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Karim El Mestekawy
karimelmestekawy@yahoo.com
This file is for Oral Surgery for Membership of the
Faculty of Dentistry of the Royal College of
Surgeons in Ireland Part 2 Exam.
Sources for MFD Part 2 Exam depends mainly on
candidates' feedback and there are no pictures
associated with the feedback. So, I tried to make a
more useful feedback by adding pictures that
match the questions.
NOTE: I added pictures in station 13 which are
different from the previously added pictures in my
(questions file) for Oral Surgery for more
illustration for the question.
You can find my questions file in this LINK
The questions & answers file.
Oral Surgery
Station 2
Picture 1
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
OPG, upper occlusal and 2 periapical views of the upper anterior teeth showing
impacted upper canines.
1. Name of this technique?
Parallex Technique.
NOTE:
There are two types of parallex technique :
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
1.Horizontal Parallex Technique.
This technique includes moving the tube head in a horizontal direction mesially or
distally as in the pictures using the SLOB Technique (Same Lingual Opposite
Buccal) as below:
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
This technique includes moving the tube head in a horizontal direction upward or
downward as in the pictures using the SLOB Technique (Same Lingual Opposite
Buccal) as below:
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
1. The patient is seated with the head supported and with the occlusal plane
horizontal and parallel to the floor and is asked to support a protective thyroid
shield.
2. The image receptor, suitably barrier wrapped, is placed flat into the mouth on
to the occlusal surfaces of the lower teeth. The patient is asked to bite together
gently. The image receptor is placed centrally in the mouth with its long axis
crossways in adults and anteroposteriorly in children.
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
3. The X-ray tube head is positioned above the patient in the midline, aiming
downwards through the bridge of the nose at an angle of 65–70° to the image
receptor.
NOTE
A Diagram showing the position of the image receptor in relation to the lower
arch.
B Positioning from the front; note the use of the protective thyroid shield.
C Positioning from the side.
D Diagram showing the positioning from the side.
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
Example of the resulting upper occlusal radiograph.
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MFD Part 2 , May 2012, Dublin
Station 3
Station 4
1. Where is the canine impacted?
It is impacted palatally because when the x-ray tube moves distally the impacted
canine moves in the same direction and vice versa.
2. What technique is this?
Horizontal Parallex Technique.
SLOB Technique ( Same Lingual Opposite Buccal)
3. How do you take an upper occlusal view?
1. The patient is seated with the head supported and with the occlusal plane
horizontal and parallel to the floor and is asked to support a protective thyroid
shield.
2. The image receptor, suitably barrier wrapped, is placed flat into the mouth on
to the occlusal surfaces of the lower teeth. The patient is asked to bite together
gently. The image receptor is placed centrally in the mouth with its long axis
crossways in adults and anteroposteriorly in children.
3. The X-ray tube head is positioned above the patient in the midline, aiming
downwards through the bridge of the nose at an angle of 65–70° to the image
receptor.
4. What are the treatment options for the palatally impacted canine?
1. Interceptive treatment by extraction of the deciduous canine (SIGN Grade A)
2. Transplantation (SIGN Grade B)
3. Surgical exposure and orthodontic alignment (SIGN Grade C)
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
4. Surgical removal of the palatally ectopic permanent canine (SIGN Grade C)
5. No active treatment/leave and observe (SIGN Grade C)
NOTE : These treatment options are according to SIGN Guideline in the
management for the palatally ectopic maxillary canine.
LINK TO DOWNLOAD THE PAPER
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Station 5
Station 6
1. What is this?
You should first biopsy the lesion to identify it.
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
Most probable mucocele
2. Two Differential Diagnosis.
1. Hemangioma
2. Pyogenic granuloma.
3. What is the difference between the lesions you mentioned from the lesion in
the picture?
Hemangioma and pyogenic granuloma have a blood content while Mucocele
contains mucous.
4. Treatment.
You should first biopsy the lesion to identify it.
Surgical excision with the associated damaged gland and duct.
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Station 7
Panoramic X-ray
2. Differential Diagnosis?
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
1. Ameloblastoma
2. Odontogenic Myxoma.
3. Odontogenic Keratocyst
3. Spot Diagnosis.
According to US National Library of medicine :
Spot diagnosis means the initial pattern that may trigger the possible
diagnosis.
In case of ameloblastoma, It can cause expansion of the mandibular bone and
facial asymmetry.
NOTE:
In case of presence of histological picture
View 1
View 2
2. The image receptor, suitably barrier wrapped, is placed flat into the mouth on
to the occlusal surfaces of the lower teeth. The patient is asked to bite together
gently. The image receptor is placed centrally in the mouth with its long axis
crossways in adults and anteroposteriorly in children.
3. The X-ray tube head is positioned above the patient in the midline, aiming
downwards through the bridge of the nose at an angle of 65–70° to the image
receptor.
3. What is the name of the technique used to localize the canine?
Horizontal Parallex Technique
4. Position of the canine in relation to other teeth?
It is palatally impacted
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MFD Part 2 UAE April 2015
Station 10
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
1. Diagnosis?
You should first biopsy the lesion to identify it.
Mucocele.
2. What are the two structures that I should care about during treatment?
1. Lingual Nerve.
2. Labial branch of mental nerve.
3. Type of content?
Mucus content
4. Other areas where you can find this lesion?
1. Floor of the mouth.
2. Buccal mucosa.
5. Affect which part of the gland?
The duct and acini of the gland
6. Lined with epithelium?
No. Not lined with epithelium.
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MFD Part 2 , Dublin , May 2015
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
Station 11
3. Soft-tissue management.
4. Hard-tissue management.
5. Curettage of area.
6. Resection of root.
8. Retrograde filling.
10.Post-operative care.
--------------------------------------------------
Bahrain June 2015
Station 12
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
View 1
View 2
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
in the right posterior area of the mandible extending mesiodistally from the
premolar area to the right ramus of the mandible. It has a unilocular
appearance and a well-defined margin.
3. Differential diagnosis?
1. Ameloblastoma.
2. Dentigerous Cyst.
3. Odontogenic Myxoma.
4. Odontogenic Keratocyst.
NOTE : you can see in the panoramic x-ray that the radiolucent lesion is
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
associated with impacted tooth which may lead some to think that the lesion has
only one diagnosis possibility of being a dentigerous cyst, but you have to look
also at the CT x-ray to notice the presence of expansion which can also lead to the
diagnosis of ameloblastoma.
4. Management?
You should first biopsy the lesion to identify it.
Surgical Removal.
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Station 13
View 1
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
View 2
2. The image receptor, suitably barrier wrapped, is placed flat into the mouth on
to the occlusal surfaces of the lower teeth. The patient is asked to bite together
gently. The image receptor is placed centrally in the mouth with its long axis
crossways in adults and anteroposteriorly in children.
3. The X-ray tube head is positioned above the patient in the midline, aiming
downwards through the bridge of the nose at an angle of 65–70° to the image
receptor.
3. Evaluation of the size and extent of lesions such as cysts or tumors in the
anterior maxilla.
Station 14
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
healing.
2. In case of failure of RCT, persistent infection or the lesion doesn’t resolve,
surgical treatment is the treatment of choice as we need to remove the
lesion and do biopsy. So, we may consider Apicectomy.
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
4. Steps of the procedure.
Steps of Apicectomy procedure:
1. Pre-operative care.
3. Soft-tissue management.
4. Hard-tissue management.
5. Curettage of area.
6. Resection of root.
8. Retrograde filling.
10.Post-operative care.
------------------------------------------------------
Bahrain 2016
Station 15
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
View 1
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View 2
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
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Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
View 3
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View 4
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
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Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
View 5
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View 6
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
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2. Which one is the most difficult type of impaction and which one is the
easiest according to the x-ray radiographs?
The most difficult type : Distoangular
The easiest one : Mesioangular
5. What are the radiographic and clinical signs of third molar proximity to
the inferior alveolar canal?
The Radiographic signs :
1. Darkening of the roots.
2. Deflected tooth roots.
3. Interruption of the one or two white lines of the inferior alveolar
canal.
The Clinical Sign :
Third molar proximity to the inferior alveolar nerve can lead to inferior
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
alveolar nerve damage which can cause post-operative sensory
disturbances.
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MFD Part 2 UAE April 2017
Station 16
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
Picture 1
1. Differential Diagnosis
1. Periapical Granuloma
2. Periapical Cyst (Radicular Cyst).
2. Treatment.
You should first biopsy the lesion to identify it.
1. Extraction of the deciduous canine and removal of the periapical
pathology.
2. Alignment of the impacted canine in its proper position.
Picture 2
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
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Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
Station 18
Dr.Karim El Mestekawy
karimelmestekawy@yahoo.com
1. Differential Diagnosis
1. Dentigerous Cyst.
2. Odontogenic Keratocyst.
3. Ameloblastoma.
2. Risk Factors
1. Swelling.
2. Difficulty in opening the mouth (Trismus)