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Informed consent
Informed is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention. In the communications process, you, as the physician discuss with your patient:
patient's diagnosis, if known nature and purpose of a proposed treatment risks and benefits of a proposed treatment Alternatives treatment risks and benefits of the alternative treatment or procedure The risks and benefits of not receiving or undergoing a treatment or procedure
patient should have an opportunity to ask questions to elicit a better understanding of the treatment or procedure, so that he or she can make an informed decision to proceed or to refuse a particular course of medical intervention.
Blacks Classification
Class Iocclusal areas and buccal or lingual pits Class IIposterior interproximal Class IIIanterior interproximal Class IVanterior interproximal including the incisal corner Class Vgingival at facial or lingual (Class VIcusp tip)
Cement Base
Choose a cold large slab Put a scoop of powder on the slab ÷ it into 6 Two drops of liquid Mix powder to one drop of liquid. Adding more powder if needed or liquid to the mixture Mix in a large circular motion and folding motion
Matrix Placement
Observe the video for better understanding http://www.youtube.com/watch?v=an5hdF8Rl8&feature=related
AND DOC AYUs SLIDES
Burnisher
Remember
The open end of the U-shaped head must be always face the gingiva The long knob and short knob end should be facing out of the mouth.
LOCAL ANESTHESIA-Diyana
Pre-injection procedures Fisher technique Plus+ Maxillary injection tech Mandibular injection tech
http://www.nysora.com/peripheral_nerve_blo cks/head_and_neck_block/3062oral_maxillofacial_regional_anesthesia.html
Sila chekkidout
Wash hands
Break ampule
Wear gloves
Wash hands
Wear mask
Recap syringe
Fisher Technique
1ST POSITION Locate linea obliqua externa geser median to locate linea obliqua interna (melalui trigonum retromolar) Punggung jari menyentuh buccoocclusal gigi terakhir Syringe at premolar region Tengah2 lengkung kuku penetrate until contact with bone 2ND POSITION Syringe now sejajar dataran occlusal Penetrate 6mm, ASPIRATE Aspiration ve, 0.5cc N.Lingualis 3RD POSITION Syringe now at canine region Penetrate 10-15mm until contact with bone hilang ASPIRATE, -ve, 1cc N. Alveolarius Inferior
MAXILLA
Nasopatine nerve
Supraperiosteal/ local infiltration Tarik pipi n bibir sehingga jaringan tegang Tusuk pada lipatan mukobukal Jarum tusuk ke arah apeks . Jarum dimasukkan sampai ujung jarum di daerah apeks gigi Aspirate, 0.6-1cc slowly (20sec)
Blok N. Palatinus Mayus Baal sampai canine Foramen at distal 2nd molar (pertemuan palatum durum n processus alveolaris) Jarum tusuk slowly 0.5mm 0.5cc-0.75cc
Blok N. Nasopalatinus Jarum inserted thru papila nasopalatinus sampai jalan masuk canalis incisivum Contact dgn tulang jarum keluarkan lagi 0.5-1mm, anestetikum 0.1cc-0.2cc slowly
Infiltrasi palatum Tujuan: jaringan gusi 5-10mm dr gingival margin Jarum 45degree Anestetikum 0.20.3cc
MANDIBLE
Fisher blok Buccal Nerve Block
Buccal Nerve Block Dilakukan pd coronoid notch (median frm linea obliqua . Mukosa bukal ditarik.) Jarum tusuk lateral and distal gigi geraham terakhir setinggi oklusal 2-3mm, aspirate, 0.5cc
Microbe-Fit
Removing Gloves: 1. Remove gloves carefully to prevent splattering. Grab the outside wrist of one glove with your other hand. Turn glove inside out as you remove it. 2. Drop the inverted glove into the other hand and slide your bare finger under the second glove to invert it and trap the first glove inside. 3. Wash hands after removing gloves.
ORTHODONTIC
Hani
OVERBITE
OVERBITE
NORMAL
HOW TO MEASURE?
Mark a short line on labial surface of lower incisor with
sharpened pencil
Distance from incisive edges
OVERJET
Normal
MALE
FEMALE
2,2 mm + 0,8 mm
2,5 mm + 1,1 mm
Overjet
HOW TO MEASURE?
Measure horizontal distance from
ANGLES CLASSIFICATION
The classifications are based on the relationship of the
labioversion of maxillary
incisors
Type 3-linguoversion of
maxillary incisors Type 4-incisors and canines normally positioned Type 5-mesioversion of molars
Class II division I when the maxillary anterior teeth are proclined and a large overjet is present Class II division II Molar relationship shows the
Deweys modification:
Type 1- well-aligned teeth and dental arches Type 2- Crowded mandibular incisors Type 3- Crowded maxillary incisors
CEPHALOMETRIC LANDMARK
A (subspinale) deepest
point between ANS and inferior most point in maxillary alveolar process B (supramentale) deepest point between pogonion and superior most point in
Pogonion (Pog) anterior most point in contour of lateral shadow of chin Gnathion (Gn) most anterior and inferior point on lateral
MODEL ANALYSIS
ANALISIS BOLTON
TOOTH SIZE DISCREPANCY (TSD)
OBJECTIVE
Evaluates maxillary and mandibular teeth for tooth size discrepancies
Comparing the size of the maxillary teeth the size of the mandibular dentition
There are two measurements: - The ratio of anterior (6 anterior teeth) - The ratio of total (12 teeth)
STAGES
Stage 1: Measure and record all the mesio-distal tooth size in mm (such as analysis ALD) - 6 anterior teeth RA (13-23) - RB 6 anterior teeth (33-43) - 12 teeth RA (16-26)
- 12 teeth RB (36-46)
RATIO ANTERIOR
TOTAL RATIO
Stage 2:
Calculations with Boltons formula
-Use the correct size of the maxillary teeth is to see the size of the teeth mandible should be on the Boltons table. -Measure the mandibular teeth of the patient -Reduce the size of the mandibular teeth of the table -The results of this reduction is the difference between mandibular tooth size excess
If,
Then the true size of the mandibular teeth, the size of the maxillary teeth are too big than it should
Use the true size of mandibular teeth to measure the size of maxillary teeth that should be in Boltons table Measure the maxillary teeth on patient Reduce the size of maxillary teeth from the table Result of reduction is the excess of maxillary tooth
Pasien
Selisih
------ mm
Mand 6
Maks 6
Mand 12 Maks 12
------ mm
------ mm ------ mm
CONTOH KASUS
Ukuran 12 gigi RB = 90 mm Ukuran 12 gigi RA = 95 mm Menurut Rumus Bolton : 90 ---- x 100 = 94,7% 95 94,7% kesimpulan geligi madibula yang salah (ukurannya terlalu besar dibandingkan seharusnya) dan gigi maksila yang benar. Lihat di tabel Bolton angka 95 untuk ukuran gigi maksila yang benar, maka ditemukan ukuran gigi mandibula seharusnya 86,7 mm. Maka ukuran 12 gigi mandibula berlebih sebanyak = 90 86,7= 3,3 mm.
Seharusnya (Tabel)
------mm
Selisih
------ mm
Maks 6
Mand 12
------ mm
90 mm
-------
mm
------ mm
3,3 mm
86,7 mm
Maks 12
95 mm
mm
mm
Analisis Howes
Analisis Howes
State of dental crowding (crowding) is not only due to the size of the teeth that are too big but can also be caused by the curved jaw bone is too small.
Arch width / Width Base Apical = distance between the deepest point canine fossa, measured from the point at the tip apex of tooth 14 to tooth 24
Howes Formula
1. 100 X Apical base ________________ Total Mesiodistal 16 26 100 X .. mm = ______________ mm = .%
2. Dental arch width (buccal tip14-24) = .........mm dental arch width (apical base) = .........mm ________________ reduction = mm
ANALYSIS RESULT
1. 44% = INDICATES THAT THE APICAL BASE WIDE ENOUGH FOR ALL TEETH FROM 6 TO 6
2. < 37% =ARCH CURVE IS SMALL UNTIL EXTRACTION NEEDED 3. 37 %-44 % = DOUBTFUL CATEGORY BETWEEN EXTRACTION OR EXPANSION 4. > 44% = JAW ARCH WIDTH> DENTAL ARCH WIDTH UNTIL P1 SO EXPANSION CAN DONE SAFELY
Analisis PONT
The rationale is: greater mesiodistal widths 4 incisive maxillary teeth, the greater the width dental arch between P1 and M1 so that no crowding
1. Mesiodistal width 12 11 21 22
x 100 =... mm
Ponts table
PATIENT 14 -24 16-26 .. mm ..mm PONT ..mm ..mm DIFFERENCE ..mm ..mm
If the result is - (negative) contraction occur If the result is + (positive) distractions occur
Oral Surgery-Alyana
-Choose the right tang for extraction -Show extraction procedure -Write prescription for a case (extraction) -Prescribe: mefenamic acid and amoxicillin
Maxillary forceps
The S, I, and Z shaped forceps are used on the maxillary arch.
to extract maxillary first and second molars Smooth, concave surface for the palatal root Pointed design that will fit into the buccal bifurcation on the buccal beak.
Mandibular forceps
Forceps which are C and L shaped are used on the mandibular arch Bentuk paruh
forceps No. 17
lower molar forceps beaks have bilateral pointed tips in the center to adapt into the bifurcation of the molar teeth. the beak adapts well to the bifurcation.
HAWKBILL-TYPE FORCEPS
Mead #MD3 forceps
For mandibular anteriors and bicuspids
#13 forceps
For mandibular bicuspids
#22 forceps
For mandibular first, second, and third molars.
How to extract
Anamneses Extra oral and intra oral exam Explain what you are going to do Informed consent!!! Inject local anesthetic. Separate the gum from the tooth. Loosen the tooth - baine Take out the tooth.
Right hand: pgg tang Left hand: fix gigi
Stop the bleeding gigit tampon hrs Suture is must depending on the surgical area Explain to the person what to do at home to look after the wound.
docs sign
docs sign
docs sign
docs sign
Pedodontics-Fuzah
Question 1
Anak laki-laki, 5 thun, dtg rsgm bersama ibu Gigi kanan atas sakit, ingin dirawat Intraoral exam. : caries profunda gigi 55
Cara mendiagnosis
Rencana perawatan
Visual showing a deep Pulpotomy + SSC cavity involving the pulp, confirmed using a probe. If the probe is sent deep into the pulp, both pain and hemorrhage would be seen. Radiograph It may show exposure of the pulp and deep cavity. The periapical area usually is normal, with some widening of the periodontal ligament sometimes. Percussion Exudate in the pulpal cavity increases the intrapulpal pressure, which leads to tenderness on percussion of the tooth. Vitality test
Question 2
Anak laki-laki, 7 tahun gigi kiri atas(64) berbau (halitosis) Makan/minum dingin : xde rasa ape2
Anak perempuan, 4 tahun Mengeluh sakit berdenyut hebat pada 54, menangis dan tak boleh tidur Ada pembengkakan pada 54 smpi bwh mata kanan
Rencana perawatan 1) Incision and extraction of 54. *adequate drainage is almost impossible to achieved in primary tooth. 2) Space maintainer OR Mummifikasi (DSP6 punyer slides by dr inne n dr yetty)
Anak perempuan, 6 tahun Mengeluh sakit gigi kanan bawah (85) bile minum/mkn dingin Pt ingin ditambal
Ini sgt instant. Kalau ade yg salah or nk tmbh, mangga di benerin nyak!
Ref:
Slides doc indri Slides doc inne n doc yetty Dentistry for child and adolescent (ebook DSP 9)
Radio-Fieka
Radiology Periapical : Bi-centric technique
Communication
Bila patient masuk : Greet patients with salam and senyum mesra Suruh patient duduk Read status and confirm with patient : nama, alamat pendek, case Explain risk secara overview, eg Explain procedure to patient
Preparation (1)
Operator : wear baju kebal, mask and glove Patient : position on chair Maxilla tegak 90* Mandible sudut mulut to tragus // lantai Film positions principles : White surface faces teeth The dot faces occlusal
Note :
1) film @ palatal/lingual gigi only 2) Maxilla : patient pegang dengan thumb Mandible : patient pegang dengan jari tunjuk 3) Anterior : film vertical 4) Posterior : film horizontal
Preparation (2)
Adjust angles and timer based on case
Set voltage to 6V (standard) Note : ada juga yang kata 5-6 so tak tau le
Shoot
Confirm angles based on case Check patients head and film positions Turn the machine on Shoot.
Yam
Class I : Bilateral edentulous areas located posterior to the natural teeth (bilateral free end)
Class II : A Unilateral edentulous area located posterior to the remaining natural teeth (unilateral berujung bebas (free end unilateral))
Class III : A Unilateral edentulous area with natural teeth remaining both anterior and posterior to it (gigi bersandaran ganda)
Class IV : A single but bilateral (crossing the midline), edentulous area located anterior to the remaining natural teeth
Applegates rule
Klasifikasi dibuat setelah semua extraction selesai dilakukan Bila M3 hilang dan tidak diganti, so tak masuk klasifikasi Bila M3 ada dan akan digunakan sebagai gigi penahan, so masuk dalam klasifikasi. Bila M2 dah hilang dan tak akan diganti, so tak masuk dalam
klasifikasi.
Bagian tak bergigi paling posterior selalu menentukan kelas
Daerah tak bergigi yang tak masuk dalam klasifikasi, disebut modifikasi. Jumlah gigi yang hilang tak dipersoalkan; yang dipersoalkan adalah jumlah ruangan gigi yang hilang (untuk dimasukkan sebagai klasifikasi atau modifikasi) Tidak ada modifikasi untuk kelas IV
Cuba test!
Klasifikasi Soelarko
Kelas I: berujung bebas Kelas II: bersandaran ganda Kelas III: gabungan berujung bebas dan bersandaran ganda Aturan divisi Divisi 1: satu sisi Divisi 2: dua sisi Divisi 3: meliputi garis median
SURVEYING
Survey model menggunakan surveyor. Surveyor adalah alat yang dipakai untuk meninjau kesejajaran dari 2 permukaan gigi atau lebih, atau bagian lain dari model. Surveyor The Ney Kegunaan Surveyor: Menentukan arah pemasangan Menentukan garis survey Menentukan daerah gerong (undercut) Menentukan guiding plane Menentukan penempatan cangkolan Menutup daerah gerong yang tak diperlukan.
Garis survey merupakan garis singgung yang menunjukkan kontur terbesar suatu permukaan (gigi, alv ridge) pada arah pemasangan tertentu. Letak model atas meja model dgn zero tilting cari undercut kalau dapat undercut dgn baik, maka arah pemasangan sejajar oklusal then buat garis survey pada semua permukaan ggi sandaran dgn carbon marker kalau tak dapat, tilting ke arah ant/ post/ kiri/kanan kalau dpat undercut yg baik, kunci meja model then buat gari survey sebelum melepas model, buat tripoding (untuk mencari ulang posisi terakhir survey)
(baca dekat slide dr. taufiq) Aku bukan malas ehhhhhhhhhhhhhhhhCuma nanti I copy paste jugak hahahaha
Desain
Retensi: kemampuan GT bertahan terhadap gaya yang melepaskan (DARI ARAH VERTIKAL) . (retensi untuk GTSL dari cangkolan (retainer) pada gigi sandaran) Stabilisasi: kemampuan GT agar tidak goncang/bergeser pada pemakaian. (dari arah horizontal). (stabilisasi terutama berhubungan dengan dukungan/support (dari gigi/mukosa) dan dari oklusi Estetika: keindahan yang sesuai dgn keperibadian Support: kemampuan GT utk menahan tkanan dari arah apikal Arah pemasangan
Tentukan gigi sandaran surveying buat garis survey tentukan arah pemasangan (dri surveying) tentukan perluasan landasan
Cangkolan
Cangkolan adalah bagian dari GTSL yang biasanya dibuat dari kawat khusus (kawat klamer) atau dari logam cor. Melingkari dan menyentuh sebagian besar, keliling gigi, memberi retensi, stabilisasi dan suport bagi GTSL tersebut. Cangkolan C, Cangkolan bukal, Cangkolan E atau Cangkolan Bola (Ball clasp)
Syarat2 Cangkolan
1/3-1/2 ujung lengan retentif berada di daerah gerong dan ujungnya 1-2 mm diatas tepi gusi. 1/3 awal lengan retentif harus berada di daerah non gerong Kontak cangkolan dgn permukaan gigi harus kontak berkesinambungan. Cangkolan harus beradaptasi dan tidak menekan gigi. Bila memakai oklusal rest tidak boleh mengganggu oklusi Ujung lengan dibuat sepanjang mungkin Ujung lengan dibentuk sehingga tidak tersangkutnya sisa makanan, bibir, pipi serta lidah Cangkolan tak boleh cacat bekas tang Utk tangan cangkolan yg panjang (misal pd ggi molar) gunakan kawat klamer 0.8 mm.
Mengukur
Yang nak ukur linggir, daerah x bergigi semua tuI honestly x tau sgt punkat buku xde,,secara teorinyaso, I rase basically ape yg kita buat dalam labmain point is pakai pembaris besi yang mula dari nol tu. Nak ukur dari mesial ke distal ke ape keI kurang tahumaaf ya teman2kalau ade yg tau.,,nanti kongsi2 kayyy Love u alllawhhhhh gewdixxx Raaawwrrrrrrr..
DMT-nina
Alginate Model cast
alginate
alat2
Sendok cetak/tray: berlubang, ruang 4-6mm dari gigi. RA: sampai daerah AH-line RB: sampai molar terakhir/retromolar pads. Tak cukup: tambah lilin dgn retensi.
alginate
metode
Cetakan mukostatis Tekanan minimal Bahan cetak hidrokoloid Indikasi: gigi goyang, byk undercut & diastema
alginate
persiapan
Mulut: bahu & siku operator Instruksi pasien nafas ikut hidung. Oklusal rahang sejajar lantai. Pasien kumur dahulu.
Operator bersih + wear gloves. Cetak Rahang Bawah dulu! Posisi cetak: -RA diri depan kanan, masukkan sendok cetak, fix, pindah ke kanan belakang. -RB depan kanan.
alginate
persediaan
RA: 2.5 scoop alginate, 1 sukatan air RB: 2 scoop alginate, sukatan air Guna air dingin lengthen working time Masuk air dalam bowl Shake powder dalam beg ambil, ratakan pakai spatula If ada kertas disediakan -> tempat letak powder. Bubuk -> air Sediakan another bowl of air utk ratakan impression
alginate
pengadukan
Aduk sampai semua terbasahi 1 minit/ 45-60 saat Menekan ke dinding bowl alginat larut, buang udara, homogen Isi sendok posterior ke anterior Ratakan pakai jari basah. Work quickly before color changed.
alginate
mencetak
- RB dulu! -telunjuk kiri tarik sudut mulut pasien - kanan sendok cetak masuk dulu -posisikan segaris midline -tekan sendok posterior anterior
RB instruct patient utk gerakkan lidah ke atas dan ke depan. -kalau ada yg belum tertutup (vestibulum), tambah alginat. -hold in place for atleast 2mins -cek kekerasan dgn excess di bowl
-buka seal dengan retracting cheek to allow air inside - RA: tarik tangkai ke atas, lepaskan posterior dulu, sejajar tooth axis - RB: tekan tangkai ke bawah, lepaskan posterior dulu.
alginate
Hasil cetakan
Semua anatomi tercetak (muccobuccal fold, frenulum, etc) Hopefully takde: Bubbles yang besar Vestibule tak tercetak sebab tak cukup tinggi Penyimpangan midline Decreased/increased depth
Rinse with water to remove saliva & blood Remove excess water..done! Cor gips within 15-30mins..kalau lebih, moisten alginate with damp tissue
Cast model
Plaster Gips ; study model 50-60cc:100gr Stone Gips; work model 30cc:100gr
RA: 100 gr RB: 80 gr Letak powder on paper or alas if ada.
Cast model
mixing
Isi air dlm bowl Tuang powder (15s) Tekan2 with spatula until all wet (15s) Aduk until homogen (60s) Use vibrator or ketuk2 atas meja with the upper side of bowl tertutup, until bubbles xde (1.5mins).
Cast model
loading
Place posterior part higher Tgn kiri pgg handle, tgn kanan load Masuk dari satu arah shj! Ketuk2 kat meja to let it flow until cervical Tutup semua tapi jgn terlebih nnt susah buka Tunggu smpi gips hilang shine and cool down. Buat retensi
Cast model
removing
Minimum 30 mins, maksimum 60 mins Buang excess dulu Under running water
If gips chalky because: Impression not clean Ada air on impression Remove too early/too late Low w/p ratio
ORAL MEDICINEsuga
Anamnesis
Chief Complaint Location of the lesion Time Course Quality of pain Factors that reliefs the pain Factor that triggers the pain Whether been treated before What wants to be done
Patient is rested and relaxed. Check with the patient as to which arm is usually used for the cuff (preference as a result of existing medical conditions or previous procedures). Ensure that the arm to be used is supported at the same level as the heart. The elbow needs to be extended, to allow the best detection of the brachial artery in the elbow joint.
Palpate the brachial pulse, this is where the stethoscope will be placed when listening for the Korotkoff sounds. Size the cuff correctly, the bladder portion must extend at least 80% around the arm. Apply the cuff to the upper arm, the centre of the bladder in line with the brachial artery. The cuff needs to be positioned to allow the stethoscope diaphragm clear access to the brachial artery (not too tight or loose). Should be no trapped clothing beneath the cuff: reading error, due to a pressure point.
Find the radial pulse and keep monitoring this. Close the control valve (arrowed) on the sphygmomanometer. Gently pump the bulb until radial pulse cannot be felt. Continue to inflate adding 30 mmHg. Then, gently open the valve for a slow controlled release of air from the cuff with 2mm Hg per second. Listen carefully for the first beat: REAL SYSTOLIC PRESSURE.
At some point, you will not be able to detect the beat. This is the: DIASTOLIC PRESSURE. Open the air valve fully, to rapidly deflate the cuff. Release the patient from the equipment. Record your readings, Systolic over Diastolic.
SUMMARY:
Topical Medication
Needed Items
Pinset Topical Medication (gel/ointment) Gloves Cotton pellet Glass lab Gauze
Wash your hands and wear the gloves. Place the gel or ointment on the glass lab. Use gauze to dry the mucosal tissue completely. Prevent using cotton roll to dry the tissue that can cause the wools stick onto the lesion.
Use the cotton pellet to apply a small amount of the medication onto the lesion and a bit of the surrounding. Leave the area untouched for 5 min for a full absorption. If the lesions is on the palate, use folded gauze and ask the patient to bite it for 5 min.
Periodontology-githa, ashley
Color: coral pink Size: depends on vascular supply Contour: marginal gingiva (collar like/scalloped) Shape: interdental gingiva (anterior: pyramidal shape, posterior: flattened) Consistency: firm, resilient Surface texture: stippled- on attach gingiva Position: gingival margin
2. Basic instruments
Explorer Mouth mirror Pinset Probe
3. Examination
Anamnesis Medical history Bad habits Intraoral Drifting of teeth Tooth mobility Attrition Sensivity
- Abrasion - Pain - Gingival bleeding(spontaneous/ non-spontaneous) - Stillmans Cleft (dry mouth and severe gingivitis)
4.Types of periodontal disease Gingival disease - plaque induced - non plaque induced acute / aggressive periodontitis - localized/ generalized Chronic periodontitis - localized/ generalized
5. Brushing method Vertical :disadvantage - cause gum recession Horizontal :disadvantage- interdental not cleaned, abrasion, recession Roll : for patient with healthy gingiva & brush placed above free gingiva and bristles towards apices Circular / Strokes: For children Vibratory 450 into gingival sulcus & mainly for periodontitis patient