk of adverse outcomes from endocarditis, including:
• Prosthetic cardiac valve or prosthetic material used in valve repair
• Previous endocarditis
• Congenital heart disease only in the following categories:
– Unrepaired cyanotic congenital heart disease, including those with palliative shunts and conduits
– Completely repaired congenital heart disease with prosthetic material or device, whether placed by surgery or catheter
intervention, during the first six months after the procedure*
– Repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or
prosthetic device (which inhibit endothelialization)
• Cardiac transplantation recipients with cardiac valvular disease *Prophylaxis is reasonable because endothelialization of
prosthetic material occurs within six months after the procedure. Dental procedures for which prophylaxis is reasonable in
patients with cardiac conditions listed above.All dental procedures that involve manipulation of gingival tissue or the
periapical region of teeth, or perforation of the oral mucosa*
*Antibiotic prophylaxis is NOT recommended for the following dental procedures or events: routine anesthetic injections
through noninfected tissue; taking dental radiographs; placement of removable prosthodontic or
orthodontic appliances; adjustment of orthodontic appliances; placement of orthodontic brackets; and shedding of
deciduous teeth and bleeding from trauma to the lips or oral mucosa.

http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_307684.pdf
3 30. Positive TB test means patient recovered from TB. It does not indicate current status
0 a. (F, T) – (+) TB can also mean the person was vaccinated.

**: What Are False-Positive Reactions?

Some persons may react to the TST even though they are not infected with M. tuberculosis. The causes of these false-
positive reactions may include, but are not limited to, the following:
● Infection with nontuberculosis mycobacteria
● Previous BCG vaccination
● Incorrect method of TST administration
● Incorrect interpretation of reaction
● Incorrect bottle of antigen used

What Are False-Negative Reactions?

Some persons may not react to the TST even though they are infected with M. tuberculosis. The reasons for these false-
negative reactions may include, but are not limited to, the following:
● Cutaneous anergy (anergy is the inability to react to skin tests because of a weakened immune system)
● Recent TB infection (within 8-10 weeks of exposure)
● Very old TB infection (many years)
● Very young age (less than 6 months old)
● Recent live-virus vaccination (e.g., measles and smallpox)
● Overwhelming TB disease
● Some viral illnesses (e.g., measles and chicken pox)
● Incorrect method of TST administration
● Incorrect interpretation of reaction

http://www.cdc.gov/tb/publications/factsheets/testing/skintesting.htm

3 DUPLICATE Q 31. Most related to root resorption?

1 a. Intrusion and lingual root torque
3 32. tetracycline staining around TADS shows:
2 a. No movement in bone
b. Slow movement (0.1mm/mo)
c. High area of bone remodeling
d. Lamellar bone with slow remodeling
e. Osseo integration is not needed

AA: could not find anything as it relates to TADs, but saw some other info that discusses tetracyclines use for staining
newly mineralizing bone. That being the case, this would lead me to think “high area of bone remodeling” is the answer?

3 33. When is the best time to use Twinblock?

3 a. Late mixed dentition (O’Brien 2009)

**: According to ABO paper by O’Brien-- phase I twin block treatment does NOT result in any significant long term
differences as treatment started in the late-mixed or early-permanent dentition. There are actually burdens to patients in
early treatment, including attendance, cost, tx duration, and final occlusal result.

3 34. Which of the following is not associated with growth?

4 a. Synostoses*
b. Synchondrosis
c. Syndesmosis

**:
Synostosis- the joining of two bones by the ossification of connecting tissues. It occurs normally in the fusion of cranial bones
to form the skull.

Synchondrosis- a cartilaginous joint creating a union between two immovable bones, such as the synchondroses of the
cranium, the pubic symphysis, the sternum, and the manubrium.

Syndesmosis- a fibrous union in which two bones are connected by interosseous ligaments, such as the anterior and the
posterior ligaments in the radioulnar and tibiofibular articulations.

all taken from mosby’s medical dictionary

**: so shouldnt the answer be syndesmosis?
3 35. Which of the following is true
5 a. There was no advantage of 2 phase treatment in skeletal Class II.

**: obviously cannot see what other options were, but O’brien’s twin block study says that his results are consistent with
other RCT on class II correction; they say early class II tx is not justifiable.

3 36. What is common with hypocalcemia?

6 a. Muscle hyperactivity and decrease in cardiac output *
b. Irritability and hypermobility

**: Cardinal features are muscle spasm, irritability, tetany, paresthesias, seizures, and cardiac dysrhythmias
https://www.clinicalkey.com/topics/endocrinology/hypocalcemia.html
The neuromuscular symptoms of hypocalcemia are caused by a positive bathmotropic effect due to the decreased
interaction of calcium with sodium channels. Since calcium blocks sodium channels and inhibits depolarization of nerve and
muscle fibers, diminished calcium lowers the threshold for depolarization[1]. The symptoms can be recalled by the mnemonic
"CATS go numb"- Convulsions, Arrhythmias, Tetany and numbness/parasthesias in hands, feet, around mouth and lips.
● Petechiae which appear as on-off spots, then later become confluent, and appear as purpura (larger bruised areas,
usually in dependent regions of the body).
● Oral, perioral and acral paresthesias, tingling or 'pins and needles' sensation in and around the mouth and lips, and
in the extremities of the hands and feet. This is often the earliest symptom of hypocalcaemia.
● Carpopedal and generalized tetany (unrelieved and strong contractions of the hands, and in the large muscles of the
rest of the body) are seen.
● Latent tetany
○ Trousseau sign of latent tetany (eliciting carpal spasm by inflating the blood pressure cuff and maintaining
the cuff pressure above systolic)
○ Chvostek's sign (tapping of the inferior portion of the zygoma will produce facial spasms)[2]
● Tendon reflexes are hyperactive
● Life threatening complications
○ Laryngospasm
○ Cardiac arrhythmias
● ECG changes include:
○ Intermittent QT prolongation, or intermittent prolongation of the QTc (corrected QT interval) on the EKG
(electrocardiogram) is noted. The implications of intermittent QTc prolongation predisposes to life-threatening
cardiac electrical instability (and this is therefore a more critical condition than constant QTc prolongation).
This type of electrical instability puts the patient at high risk of torsades de pointes, a specific type of
ventricular fibrillation which appears on an EKG (or ECG) as something which looks a bit like a sine wave
with a regularly increasing and decreasing amplitude. (Torsades de pointes, as with any type of ventricular
tachycardia, causes death, unless the patient can be electrically cardioverted, and returned to a normal
cardiac rhythm.)
3 DUPLICATE Q 37. Which of the following is true about Herbst/MARA
7 a. It opens bite* (most people thought this was the right answer)

3 DUPLICATE Q 38. When compared to a patients who has not been treated with functional appliance, patients treated with functional
8 appliances _____ in mandibular length.
a. Increase in short term *
b. increase in long term
c. Increase in short and long term
d. No difference

**: as we had discussed, functional appliance therapy leads to short term increases in mandibular length; however, long
term the mandible winds up being the same length

3 39. Two Twinblock multiple choice questions – look these up

9 a. Mostly dentoalveolar effect
b. Acrylic over lower incisor to control their position
c. More growth than control after 4 year

**: “early twin block use” by O’Brien

● no advantage to early treatment
● burden of more appts, cost, longer tx time placed on patient
● early treatment did result in early reduction of OJ, small but favorable change in skeletal pattern, and improved
self-esteem “twin block vs. herbst” by Schaeffer
● both successfull treated class II
● twin block had greater overjet reduction, greater molar correction, greater sagittal correction of between jaws
(ANB), and produced greater increases in total mandibular length (due to increased height of the ramus)
● Dentoalveolar changes were similar for both; incisor position fell WNL
● Twin block noted for requiring patient compliance “timing of twin block therapy” by baccetti (may he RIP)
● compared patients treated with twin block at CVMI 1-2 with patients treated at CVMI 3-5
● results show that timing is optimal during or just before pubertal growth
● late tx group showed greater skeletal contribution to molar correction, larger increments in total mandibular
length and ramus height, and more posterior direction of condylar growth
● skeletal vs. dental change to correct overjet was the same in each group
4 40. When do you want to nasolabial molding ?
0 a. Within 3 month of birth (I think you do it really early in life to so the soft tissue grows somewhat normally for cleft
lip/palate pts.)

**: sequence of treatment for cleft patient

2-4 weeks-- lip closure
12-18 months-- palate closure
7-8 years-- align maxillary incisors
7-9 years-- alveolar bone graft (to be done before maxillary laterals, if present, or canines erupt)
Adolescence-- ortho + lip/nose revision
late adolescence-- orthognathic surgery

Profitt pg. 321

Stretches tissue before surgery

4 DUPLICATE Q 41. When do you get reduction in 50% strength of elastomer after how many days?
1 a. 1 * (Nanda)
b. 2
c. 3
d. 5

4 42. Short class II elastic through center of resistance of maxilla and distal to center of resistance of mand will
2 a. steepen maxillary occlusal plane
b. flatten maxillary occlusal plane
c. neither flatten nor steepen max occlusal plane*
d. flatten mand occl plane

**: pulling through the center of resistance of a tooth, for example, would cause bodily translation, not a change in
angulation; the same should hold true for the maxilla, ie. the occlusal plane does not change.

4 DUPLICATE Q 43. How much DI point can you give for the molar relationship of this pt? pt had full cusp Cl III
3 a. Give 4 pts per side for full cusp and 2pts per side for edge to edge
4 44. How do you treat black triangle of patient with ideal tooth size.
4 a. Diverge root (I would think this will worsen)
b. IPR *

**: reducing black triangles is accomplished most readily by removing enamel at the contact point so the teeth can be
moved closer together
Profitt pg. 315
or converge root

**: But if teeth sizes are ideal, then you cant IPR and have to change contact point by means of tip of the root????

4 45. What do you want to look for when you see pt w/ black triangle
5 a. Crown width
b. Crown height
c. Ratio of crown width to height
d. Mesiodistal tip *
e. Axial inclination

4 46. What is ratio of mand to max dentiton 6-6?

6 a. 91%

**: bolton ratios for mand:max

6-6 = 91.3%
3-3 = 77.2 %
● ratios larger than the average indicate mandibular excess
● ratios smaller than the average indicate maxillary excess

4 47. Bolton discrepancy can be associated with all of the following except:
7 a. End to end ant occ
b. Difficulty getting Class I posteriorly
c. Small maxillary lateral incisors
d. Posterior transverse discrepancy *
e. Lack of protrusive protective guidance.
4 48. Which of the following increase from age 8 to 18.
8 a. Facial axis *
b. Mandibular plane angle (would decrease)
c. Facial convexity (would decrease)
d. Mandibular plane angle and facial axis
**: Facial axis - angle formed between BaN plane and the plane from foramen rotundum (PT) to Gn. On average usually 90
degrees. A lesser angle suggest a retropositioned chin, whereas an angle greater than 90 degrees suggests a protrusive
chin. Ricketts. PT = intersection of the inferior border of foramen rotundum with the posterior wall of the pterygoid
maxillary fissure.

Not to confuse with Facial angle = FH and N-Pog

4 DUPLICATE Q 49. What do you do when you are finishing a case with CO-CR slide less than 2mm and want coincident midline?
9 a. Occlusal equabilation

Refer to initial review #65

5 DUPLICATE Q 50. You are doing an experiment and want to see how 3 things relate. What do you want to use?
0 a. Correlation
b. ANOVA *

**: as we discussed, ANOVA for 3+ comparisons, t-test for comparing 2 things

**: yoU CAN use a “correlation” test multiple variables. not a regular pearson but a variation of it....I thin the answer may
be correlation.

The coefficient of multiple correlation, denoted R2, is a scalar that is defined as the square of the Pearson correlation
coefficient between the predicted and the actual values of the dependent variable in a linear regression model that includes
an intercept.

5 51. What happens to molar when you use intrusion arch?

1 a. Distal tip and extrude

**: “intrusion mechanics” by Burstone (pg. 5)

intrusion arch places an extrusive force on the molars as well as crown distal/root mesial tip
other side effects: from lateral view, maxillary occlusal plane tends to steepen (counteracted by keeping intrusive forces
low and using occiptal headgear that is anterior to the maxillary center of resistance)
from the frontal view, there is an extrusive force on the molars that also tips the crown palatally (counteracted by use of
palatal arch)
5 52. If you use rectangular AW utility archwire, what is the best way to prevent adverse effect on molar?
2 a. HP HG with short outerbow
b. HP HG with short outerbow and TPA*
c. HP HG with short longbow and TPA

5 53. One central incisor is late to emerge. A periapical film shows that its incisal edge is 5mm from the level of the CEJ of
3 adjacent central incisor. Which technique gives most esthetic final result?
a. APF
b. Closed eruption*
**: From article: #69: Uncovering labially impacted teeth: apically positioned flap and closed-eruption techniques
Conclusions
A. Teeth uncovered with APF have more unesthetic sequalae compared to closed eruption technique
1. Inc clinical crown length, inc width of attached tissue, gingival scarring, intrusive relapse
B. Perio attachment differences between uncovered and contralateral control not clinically significant for either
group

5 DUPLICATE Q 54. What happens with Scaphocephaly?

4 a. Early fusion of coronal suture
b. Early fusion of sagittal suture* (I think it is same thing as scaphocephaly)

5 DUPLICATE Q 55. Gorlick found that 50% of patients have decalcification (white spots). Gorlick recommended waiting 2-3months after
5 debond b/f applying fluoride. àBoth true
5 56. Which of the following form floor of orbit? Maxilla, zygomatic and..
6 a. Palatine

**::

**: Roof of orbit: Frontal bone and lesser wing of sphenoid

Medial wall: Maxilla, lacrimal bone, ethmoid, sphenoid
Floor: Maxilla, zygomatic bone, palatine bone
Lateral wall: zygomatic bone, greater wing of sphenoid

5 57. Order of growth

7 a. Width first, sagittal then vertical
Profitt page 104

5 58. Maximum force for immediate loading of TADs

8 a. 100-200g (Chen article)
**: Chen’s findings--
1. placement-related factors-
● pilot hole 0.2-0.5 mm less than diameter of implant and slightly less than length of implant (this was MOST
important finding for success)
2. loading-related factors-
● no 6-month healing period required; early or immediate horizontal loading of 100-200 g is successful
● TADs stable with both direct and indirect anchorage, but indirect anchorage was associated with some anchorage
loss
3. size-related factors
● TADs with diameter of 1.2-1.3 mm are considered safe for interradicular placement; greater than 2 mm cannot be
considered safe for interradicular placement
5 59. Where is center of rotation
9 a. Apical ⅓ (wrong)

**: Center of rotation-- the point around which rotation occurs when an object is being moved. If a force and a couple are
applied to an object, the center of rotation can be controlled and made to have any desired location
Center of resistance-- a point at which resistance to movement can be concentrated for mathematical analysis; for a tooth,
this is approximately the midpoint of the embedded portion of the root.

Profitt pg. 373

Biology of tooth movement p.325

S**: Cres single roots: 66% from apex, multi-roots near furcation (varies in cases of bone loss)
Per Biomechanics course we can move the force to control Crot
M/F ratio:
12/1: root movement
10/1 = translation
5/1: controlled tipping around apex
0/1: uncontrolled tipping around mid-root

6 60. Which of following NOT acceptable radiographic record for patient older than 18 for ABO clinical exam (From Grubb
0 2008)
a. Full-mouth periodontal probing recorded by the examinee prior to initiating orthodontic therapy.
b. Written documentation of pretreatment periodontal status including a full periodontal charting received from a
periodontist, general or pediatric dentist.
c. Pretreatment panoramic, vertical or conventional bitewings, and maxillary and mandibular periapical radiographs.
d. Full-mouth series of periapical and bitewing radiographs.
e. PSR *

**: the first four options are the guidelines as outlined by the ABO article #10 by Grubb; in addition, it says that post-
treatment documentation of similar format must be submitted for comparison of the patient’s pre-tx and post-tx
periodontal status.
**: PSR=periodontal screening record. You only chart highest probing depth in that sextant. Board wants full perio-
charting
6 Your adult patient Options:
1 with history of a. 2-3 months after active treatment
periodontitis has b. After getting approval from the periodontist to start orthodontic treatment.
received treatments Answer:
and now is in **:
maintenance phase. b. I think you need to get approval from the periodontst that periodontal disease has resolved and is in a maintenance
When should you phase. “2-3 months after active treatment” is probably not the right answer because there’s no guarantee that the
start the orthodontic periodontitis is under control, it just means the patient has had treatment but you don’t know it was effective.
treatment. Furthermore, just because a patient had

Proffit Ch. 18 pg 639 Special Considerations for Treatment in Adults:

Boyd RL, Leggon Pl, Quinn RS, et al. Periodontal implications of orthodontic treatment in adults with reduced or normal
periodontal periodontal tissues versus those of adolescents. Am J Orthod Dentofac Orthop 96:l9l-199, 1989

“Orthodontic tooth movement superimposed on poorly controlled periodontal health can lead to rapid and irreversible
breakdown of the periodontal support apparatus. Scaling, curettage( by open flap procedures, if necessary)and gingival
grafts should be undertaken as appropriate. Surgical pocket elimination and osseous surgery should be delayed until
completion of the orthodontic phase of treatment because significant soft tissue and bony recontouring occurs during
orthodontic tooth movement. Clinical studies have shown that orthodontic treatment of adults with both normal and
compromised periodontal issues can be completed without loss of attachment, providing there is good periodontal
therapy both initially and during tooth movement.

It is often wise to use surgical flaps to expose these areas to ensure the best possible scaling. Procedures to facilitate the
patient's long-term maintenance like osseous recontouring or repositioned flaps to compensate for areas of gingival
recession, are best deferred until the final occlusal relationships have been established. A period of observation following
preliminary periodontal treatment, to make sure that the patient is adequately controlled and to allow healing after the
periodontal therapy, should precede comprehensive orthodontics.

J Indian Soc Periodontol. 2012 Jan-Mar; 16(1): 11–15.

doi: 10.4103/0972-124X.94597
PMCID: PMC3357017 Orthodontic–periodontics interdisciplinary approach
K. Vinod, Y. Giridhar Reddy, Vinay P. Reddy,1 Hemant Nandan,1 and Meenakshi Sharma2

Patient's compliance, motivation, and oral hygiene maintenance will help determine the best time to start adjunctive
orthodontic treatment. It is suggested that tooth movement can be undertaken 6 months after completion of active
periodontal treatment if there is sufficient evidence of complete resolution of inflammation.[26] Sanders[30] has
recommended a three-step comprehensive protocol to be followed before, during, and after adjunctive orthodontic
therapy.
Sanders NL. Evidence-based care in orthodontics and periodontics: A review of the literature. J Am Dent Assoc.
1999;130:521–7.
“Suggested protocol before orthodontic therapy. Before orthodontic treatment is begun, each member of the dental team
must be sure that the patient is practicing excellent oral hygiene and is free of active periodontal disease. Ideally, the
restorative dentist or periodontist should, at the time of orthodontic referral, provide the orthodontist with the following:
copy of the patient’s recent periodontal charting; recent anterior periapical radiographs and bitewing radiographs; a
written periodontal clearance statement that the patient may safely begin orthodontic treatment.
…
Patients with evidence of periodontal disease. If there is evidence of periodontal disease, orthodontic treatment must be
postponed. The patient must be referred for appropriate periodontal therapy, including subgingival
débridement and, if appropriate, periodontal surgery, followed by a two- to four month healing and observation
period. If the patient has maintained excellent oral hygiene during this period, and there are no sites of significant bleeding
on probing, the periodontist or restorative dentist should provide the orthodontist with a written periodontal clearance
statement. If, on the other hand, bleeding sites are still observed on probing, other appropriate forms of periodontal
therapy may be indicated, followed by another observation period.”

**: Article 86: After RP+S wait 3 months, approx. time needed for inflammation to diminish
6 Which correction is Options:
2 most stable/ has least a. Class II *
relapse potential? b. Leveling curve of spee
c. Rotation
d. Incisor alignment
e. Expansion

answer:
**: I think maybe b is the better option after reading Proffit, who seemed to say Class II correction could relapse quickly if
the patient still had growth left at debond and class II elastics were used. Not sure where peter got the 16% relapse of
Curve of Spee. Maybe a good question to confirm with Dr. Suri?

Graber pg 1009-1011
Limited Retention required for:
- Corrected Anterior crossbites, Corrected Posterior crossbites not expanded orthopedically or surgically
- Dentitions corrected by serial extract
- High Canine Extraction cases
- upper bi extraction cases
- Corrections achieved by retardation of maxillary growth after patient is done growing
- Dentitions where teeth have been separated to allow room for blocked out teeth

Moderate retention required:

- Class I non-ex cases, Class I or II exo cases: retain until normal lip and tongue function achieved
- Correction of deep overbites, use retainer with bite plane, if corrected with clockwise mandibular rotation, retain until
ramal growth catches up and neuromuscular balance can adapt
- early correction of rotated teeth if root fo
- excessive spacing between maxillary incisors requires prolonged retention
- Class II Div 2 need long retention

Permanent or semipermanent retention required

- expansion of intercanine width
- considerable or generalized spacing
- severe rotation, esp adults

Peter’s doc says “Curve of Spee correction is relatively stable with an average relapse of 16%”

Proffit pg 619
In late adolescence, continued growth in the pattern that caused a Class II, Class III, deep bite or open bite problem in the
first place is a major cause of relapse after orthodontic treatment and requires careful management during retention.6
 Overcorrection of the occlusal relationships as a finishing procedure is an important step in controlling tooth movement
that would lead to Class II relapse. Even with good retention, 1 to 2 mm of anteroposterior change caused by adjustments
in tooth position is likely to occur after treatment, particularly if Class II elastics were employed. This
change occurs relatively quickly after active treatment stops.

6 When impacting Options:

3 maxilla where to put a. Incisal display at rest (But Burstone paper says you don’t want more than 3mm incisal display at rest)
upper incisors? b. Incisal display at full smile *
**: From Sarver article: “Some amount of gingival display [when smiling] is ...esthetic and youthful appearing. Conversely,
a complete lack of gingival display (defined in terms of the percentage of incisor show on smile) is not as attractive as
complete tooth dispaly or even some gingival display. Males as a group show less of the maxillary incisors and more of the
mandibular incisors at rest and on smile than do females. It is a characteristic of aging to show less of the maxillary incisors
at rest and on smile, so that, to a degree, more tooth display is considered a more youthful smile.” I think you would
impact the maxilla based on the amount of incisor and gingival display on smiling, not at rest.
6 Question on CMV. Per Baccetti’s 2005 article:
4 Asked what do you
know about growth Cervical stage 1 (CS1, Fig 3). The lower borders of all the three vertebrae (C2-C4) are flat. The bodies of both C3 and
potential of this C4 are trapezoid in shape (the superior border of the vertebral body is tapered from posterior to anterior). The peak in
person. It had mandibular growth will occur on average 2 years after this stage.
concave C2 and
relatively flat C3 and
4. But non of the Cervical stage 2 (CS2, Fig 4). A concavity is present at the lower border of C2 (in four of five cases, with the remaining
choices made much subjects still showing a cervical stage 1). The bodies of both C3 and C4 are still trapezoid in shape. The peak in mandibular
sense. There were no growth will occur on average 1 year after this stage.
question on hand-
wrist Cervical stage 3 (CS3, Fig 5). Concavities at the lower borders of both C2 and C3 are present. The bodies of C3 and C4
may be either trapezoid or rectangular horizontal in shape. The peak in mandibular growth will occur during the year
after this stage.

Cervical stage 4 (CS4, Fig 6). Concavities at the lower borders of C2, C3, and C4 now are present. The bodies of both
C3 and C4 are rectangular horizontal in shape. The peak in mandibular growth has occurred within 1 or 2 years before this
stage.

Cervical stage 5 (CS5, Fig 7). The concavities at the lower borders of C2, C3, and C4 still are present. At least one of the
bodies of C3 and C4 is squared in shape. If not squared, the body of the other cervical vertebra still is rectangular
horizontal. The peak in mandibular growth has ended at least 1 year before this stage.

Cervical stage 6 (CS6, Fig 8). The concavities at the lower borders of C2, C3, and C4 still are evident. At least one of the
bodies of C3 and C4 is rectangular vertical in shape. If not rectangular vertical, the body of the other cervical vertebra is
squared. The peak in mandibular growth has ended at least 2 years before this stage.

Baccetti’s 2002 Article (that is, the actual board article says):

CVMS I: the lower borders of all the three vertebrae are flat, with the possible exception of a concavity at the lower border
of C2 in almost half of the cases. The bodies of both C3 and C4 are trapezoid in shape (the superior border of the vertebral
body is tapered from posterior to anterior). The peak in mandibular growth will occur not earlier than one year after this
stage.

CVMS II: Concavities at the lower borders of both C2 and C3 are present. The bodies of C3 and C4 may be either
trapezoid or rectangular horizontal in shape. The peak in mandibular growth will occur within one year after
this stage.

CVMS III: Concavities at the lower borders of C2, C3, and C4 now are present. The bodies of both C3 and C4 are
rectangular horizontal in shape. The peak in mandibular growth has occurred within one or two years before
this stage.

CVMS IV: The concavities at the lower borders of C2, C3, and C4 still are present. At least one of the bodies of
C3 and C4 is squared in shape. If not squared, the body of the other cervical vertebra still is rectangular horizontal.
The peak in mandibular growth has occurred not later than one year before this stage.

CVMS V: The concavities at the lower borders of C2, C3,and C4 still are evident. At least one of the bodies of
C3 and C4 is rectangular vertical in shape. If not rectangular vertical, the body of the other cervical vertebra
is squared. The peak in mandibular growth has occurred not later than two years before this stage.

When CVMS I is diagnosed in the individual patient with mandibular deficiency, the clinician can wait at least one
additional year for a radiographic re-evaluation aimed to start treatment with a functional appliance. CVMS II represents
the ideal stage to begin functional jaw orthopedics, as the peak in mandibular growth will occur within one
year after this observation. In the sample examined here, total mandibular length exhibited an average increase of 5.4
mm in the year following CVMS II, a significantly greater increment when compared both to the growth interval from
CVMS I to CVMS II (about 2.4 mm) and to following between-stage intervals (1.6 mm and 2.1 mm for the intervals
from CVMS III to CVMS IV and from CVMS IV to CVMS V, respectively).
**: Does article say approx. % of growth remaining at each stage? It sounds like that is what they are looking for.
**: It’s the hand-wrist analysis that uses the metric % of growth left, not CVM
6 What do you use to Options:
5 see perforated disk? a. MRI
b. Anthrogram*

**: Let’s discuss this:

Graber pg 114:
Magnetic Resonance Imaging: Imaging of the soft tissues in and around the TMJs using MRI has coincided
with and created interest in the function and biology of the TMJ. Because x-ray–based imaging, including CT
scans and tomograms, is unable to show intraarticular soft tissues adequately, MRI is the preferred imaging
technique when information regarding the articular disk, presence of adhesions, perforations, or joint effusion is
desired. MRI has the advantage of creating an image without using ionizing radiation, without pain, and
without distorting tissues...Recently, MRI spectrometry and functional and dynamic MRI have been used to supply clinical
information about jaw function. Interpretation of MRI has been able to achieve 90% or greater accuracy in the
identification of condylar erosions, osteophytes, and flattening and disk position.

Arthrography: Arthrography relies on radiographic image acquisition following the intraarticular administration
of an iodinated contrast agent. The contrast is placed transcutaneously under fluoroscopic guidance. Arthrography has
contributed greatly to the understanding of disk position, but in recent years MRI has reduced the number of arthrograms
performed on the TMJ. Arthrography has an advantage over MRI of dynamic visualization, in identifying the presence of
the perforations between the superior and inferior joint compartments and adhesions but has the disadvantages of
increased patient risks related to radiation dosage, percutaneous injection into the TMJ, and potential for allergic reaction.

http://www.appliedradiology.com/Issues/2008/09/Articles/MRI-of-temporomandibular-joint-disorders.aspx

This source implies that arthography has been the traditional means of imaging the disc, but with new dynamic imaging
MRI, all soft tissues can be seen adequately and you would be able to diagnose a perforated disc with an MRI without the
radiation exposure.

From Katzberg R, Temporomandibular Joint Imaging, Anesth Prog 37:121-126 1990:

Arthrography is indicated for an evaluation of the soft-tissue components of the TMJ, especially disk position, function, and
morphology in those patients presenting with a suspected internal derangement.

The arthrographic procedure for depiction of the joint space entails the injection of a water-soluble contrast material
into the lower alone or lower and upper joint compartments under fluoroscopic guidance and using a 23-
gauge scalp vein needle.12 Approximately 0.4-0.5 mL of contrast medium is injected into the lower compartment
under fluoroscopic observation. We use approximately 0.03 mL of 1: 1000 epinephrine mixed into 3 mL of
contrast material to allow intraarticular containment of contrast medium for subsequent imaging.
Articulation, fluoroscopic-dynamic videotape images are recorded during opening and closing of the jaw (Figure
3a, b). In those patients having disk displacement without reduction or in those articulations that are normal or
indeterminate, multidirectional tomography (arthrotomography) is performed following the fluoroscopic component
of the examination.

The advantages of arthrography are: a) it accurately depicts the anatomic relationship of the disk to the condyle
and temporal bone; b) it enables a dynamic functional assessment of normal and abnormal physiology; c) it is
easy to perform in experienced hands; d) it has limited requirements for specialized imaging technology; and e)
it is relatively inexpensive compared with computed tomography (CT) and magnetic resonance (MR) imaging.

The disadvantages of arthrography are: a) it involves a substantial radiation dose in a predominantly young, female
population; b) it is an invasive procedure; c) its successful performance requires training and experience;
d) it cannot accurately depict bony pathology; e) it is probably less precise in demonstrating anatomic, positional
abnormalities than MR; and f) it cannot directly depict the soft-tissue components of the articulation.
6 What is the best way Options:
6 to diagnose condylar a. Tech99 * (you see + tech99 bone scan with condylar hyperplasia)
hyperplasia? b. CBCT

**: Get conflicting information, think bone scan is the way to go since condylar hyperplasia dx is concerned with detecting
metabolic activity

Proc (Bayl Univ Med Cent). 2009 October; 22(4): 321–329. PMCID: PMC2760163 Surgical management of mandibular
condylar hyperplasia type 1 Larry M. Wolford, DMD, Carlos A. Morales-Ryan, DDS, MSD, Patricia García-Morales, DDS,
MSD, and Daniel Perez, DDS

Determining active growth

Active CH type 1 growth can usually be determined by worsening functional and aesthetic changes with serial assessments
(preferably at 6- to 12-month intervals) consisting of 1) clinical evaluation; 2) dental analysis with orthodontically trimmed
models or articulator-mounted models in centric relation; and 3) radiographic evaluation by superimposition including
lateral cephalometric radiographs, frontal cephalometric radiographs (particularly helpful in unilateral CH cases), and
lateral cephalometric tomograms that include the TMJ, mandibular ramus, and body.
Bone scanning with technetium-99m pyrophosphate or technetium-99m methylene diphosphonate has been advocated
to detect active growth in the condyle (22–26). This may be most effective in unilateral cases, especially if applied after
the normal growing years when condylar growth should have ceased. However, the senior author has not found bone
scans diagnostic in most cases and therefore does not recommend the use of bone scans for CH type 1 patients. Normal
condyles have increased uptake with bone scanning, and the rate of accelerated growth may not be detectable.
Furthermore, in asymmetric CH types 1A and 1B, the contralateral TMJ may present with arthritic condylar changes, a
displaced articular disc, and associated inflammation that may also present with increased isotope uptake, rendering the
bone scan inconclusive. In our experience, we have found bone scans to be inconclusive in younger patients, in patients
with slow-growing CH, and in patients with coexisting disc displacement on the contralateral side. Hand-wrist films are of
no value in CH since the mandible can continue to grow well beyond the normal growth years.

J Contemp Dent Pract. 2012 Nov 1;13(6):914-7. Condylar hyperplasia. Shankar U, Chandra S, Raju BR, Anitha G, Srikanth KV,
Laheji A.
“The diagnosis and treatment of mandibular asymmetry is quite difficult because of complexity of the deformity. Because
treatment is influenced by the patients’ growth, it is important to determine whether growth is still occurring. this can best
be accomplished by using technetium-99m bone scans. CH usually occurs after puberty and is completed by 18-25 years.
Prominent features of CH include an enlarged condyle, elongated condylar neck, outward bowing and downward growth of
the body and ramus on the affected side.”
6 CBCT gives better T/f?
7 image than medical **: F
CT.
Disadvantages of CBCT technology
De Vos, W; et al. Cone-beam computerized tomography (CBCT) imaging of the oral and maxillofacial region: A
systematic review of the literature. Int J Oral Maxillofac Surg 2009;38:609–625.

Mah, P; et al. Deriving Hounsfield units using grey levels in cone beam computed tomography. Dentomaxillofacial
Radiology 2010;39:323–335.

There are a number of drawbacks of CBCT technology over that of medical-grade CT scans, such as increased susceptibility
to movement artifacts (in first generation machines) and to the lack of appropriate bone density determination.[5] Dental
CBCT systems do not employ a standardized system for scaling the grey levels that represent the reconstructed density
values and, as such, they are arbitrary and do not allow for assessment of bone quality.[12] In the absence of such a
standardization, it is difficult to interpret the grey levels or impossible to compare the values resulting from different
machines. While there is a general acknowledgment that this deficiency exists with CBCT systems (in that they do not
correctly display HU), there has been little research conducted to attempt to correct this deficiency.[13]
CBCT doesn’t give as many shades of grey.

6 Why do you use Options:

8 platelet rich plasma? a. something about growth factor
**: Platelet-rich plasma (PRP) is blood plasma that has been enriched with platelets. As a concentrated source of
autologous platelets, PRP contains (and releases through degranulation) several different growth factors and other
cytokines that stimulate healing of bone and soft tissue.
The efficacy of certain growth factors in healing various injuries and the concentrations of these growth factors found
within PRP are the theoretical basis for the use of PRP in tissue repair.[1] The platelets collected in PRP are activated by the
addition of thrombin and calcium chloride, which induces the release of these factors from alpha granules. The growth
factors and other cytokines present in PRP include:[1][2]
● platelet-derived growth factor
● transforming growth factor beta
● fibroblast growth factor
● insulin-like growth factor 1
● insulin-like growth factor 2F
● vascular endothelial growth factor
● epidermal growth factor
● Interleukin 8
 ● keratinocyte growth factor
● connective tissue growth factor

6 Most common a. Odontoma *

9 odontogenic b. Ameloblastoma
pathology? c. OKC
d. Cementoblastoma

**: Peter’s doc and Temple doc say odontomas; It’s important to note that if they ask for just “most common,” answer is
odontoma, but if they ask for most common clinically significant or true neoplasm, it’s ameloblastoma.

http://www.utmb.edu/otoref/grnds/Odontogenic-tumor_2002-02/Odontogenic-Tumors-2002-02.htm
Odontogenic Tumors-Epithelial Odontogenic Tumors
“Ameloblastoma – The ameloblastoma is the most common odontogenic tumor. It is a benign but locally invasive
neoplasm derived from odontogenic epithelium.”

Neville, Oral and Maxillofacial Pathology, Second Edition, Ch. 13

“ The Ameloblastoma is the most common clinically significant odontogenic tumor. It’s relative frequency equals the
combined frequency of all other odontogenic tumors, excluding odontomas...slow growing, locally invasive, usually benign;
can be multicystic, unicystic, or peripheral/extraoseous.
Odontomas are the most common types of odontogenic tumors. Their prevalence exceeds that of all other odontogenic
tumors combined. they’re considered to be developmental anomalies (hamartomas) rather than true neoplasms. They
don’t infiltrate, cause pain.”

7 Where do you Register on sella. Best fit on platinum splenoum, cribliform plate and sphenoid and occiput
0 superimpose anterior duplicate
cranial base?
**: From ABO
http://www.americanboardortho.com/professionals/downloads/Clinical%20Examination%20Guide.pdf
Craniofacial Superimpositions - register on Sella with the best fit on the anterior cranial base
bony structures (Planum Sphenoidum, Cribiform Plate, Greater Wings of the Sphenoid) and Occiput to
assess overall growth and treatment changes.
7 Where do you a. Inner cortical of symphosis with best fit on mand canal
1 superimpose mand?
**: http://www.americanboardortho.com/professionals/downloads/Clinical%20Examination%20Guide.pdf

2. Maxillary Superimpositions - register on the vertical legs of the key ridges (anterior and
posterior contours of the zygomatic arches); align the key ridges both horizontally and vertically and
the best fit of the internal structures of the maxillary bony complex.

3. Mandibular Superimpositions - register on the internal cortical outline of the symphysis with the
best fit on the mandibular canal to assess mandibular tooth movement and incremental growth of the
mandible.

7 What points do ABO a. Menton and constructed gonion

2 use for mand plane?
**: menton to constructed gonion is correct, reference:
http://www.americanboardortho.com/professionals/clinicalexam/casereportpresentation/preparation/mandibularplaneex
hibit.aspx
7 Which of the a. Agenesis of third molar 10% * (should be 20%)
3 following is not true? b. Agenesis of unilateral 2nd premolar 3%
c. Agenesis of third molar associated with 13x chance of missing other teeth
d. Agenesis of third molar not related to crown shape of lateral and premolar

From Article #37, Vastardis, The genetics of human tooth agenesis: New discoveries for understanding dental anomalies,
American Journal of Orthodontics & Dentofacial Orthopedics, Volume 117, Issue 6, Pages 650-656, June
2000
I. Clinical Epidemiology
A. Incidence of permanent tooth agenesis: 1.6-9.6% (excluding 3rd molars)
B. Incidence of primary dentition agenesis: 0.5-0.9%
C. Severe tooth agenesis (absence 4 or more teeth beside 3rd molars): 0.25%
D. Third molar agenesis is most common (20%)
1. Debate between 2nd most commonly missing tooth: max lateral or mand 2nd premolar: in a sample of 5127
patients, agenillary lateral incisors had a 2.2% frequency and agenesis ofthe second premolar had a 3.4%
frequency. In reference to second premolars, agenesis of a single second premolar is the most common form
and absence of the 3 premolars occurs least frequently.
2. Max lateral most frequently missing when 1 or 2 teeth absent
3. 2nd premolars most frequently missing when more than 2 teeth absent
E. If 3rd molar absent:
1. Agenesis of remaining teeth is 13x more likely
2. Predisposition for reduced size and delayed development of certain teeth: Molars and premolars of same
quadrant delayed in formation and eruption
3. Also linked to diminished stability of specific molar cuspal patterns (reduction cusp of Carabelli)
F. Agenesis of one lateral often accompanied by small lateral on contralateral side
G. Elevated tooth agenesis in patients with:
1. Max canine-first premolar transposition
2. Palatally displaced max canine
3. Mand lateral-mand canine transposition
H. Prevalence for missing teeth depends on population
7 How does suture a. Functional matrix
4 grow?
**: I’m not really sure what this question is getting at, without seeing what the other options are.

Proffit pg 55
Moss theorizes that growth of the face occurs as a response to functional needs and neurotrophic influences and is
mediated by the soft tissue in which the jaws are embedded. In this conceptual view, the soft tissues grow, and
both bone and cartilage react. The growth of the cranium illustrates this view of skeletal growth very well. There can be
little question that the growth of the cranial vault is a direct response to the growth of the brain. Pressure exerted by the
growing brain separates the cranial bones at the sutures, and new bone passively fills in at these sites so that the brain case
fits the brain.

Proffit, pg 34
Cranial Vault: Intramembranous ossification
“Remodeling and growth occur primarily at the periosteum-lined contact areas between adjacent skull bones, the cranial
sutures, but periosteal activity also changes both the inner and outer surfaces of these platelike bones. After birth,
apposition of bone along the edges of the fontanelles eliminates these open spaces fairly quickly, but the bones remain
separated by a thin, periosteum-lined suture for many years, eventually fusing in adult life. Despite their small size,
apposition of new bone at these sutures is the major mechanism for growth of the cranial vault. Although the majority of
growth in the cranial vault occurs at the sutures, there is a tendency for bone to be removed from the inner surface of the
cranial vault, while at the same time, new bone is added on the exterior surface. This remodeling of the inner and outer
surfaces allows for changes in contour during growth.

Cranial Base: endochondral ossification

As one moves laterally, growth at sutures and surface remodeling become more important, but the cranial base is
essentially a midline structure. The situation is more complicated, however, than in a long bone with its epiphyseal plates…
As ossification proceeds, bands of cartilage called synchondroses remain between the centers of ossification (Figure 2-24).
These important growth sites are the synchondrosis between the sphenoid and occipital bones, or spheno-occipital
synchondrosis, the intersphenoid synchondrosis between two parts of the sphenoid bone, and the spheno-ethmoidal
synchondrosis, between the sphenoid and ethmoid bones. Histologically, a synchondrosis looks like a two-sided epiphyseal
plate( Figure 2-25). The area between the two bones consists of growing cartilage. The synchondrosis has as an area of
cellular hyperplasia in the center with bands of maturing cartilage cells extending in both directions, which will eventually
be replaced by bone.

Maxilla: intramembranous ossification

combination of growth at sutures and direct remodeling of the surfaces of the bone. The maxilla is translated downward
and forward as the face grows, and new bone fills in at the sutures. The extent to which growth of cartilage of the nasal
 septum leads to translation of the maxilla remains unknown, but both the surrounding soft tissues and this cartilage
probably contribute to the forward repositioning of the maxilla.

Mandible: endochondral proliferation at the condyle and apposition and resorption of bone at surfaces. It seems clear that
the mandible is translated in space by the growth of muscles and other adjacent soft tissues and that addition of new bone
at the condyle is in response to the soft tissue changes.

7 How does a. Capsular matrix

5 craniofacial growth b. Functional space
occur? A and B *
Functional space ie. airway

**: Good summary I found of Functional Matrix theory http://www.scribd.com/doc/58510397/Theories-of-Growth

Fundamentally, the functional matrix hypothesis maintains that, heredity and the genes play no significant deterministic
role in the growth of skeletal structures in general and of the craniofacial skeleton in particular. The craniofacial skeleton,
like all skeletal structures throughout the body,develops initially and grows in direct response to its extrinsic, epigenetic
environment. As stated by Moss, “bones do not grow; bones are grown.” A number of relatively independent functions are
carried out in the craniofacial region of the human body like respiration, mastication,swallowing, speech etc. Each of these
functions is carried out by functional cranial component. Each functional cranial component consists of all the tissues,
organs, spaces and skeletal parts necessary to carry outthe given functions. Functional cranial components are comprised
of the following two elements:
(1) a functional matrix
and
(2) a skeletal unit

The functional matrix refers to all the soft tissues and spaces that perform a given function. The skeletal unit refers to the
bony structures that support the functional matrix and thus are necessary or permissive for that function. Individual bones
defined according to traditional anatomy may be comprised of a number of overlapping skeletal units as the skeletal unit
refers not to the individual bone directly, but to the function(s) that it supports.

There are two types of functional matrices

 The periosteal matrix: corresponds to the immediate local environment, typically muscles, blood vessels, and
nerves.
  The capsular matrix: defined as the organs and spaces that occupy a broader anatomical complex. Within the
craniofacial complex, the capsular matrices would include such organs as the brain and globes of the eyes, as well
as actual spaces such as the nasopharynx and oropharynx.

There are also two categories of skeletal units:(1)microskeletal units and(2) macroskeletal units
Functional variations in the periosteal matrix, such as muscle activity for example, may be locally expressed within the
microskeletal unit as tuberosities and processes or ridges for muscle attachment. Growth in size and shape of microskeletal
units is typically associated with transformation from an embryonic cell type to an osteoblast-osteocyte associated with
periosteal deposition. Changes in the size and shape of macroskeletal units, which include the neurocranium and
maxillomandibular complex, are the result primarily of expansion of the capsular matrices and
translational growth of associated skeletal structures. According to the functional matrix hypothesis, the craniofacial
skeleton does not grow in primary fashion to permit expansion of the soft tissues, organs and spaces comprising the
functional matrix. Rather, translation of skeletal units and associated local transformational bone growth of bone tissue
occurs secondarily and in compensatory fashion to growth of the functional matrix, and in particular of growth-related
expansion of the capsular matrices

7 What does HIPPA Health Insurance Portability and Accountability Act

6 mean?
**: yes, this is what it stands for
http://www.hhs.gov/ocr/privacy/

7 Most common cause Parafunction

7 of TMD?
DUPLICATE
7 what is % of topical a. 0.05
8 fluoride mouth rinse?
**: Act has .05% sodium fluoride
All ACT products in an 18oz or smaller bottle, with the exception of ACT Total Care Dry Mouth, contain 0.05% sodium
fluoride, which is equivalent to 0.02% of the fluoride ion. These products are designed to provide all the benefits of fluoride
if used just once daily. Our 33oz bottles and 18oz Total Care Dry Mouth contain 0.02% sodium fluoride, which is equivalent
to 0.009% of the fluoride ion. These products are designed to provide all the benefits of fluoride when used twice daily.

http://www.listerine.com/products/total-care-fresh-mint-anticavity-mouthwash
Listerine Total Care also .05% (Wrong! Listerine Total care is actually .02% NaF but is directed to use twice a day)

Colgate Phos-Flur
Cool Mint
● Active Ingredients: Sodium fluoride 0.044% (w/v)
● Inactive Ingredients: Purified water, sorbitol solution 70% sodium phosphate monobasic, poloxamer 338, flavor,
potassium sorbate, phosphoric acid, polysorbate 20, FD&C Blue #1

7 Wormian bone is a. Osteopetrosis

9 found in b. Alveolar osteitis
c. Cleidocranial dysositosis*
d. Paget’s disease
e. Osteoporosis

http://radiopaedia.org/articles/wormian-bones:
Dr Frank Gaillard et al. view revision history
Wormian bones are a subset of the small intrasutural bones that lie between the cranial sutures formed by the bones of
the skull vault. The title Wormian bones is given to abnormal intrasutural bones that are typically found around the
lambdoid suture.
Some consider them abnormal if only greater than 10 in number.

Epidemiology
The reported incidence is variable, ranging from around 10% (in Caucasian skulls), 40% (in Indian skulls) to 80% (in Chinese
skulls). In general, males are more frequently affected than females.

Associations
Their associations are protean, and inclusive of
● pyknodysostosis
 ● osteogenesis imperfecta
● rickets
● kinky hair syndrome
● cleidocranial dysostosis
● hypothyroidism
● hypophosphatasia
● otopalatodigital syndrome
● primary acroosteolysis (Hajdu-Cheney syndrome)
● pachydermoperiostosis
● progeria
● Down syndrome
Wormian bones can also be idiopathic (anatomical variant)
A useful mnemonic is PORKCHOPS.

Locations
● lambdoid suture : most common
● lambda (also known as the preinterparietal or inca bone)
● pterion : up to 12%; former anterolateral fontanelle (also known as the epipteric bone or pterion ossicle)
● sagittal and coronal sutural bones : uncommon

Etymology
Erroneously, these bones are named after the person who was supposed to have first described them:
● Ole Worm (1624-1639): professor of Anatomy at Copenhagen, Denmark
8 Put buccal crown a. Above
0 torque on lower left b. Below*
molar, once inserted c. Level of tube
in the left tube,
where does it fall in duplicate
relation to lower
right tube?

8 Gardner’s syndrome a. Osteosarcoma

1 has increase risk of
the following except:

**: Gardner syndrome, also known as familial colorectal polyposis,[2] is an autosomal dominant form of polyposis
characterized by the presence of multiple polyps in the colon together with tumors outside the colon.[3] The extracolonic
tumors may include osteomas of the skull, thyroid cancer,epidermoid cysts, fibromas and sebaceous cysts,[4] as well as the
occurrence of desmoid tumors in approximately 15% of affected individuals.

An osteoma (plural: "osteomata") is a new piece of bone usually growing on another piece of bone, typically the skull. It is a
benign tumor.

Osteosarcoma is an aggressive malignant neoplasm

8 Hemifacial (based on CDABO first is true. It says can cause small to complete agenesis of condyle and can happen bilaterally. If it is
2 microsomia is occurs bilateral, it is called bilateral hemifacial microsomia)
in the first trimaste,
(t/f?). It occasionally DUPLICATE, BUT DISCUSS whether it can be bilateral
occurs with bilateral
agenesis of condyle,
(t/f?)

8 Occlusal interference **: First is true, refer to #55 above. Second is true intuitively.
3 is associated with
bruxism (t/f?).
Occlusal interference
is not associated with
anxiety and stress
(t/f?).
8 The most effective a. Implant studies
4 method for studying DUPLICATE
growth is?

8 Apexification requires a. FF
5 you to delay
orthodontic tooth
movement so apical DUPLICATE
barrier can form
(t/f?). The reason for
this is that the you
get more root
resorption before
apical barrier forms
(t/f?).

8 Pilot drill increase DUPLICATE

6 TADs stability (T/F)

8 Error with a. Landmark identification

7 cephalometrics is due
to **: Jacobson , Graber pg 110
The following issues question the validity of two-dimensional cephalometry to derive clinical information used in treatment
planning:

1. A conventional head film is a two-dimensional representation of a three-dimensional object. When a

three-dimensional object is represented in two dimensions, the imaged structures are displaced vertically and
horizontally. The amount of structural displacement is proportional to the distance of the structures
from the film or recording plane.6

2. Cephalometric analyses are based on the assumption of perfect superimposition of the right and left sides
about the midsagittal plane6 (Figure 4-1). A perfect cube aligned in a “cephalostat” will NOT show superimposition of the
right and left sides due to the “differential magnification” between right and left sides. If the images of the “right and left”
sides were in alignment, the “cube” would have to be asymmetric.

Perfect superimposition is observed infrequently because facial symmetry is rare and because of the relative image
displacement of the right and left sides as described previously. These inherent technical limitations do not produce an
accurate assessment of craniofacial anomalies and facial asymmetries.
3. The projection geometry precludes the ability to acquire accurate dimensional information aligned in the direction of
the x-ray beam.

4. A significant amount of external error, known as radiographic projection error, is associated with image acquisition.
These errors include size magnification, errors in patient positioning, and projective distortion inherent to the film–
patient–focus geometric relationships.

5. Manual data collection and processing in cephalometric analysis have been shown to have low accuracy
and precision.

6. Significant error is associated with ambiguity in locating anatomic landmarks because of the lack of well-defined
anatomic features, outlines, hard edges, and shadows and variation in patient position Such landmark identification errors
are considered major source of cephalometric errors. Despite these limitations of cephalometry, many cephalometric
analyses have been developed to help diagnose skeletal malocclusion and dental faical deformities.

Internal orientation error: This error refers to the three dimensional relationship of the patient relative to the
central x-ray beam or imaging device and assumes that a minimal error of this type occurs with a specific
and consistent head position. Because this is not always true, an internal orientation error is introduced.

External orientation error: This error refers to the three dimensional spatial relationship or alignment of the imaging
device, patient-stabilizing device, and the image-recording device. Minimal error is assumed when the x-ray source is 60
inches from the mid-cephalostat as the central ray passes through the ear rods and the beam is horizontal to the horizon
and perpendicular to the film plane. Furthermore, the distance from the mid-cephalostat plane to the film
plane should be known and be consistent between images. Any deviations from these assumptions will introduce errors
into the final image.

Geometric error: This error primarily refers to the differential magnification created by projection
distance between the imaging device, recording device, and a three-dimensional object. For example, structures farthest
from the film will be magnified more than objects closer to the film. This error is related to the divergence of the x-ray
beam on its path from the x-ray source to the recording device.

Association error: This error refers to the difficulty in identifying a point in two or more projections acquired from different
points of view. The difficulty in identifying the identical point on two or more images is proportional to the magnitude of
change in the angle of divergence between the projections.

**: Projection errors and errors of identification I want to say I also saw this in an article?? Not sure which.
8 Magnification error a. Patient to anode*
8 with ceph is most by b. Vertical head position

**: Jacobson P 35
**: ie. Left closest to film, beam enters from right. Right side will appear more magnified than left.
Cathode = beam , Anode = film

Which increase a. Angle of convexity

8 during growth? b. Facial angle *
9 c. SN-MP
**: Facial angle the angle that relates cranial base to mandible and thus as the maxilla grows and translates and the
mandible grows and translates, facial angle is most likely to change; angle of convexity mandibular plane angle remain the
same proportionately

**: Facial angle = FH and N-Pog

9 What type of bone is a. Fibrous

0 around tension side b. Woven
of orthodontically c. Lamella
moved tooth?
**: Woven
Graber pg 295:
Woven Bone. Woven bone varies considerably in structure; it is weak, disorganized, and poorly mineralized.
Woven bone serves a crucial role in wound healing by (1) rapidly filling osseous defects, (2) providing initial
continuity for fractures and osteotomy segments, and (3) strengthening a bone weakened by surgery or trauma.
The first bone formed in response to orthodontic loading usually is the woven type. Woven bone is not found in
the adult skeleton under normal, steady-state conditions; rather, it is compacted to form composite bone, remodeled
to lamellar bone, or rapidly resorbed if prematurely loaded.

9 How do you measure o Incisal edge to edge + overbite * ( penn review)

1 maximum opening o Incisal edge to edge + overjet
o Incisal edge to edge

**: Temple document picked first option, I think edge to edge. Graber pg 186:
The normal range19–21 of mouth opening when measured interincisally is between 53 and 58 mm. Even a 6-year-old child
can normally open a maximum 40 mm or more.22,34 The patient is asked to open slowly until pain is first felt (Figure 7-8).
At that point, the distance between the incisal edges of the maxillary and mandibular anterior teeth is measured. This is the
maximum comfortable opening. The patient is then asked to open the mouth optimally. This is recorded as the maximum
opening. In the absence of pain the maximum comfortable opening and maximum opening are the same.
9 First a. Maxilla and mandible
2 brachial/pharyngeal b. Maxilla
arch form forms c. Ear and eye
which of the d. Hyoid bone
following?
DUPLICATE

9 Frontomaxillary a. Ala of nose

3 process form which b. Philtrum
one? (I could pick c. Colummela of nose
only one answer)
**: I don’t know what this question is getting at, the frontomaxillary suture is not really near any of the structures above

Philtrum is formed by the nasomedial and maxillary processes

Medial nasal processes form the nasal septum / columella
Lateral nasal prominences form the alae of nose

9 Pt with disk a. Flat plane occlusal splint

4 displacement. What b. Anterior repositioning splint
do you want to use to c. Vertical repositioning splint
correct it?
Flat plane occlusal splint is probably best answer; all splints change vertical and an anterior repositioning splint
has more risk of adverse effects
http://tmj.org/site/content/splints
Types: There are several distinct types of occlusal splints.
● Stabilization or flat plane splint. This splint covers all the upper teeth and its flat surface is intended to help reduce
tooth grinding and relax your sore jaw muscles. However, it does not prevent tooth clenching because the lower
teeth can still contact it. Therefore, in some patients, their condition can be aggravated by the splint.
● Modified Hawley splint. This splint fits on the upper jaw and makes contact with only the six lower front teeth.
Thus it keeps the back teeth from touching and prevents both clenching and grinding. It is generally worn only at
night because constant wear may allow the back (posterior) teeth to shift.
● NTI-tss (Nociceptive Trigeminal Inhibition Tension Suppression System). The NTI appliance fits on the upper front
teeth and is designed to prevent tooth clenching and grinding. However, because it fits on only a few teeth, it
places a great deal of stress on them and that can be harmful. Also, because of its small size, if it comes off during
the night, there is danger that it could be swallowed or aspirated.
● Repositioning splint. This splint is used to move the lower jaw either forward or backward. It is intended to put the
jaw into a new position and therefore it can cause permanent changes in the bite. It is a more invasive form of
splint treatment.
J Orofac Pain. 2010 Summer;24(3):237-54. Systematic review and meta-analysis of randomized controlled trials
evaluating intraoral orthopedic appliances for temporomandibular disorders. Fricton J, Look JO, Wright E, Alencar FG Jr,
Chen H, Lang M, Ouyang W, Velly AM.
Source: University of Minnesota School of Dentistry, Minneapolis, Minnesota 55455, USA.
Abstract
AIMS: To conduct a systematic review with meta-analysis of randomized controlled trials (RCTs) that have assessed the
efficacy of intraoral orthopedic appliances to reduce pain in patients with temporomandibular disorders affecting muscle
and joint (TMJD) compared to subjects receiving placebo control, no treatment, or other treatments.
METHODS: A search strategy of MEDLINE, the Cochrane Library, the Cochrane CENTRAL Register, and manual search
identified all English language publications of RCTs for intraoral appliance treatment of TMJD pain during the years of
January 1966 to March 2006. Two additional studies from 2006 were added during the review process…
RESULTS: A total of 47 publications citing 44 RCTs with 2,218 subjects were included. Ten RCTs were included in two meta-
analyses. In the first meta-analysis of seven studies with 385 patients, a hard stabilization appliance was found to improve
TMJD pain compared to non-occluding appliance. The overall odds ratio (OR) of 2.46 was statistically significant (P = .001),
with a 95% confidence interval of 1.56 to 3.67. In the second meta-analysis of three studies including 216 patients, a hard
stabilization appliance was found to improve TMJD pain compared to no-treatment controls. The overall OR of 2.15 was
positive but not statistically significant, with a 95% confidence interval of 0.80 to 5.75. The quality (0 to 1) of the studies
was moderate, with a mean of 55% of quality criteria being met, suggesting some susceptibility to systematic bias may
have existed.
CONCLUSION: Hard stabilization appliances, when adjusted properly, have good evidence of modest efficacy in the
treatment of TMJD pain compared to non-occluding appliances and no treatment. Other types of appliances, including
 soft stabilization appliances, anterior positioning appliances, and anterior bite appliances, have some RCT evidence of
efficacy in reducing TMJD pain. However, the potential for adverse events with these appliances is higher and suggests
the need for close monitoring in their use.

Confirm with George

9 When do you extract a. When space is available for prosthesis

5 ankylosed primary b. When you see vertical bone difference *
molar? c. ASAP

**: B, proffit pg 138

In 5-10% f U.S. children, at least one primary molar becomes ankylosed (fused to the bone) before it finally resorbs and
exfoliates. Although this delays eruption of its permanent successor, there is usually no lasting effect, but a primary molar
that becomes ankylosed at a young age can become totally submerged. In that case, the primary molar is unlikely to
exfoliate, the permanent premolar is severely delayed, and drift of other permanent teeth into the space of the delayed
tooth can create a significant malocclusion.

i take this to mean, once you see an ankylosed primary molar is submerged, extract it because if not extracted, it could
cause malocclusion

9 An implant is less a. Missing papilla*

6 than 1mm from the b. Accelerated horizontal bone loss
root of lateral incisor, c. Labial recession
what will happen? **: “Previous articles have suggested that space between the implant and natural tooth should be at least 1mm, to ensure
proper healing and adequate space for the development of a papilla”
Board Article #88: Spear, mathews, Kokich. Interdisciplinary Managemant of single tooth implants Seminars in
Orthodontics 1997
9 Where to place hand a. Upper half sternum
7 on CPR b. Lower half of sternum*
c. One palm width below sternum
**: Mid nipple line

9 Undermining a. Physiological? tooth movement*

8 resorption is b. Osteoclast from medullary space
described by all of c. Hyalinization near lamina dura
the following except **: From Graber Chaper 9 “During the crucial stage of the initial application of force, compression in limited areas of the
membrane frequently impedes vascular circulation and cell differentiation,causing degradation of the cells and vascular
structures rather than proliferation and differentiation.The tissue reveals a glasslike appearance in light microscopy,which
is termed hyalinization
Hyalinization represents a sterile necrotic area, characterized by three main stages: degeneration, elimination of destroyed
tissue, and establishment of a new tooth attachment.
Degeneration starts where the pressure is highest and the narrowing of the membrane is most pronounced, that is, around
bone spicules. Degeneration may be limited to parts of the membrane or extend from the root surface to the alveolar
bone. Electron microscopy has shown that advanced cellular and vascular changes may occur within a few hours of the
application of the force. Retardation of the blood flow is followed by disintegration of the vessel walls and degradation of
blood elements, all occurring by mechanisms different from those seen during physiologic breakdown. The cells undergo a
series of changes, starting with a swelling of the mitochondria and the endoplasmic reticulum and continuing with rupture
and dissolution of the cytoplastic membrane. This leaves only isolated nuclei between compressed fibrous elements
 (pyknosis) and is the first indication of hyalinization. In hyalinized zones, the cells cannot differentiate into osteoclasts and
no bone resorption can take place from the periodontal membrane. Tooth movement stops until the adjacent alveolar bone
has been resorbed, the hyalinized structures are removed, and the area is repopulated by cells. A limited hyalinized area
occurring during the application of light forces may be expected to persist from 2 to 4 weeks in a young patient. When
bone density is high, the duration is longer. The peripheral areas of the hyalinized compressed tissue are eliminated by an
invasion of cells and blood vessels from the adjacent undamaged PDL. The hyalinized materials are ingested by the
phagocytic activity of macrophages and are removed completely. The adjacent alveolar bone is removed by indirect
resorption by cells that have differentiated into osteoclasts on the surfaces of adjacent marrow spaces or, if the alveolar
wall and the outer cortical bone are fused, on the surface of the alveolar process.
Reestablishment of the tooth attachment in the hyalinized areas starts by synthesis of new tissue elements as soon as the
adjacent bone and degenerated membrane tissue have been removed. The ligament space is now wider than before
treatment started, and the membranous tissue under repair is rich in cells.

9 Somatic growth rate a. Conception to birth*

9 is greatest from b. Birth to 2 years
c. 10-12 years
NF: Repeat
**: Prior question didnt include conception - birth as an option. It only asked about birth and on.

1 What is sequence of
0 bone maturation a. Woven – compact – lamella*
0 b. Woven – compact – bundle – lamella

Repeat: a*
SK: Bone is specialized connective tissue with a calcified extracellular matrix (bone matrix) and 3 major cell
types: the osteoblast, osteocyte, and osteoclast. The first type of bone formed developmentally is primary or
woven bone(immature). This immature bone is later replaced by secondary or lamellar bone (mature).
Secondary bone is further classified as two types: trabecular bone (also called cancellous or spongy bone) and
compact bone (also called dense or cortical bone).
Bundle bone is a type of lamellar bone.
Group thought q remembered incorrectly, answer choice should be “composite” bone not “compact” bone

1 T/F question- In early mixed dentition, you need to treat skeletal open bite because you can diagnose open bite easily at
0 this stage.
1
False - Incisors have not fully erupted in early mixed dentition
1 RPE + face mask a. Procline maxillary anterior
0 correct Class III by all b. Retrocline mand posterior
2 the the following c. Allow mandible to grow*
except, d. Allow maxilla to come forward

**: Not sure how RPE + Facemask would retrocline mandibular posterior, But allowing the mandible to grow would
worsen the Cl III
**: Mandible also rotated backward.

1 Canine substitution a. do not consider opposite side buccal occlusion

0 case-
3 For a unilateral canine substitution case the canine substitution would result in a Cl II on that side assuming all other teeth
are present and no implant space is being left open.

1 Which of the a. Something about informed consent

0 following is correct b. It is accurate.
4 about VTO c. Can predict maxillary lip retraction by 1:1

**: Prior question about VTO for extraction cases-which is accurate.

Upper lip prediction accurate but not 1:1
Lower lip not as predictable
Informed consent recommended regarding expectations of patient.
RR: From article
I. Results
A. Upper lip retracted 58% of distance that upper incisors were retracted
B. Lower lip retracted 120% of distance that lower incisors were retracted
C. Upper lip predictions accurate compared to actual
1. Lower lip predictions less accurate --> computer predicted lower lip to be significantly more forward compared to actual
(fuller lower lip)
D. Lay persons rated image predictions significantly better than orthodontists
1. For both groups, nose and nasolabial angle predictions rated the highest
II. Discussion
A. Many factors can contribute to difficulty of predicting lower lip position
1. Incisor angulation, tissue thickness, tissue tonicity
2. Changes in lower lip may be explained by its release from influence of upper incisor --> rotation of lip up and back around
inferior labial sulcus
a) Pretreatment lip eversion due to max protrusion relieved after extraction treatment
B. Video image predictions had greater magnitude of error compared to predicted VTOs
III. Conclusions
A. Computer generated VTO predictions accurate in simulating outcomes of adult extraction therapy
1 T/F question - Digital radiography uses 8bit (2^^8= 256 shades of gray). It is good b/c human eye have limited ability to
0 distinguish shades of gray.
5
**: These numerical assignments translate into 256 shades of gray. The human eye is able to detect approximately 32 gray
levels
Bushong SC. Radiologic science for technologists: Physics, biology, and protection. 7th Edition. St.
Louis, CV Mosby, 2001:374
**: True / True

1 T/F question – layperson can detect small changes in buccal corridor.

0 Repeat
6

1 Case) which of the

0 following is true. Pick
7 more than 1 of the
following.
a. This person has excess posterior vertical buccal corridor
b. Has ideal buccal corridor
c. Has excess buccal corridor
d. Has flat smile arc
What is a vertical buccal corridor...Too much corridor in height? I never heard it referred to in this manner?

1 Who first brought

0 cephalometric to a. Steiner
8 orthodontics b. Tweed
c. Angle
d. Broadbent*

Orthodontics in 3 millennia. Chapter 7: Facial analysis before the advent of the cephalometer
(Am J Orthod Dentofacial Orthop2006;129:293-8)
1 Want max ridge
0 development for a. Extract Bs and let 3s erupt mesial and retain Ucs *
9 implants in U2 b. Extract Cs so 3s can erupt into right spot and retain Bs
position and the
upper B’s are still “If the maxillary lateral incisor tooth is congenitally absent and the maxillary canine has erupted distal to the central
present…what do you incisor, the primary canine may still be present distal to the permanent canine. When should the primary canine be
do? extracted? If it is extracted too early, the ridge will undergo resorption and the buccolingual thickness will decrease.
However, the permanent canine must be moved into the primary canine space. In this situation, the primary canine should
be extracted just before moving the permanent canine distally. This will ensure that significant resorption of the ridge will
not occur.”

Board article #88 Spear, Mathews, and Kokich

1 Which of the a. Orbiculis oris*

1 following muscle b. Risorious
0 least likely to be in c. Zygomaticus major
use during smiling d. Zygomaticus minor

1 Which of the a. Tech 99 bone scan

1 following has the b. CBCT
1 most radiation c. Medical CT*

Bone Scan: These doses result in radiation exposures to the patient around 10 mSv (1000 mrem)
doi:10.1016/j.jacr.2007.07.020
CBCT: Effective dose values ranged from 13 to 82Sv for CBCT
Medical CT: 474 to 1160Sv for MSCT
doi::10.1016/j.ejrad.2008.06.002

1 Cardinal symptoms of a. Clicking/sounds

1 TMD, except b. pain
2 d. limited motion
c. anteriorly positioned condyle *
Repeat - pain is the only symptom listed
Symptom - subjective
Sign - objective
1 which of the a. Has maxillary predilection*
1 following is true b. Related to arch length/width
3 about transposition?
The maxillary canine is the tooth most often affected. The long retention of deciduous teeth is often associated with
displacement of the permanent tooth. Whether prolonged retention causes displacement or an abnormal path of eruption
is the reason for retention of the deciduous tooth is a matter of speculation.

Yehoshua Shapira and Mladen M. Kuftinec (1989) Tooth transpositions — a review of the literature and
treatment considerations. The Angle Orthodontist: December 1989, Vol. 59, No. 4, pp. 271-276.
G. Elevated tooth agenesis in patients with:
20
1. Max canine-first premolar transposition
2. Palatally displaced max canine
3. Mand lateral-mand canine transposition

1 GOSLON yardstick is used to measure dentition in CLP. Later repair has better prognosis than early repair (T/T, Early repair
1 may interfere with maxillary growth by the formation of scar tissue and may give the patient more maxillary hypoplasia)
4
Repeat
Remember the “Rule of 10s”:(10 weeks old, weight of 10 pounds and 10 grams of hemoglobin): first surgery
lip repair

1 T/F question Latero-occlusion is defined as difference between CO/CR in asymmetric case? (true)
1
5 “Cross-bite cases with lateral shifting of the mandibular midline can be differentiated as either latero-occlusion
or laterognathy. With latero-occlusion, the midline shift can only be observed in the occlusal position, whereas
with laterognathy, the midline shift can be observed in both the occlusal and postural positions. Without
treatment, cross-bite and latero-occlusion during the growth period can lead to asymmetric jaw growth”

Functional Treatment of an Asymmetry Case Having Left Side Paralysis: A Case Report Eur J Dent.
2010 July; 4(3): 341–347.
1 if you want a. Distal
1 clockwise rotation of b. Mesial
6 maxilla where do you c. Up
want head gear force d. Down
to be?

From Proffit
 Question asks about maxilla not molar. Possibly reverse headgear question?
Article #34: Protraction FM:
1-piece with adjustable anterior wire and hooks for downward and forward pull of maxilla at 30 degrees with
elastics near canines, reduces counterclockwise movement that could open bite.

1 In which of the
1 following cleft types b. Oro-ocular
7 is hypertelorism c. Lateral
found? d. Oblique
e. Midline

Tessier Clefts:

Most likely midline. Hypertelorism is associated with Tessier Facial clefts 0-median,1-paramedian,,11,12,13,14,
1 According to some
1 study which of the a. Normal maxilla with retrusive mandible
8 following do you see
most with skeletal Cl Hyperplastic maxilla is rare
II?

1 Which of the a. Has twice deflection compared to stainless steel*

1 following is correct of b. Does not have shape memory
9 TMA c. Has low friction

TMA does exhibit shape memory and and has relatively high friction
Springback greater than steel

1 A fractured tooth a. 3 months

2 that has been b. 6 months * (Kokich: After the intrusion or extrusion process has been accomplished, the teeth must be stabilized by
0 extruded 4 mm in a 1 the orthodontic brkt or by splinting for 6mo. Proffit says 3-6 weeks are sufficient)
month, what is the
minimal amount of Rapid vs. slow extrusion guidelines???
time it should be http://www.kokichorthodontics.com/hub_sites/kokich-
stabilized? vincent/www/assets/uploads/files/Altering%20Vertical%20Dimension.pdf

Profitt indicates after extrusion 3-6 weeks stabilization and not more than 6 weeks.??

1 PFE occurs more in the anterior region, and the teeth in PFE do not become ankylosed until extrusive force is placed on
2 them. - False, true
1
Proffit
“Diagnosis of primary failure of eruption often occurs in the late mixed dentition period when some or all the permanent
first molars still have not erupted (see Chapter 6). Incomplete eruption of other teeth in the same quadrant, even though
their eruption path has been cleared, confirms the diagnosis (Figure 12-47).1A0 family history of teeth that did not erupt is
further indication that the problem is primary failure of eruption, because there is a genetic component to this problem.
3' The affected teeth are not ankylosed, but do not erupt and do not respond normally to orthodontic force. If tooth
movement is attempted, usually the teeth will ankylose after 1- 1.5 mm of movement in any direction, so the correct
diagnosis is important in preventing what would be futile orthodontic treatment. In the long term, prosthetic replacement
of the teeth that failed to erupt is almost the only treatment possibility”
 Also -> Suri et al. Delayed tooth eruption: Pathogenesis, diagnosis, and treatment. Am J Orthod Dentofacial Orthop.
2004;126(4):432-45.

Primary failure of eruption is a syndrome where affected posterior teeth fail to erupt, presumably because of a defect in
the eruption mechanism. In these individuals, bone resorption apparently proceeds normally but the teeth involved simply
do not follow the path that has been cleared. These teeth do not respond to orthodontic force and cannot be moved into
position.

1 Which of the a. Supra-crestal

2 following are b. Transseptal*
2 responsible for
relapse following Board article # “In any case the potential for relapse forces in the fibers of the periodontal ligament and transseptal groups
orthodontic most adjacent to the alveolar crest is certainly minimal because these tissues have been shown to possess a dynamic
treatment? remodeling. Although the transseptal groups adjacent to the alveolar crest, as well as the principal fibers of the periodontal
ligament, do show relatively rapid reorganization following tooth rotation and thus are presumably not of importance in
the relapse mechanism, the only clinical method to determine that the more coronal transseptal fibers have been properly
transected is to feel the surgical blade enter the enlarged periodontal ligament space.“’

Profitt “
Within 4 to 6 months, the collagenous fiber networks within the gingiva have normally completed their reorganization, but the elastic supracrestal
fibers remodel extremely slowly and can still exert forces capable of displacing a tooth at one year after removal of an orthodontic appliance In
patients with severe rotations, sectioning the supracrestal flibers around severely malposed or rotated teeth,at or just before the time of appli- ance
removal, is a recommended procedure because it reduces relapse tendencies resulting from this fiber elastic....p.618

Not clear: transseptal or supracrestal??

1 Which of the a. Lymphoid
2 following in b. Neural*
3 scammon’s curve c. Somatic
develop first

Growth of the neural tissues is nearly complete by 6 or 7 years of age.

1 Which is the major a. Kidney

2 regulator of Ca Repeat
4 metabolism?

1 Which of the a. FMA *

2 following doesn’t b. M1-MP
5 give additional score c. SN-MP
when calculating DI d. ANB
index? Repeat

1 What does DI a. Difficulty of case

2 measure? b. Complexity of case*
6
Repeat
1 Which is not true a. Delayed healing
2 about b. Cause increase bone density
7 bisphosphonate c. Decrease osteoblast* (I think it works through inhibition of osteoclast)
d. Can cause osteonecrosis
e. Can decrease orthodontic tooth movement
Bisphosphonate binds to HA in bone and inhibit osteoclast mediated bone resorption so slows ortho tooth movement,
impair bone healing and cause osteonecrosis.
Theory: initially bisphosphonate decrease osteoclast activity and osteoblasts increased à more bone formation à drug
concentration increases and may start to decrease osteoblasts and new capillary forms in new bone (ddecrased bone
turnover and bone repair) à osteoclast activity decreased enough to not allow normal removal of diseased bone. à new
bone is laid over defective bone w/ decreased capillary formation and blood supply (osteopetrosis) à osteonecrosis.

1 What is side effect of a. Dilated pupil

2 prolong use of b. Constricted pupil
8 amphetamine? (it is c. Dilated vasculature
sympathomimetic d. Constricted vasculature
amine and stimulant)
Non-physiological causes of mydriasis include disease, trauma, or the use of drugs. Normally, the pupil dilates in the dark
and constricts in the light to respectively improve vividity at night and to protect the retina from sunlight damage during the
day. Amydriatic pupil will remain excessively large even in a bright environment and is sometimes colloquially referred to as
a "blown pupil". More generally, mydriasis refers to the dilation of pupils, for instance in low light conditions or under
sympathetic stimulation. The excitation of the radial fibres of the iris which increases the pupillary aperture is referred to as a
mydriasis.
An informal term for mydriasis is blown pupil

1 What distinguish a. Doesn’t have epithelial lining

2 mucoele from true A cyst is a closed sac, having a distinct membrane and division compared to the nearby tissue. It may contain air, fluids, or
9 cyst? semi-solid material.

1 Pt has fever, a. Acute herpetic stomatitis*

3 lymphadenopathy b. Recurrent herpetic infection
0 and gingival lesion. c. Apthus ulcer
What is this? d. ANUG

http://media.dentalcare.com/media/en-US/education/ce110/ce110.pdf
Recurrent herpetic lesions/ANUG are not associated with fever/lymphadenopathy, aphthous ulcers do not occur on
keratinized tissues.
1 duplicate of (53)
3 What is the last
1 movement in
Posselt’s envelope?
a. Hinge

from C to R is hinge.

1 1. Digital is better Resolution in film is better b/c: In digital radiography, the image produced from the scan is relative to the size of the computer
3 than film except screen it is viewed on and the software being used to create the image
2 a. Resolution
read this several places on line and also asked a radiologist.

1 1. Which of the from reading online: you can compress a file in a lossless (fully recoverable) or a lossy way. TIF, PNG, GIF, BMP and most
3 following causes other image file formats are lossless. This integrity requirement does limit efficiency, limiting compression of photo image
3 most loss of data? data to maybe only 10% to 40% reduction in practice (graphics can be smaller). But most compression methods have full
a. JPEG
lossless recoverability as the first requirement. JPG files don't work that way. JPG is a big exception. JPG compression is not
lossless. JPG compression is lossy. Lossy means "with losses" to image quality. JPG compression has very high efficiency
(relatively tiny files) because it is intentionally designed to be lossy, designed to give very small files without the requirement
for full recoverability. JPG modifies the image pixel data (color values) to be more convenient for its compression method.
Tiny detail that doesn't compress well (minor color changes) can be ignored (not retained).
1 1. CPR ratio and From: 91. Highlights of the 2010 American Heart Association Guidelines for CPR and ECC
3 sequence of [Summary for Basic Life Support (BLS) for Advanced Cardiovascular Life Support (ACLS)
4 compression a. 30 to 2.
a. 30 compression 2 Also know:
breath -A compression rate of at least 100/min (a change from “approximately” 100/min)
b. 2 breath, 30 A compression depth of at least 2 inches (5 cm) in adults and a compression depth of at least one third of the
compression anterior- posterior diameter of the chest in infants and children.
c. 15 compression 1 -C. Rescue breaths be given in approximately 1 second
breath -A Change From A-B-C to C-A-B ((excluding the newborns))
d. 30 compression -if you see someone collapse: assume cardiac arrest: activate the emergency response system, retrieve an AED,
1breath and return to the victim to provide CPR and use the AED.
-For a presumed victim of asphyxial arrest such as drowning, the priority would be to provide chest compressions
with rescue breathing for about 5 cycles (approximately 2 minutes) before activating the emergency response
system.

1 1. According to I dont know the answer to this.

3 some RCT experient,
5 what % of early Also from: Treatment timing for Twin-block therapy
correction of skeletal Treatment effects in early treated group
Cl II get improvement A. Treatment effects in early treated group
in OJ? 1. OB and OJ correction
a. 75% ( I think it’s a) OJ correction was 55% skeletal; mand incisors proclined significantly by tx
in proffit) 2. Skeletal and dentoalveolar contributions to molar correction almost equivalent
3. Sig forward displacement of condylar head
B. Treatment effects in the late treated group
1. Skeletal contribution to OJ correction was 54% (mainly due to mand changes)
2. Skeletal contribution to molar correction was 67%

Pre-adolescent Growth Modification: RCT of early Class 2 tx: Skeletal changes are likely to be produced by early tx, but tend
to be diminished or eliminated by subsequent growth.
1 1. Wavelength of from Graber:
3 orthodontic “The evidence available in the field of composite resins suggests that maximum light scattering occurs at particle
6 curelight? size equivalent of the half of the wavelength of a photoinitiator of the polymerization, which for camphorquinone
a. 300-350 is 468 nm”
b. 400-440 wide array of light curing sources include: plasma arc, laser, and LED lights
c. 460-480* -Plasma lamps:
(Graber: 488nm) * intensity = (1600 to 2100 mW/cm2) (highest!)
* spectrum of 450 to 500 nm
* higer cost, with life span of 5,000 hours relative to 40 to 100 hours for halogen.
* 6 seconds for SS brackets and 3 seconds for ceramic.
-Laser lights:
*Intensity = 700 to 1000 mW/cm2,
* monochromatic spectrum of variable wavelength (454, 458, 466, 472, 477, 488, and 497 nm)
* costly,but have an almost infinite life span.
* 5 seconds
-Light-emitting diode (LED):
*maximum intensity= 1100 mW/cm2
* spectrum = 420 to 600 nm, have a cost comparable to that of conventional
halogen lights, and possess a nearly infinite life, Cordless

may also need to know about BLUE light and bisGMA.

Blue light: some evidence it affects mitochondrial DNA through possibly ROS (reactive Oxygen species.)
Bis GMA: dry grinding/heat-->PBA-->endocrine disruption

1 1. What is the most From Graber: Almost all the light-cured adhesives use camphorquinone as a photoinitiator of the polymerization. This
3 commonly used molecule is contained in the resinous phase at a concentration of 0.2% to 1% of the matrix and shows a peak absorbance
7 photoinitiator in wavelength of 468 nm, which implies that increased light intensity in other frequencies may not be effective to excite the
orthodontic bonding? molecule. so buy a curing light suitable for the photoinitiator Camphorquinone is a bit yellow/ugly! so its has been recently
camphorquinone replaced in some composite resins by 1-phenyl-1,2-propanedione (PPD) with a peak absorbance in the area of 390 to 410
nm so you may have to change the peak in lamp accordingly.

1 1. What’s average Duplicate

3 angle between SN
8 and natural head
position? (it did not
say FH)
a. 7 degrees
b. There is no
average
1 1. Meckel’s Duplicate.
3 cartilage forms which
9 of following incus and Maleus.
a. Incus
b. Stapes
c. Styloid process

1 1. Where does **: Deposition occurs definitely on posterior and buccal side.The oral side of the palate is depository, which is the most
4 deposition not inferior BUT and the nasal side of palate is resorptive.
0 happen on maxilla
(could pick more than From Graber:
one answer) deposition occurs along the posterior margin of the maxillary tuberosity, resulting in an increase in the length of
a. Superior the entire maxilla and of the dental arches. The posterior maxilla is a major remodeling site that accounts for
b. Inferior most increases in maxillary length as the cortices of the maxillary tuberosity drift posteriorly. The anterior periosteal
c. Anterior surface of the maxilla is slightly resorptive, while the buccal surfaces undergo substantial bony deposition.
d. posterior From Proffit page 112:
anterior surface is resorptive except for anterior nasal spine area.

1 1. Bony chin Duplicate

4 remodeling - asked During the descent of the maxillary arch and the vertical drift of the mandibular teeth , the anterior mandibular teeth
1 for exact site of simultaneously drift lingually and superiorly. This produces a greater or lesser amount of anterior overjet and overbite. The
resorption/appositio remodeling process that brings this about involves periosteal resorption on the labial bony cortex (a ), deposition on the
n on anterior mand alveolar surface of the labial cortex (b ), resorption on the alveolar surface of the lingual cortex (c), and deposition on the
a. Deposition lingual side of the lingual cortex (d ). At the same time, bone is progressively added onto the external surface of the
lingual to symphysis* mandibular basal bone area, including the mental protuberance (chin). The reversal between these two growth fields
b. Deposition usually occurs at the point where the concave surface contour becomes convex. The result of this two-way growth process
inferior to s is a progressively enlarging mental protuberance.
c. Deposition
inferior to symphysis
(CDABO says inferior
anterior border is
relatively stable. )
1 1. Which of the Duplicate.
4 following is not **: Treacher Collins syndrome or mandibulofacial dysostosis is a rare autosomal dominant congenital disorder
2 correct about characterized by craniofacial deformities, such as absent cheekbones. The typical physical features include downward
treacher colins slanting eyes, micrognathia, conductive hearing loss, underdeveloped zygoma, drooping part of the lateral lower eyelids,
a. ANB great than 5 and malformed or absent ears.
b. Hearing **: cleft palate in some, ant open bite, macrostomia (wide mouth)
impairment
c. Down slanting
eye
d. Maxillary
hypoplasia *
(CDABO:They have
micrognathia,
hypoplasitic condyle
and short ramus)
e. Underdeveloped
malar bone

1 1. Which of the **: Trisomy 21: most common, 47 chromosomes. 1/650 births. Average life span=35 yrs. short stature, mental retardation,
4 following is not true Up slantin palpebral fissures, brachycephaly, flat occiput, midface hypoplasia and relative mandibular prognathism, open
3 about Down mouth with protruding tongue, ocular hypotelorism, severe macroglossia, narrow palate,primary dentition with enamel
syndrome hypoplasia, 90% have severe gingival and periodontal involvement even before age 6.
a. Mental delay
b. Warmian bone Warmian bone (aka Ole worm)are a marker for various diseases and important in the primary diagnosis of Brittle Bone
(Down syndrome can Disease osteogenesis imperfecta.
have warmian bone) Wormian bones may also be seen in:
c. Maxillary ● Pycnodysostosis
hypoplasia ● Osteogenesis imperfecta
d. Accelerated ● Rickets
eruption* ● "Kinky-hair" Menke's syndrome
e. Protruding ● Cleidocranial dysostosis
fissured tongue ● Hypoparathyroidism and hypophosphatasia
● Otopalatodigital syndrome
● Primary acro-osteolysis
● Down's syndrome
The causes can be remembered by the mnemonic "PORKCHOPS
1 1. The following is Peutz–Jeghers syndrome, also known as hereditary intestinal polyposis syndrome, is an autosomal dominant genetic
4 true about Peutz- disease characterized by the development of benign hamartomatous polyps in the gastrointestinal tract and hyperpigmented
4 Jeghers syndrome macules on the lips and oral mucosa. Intraorally, they are most frequently seen on the gingiva, hard palate and inside of the
cheek. The mucosa of the lower lip is almost invariably involved as well. The oral findings are consistent with other
except, conditions, such as Addison's disease and McCune-Albright syndrome, and these should be included in the differential
a. Intestinal polys diagnosis.
b.
Hyperpigmentation
c. ?? ß the above
were true. Can’t
remember the wrong
answer.

1 1. Which of the **: Cleidocranian dysplasia:

4 following is not true Delayed ossification of the fontanels.
5 about Cleidocranial Aplastic or hypoplasia of both clavicle, exaggerated/wider cranium, short stature, brachycephalic + frontal and parietal
dysostosis bossing.
a. No clavicle max/zygoma are hypoplastic, Relative mandibular prognathism, premaxilla development is poor, hypoertelorism
b. Class III oral: high arched palate, cleft palate often, delayed union of mandibular symphysis, multiple supernumerary teeth, lack
c. Missing teeth* of or delayed eruption or arrested deciduous root resorption due to failure of bone to resorb.
d. Supernumanry
teeth
e. Delayed eruption

1 1. Which of the **: Triad: Craniosynostosis, midfacial malformation, syndactyly of hands and feet (symmetric)
4 following is not 15/1 million newborns,
6 correct about Apert Mental retardation may be present. propotosis and horizontal grooves above upraorbital ridges. Turribrachycephaly, down
a. Closure of suture slanting of fthe palpebral fissures, beaked nose, midface retruded (hypoplasia)relative mandibular prognathism.
b. Syndactyly Oral: lips are trapesoidal, hight palatal arch, constricted max (byzantine V shaped), large palatal swelling increasing with
c. Mental delay age, cleft of soft palate, class III malocclusion with ant open bite, and AP cross bite, delayed dental eruption
d. Maxillary Gene for Apert: FGFR2, C5 to C6s fused.
hypoplasia Gene for Crouzon: FGFR 2, C2-C3 fused
e. Absence of
infraorbital rim (it’s Treacher Collins: does have absence of infraorbital rim and malar bones.
common w/ Treacher
Colins)*
1 1. Marfan The syndrome is inherited as a dominant trait, carried by the gene FBN1, which encodes the connective protein fibrillin.
4 syndrome is mutation Marfan syndrome has a range of expressions, from mild to severe. The most serious complications are defects of the heart
7 of which gene valves and aorta. It may also affect the lungs, the eyes, the dural sac surrounding the spinal cord, the skeleton and the hard
a. Fibrillin-1* palate.
(CDABO)

1 1. T/F question: Duplicate of #17.

4 CBCT is excellent at CBCT: note a good way to quantify density but shows teeth better than CT.
8 looking at hard tissue
and some soft tissue.
You can clearly see
origin and insertion
of muscles using
CBCT (T,F)

1 A patient presents **: from Graber: page 951

4 with a unilateral x- The time to diagnose mandibular shifts is before treatment is initiated and is accomplished through the use of superior
9 bite without a repositioning deprogramming splints, leaf gauge condylar seating, or careful manipulation of the mandible. If such
detectable functional discrepancies are not detected before appliance placement but show up during treatment, the clinician has
shift, what else can an obligation to document and inform the patient of the diagnostic data arising during treatment and advise the patient of
be done to evaluate a any recommended change in the plan. The patient then must decide whether to pursue or reject the surgical plan.
functional shift? Undetected functional shifts in maxillary vertical excess and mandibular deficiency cases can lead
a. Take a PA ceph to a treatment plan that calls for Le Fort impaction only. The operating room, with the patient under general anesthesia, is
b. Mount the not the place for the surgeon to revise the treatment plan from a one-jaw procedure to a double-jaw procedure.
models other pages:
c. Flat plane splint* The diagnostic appliances are generally bite places and splints. The acrylic splints are acrylic and wire bite planes with
d. evaluate dental several features that are helpful, depending on the patient’s problem. Some of the ways in which these appliances prove
midlines useful follow:
• For neuromuscular deprogramming
• As therapeutic adjuncts to reduce joint inflammation, pain, and parafunction
• As intermediaries during corrective orthodontic therapy to avoid transitory occlusal trauma or treatment-induced TMJ
symptoms
Table 25-5 of Graber: Bite Splint is for Neuromuscular habits and deprogramming muscles of mastication, Duration: 1 to 6
months; reevaluate new cephalogram and mounted study models

Also, in multi disciplinary sequence of pts for dentofacial imbalance, splint is mentioned for diagnostic purpose in TMD
1 1. How do you From article:85 Guidelines for managing the Orthodontic – Restorative Patient
5 prepare space for peg Peg shaped lateral incisors-
0 lateral? - Build-up early if possible. If spaces needs to be created, it is often beneficial to create more space than necessary so the
a. You want to dentist has more room to contour the mesial and distal surfaces.
make a little more -M-D: The peg should be positioned more toward the central then the cuspid because the distal surface of a natural lateral
space than incisor is more convex.
contralateral lateral - B-L: If crowning the peg, place in the center of the ridge with 0.50-0.75 mm of overjet. If veneering or bonding the peg,
position the peg palatally to allow room for the restorative material buccally.
- I-G: Place peg so gingival margin is slightly incisal to the centrals and symmetric with the contralateral lateral incisor

Nanda page: 361-362:

Lateral ⅔ width of central (golden proprotion), move the peg latelra mesially so the emergence profile is flat mesially. place
push coils on adjacent teeth. if space already exists, restore first.

1 1. Success of TADS **: #8: Systematic review of the experimental use of temporary skeletal anchorage devices in orthodontics
5 is based on what? Conclusions
1 a. Primary stability, Dec implant diameter --> inc potential insertion sites and facilitate removal
direction of force, 1. Risk of screw fracture
loading 2. Length of screw does not relate to stability whereas diameter does

A. Stability of implant possible with 5% osseointegration

B. Little agreement about optimum loading and minimum healing period needed for stability
1. Immediate loading acceptable with reduced force
C. Factors that may contribute to implant failure: implant site, surgical technique, healing time, magnitude of
force

1 1. When do you **: Graber page 823: physiologic space normally is present between the maxillary central incisors until eruption of the
5 close diastema on canines in the adolescent dentition. In addition, a frenectomy may cause scar tissue that could prevent orthodontic space
2 this patient? Pt was closure. With large diastemas (6 to 8 mm) in the early transitional dentition, a frenectomy usually is recommended to
around age 8 and facilitate space closure, regain space at the midline, and prevent ectopic eruption of the lateral incisors or canines. These
canines were not interceptive early treatment problems require complete orthodontic supervision, usually additional mechanotherapy, and
erupt several stages of treatment.
a. We don’t need to
treat now.
1 1. When and how **:: Graber 1064
5 do you close When indicated, a laser assisted labial frenectomy is a simple procedure that is best performed after the diastema is closed
3 diastema on this as much as possible
patient (pt around
age 11, no high
frenum)
Orthodontic closure
and no need for
frenectomy

1 1. A patient with a Why Internal Vertical ramus Osteotomy over a BSSO?

5 severe Class III
4 malocclusion with
TMD symptoms,
what is the best
surgical procedure
a. BSSO
b. Internal Vertical
ramus osteotomy *
c. Maxillary
impaction
Internal vertical
ramus osteotomy
(VRO) is useful for
correction of
mandibular
prognathism. Initially,
this procedure was
performed extra-
orally with the
advantage of good
visibility.
Disadvantage was
external scar and
potential of facial
nerve injury.
1 1. What prevents Duplicate
5 attaining an ideal
5 Angle Cl I posterior
occlusion?
a. Axial inclination
of the canine
b. Excessive
mandibular lingual
torque
c. Excessive
maxillary buccal
torque
d. Steep premolar
cusps
e. Procumbent
maxillary incisors

1 1. What is the most Duplicate

5 likely cause of loss of **: b cause its saying “loss”
6 a tooth following
autotransplantation? Graber 836
a. Ankylosis The most common cause of ankylosis generally is believed to be trauma to a tooth. External root resorption
b. Resorption commonly is associated with tooth replantation. Many reports have discussed the possible causative factors associated
with ankylosis

interesting to know: A high incidence of tooth ankylosis and external root resorption reportedly has been associated with
impacted teeth that have been uncovered and ligated with dead soft stainless steel at the cementoenamel junction area

any idea where to look for resorption specifically due to autotransplantation?

1 1. Which wire I dont really know? are they asking during deflection? low and cont force?
5 allows for the most SK: From: #66: A review of contemporary archwires: Their properties and characteristics
7 constant force over a During initial leveling --> great range and light forces needed
long range? 1. Suggested wire: multistranded stainless steel or nitinol-type wire
a. M-NiTi A. Conventional nitinol
b. A-NiTi* 1. Martensitic stabilized alloy with low force per unit of deactivation (low stiffness)
2. Limited by lack of formability
B. Pseudoelastic nitinol
1. Austenitic active alloy
a) Both martensitic and austenitic phases play important role during mechanical deformation
b) Note martensite - low stiffness phase, austenite - high stiffness phase
c) Initially there is high modulus austenitic region --> stress induced phase transformation occurs
from austenite to martensite
(1) Upon deactivation, there is second plateau at lower force (martensitic phase gradually
transformed to austenitic phase --> pseudoelasticity)
C. Thermoelastic nitinol
1. Martensitic active alloy that exhibits thermally induced shape memory effect
a) Wire starts out in martensitic stage --> oral temp converts it to austenitic stage

1 1. During pre- both are correct

5 surgical phase to
8 prepare for Class III
surgical correction
which of the
following do you
want to accomplish?
a. Reduce U incisor
proclination
b. Resolve crowding
1 Preferred way to tx a I dont know where to look this up, but in the papers that Dr. Han sent, and from my conversation with her my
5 class II pt is to understanding is the Occlusal plane need to turn counterclock wire (without mandibular plane changing). In class III, you
9 decrease the OP to want to at least preserve occlusal plane or turn it clockwise, again, without mandibular plane change. ofcourse this
SN angle. This is b/c acomplished with MEAW, NOT class II/III elastics alone.
increasing SNMP
leads to instability. Graber: Page 535
(Proffit says Class II The hallmark of modern Tweed-Merrifield edgewise treatment is the use of directional force systems to move
involves eruption of the teeth. Directional forces can be defined as controlled forces that place the teeth in the most harmonious relationship
mand molar and with their environment. To use a force system that controls the mandibular posterior teeth and the maxillary anterior teeth
clockwise rotation of is crucial. The resultant vector of all forces should be upward and forward to enhance the opportunity for a favorable
occlusal plane. It also skeletal change, particularly during dentoalveolar protrusion Class II malocclusion correction (Figure 15-24). An upward and
says tilting occlusal forward force system requires that the mandibular incisor be upright over basal bone so that the maxillary incisor can be
plane too much leads moved properly (Figure 15-25). For the upward and forward force system to be a reality, vertical control is crucial. To
to instability) control the vertical dimension, the clinician must control the mandibular plane, palatal plane, and occlusal plane. If point B
True/True drops down and back, the face becomes lengthened, the mandibular incisor is tipped forward off basal bone, and the
maxillary incisor drops down and back instead of being moved to a proper functional and aesthetic position (Figure 15-26).
The unfortunate result of this procedure is a patient with a lengthened face, a gummy smile, incompetent lips, and a more
recessive chin.
1 1. What is negative **: occlusion is altered but I am not sure about TMD (longterm no, short term yes), inf LPM is shortened however. so there
6 effect of using is changes in TMJ.
0 repositioning
appliance for the from #14: Influence on the masticatory system in treatment of obstructive sleep apnea and snoring with a
correction of sleep mandibular protruding device: A 2-year follow-up
aphnea?(could pick
more than one) III. Results
a. Alteration of A. OJ and OB gradually decreased between baseline and 2 year follow up
occlusion* B. Avg mandibular advancement with MPD was 6.6 mm
b. Development of C. 9 patients developed lateral open bites
TMJ discomfort* D. Found significant reduction in pain during mandibular movements at 2 year follow up
IV. Discussion
A. MPD probably acted as occlusal splint --> reduce TMD symptoms
1. Long term, no risk of developing TMD problems (2 years)
2. Short term, some risk could be present (6 months)
B. MPD previously not used due to fear of side effects (occlusal changes, muscle and joint pain)
1. Adverse events minor compared to positive effects on sleep
2. Pts had reduction of headache frequency --> improved oxygen saturation when breathing normalized
C. Occlusal changes after MPD thought to be caused by alterations of soft tissues of TMJ
1. Speculate that inferior lateral pterygoid muscle shortened when MPD used
a) If mandible not retruded to normal position during day --> muscle permanently shortened -->
condyle cannot attain normal position
V. Conclusion
A. MPD can be used to treat patients with mild and moderate OSA --> risk of occlusal problems is minimal

1 1. What is the **: Wikipedia!

6 established In dentistry, centric relation is the mandibular jaw position in which the head of the condyle is situated as far anterior and
1 consensus of where superior as it possibly can within the mandibular fossa/glenoid fossa.
condyle should bet at
Centric relation is an old concept in dentistry based on an old mechanical viewpoint of dentistry. There are over 26 different
CR?
definitions of Centric Relation since the term was first developed as a starting point for making dentures
a. Most superior
(most superior and
anterior was not a
choice)
b. Most posterior
c. There is no
consensus *
1 1. Which of the mSV: equivalent radiation dose, effective dose, and committed dose.
6 following is not true Grays: absorbed
2 a. mSV means
effective dose
b. mSV means
absorbed dose

1 1. NSAID decreases Duplicate

6 orthodontic tooth
3 movement.
Parathyroid hormone
and thryoxine has
inhibitory effect on
orthodontic tooth
movement.

1 1. TMJ is different Duplicate

6 from others because..
4 a. Has fibrous CT
instead of hyaline

1 1. Articulating Fibrocartilage
6 surface of condyle
5 has which connective
tissue
a. Dense CT
b. Hyaline

1 1. Which of the I couldn’t find a resource but I think the answer is a. Nance. The tongue pressure on the TPA helps maintain vertical and
6 following is least obviously the high pull headgear
6 effective in
maintaining vertical? SG: Profitt Pg 293
a. Nance
b. TPA
c. High pull
headgear
1 1. Who sets
6 standard of care?
7 (dental association
and ABO both in Duplicate Q
choices)
a. Dental
associations
b. Court rulings
c. ABO

1 Teeth : Following orthodontic treatment, endodontically treated teeth exhibit relatively less root resorption than teeth with vital
6 endodontically tx has pulps.
8 ____ root resorption Source: Root resorption of endodontically treated teeth following orthodontic treatment: a meta-analysis.
a. significantly less SG: Profit pg 318
b. significantly more
c. about the same* Although some investigators have suggested that root-filled teeth are more subject to root resorption,the current consensus is that this is not a major
concern
d. not sure

1 which of the I think its a. drifts up and back. Technically it should be “remodels or grows up and back”. Enlow makes a point that the
6 following is true condyle doesn’t push against the articulation. Rather the soft tissue pulls the mandible forward and downward. This would
9 about condyle make choice b. incorrect. The condyle grows by endochondral ossification.
a. Drifts up and
back* Similarly, the whole mandible (Fig. 1-5) is displaced "away" from its articulation in each glenoid fossa by the growth
b. Pushes mandible enlargement of the composite of soft tissues in the developing face. As this occurs, the condyle and ramus grow upward
forward and down and backward (relocate) into the "space" created by the displacement process. Note that the ramus also remodels in shape
c. Grows by and size as it relocates posterosuperiorly. It becomes longer and wider to accommodate (1) the increasing mass of
intramembranous masticatory muscles inserted onto it, (2) the enlarged breadth of the pharyngeal space, and (3) the vertical lengthening of
ossification the nasomaxillary part of the growing face.

'" The process of new bone deposition does not cause displacement by pushing against the articular contact surface of
another bone. Rather, the bone is carried away by the expansive force of all the growing soft tissues surrounding and
attached to it by anchoring fibers. As this takes place, new bone is added immediately (remodeling), the whole bone
enlarges, and the two separate bones thereby remain in constant articular junction~

The mandible "remodels" and is simultaneously "displaced" as "forward and downward" movement proceeds from the
temporomandibular interface.
-Enlow
1 170. Which of a. Tip of canine*
7 the following affects b. Buccal torque of molar
0 posterior occlusion? c. Flared incisor

A tipped canine can take up more room affecting posterior occlusion. Flared incisors as a whole would affect posterior
occlusion also but answer choice c. only states a singular flared incisor. I believe this is discussed in the 6 keys to normal
occlusion.

171. Condylar a. Twice *

width is __ AP depth : b. Same
c. less

This is correct.

172. Preadjusted Preadjusted appliances on most cases guarantee optimal tooth position(F) however on most cases we require bends to
appliances on most optimally position a few teeth (T)
cases guarantee
optimal tooth Preadjusted appliances do not guarantee optimal tooth position. Too many variables with bracket positioning, tooth
position(F) however anatomy, bolton discrepancies, slop between the wire and bracket. Even if you get these things right this does not
on most cases we guarantee optimal tooth position.
require bends to
optimally position a
few teeth (T)
173. PA ceph –
identify lesser wing of
sphenoid
174. Illustration -
Lingual nerve–
superior to CN12 just
below tongue, runs
over hyoglossus
muscle and
associates with
submandibular
ganglion on top of
this muscle.
179. Illustration -
Levator labii
superiolis
180. Illustration - Duplicate Q
Procerus
181. Illustration -
Buccinators
182. Illustration -
Nasalis

183. Lat ceph- Duplicate Q

Sphenoid sinus

184. Illustration - Duplicate Q

Sphenopalatine
artery going into
sphenoplatine
foramen in
pterygomaxillary
fissure
185. Illustration of The suboccipital triangle is a region of the neck bounded by the following three muscles of the suboccipital group of
suboccipital triangle : muscles:
obliquus capitis ● Rectus capitis posterior major - above and medially
superioris ● Obliquus capitis superior - above and laterally
● Obliquus capitis inferior - below and laterally
186. On ceph,
Identify where
anterior digastric
attach. (genial
tubercle was also
choice but I picked
just below that)
187. Geniohyoid ? Anterior Digastric attaches in the areas described but more superficial than the geniohyoid. Image above.
The illustraction of ¾
view of midsagittal
section. I swear it
was pointing at
geniohyoid but it was
not in the choice. The
muscle was coming
from genial tubercle
to hyoid bone. The
choices were
genioglossus,
hyoglossus and
anterior digastic.

An asian girl around i. Asymmetric mandiblar arch

15 years old had ii. Asmmetric maxillary arch
asymmetric mand. iii. Previous trauma *
Class III subdiv left. iv. Functional shift
(188-190) v. Functional shift may be the answer (created by unilateral hyperplastic condyle)

188. what is the It depends on the case. If the patient has a posterior crossbite with a constricted maxilla I would say functional shift.
most likely cause of
asymmetry? SK: AND if no cross bite, trauma? (as most common cause of asymmetry?)

189. To ensure that i. Shaving articular surface of condyle. I think the question was referring to condylar hyperplasia.
the patient doesn’t ii. Proffit pg 146-147: Girls b/w age 15-20 but may start as early as 10 and continue as late as early 30s in either sex. It
get any more excess may stop spontaneously but may require removal of condyle.
growth of mand,
what do you have to Duplicate Q (90 from 1st set) condylectomy needed to stop growth
do?

190. What i. You can pick combilation of the extraction pattern I picked 1st premolar on all side except UL2 where it was Class III
extraction pattern do Class I extraction patteren: (4) 4s or (4) 5s
you want? Class II extraction pattern: U4s L5s
Class III extraction pattern: U5s L4s

In the above example if the left side is class III I would consider extracting UL5 not UL2.
An Hispanic girl with I picked short upper lip
anterior open bite
with constricted
maxilla, high anterior
facial height and
short lip (191-194)

191. What stands

out based on her
profile?

192. Which of the a. She was typical adenoid facies. I picked excess posterior maxillary height as the answer
following doesn’t
describe her Adenoid facies:
Facial features associated with predominant mouth breathing include excessive anterior facial height, incompetent lip
posture, protruding maxillary teeth, widely flared external nares, a steep mandibular plane, and posterior dental crossbite.
-Graber

193. What is the a. I picked three piece Lefort 1 with expansion and possible mand advancement
treatment of choice
for surgical It depends on the case but this answer sounds correct. A three piece Lefort would provide the expansion needed. Pt may
correction also need impaction and autorotation to close bite and fix class two. A BSSO is usually then needed for occlusion and
depending on the case a possible mand advancement may be indicated.

**: i agree, except this make “excess post maxillary” a feature in the previous question then...

194. If you do i. Extrusion of upper anteriors *

surgery, which of the ii. Leveling upper arch with continuous arch wire
following are iii. I picked both b/c you want segmental Lefort to correct open bite
contraindicated?
For 2-plane occlusion you want to level segmentally. Extrusion is an unstable movement so you want to close the bite
surgically not dentally.
An Indian boy, age a. Non-extraction treatment with Herbst *
14, with Class II,
maxillary protrusion Herbst would flare mandibular incisors further.
(U1s were sticking
way out with ~3mm
diastema in between
them), lip
incompetence and
max/mand crowding.
The patient had high
IMPA (Q 195-196)

195. Which of the

following treatment
is contraindicated?

196. When and a. Frenectomy now and let the teeth drift and then do ortho
how do you close his b. Bond fixed appliance first and do frenectomy after 1 year
diastema? c. Don’t do frenectomy * ( I picked this because he didn’t have high frenum attachment)

You want to close the space first and then do the frenectomy. Doing the frenectomy beforehand causes scar tissue to form
inbetween the teeth and then it is hard to close the space. Doing the frenectomy after the space is closed allows the tissue
to heal around the teeth in the position you want them in.

A non-growing man i. Hass

with repaired cleft ii. Hyrax
palate and unilateral iii. bonded expander with occlusal coverage * ( he was high angle)
loss of 2. (197-198) iv. fan-shaped (This could be the answer. I know you sometimes use this when you want more anterior expansion.
This guy had crossbite from premolar forward. Look it up)
197. When you
expand this patient, It depends on the case. In the Haas article, he says that you want to use an expander with acrylic palatal coverage in
what expander do skeletally more mature patients to help get more skeletal expansion and in a high angle case you would want a bonded
you want to use? expander but if in the case the patient primarily just needs anterior expansion because of the constriction of scar tissue
from the cleft palate then I think it would be the fan- expander.
 198. The patient i. F, T- the guy had no bone around cleft site. Know that implant is not a good choice of restoration for previous cleft
had adequate site.
amount of bone
graft. Ideally you Do bone graft at age 7-9.
want bone graft
before eruption of
canine so tooth can
erupt into graft.

Case: A girl with a. Extract lower incisor with Class III elastics
slight Class III b. Extract lower first premolars
199. If the patient
refused surgical Depends on case. If buccal occlusion is just slightly class III and anterior occlusion is edge to edge, I would think it would be
option, how would extraction of a lower incisor. Remember that if you extract just lower premolars the upper 2nd molars are often times
you camouflage this unopposed.
case?

TPAs: know what the literature says regardning how good TPAs are for anchorage, molar intrusion/vertical control etc

General overview
· Not much radiology question - No question on kvP, mA and exposure stuff.
· Not much question on furcation, GTR
Things to know
· Everything about TMJ especially closed lock, open lock, ADD with and/or without reduction.
o Know which side the chin deviates and which side is affected by lateral movement
o Disc displacement (internal derangement) w/ reduction
§ From a closed mouth position, temporarily misaligned disc reduces or improves it’s structural relation w/ condyle when ,and translate with mouth opening, producing clock or
pop. A reciprocal click is heard during opening and closing
o Dis displacement iwhtout reduction (closed lock)
§ Altered disc-condyle relationship is maintained during mandibular translation causing limited opening. Manifested as straight line deviation to the affected side upon opening
§ normal lateral movement to the affected side but limited lateral movement to opposite side
§ w/ closed lock, you see deviation on opening on AFFECTED side. It doen’t allow complete translation of condyle.
§ Pain may or may not be reported
o Open lock is a hyperextension of TMJ. Joint is fixed in open position preventing any translation. So pt can’t close mouth. Occurs most often in joints with anatomic
features that produce subluxation. Ligament laxity, steep angle of eminence. Usually no pain reported unless pt subluxates often. Superior lateral pterygoid may overcome the
superior retrodiscal lamina and disc will be pulled through the anterior joint space. The precise position of disc relative to the condyle may vary, however, in any case, the
condyle is always in front of the eminence.
· A lot of questions on functional appliances and what happens to mandibular length in short/ long term. Does it increase or more than control etc.
CLINICAL TOPICS Growth patterns
“Gummy” smile
Adult treatment Hand wrist radiographs
African American cephalometric norms Impacted canine
Alveolar ridge for implants Implants
Anterior facial height Incisor crowding
Arch form Lateral open bite
Arch length discrepancy Mandibular asymmetry
Assessing hand-wrist radiographs Mandibular retrognathia
Bicuspid extraction treatment Maxillary deficiency
Bimaxillary protrusion Maxillary protrusion
“Black triangles” / tooth morphology Missing mandibular incisor
Blocked out canines Missing molars
Bolton’s tooth size discrepancy Missing teeth
Bruxism Open bite
Class II, Division 1 malocclusion Orthodontic relapse
Class II, Division 2 malocclusion Orthognathic surgery
Class III malocclusion Over erupted incisors
Closed bite Over retained primary teeth
Congenitally missing premolars Posterior crossbite
Deep overbite Posterior discrepancy
Dental age vs skeletal age vs Primary failure of eruption
chronological age Retained primary molars
Dental midline deviations Root resorption
Diastema Severe rotations
Early loss of primary teeth Space maintenance
Ectopic canines Subdivision classification
Endodontically treated teeth Surgical procedures
Excessive spacing Third molars
Facial asymmetry TMD
Facial type classification Tongue thrust habit
Frenum management Upper lip to incisor relationship
Functional shift