lots of questions part 1

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Biomaterials Practice Exam Questions


1. 510K FDA approval means:

A. The device is approved for clinical trials B. It is a new medical device C. It is similar to previously approved medical

device


Q1 Answer

ď‚— 510K FDA approval means:

A) The device is approved for clinical trials only B) It is a new medical device C) It is similar to previously approved medical device – Source: www.fda.gov


Q1 Explanation – 510K FDA approval  510(k) ClearancesOverviewSection 510(k) of the Food, Drug and Cosmetic Act requires device

manufacturers who must register, to notify FDA of their intent to market a medical device at least 90 days in advance. This is known as Premarket Notification - also called PMN or 510(k). This allows FDA to determine whether the device is equivalent to a device already placed into one of the three classification categories. Thus, "new" devices (not in commercial distribution prior to May 28, 1976) that have not been classified can be properly identified. Specifically, medical device manufacturers are required to submit a premarket notification if they intend to introduce a device into commercial distribution for the first time or reintroduce a device that will be significantly changed or modified to the extent that its safety or effectiveness could be affected. Such change or modification could relate to the design, material, chemical composition, energy source, manufacturing process, or intended use.


2. What does titanium alloy consist of? A. Titanium B. Aluminum C. Vanadium D. All of the Above


Q2 Explanation - Titanium Alloy ď‚— There are four grades of CP titanium (grades I to IV), and

many grades of titanium alloy.

ď‚— Regardless of the grade of titanium or alloy, the surface

condition to the bone is similar (i.e., titanium oxide). With its highly active titanium oxide layer, these materials are extremely well tolerated by local tissues.(grade V) Alloy (Ti6Al-4V) has been shown to exhibit the most attractive combination of mechanical and physical properties, corrosion resistance, and general biocompatibility of all metallic biomaterials.


3. What is titanium graded by?

A. The amount of impurities B. Compression load strength


Q3 Answer ď‚— What is titanium graded by?

A) The amount of impurities – Source: Study Guide B) Compression load strength


Q3 Explanation - Unalloyed Titanium

Unalloyed titanium grades are often referred to by their tensile strengths. The difference has to do with sub-percentage traces of oxygen and iron in the metal. More impurities increase the tensile strength. Unalloyed Ti ("Pure") Grade 1 35A - Min. Tensile(KSI)- 35 Grade 2 50A - Min. Tensile (KSI)- 50 Grade 3 65A - Min. Tensile (KSI)- 65 Grade 4 80A - Min. Tensile (KSI)- 80 Alloys Grade 5 Ti-6Al-4v - Min. Tensile (KSI)- 130 Grade 6 Ti-5Al-2.5Sn - Min. Tensile (KSI)- 120 Grade 7 Ti-0.15Pd - Min. Tensile (KSI)- 50

Min. Yield(KSI)- 25 Min. Yield(KSI)- 40 Min. Yield(KSI)- 55 Min. Yield(KSI)- 70

Mod. of Elasticity(PSI)- 14.9 Mod. of Elasticity(PSI)- 14.9 Mod. of Elasticity(PSI)- 14.9 Mod. of Elasticity(PSI)- 15

Min. Yield(KSI)- 120 Mod. of Elasticity(PSI)- 16.4 Min. Yield(KSI)- 115 Mod. of Elasticity(PSI)- 16 Min. Yield(KSI)- 40 Mod. of Elasticity(PSI)- 14.9


4. Contraindications to using gold as a prosthesis are its: A. Electrochemical properties B. Cost C. Modulus of elasticity


Q4 Explanation - Gold vs CoCr ď‚— J Oral Implantol. 2008;34(5):248-55. Rubo, Souza . Finite

element analysis of stress in bone adjacent to dental implants. ď‚— The variables introduced in the computer model were

cantilever length, elastic modulus of cancellous bone, abutment length, implant length, and framework alloy (AgPd vs CoCr). In general, the stress distribution was better with stiffer cancellous bone, longer abutments and implants, and shorter cantilevers. The use of a CoCr alloy framework appears to contribute to a better stress distribution.


5. Pertinacious material may be removed by: A. Steam autoclaving B. Pressure autoclaving C. Radio frequency glow discharge


Q5 Answer ď‚— Pertinacious material may be removed by:

A) Steam autoclaving B) Pressure autoclaving C) Radio frequency glow discharge PG295


Q5 Explanation - Radiofrequency Glow Discharge J Oral Implantol. 1992;18(3):236-42. Radiofrequency gas plasma (glow discharge) disinfection of dental operative instruments, including handpieces. Baier RE, Carter JM, Sorensen SE, Meyer AE, McGowan BD, Kasprzak SA.

The radiofrequency-stimulated argon gas plasma (glow discharge) technique, already well-known for surface cleaning and activation of adhesion, was investigated for determination of its separate potential for rapid disinfection of dental operative instruments. Disinfection effectiveness was judged from diminished post-treatment recovery of viable organisms from the instruments agitated in saline. Streptococcus salivarius, Bacillus stearothermophilus, and Escherichia coli were used as primary contaminant organisms, dried from gelatin-thickened laboratory cultures onto the instruments and not subjected to any preliminary cleaning steps. Significant disinfection was obtained, with no sensible temperature increases, in under 10 minutes in laboratory apparatus consuming fewer than 5 Watts of power per cycle. Also, clinically used and deliberately-saliva-contaminated high-speed handpieces were gas-discharge-treated, with their resultant rapid disinfection noted by complete suppression of the viability of any transferred natural contaminant organisms within two minutes


6. The best impression material for making an implant supported overdenture is: A. Polyethylene B. Poly Vinyl Siloxane C. Add-red silicone D. Alginate


Q6 Explanation - PVS Types of Impression Materials Misch 3rd edition Three major types of elastic materials used for direct bone impressions: polysulfides, silicones, and polyethers. A review of ideal qualities, types of materials, dimensional changes, working and setting times, permanent deformation, flow, toxicity, hardness, and tear strength indicate. Addition silicone

(polyvinyl siloxane) is the impression material of choice.


7. Bone D1 has a module of elasticity most similar to: A. Ceramic B. Titanium C. Titanium Alloy D. Surgical Steel


Q7 Answer and Explanation ď‚— Bone D1 has a module of elasticity most similar to:

(Cortical Bone MOE: 10-22) A) Ceramic (MOE 300) B) Titanium (MOE 103) C) Titanium Alloy (MOE 113) D) Surgical Steel (MOE 200)


8. Which has the greatest affect on prognosis of root form implants of the same size, shape, and cyclic loading? A. Axial relationship B. Anterior-posterior relationship


Q8 Answer and Explanation ď‚— Which has the greatest affect on prognosis of root form

implants of the same size, shape, and cyclic loading? A) Axial relationship Loading along implant long axis decreases periimplant bone loss B) Anterior-posterior relationship Not sure what this has to do with a question about individual implants?


9. Which is true of autogenous bone grafts? A. Cancellous bone grafts heal differently than

cortical bone grafts B. Cancellous bone grafts heal the same as cortical

bone grafts


Q9 Answer & Explanation ď‚— Which is true of autogenous bone grafts?

A) Cancellous bone grafts heal differently than cortical bone grafts Cancellous bone will turnover faster than cortical

B) Cancellous bone grafts heal the same as cortical bone grafts

bone.


10. When using a standard type steam pressure autoclave, all of the following are potential sources of surface alteration of a biocompatible implantable material except one. Which one is the exception?

A. Rate of heating and cooling B. The degree of temperature C. The amount of pressure D. The source of steam


Q10 Explanation ď‚— One of the more important aspects of the CPCs relates to the possible

reactions with water. For example, hydration can convert other compositions to HA; also, phase transitions among the various structural forms can exist with any exposure to water. This has caused some confusion in the literature, in that some CPCs have been steam autoclaved for sterilization purposes before surgical implantation. Steam or water autoclaving can significantly change the basic structure and properties of CPCs (or any bioactive surface) and thereby provide an unknown biomaterial condition at the time of implantation. This is to be avoided through the use of pre-sterilized or clean, dry heat or gamma sterilized conditions. Misch pp 521


11. How do you passivate Ti and Ti Alloy? A. Air contact B. Nitric acid bath


Q11 Answer & Explanation  How do you passivate Ti and Ti Alloy?

A) Air contact B) Nitric acid bath – Study Guide p128


Q11 Explanation - Passivation Passivation is the process of whereby the implant is rendered biologically inert. The ASTM (ASTM B600, ASTM F-86) specifications for final surface treatment of surgical titanium implants require pickling and descaling with molten alkaline base salts. This is often followed by treatment with a solution of nitric or hydrofluoric acid to decrease and eliminate contaminants such as iron. Iron or other elements may contaminate the implant surface as a result of the machining process. This type of debris can have an effect of demineralizing of the bone matrix. But these finishing requirements remain very general. Studies of fibroblast attachment on implant surfaces showed great variations depending on the different processes of surface preparation. Inoue et al. showed fibroblasts developed a capsule or oriented fibrous attachment following the grooves in titanium disks. Contact angles are also greatly modified by acid treatment or water rinsing. Machining operations, polishing, texturing process, residual chemical deposits, and alloy microstructure all inadvertently affect the surface composition. There are also many ways to intentionally modify the surface of the implant. They include conventional mechanical treatment (sand Blasting), wet or gas chemical reaction treatment, electroplating or vapor plating, and ion-beam processing, which leaves bulk properties intact and has been newly adapted to dentistry from thin film technology. Preliminary studies by Schmidt and Grabovski et al. showed modified fibroblast adhesion on nitrogen and carbon-ion implanted titanium. A general rule has been that cleaner is better.


12. Calcium Phosphate is: A. Bioactive B. Bioinert


Q12 Explanation – Calcium Phosphate


13. Gingival tissue can attach to metal. This can be seen by the presence of?

A. Muccopolysaccharides B. Hemidemosomes C. Lamina


Q13 Answer ď‚— Gingival tissue can attach to metal. This can be seen

by the presence of: A) Muccopolysaccharides B) Hemidemosomes – Study Guide p85 C) Lamina


Q13 Explanation - Hemidesmosomes Connective tissue in tissue-implant biologic seal: The hemidesmosomal attachment provides a seal against the outside environment. This seal around teeth is protected by Sharpey’s fibers extending from the gingival fibers into the tooth, and both implants and teeth are further protected by alternating bands of epithelium and connective tissue in the surrounding gingival cuff. These alternating bands form a viscoelastic system that provides mechanical protection of the hemidesmosomal seal against tearing, which could result from displacement of the cuff by mechanical forces applied within the sulcus (eg those exerted by toothbrush bristles or popcorn husks, or hydraulic pressure from a dental hygiene irrigating device (Prophy-Jet). This tissue effect must follow basic mechanical laws.


14. All of the following are allografts except: A. Bovine bone B. Freeze dried bank bone C. Radiated cancellous bone


Q14 Answer ď‚— All of the following are allografts except:

A) Bovine bone – Study Guide B) Freeze dried bank bone C) Radiated cancellous bone


15. All of the following are correctly associated with demineralized freeze dried bone except:

A. Alloplastic B. Osteoinductive C. Osteoconductive


Q15 Answer  All of the following are correctly associated with

demineralized freeze dried bone except: A) Alloplastic – Study Guide p. 173 B) Osteoinductive C) Osteoconductive – A) is the best answer but DFDB is not very osteoconductive, Study Guide p.4, 64


Q15 Explanation Alloplastic The most common osteoconductive material are alloplastic products. Alloplastic materials are exclusively synthetic biocompatible products developed to cover a broader range of indications. They come in a great variety of textures, particle sizes and shapes. They may be separated into ceramics, polymers, and composites.

Osteoinduction- new bone formation from osteoprogenitor cells derived from mesenchymal cells under the influence of one or more inducing agents present in bone matrix. Allografts-osseous transplanted tissue from same species as recipient but different genotype. Examples: frozen freeze-dried demineralized freeze-dried- more readily exposes bone morphogenic proteins.

Osteoconduction: Osteoconduction describes a nonvital graft material providing scaffold for the in-growth of osteoblasts and the precursors. Autogenous cortical bone, allografts, alloplasts, and xenografts are examples for osteoconductive materials.


16. The biological inertness of titanium is due to:

A. The titanium-oxide coating B. The hydroxyapatite coating C. Its position in relationship to gold and platinum in

the periodic table of elements D. A and C


Q16 Answer ď‚— The biological inertness of titanium is due to:

A) The titanium-oxide coating – See Pasivation B) The hydroxyapatite coating C) Its position in relationship to gold and platinum in the periodic table of elements D) A and C


17. Onlay bone graft is best utilized in a: A. 1 wall defect B. 3 wall defect C. 4 wall defect D. 5 wall defect


18. Which surface best encourages boney ingrowth? A. HA B. Polished C. Porous


Q18 Answer  Which surface best encourages boney ingrowth?

A) HA – Study Guide p.93 B) Polished C) Porous


Q18 Explanation - HA Coating Hydroxyapatite coated implants show accelerated bone formation and maturation when compared to non-coated implants. HA coating makes bone more organized and have a higher degree of mineralization. HA also increases the surface area many times over a non coated implant. The HA coating is also applied by the plasma spray technique


19. What is the most common material used for subperiosteal implants? A. CrCoMolb B. TiAlloy C. Stainless steel


Q19 Answer ď‚— What is the most common material used for

subperiosteal implants? A) CrCoMolb – Study Guide p97 - (Misch CID, p517) Modulus 235, CrO layer prevents corrosion, Mo strength and bulk corrosion resistance B) TiAlloy C) Stainless steel


20. What is the most widely used CLINICAL allograft material?

A. freeze dried bone B. DFDB C. HA D. irradiated cancellous


Q20 Answer - ?? ď‚— What is the most widely used CLINICAL allograft

material? A) freeze dried bone B) DFDB – probably the best answer C) HA D) irradiated cancellous


Q20 Explanation Misch CID Ed.3 pp. 859 The most common allografts used in implant dentistry are DFDB and FDB. The process to form FDB and demineralized DFDB is different and specific, although some variations among laboratories exist. Osteoclasts are required to resorb the bone to release its bone growth factors. This delays the release over a longer period. Coupled with the fact that very little growth factors are present, this results in a graft material that is primarily an inorganic mineral source of HA, which serves as scaffold for bone formation. Therefore FDB acts primarily through an osteoconductive process, because inductive proteins are slowly released after resorption of the mineral and often found in only minute quantities


Q20 Explanation Ctnd. ď‚— DFDB and FDB have a similar initial processing step, but DFDB is produced by

an additional step, demineralizing the ground bone powder in 0.6-N hydrochloric or nitric acid for 6 to 16 hours. The BMP is not acid soluble, but the calcium and phosphate salts of HA are acid soluble and therefore are removed from the bone in the acid-reducing process. As a result, the demineralization of the freeze-dried bone more readily exposes the BMPs.141,142

ď‚— Completely demineralized grafts have been shown to stimulate more bone

induction than partially demineralized material. 143 Because the mineral salts are removed from the bone, the nonsoluble BMPs are available in the local environment earlier than with freeze-dried bone, which requires their release by osteoclastic activity. As a result, more undifferentiated cells may transform earlier into osteoblasts.144,145. Therefore FOB is primarily osteoconductive and DFDB is not osteoconductive (as it has no mineral) but is believed to be more osteoinductive.


21. Where would a fibrous interface most likely develop? A. carbon ceramic materials B. commercially pure titanium C. titanium alloys D. aluminum oxide


Q21 Explanation PASSIVATION Passivation is the process of whereby the implant is rendered biologically inert. The ASTM (ASTM B600, ASTM F-86) specifications for final surface treatment of surgical titanium implants require pickling and descaling with molten alkaline base salts. This is often followed by treatment with a solution of nitric or hydrofluoric acid to decrease and eliminate contaminants such as iron. Iron or other elements may contaminate the implant surface as a result of the machining process. This type of debris can have an effect of demineralizing of the bone matrix. But these finishing requirements remain very general. Studies of fibroblast attachment on implant surfaces showed great variations depending on the different processes of surface preparation. Inoue et al. showed fibroblasts developed a capsule or oriented fibrous attachment following the grooves in titanium disks. Contact angles are also greatly modified by acid treatment or water rinsing. Machining operations, polishing, texturing process, residual chemical deposits, and alloy microstructure all inadvertently affect the surface composition. There are also many ways to intentionally modify the surface of the implant. They include conventional mechanical treatment(sand Blasting), wet or gas chemical reaction treatment, electroplating or vapor plating, and ion-beam processing, which leaves bulk properties intact and has been newly adapted to dentistry from thin film technology.

Preliminary studies by Schmidt and Grabovski et al. showed modified fibroblast adhesion on nitrogen and carbon-ion implanted titanium. A general rule has been that cleaner is better.


22. HA material is: A. Osteogenic B. Osteoplastic C. Osteoconductive D. Osteoinductive


Q22 Answer  HA material is:

A) osteogenic B) osteoplastic C) osteoconductive – Study Guide p.64 D) osteoinductive


Q22 Explanation - Osteoconduction  Osteoconduction describes a nonvital graft material providing scaffold for the in-

growth of osteoblasts and the precursors. Autogenous cortical bone, allografts, alloplasts, and xenografts are examples for osteoconductive materials. Bone growth by apposition from surrounding bone.  Biocompatible material-

1. Alloplasts-bioceramics- calcium phosphate- HA 2. Xenografts-inorganic bone from animals other than man.  Osteoconductive materials are either:

- Resorbable or non-resorbable - Dense HA is non-resorbable - Dense or porous

- Highly dense

- Crystalline or amorphous - Crystalline  It does not grow or integrate to the implant surface. Used to fill space and maintain bone

contour and volume. All HA products are susceptible to resorption in the presence of infection and low pH. Cellular resorption of HA is affected by particle size, porosity, and composition of material.


23. The best example of osteoinduction is: A. HA B. DBDF bovine bone C. Demineralized freeze dried bone D. Autogenous bone


Q23 Explanation - DFDB Misch CID Ed.3 pp. 859

The most common allografts used in implant dentistry are DFDB and FDB. DFDB and FDB have a similar initial processing step, but DFDB is produced by an additional step, demineralizing the ground bone powder in 0.6-N hydrochloric or nitric acid for 6 to 16 hours. The BMP is not acid soluble, but the calcium and phosphate salts of HA are acid soluble and therefore are removed from the bone in the acid-reducing process. As a result, the demineralization of the freeze-dried bone more readily exposes the BMPs.141,142 Completely demineralized grafts have been shown to stimulate more bone induction than partially demineralized material. 143 Because the mineral salts are removed from the bone, the nonsoluble BMPs are available in the local environment earlier than with freeze-dried bone, which requires their release by osteoclastic activity. As a result, more undifferentiated cells may transform earlier into osteoblasts.144,145 Therefore FOB is primarily osteoconductive and DFDB is not osteoconductive (as it has no mineral) but is believed to be more osteoinductive.


24. An HA coated root form implant may have the most advantages in which type of bone?

A. Type I B. Type II C. Type III D. Type IV


Q24 Explanation ď‚— An HA coated root form implant may have the most advantages in

which type of bone? ď‚— D4 bone has proven to be the one most at risk. Hence the benefits of HA are

most required in this type of bone. Although it may have the greatest risk relative to bacteria, the benefits of gap healing, faster bone mineralization, and increased bone contact all favor HA. Higher success rates have been reported when HA coated implants have been used in soft bone. The HA should be added to an implant body with the most macroscopic loadbearing surface area to minimize crestal bone loss, larger diameter and an increased number of implants are also suggested in this very weak bone.


25. Titanium is toxic to bacteria and this crevicular sulcus around implants is sterile.

A. True B. False C. Both in the ailing patient D. None of the above


26. Coating applied most commonly to root form implants use the technique of:

A. Fusion bonding B. Ceramo-plasty C. Vapor deprovision D. Crystal E. Plasma Spray


Q26 Explanation SURFACE COATING TITANIUM PLASMA SPRAY -TPS surface has been reported to increase the surface area of the bone-toimplant interface and acts similar to a three-dimensional surface which may stimulate adhesion osteogenesis. -The surface area increase has been reported to be as great as 600%. This increase in total surface area occurs at the microscopic level, the actual loadbearing capability of the coating increases functional area by 25% to 30%, which is still substantial. Porous surfaces in the range of the TPS (150 to 400 um) also increase the tensile strength of the bone-to-implant interface, resist shear forces, and improve load transfer.


27. Surface coated root form implants, which do not have coating extended to the very top, have metallic collars that are: A. Highly polished B. Striad C. matte finished D. Machine finished E. Porous


Q27 Answer - ?? ď‚— Surface coated root form implants, which do not have

coating extended to the very top, have metallic collars that are: A) highly polished? B) striad C) matte finished D) machine finished E) porous?


28. Implant designs should have a: A. Highly polished infrasructure B. Porous surface C. Highly polished surface


29. Castable chrome cobalt alloys used to produce dental implants contain molybdenum. All of the following describe the role of molybdenum except for one, which one is the exception?

A. Molybdenum increases strength B. Molybdenum increases inertness C. Its relative percentages thermal sensitive D. It increases carbon content


Q29 Explanation Cobalt-Chromium-Molybdenum-Based Alloy The cobalt-based alloys are most often used in an as-cast or cast-and-annealed metallurgic condition This permits the fabrication of implants as custom designs such as subperiosteal frames. The elemental composition of this alloy includes cobalt, chromium, and molybdenum as the major elements. Cobalt provides the continuous phase for basic properties; secondary phases based on cobalt, chromium, molybdenum, nickel, and carbon provide strength (four times that of compact bone) and surface abrasion resistance (see Table 24-1); chromium provides corrosion resistance through the oxide surface; and molybdenum provides strength and bulk corrosion resistance CID pp517


30. All of the following can cause galvanic corrosion except one, which one is the exception? A. nickel chrome and C.P. titanium B. nickel chrome and titanium alloy C. nickel chrome and cobalt alloy D. nickel chrome and sapphire E. nickel chrome and gold


Q30 Answer - ?? ď‚— All of the following can cause galvanic corrosion

except one, which one is the exception? A) nickel chrome and C.P. titanium B) nickel chrome and titanium alloy C) nickel chrome and cobalt alloy D) nickel chrome and sapphire? E) nickel chrome and gold


31. All of the following statements are true regarding hydroxyapatite except which one? A. The degree of resorption is unaffected by crystallinity B. HA provides a true chemical bond to bone C. HA forms an attachment to bone as early as one

week D. HA should have an amorphous anatomic

configuration


32. Which of the following statements is true regarding dental implant coating? A.

Ion (spotting) is the most common form of application

B.

Although amorphous HA is sprayed onto the surface, the high heat makes the coating crystalline

C.

Amorphous HA coatings are more soluble

D. HA is heat resistant and unchanged by temperature E.

Precise technique results in impure crystallinity


33. Which of the following materials is best described as an allograft? A. Bone graft derived from the same genotype B. Bone graft derived from another species C. Demineralized freeze dried bovine bone D. Bone morphogenic protein from cadavers E. Autogenous cortical bone graft


Q33 Answer ď‚— Which of the following materials is best described as an allograft?

A) Bone graft derived from the same genotype - Autograft B) Bone graft derived from another species - Xenograft C) Demineralized freeze dried bovine bone - Xenograft D) Bone morphogenic protein from cadavers E) Autogenous cortical bone graft - Autograft


34. All of the following are protective membrane barriers except which one? A. Fascia lata B. Acellular dermis C. Lamellar bone D. Freeze dried skin


Q34 Answer – Which one??  All of the following are protective membrane barriers

except which one? A) Fascia lata B) Acellular dermis C) Lamellar bone D) Freeze dried skin


35. Gold alloys are contraindicated in the following implant types: A. Stainless B. Co-Cr C. Cp titanium D. Titanium alloy


Q35 Answer – Which one??  Gold alloys are contraindicated in the following

implant types: A) Stainless B) Co-Cr C) Cp titanium D) Titanium alloy


36. When an HA coated implant becomes infected, the HA: A. slows bone growth B. provides a nidus for infection


37. When using type IV gold for a mesobar, the most common complication is: A. Wear B. Cost


Q37 Answer – Which one??  When using type IV gold for a mesobar, the most

common complication is: A) wear B) cost


38. Which of the following statements are correct concerning Ti and Ti alloy? A. Ti is stronger and stiffer B. Ti alloy is stronger and stiffer C. Ti is stronger, Ti alloy is stiffer D. Stiffness is equal, alloy is stronger


Bone Grafting Practice Exam Questions


39. All of the following are allografts except for which one? A. Bovine bone B. Freeze dried bank bone C. Radiated Cancellous bone


Q39 Answer ď‚— All of the following are allografts except for which

one? A) Bovine bone – Study Guide (CID) B) Freeze dried bank bone C) Radiated Cancellous bone


40. The most productive intraoral donor site for autogenous bone grafting is: A. Condyle B. Palatal torus C. Symphysis D. Tuberosity E. Parasymphysis


Q40 Answer  The most productive intraoral donor site for

autogenous bone grafting is: A) Condyle B) Palatal torus C) Symphysis – (Misch CID p.985) D) Tuberosity E) Parasymphysis


41. Acceptable donor sites for autogenous bone grafting are: zygoma, femur, fibula plateau, medial maleus, bony orbit

A. All of the above B. One of the above C. None of the above


Q41 Answer ď‚— Acceptable donor sites for autogenous bone grafting

are: zygoma, femur, fibula plateau, medial maleus, bony orbit A) All of the above B) One of the above C) None of the above


Q41 Explanation Smaller amounts of bone and autograft may be harvested from the maxillary tuberosity, zygoma, extrosseous tori, Residual ridge ostoplasty, extractin sites, implant osteotomy and bone collection devices. CID


42. When performing a sinus floor elevation, at least how many millimeters of bone are required if implants are to be placed at the same time?

A. 1 mm B. 4 mm C. 7 mm D. 10 mm


Q42 Answer & Explanation ď‚— When performing a sinus floor elevation, at least

how many millimeters of bone are required if implants are to be placed at the same time? A) 1 mm B) 4 mm C) 7 mm D) 10 mm


43. HA synthetic particulate bone grafting material is: A. Osteoconductive B. Osteogenic C. Osteoinductive D. Osteolytic E. Osteopouratic


Q43 Answer ď‚— HA synthetic particulate bone grafting material is:

A) Osteoconductive (CID, Ch 36) B) Osteogenic C) Osteoinductive D) Osteolytic E) Osteopouratic


Q43 Explanation Osteoconduction: Osteoconduction describes a nonvital graft material providing scaffold for the in-growth of osteoblasts and the precursors. Autogenous cortical bone, allografts, alloplasts, and xenografts are examples for osteoconductive materials.46 bone growth by appostition from surrounding bone. Dense HA is nonresorbable Highly dense Crystalline It does not grow or integrate to the implant surface. Used to fill space and maintain bone contour and volume. All HA products are suseptible to resorption in the presence of infection and low pH. Cellular resorption of HA is affected by particle size, porosity, and compostion of material. STUDY GUIDE


44. Nasal bleeding after sinus elevation surgery can be attributed to all of the following except one. Which one is the exception? A. Surgical perforation of the sinus mucosa B. Inappropriate use of nasal spray C. Perforating the medial wall of the maxillary sinus D. Severing the palatine artery E. Post-operative sneezing


Q44 Answer - ?? ď‚— Nasal bleeding after sinus elevation surgery can be attributed

to all of the following except one. Which one is the exception? A) Surgical perforation of the sinus mucosa B) Inappropriate use of nasal spray C) Perforating the medial wall of the maxillary sinus D) Severing the palatine artery? E) Post-operative sneezing


45. When clindamyacin has been administered orally as a preoperative antibiotic, which antibiotic should be mixed with the osseous graft?

A. Penicillin and amoxicillin B. Amoxicillin C. Clindamyacin D. Clindamyacin, erythromyacin, and tetracycline


Q45 Answer – What answer?  When clindamyacin has been administered orally as

a preoperative antibiotic, which antibiotic should be mixed with the osseous graft? A) Penicillin and amoxicillin B) Amoxicillin?? C) Clindamyacin?? D) Clindamyacin, erythromyacin, and tetracycline


46. Which of the following best describes the characteristics of osteocytes? A. Osteoinductive B. Osteocondective from autogenous bone C. Osteoinductive and autogenous D. Osteogenic from an allograft E. Autogenous osseous graft


Q46 Explanation Osteoprogenitor cells living within the donor graft, may survive during transplantation, could potentially proliferate and differentiate to osteblasts and eventually to osteocytes. These cells represent the ‘‘osteogenic’’ potential of the graft ‘‘Osteoinduction’’ on the other hand is the stimulation and activation of host mesenchymal stem cells from the surrounding tissue, which differentiate into bone-forming osteoblasts. This process is mediated by a cascade of signals and the activations of several extra and intracellular receptors the most important of which belong to the TGF-beta superfamily Study Guide pg. 3


47. After placing a graft to fill in the concavity on a buccal plate, a 2 mm gap exists as closure is attempted. The best way to get closure is:

A. Alloderm B. Free gingival graft C. Scouring the buccal mucosa D. Connective tissue graft


Q47 Answer ď‚— After placing a graft to fill in the concavity on a

buccal plate, a 2 mm gap exists as closure is attempted. The best way to get closure is: A) Alloderm B) Free gingival graft C) Scouring the buccal mucosa (release flap) D) Connective tissue graft


48. According to research reported by Becker, how did the bone regenerate under PTFE membrane respond as compared to mature bone growth?

A. Resorbed more extensively B. Mineralized more extensively C. Doesn’t integrate with the implant D. No difference


Q48 Explanation - Five-Year Evaluation of Implants Placed at Extraction and with

Dehiscences and Fenestration Defects Augmented with ePTFE Membranes: Results from a Prospective Multicenter Study

Conclusions: Implants placed at the time of extraction and augmented with ePTFE barrier membranes have favorable long-term predictability. On the other hand, long-term evaluation of implant dehiscences and fenestrations augmented with barrier membranes indicates that they have less favorable 5-year survival rates. Membrane augmentation of these may be questioned.


49. Which of the following is the most important factor for the survival of grafts? A. Osteoclast activity B. Vascularization C. NSAID treatment D. Calcium intake


Q49 Answer ď‚— Which of the following is the most important factor

for the survival of grafts? A) Osteoclast activity B) Vascularization (Schwartz, Becker, 2008) C) NSAID treatmen D) Calcium intake


50. A 60 year old male is in need of an iliac crest and sinus graft for the treatment of a severely atrophic maxilla. The sinus graft is scheduled to be completed 3-4 months prior to the iliac crest graft. What is the primary advantage for the sinus graft procedure being completed first?

A.

To minimize the possibility of infection

B.

To allow the sinus graft material to heal because the sinus graft needs more time than the onlay bone graft

C.

To allow bone growth so that the onlay bone may be fixed to it

D. It limits the time the patient is under sedation E.

For insurance purposes


Q50 Answer ď‚— A 60 year old male is in need of an iliac crest and sinus graft for the

treatment of a severly atrophic maxilla. The sinus graft is scheduled to be completed 3-4 months prior to the iliac crest graft. What is the primary advantage for the sinus graft procedure being completed first? A) To minimize the possibility of infection – Hilt Tatum? B) To allow the sinus graft material to heal because the sinus needs more time than the onlay bone graft

graft

C) To allow bone growth so that the onlay bone may be fixed to it (Misch, CID p951)? D) It limits the time the patient is under sedation E) For insurance purposes


Q50 Explanation One complication of simultaneous sinus and onlay grafts is an increased risk of postoperative infection within the first 2 months after sinus grafting, which occurs in approximately 3% of procedures. The infection compromises the sinus graftand may spread to the onlay portion of the graft. Althoughrelatively low, this risk can be eliminated by performing thesinus graft with primarily alloplasts and allografts 3 to4 months before the iliac crest graft MISCH ED 2 PP525


51. All of the terms are correctly associated with tricalcium phosphate except one. Which one is the exception?

A. Osteoconductive B. Osteoinductive C. Alloplastic D. Resorbable E. Heterogenous


Q51 Answer  All of the terms are correctly associated with

tricalcium phosphate except one. Which one is the exception? A) Osteoconductive B) Osteoinductive – Study Guide p173; (Misch CID, p947) C) Alloplastic D) Resorbable E) Heterogenous


52. Which of the following situations can reduce bone strength significantly? A. Excessive exposure to UV radiation B. Excessive smoking and alcohol consumption C. Excessive intake of carbon anion D. Excessive consumption of antacid tablets


53. What percentage of onlay graft would resorb within 5 years on a type D bone if implants are not inserted? A. 20% B. 50% C. 70% D. 90%


Q53 Answer

ď‚— What percentage of onlay graft would resorb within 5

years on a type D bone if implants are not inserted? A) 20% B) 50% C) 70% D) 90%? - (Misch CID, p.195)


54. Which statement regarding grafting is true?

A. Small particle grafts vascularize most rapidly B. Interpositional grafting is less predictable than

onlay grafting C. Cancellous bone resorbs slower than cortical bone D. Host response is quicker with regard to cortical

graft


Q54 Answer - ??

ď‚— Which statement regarding grafting is true?

A) Small particle grafts vascularize most rapidly??? B) Interpositional grafting is less predictable than onlay grafting C) Cancellous bone resorbs slower than cortical bone D) Host response is quicker with regard to cortical graft


55. When doing a sinus lift surgery most of the bleeding comes from where? A. Superior wall B. Posterior wall C. Anterior wall


Q55 Answer – Which one?  When doing a sinus lift surgery most of the bleeding comes from where?

A) Superior wall B) Posterior wall?? C) Anterior wall ??D) Lateral wall (Misch CID, p960-2) infraorbital and PSA anastamosis from maxillary artery in and out of lateral bony wall. Obturate, elevate head, C4 External Carotid compression. The other is Posterior Lateral Nasal artery on medial wall from sphenopalatine artery


56. Four days after a lateral sinus lift procedure a patient is experiencing a foul discharge and buccal swelling. The patient is on clindamyacin. The dentists should:

A. Put the patient on amoxicillin 500 mg qid B. Add augmentin to the regimen C. Refer to ENT ASAP D. Perform a culture sensitivity


Q56 Answer ď‚— Four days after a lateral sinus lift procedure a patient is experiencing

a foul discharge and buccal swelling. The patient is on clindamyacin. The dentists should:

A) Put the patient on amoxicillin 500 mg qid (possible) B) Add augmentin to the regimen (Misch CID p965 Cleocin has no activity against H. Infuenzae and M. Catarrhalis, these both have increase in b-lactamase strains decreasing Amoxicillin effectiveness)? C) Refer to ENT ASAP D) Perform a culture sensitivity (difficult to do)


57. Intra-oral bone grafts have been used for alveolar repair to allow implant placement with extremely favorable results. Block grafts can be harvested from what part of the mandible? SHORTANSWER


Q57 Answer  Intra-oral bone grafts have been used for alveolar

repair to allow implant placement with extremely favorable results. Block grafts can be harvested from what part of the mandible?  Symphysis  Ramus


58. Autologous bone harvested from the mandible (chin, ramus) for ridge augmentation has which of the following biologic advantages? A. Higher concentration of viable osteoprogenitor cells than

endochondral donor sites such as the iliac crest B. Dense mostly cortical architecture which maintains

volume upon incorporation C. Greater volume of cancellous bone compared to the ilium D. Slower revascularization which decreases the resorption

phase of the graft E. Lower concentration of osteoclasts which decreases graft

resorption


Q58 Explanation “Another hypothesis is that theimproved survival of craniofacial bone grafts is simplycaused by their threedimensional structure. Because these grafts have a thicker cortical layer, they resorb more slowly.� CID 976


59. Which of the following statements are true regarding incision line dehiscence following placement of autologous bone graft? A.

Postoperative smoking has no effect on incision line healing over autologous grafts.

B.

Incision line dehiscence is more common in the posterior maxilla.

C.

Incision line dehiscence may be prevented by using a non-resorbing suture material such as polytetrafluoethylene (PTFE)

D.

An incision made through the periosteum at the base of the flap is helpful in reducing tension on the wound closure.

E.

The most common cause in incision line dehiscence is overbulking of the graft site.


60. The first sinus augmentation procedure was done by O. Hilt Tatum, Jr DDS in 1975, the first paper was published in 1980 by: A. Tatum/Lebowitz B. Boyne/James C. Judy/Misch D. Heller/Buhite


Q60 Answer ď‚— The first sinus augmentation procedure was done by

O. Hilt Tatum, Jr DDS in 1975, the first paper was published in 1980 by: A) Tatum/Lebowitz B) Boyne/James (Misch CID, p929) C) Judy/Misch D) Heller/Buhite


61. When grafting bone to a severely atrophied D bone mandible, which is not stimulated by an implant: A. Onlay graft – 90% resorption within 5 years B. Onlay graft – 50% resorption within 5 years


Q61 Explanation Relative ease of access and harvesting from the ilium have made it a safe and well-accepted procedure. However, rapid bone resorption of 30% to 90% of the iliac crest bone grafts has been reported when conventional dentures are placed on top of the reconstruction.29 As a consequence, other treatment options have often been considered, such as zygomatic and pterygoid implants in the maxilla or 7- to 9-mm implants in an anterior mandible. However, the placement of implants into the grafted bone has dramatically modified this resorption rate. Once the implants are placed and in function, the rate of bone resorption is similar to host bone of similar quantity and density in similar conditions.


62. There is a graft over an implant, the membrane is exposed and there is slight inflammation. What is the course of treatment? A. Remove membrane B. Antibiotics C. Chlorhexidine


Q62 Explanation If the membrane is prematurely exposed to the oral environment, it should be capable of being “freed of bacterial colonization” through the use of an antimicrobial, such as chlorhexidine. Study Guide – p.172


63. The primary purpose of the membrane tack in particulate bone grafting is: A. Contain the graft B. Contain the membrane C. Prevent epthelial downgrowth


Q63 Answer - ?? ď‚— The primary purpose of the membrane tack in

particulate bone grafting is: A) Contain the graft B) Contain the membrane?? C) Prevent epthelial downgrowth


64. The primary purpose of sinus augmentation is:

A. Create adequate bone height B. Decrease the size of the antrum C. Give initial implant stability D. Create adequate width


Q64 Answer ď‚— The primary purpose of sinus augmentation is:

A) Create adequate bone height (Misch CID Ch. 38) B) Decrease the size of the antrum C) Give initial implant stability D) Create adequate width


Question 65 • Match the following with the best answer

1) SA – 1: A) Subantral option which includes a sinus lift procedure along with simultaneous implant placement B) Subantral option which includes a sinus graft procedure with a delayed implant placement. There is at least 5mm of bone present between the crest of the ridge and the antral floor. C) Subantral option which includes a sinus graft procedure and extended delay of implant placement. There exists less than 5mm of bone present. D) Conventional implant placement when there exists at least 8mm of height present between the crest of the ridge and the antral floor.

bone

E)Conventional implant placement when there exists at least 12 mm of bone height present between the crest of the ridge and the antral floor.


Q65 Answer ď‚— Match the following with the best answer

1) SA – 1: A) Subantral option which includes a sinus lift procedure along with simultaneous implant placement B) Subantral option which includes a sinus graft procedure with a delayed implant placement. There is at least 5mm of bone present between the crest of the ridge and the antral floor. C) Subantral option which includes a sinus graft procedure and implant placement. There exists less than 5mm of bone present.

extended delay of

D) Conventional implant placement when there exists at least 8mm of present between the crest of the ridge and the antral floor.

bone height

E)Conventional implant placement when there exists at least 12 mm of bone height present between the crest of the ridge and the antral floor. (Misch CID, p915)


66. Match the following with the best answer: 1) SA – 2 A.

Subantral option which includes a sinus lift procedure along with simultaneous implant placement

B.

Subantral option which includes a sinus graft procedure with a delayed implant placement. There is at least 5mm of bone present between the crest of the ridge and the antral floor.

C.

Subantral option which includes a sinus graft procedure and extended delay of implant placement. There exists less than 5mm of bone present.

D.

Conventional implant placement when there exists at least 8mm of bone height present between the crest of the ridge and the antral floor.

E.

Conventional implant placement when there exists at least 12 mm of bone height present between the crest of the ridge and the antral floor.


Q66 Answer • Match the following with the best answer: 1) SA – 2

A) Subantral option which includes a sinus lift procedure along with simultaneous implant placement (best answer) Misch CID p934-939 SA-2 is 10-12mm below antral floor w/osteotome greenstick fracture osteotomy up to 3mm elevation B) Subantral option which includes a sinus graft procedure with a delayed implant placement. There is at least 5mm of bone present between the crest of the ridge and the antral floor. C) Subantral option which includes a sinus graft procedure and extended delay of implant placement. There exists less than 5mm of bone present. D) Conventional implant placement when there exists at least 8mm of bone height present between the crest of the ridge and the antral floor. E) Conventional implant placement when there exists at least 12 mm of bone height present between the crest of the ridge and the antral floor.


67. Match the following with the best answer 1) SA – 3: A.

Subantral option which includes a sinus lift procedure along with simultaneous implant placement

B.

Subantral option which includes a sinus graft procedure with a delayed implant placement. There is at least 5mm of bone present between the crest of the ridge and the antral floor.

C.

Subantral option which includes a sinus graft procedure and extended delay of implant placement. There exists less than 5mm of bone present.

D.

Conventional implant placement when there exists at least 8mm of bone height present between the crest of the ridge and the antral floor.

E.

Conventional implant placement when there exists at least 12 mm of bone height present between the crest of the ridge and the antral floor.


Q67 Answer ď‚—

Match the following with the best answer: 1) SA – 3:

A) Subantral option which includes a sinus lift procedure along with simultaneous implant placement B) Subantral option which includes a sinus graft procedure with a delayed implant placement. There is at least 5mm of bone present between the crest of the ridge and the antral floor. (Misch CID, p939 SA-3 5-10mm high) can immediately place implant if 5mm high and 6mm wide or delay 2 months C) Subantral option which includes a sinus graft procedure and extended delay There exists less than 5mm of bone present.

of implant placement.

D) Conventional implant placement when there exists at least 8mm of bone height present between the crest of the ridge and the antral floor. E)Conventional implant placement when there exists at least 12 mm of bone height present between the crest of the ridge and the antral floor.


68. Match the following with the best answer: 1) SA – 4: A.

Subantral option which includes a sinus lift procedure along with simultaneous implant placement

B.

Subantral option which includes a sinus graft procedure with a delayed implant placement. There is at least 5mm of bone present between the crest of the ridge and the antral floor.

C.

Subantral option which includes a sinus graft procedure and extended delay of implant placement. There exists less than 5mm of bone present.

D.

Conventional implant placement when there exists at least 8mm of bone height present between the crest of the ridge and the antral floor.

E.

Conventional implant placement when there exists at least 12 mm of bone height present between the crest of the ridge and the antral floor.


Q68 Answer  Match the following with the best answer: 1) SA – 4:

A) Subantral option which includes a sinus lift procedure along with simultaneous implant placement B) Subantral option which includes a sinus graft procedure with a delayed implant placement. There is at least 5mm of bone present between the crest of the ridge and the antral floor. C) Subantral option which includes a sinus graft procedure and extended delay of implant placement. There exists less than 5mm of bone present. (Misch CID, p951 SA-4 0-5mm present, must delay placement. D) Conventional implant placement when there exists at least 8mm of bone height present between the crest of the ridge and the antral floor. E) Conventional implant placement when there exists at least 12 mm of bone height present between the crest of the ridge and the antral floor.


69. In which subantral option would an osteotome most likely be used to greenstick fracture the floor of the sinus to allow implant placement?

A. SA – 1 B. SA – 2 C. SA – 3 D. SA – 4 E. SA - 5


Question 69  In which subantral option would an osteotome most

likely be used to greenstick fracture the floor of the sinus to allow implant placement? A) SA – 1 B) SA – 2 C) SA – 3 D) SA – 4 E) SA - 5


Q69 Answer

 In which subantral option would an osteotome most

likely be used to greenstick fracture the floor of the sinus to allow implant placement? A) SA – 1 B) SA – 2 (Misch CID p934) ? C) SA – 3 D) SA – 4 E) SA - 5


70. In the layering technique of graft placement, the primary purpose of non-resorbable hydroxyapatite for the first or superior layer placed into an elevated antral region is: A.

To initiate osteoblastic response

B.

Acts as a physical barrier to keep the osteoclasts of the sinus membrane away from the sinus graft

C.

Initiates regional acceleratory phenomenon (RAP) and allows blood vessels to grow into the graft

D.

To induce undifferentiated mesenchymal cells to form osteocytes

E.

None of the above


Q70 Answer ď‚— In the layering technique of graft placement, the primary purpose of

nonresorbable hydroxyapatite for the first or superior layer placed into an elevated antral region is: A) To initiate osteoblastic response B) Acts as a physical barrier to keep the osteoclasts of the sinus membrane away from the sinus graft C) Initiates regional acceleratory phenomenon (RAP) and allows blood vessels to grow into the graft D) To induce undifferentiated mesenchymal cells to form osteocytes E) None of the above (Misch CID p947, permits bone to grow in its presence (osteoconduction) primarily act as filler of volume and possible substrate for future bone matrix)


71. To obtain platelet-rich plasma, whole blood is drawn from the patient and placed into a centrifuge. The blood is separated into three layers. Which of the following is not part of these three layers?

A.

Platelets

B.

White blood cells

C.

Red blood cells

D. Serum E.

All of the above are contained in one of the layers


Q71 Answer & Explanation ď‚— To obtain platelet-rich plasma, whole blood is drawn from the

patient and placed into a centrifuge. The blood is separated into three layers. Which of the following is not part of these three layers? A) Platelets B) White blood cells C) Red blood cells D)Serum E) All of the above are contained in one of the layers


Perio-Prosthetics Practice Exam Questions


72. Three weeks post-op you have a partial membrane exposure. Marginal epithelium is slightly inflamed. The treatment of choice is:

A. Chlorhexidine B. Antibiotics C. Remove membrane D. Do nothing


Q72 Answer ď‚— Three weeks post-op you have a partial membrane

exposure. Marginal epithelium is slightly inflamed. The treatment of choice is: A) chlorhexidine – Study Guide p.172 B) antibiotics C) remove membrane D) do nothing


73. What incision do you use when creating a papilla?

A. palatal incision on the natural tooth B. labial incision


Q73 Answer  What incision do you use when creating a papilla?

A) palatal incision on the natural tooth – see next slides B) labial incision – See next slides


74. In order to create an esthetic papillae when uncovering an implant replacing a congenitally missing #7, the incision must be made as follows: A.

Midcrestal to midcrestal

B.

Palatally from the distal line angle of #6 to the distal line angle of #8

C.

Buccal split thickness flap created, reflect the lingual full thickness

D. Lingual split thickness flap created, reflect the buccal full

thickness




75. What is the recommended therapy for perio-implantitis of an HA coated root form implant which is osseous-integrated and demonstrates acute infection?

A.

Take off HA with diamond, use rubber wheel with high suction to smooth surface

B.

Treat with tetracycline, then graft

C.

Place cover screw, take out of function, primary closure of tissue


Q75 Answer ď‚— What is the recommended therapy for perio-implantitis of an

HA coated root form implant which s osseous-integrated and demonstrates acute infection? A) take off HA with diamond, use rubber wheel with high suction to smooth surface – Study Guide B) treat with tetracycline, then graft C) place cover screw, take out of function, primary closure of tissue


76. Longitudinal studies in non-grafted periodontal cases show: A.

Complete elimination of pockets is not necessary for health

B.

Some pockets will persist after successful periodontal therapy

C.

Normal color and tone of gingival tissue is necessary for health


77. The following bacteria may be found in a healthy implant site:

A. Non-motile rods B. Spirochetes C. Strep sanguinous


Q77 Answer ď‚— The following bacteria may be found in a healthy

implant site: A) non-motile rods - DISEASE B) spirochetes - DISEASE C) strep sanguinous Study Guide p 129


78. If an implant site is insufficient in keratinized tissue, the best time to attempt to increase is:

A. During implant placement B. During second stage surgery C. After loading D. Before placement


Q78 Answer ď‚— If an implant site is insufficient in keratinized tissue,

the best time to attempt to increase is: A) during implant placement??? B) during second stage surgery C) after loading D) before placement – Dr. Mills??


79. A new implant sulcus is colonized by strep sanguinous and actinomycoces. The gingival response to this plaque:

A. No response B. Gingival bleeding C. Inflammation D. Peri-implantitis


Q79 Answer  A new implant sulcus is colonized by strep

sanguinous and actinomycoces. The gingival response to this plaque: A) no response B) gingival bleeding C) inflammation – next slide D) peri-implantitis – spirochetes



80. Patient returns to the clinic two weeks after an implant was placed and presents with a 3x3 red lesion with a fistula around the top of the implant. Otherwise the patient is asymptomatic. The implantologist should suspect: A. secondary infection B. loose cover screw C. failing implant D. temporary partial prosthetic impingement


81. The BEST technique for repairing saucerization around neck of the blade after debridement and irrigation uses? A. DFDB B. HA C. Lamellar bone D. PFTE


Q81 Answer - ?? ď‚— The BEST technique for repairing saucerization

around neck of the blade after debridement and irrigation uses? A) DFDB?? B) HA (non-resorbable) C) Lamellar bone D) PFTE


82. Patient has a white lesion on buccal mucosa with a white lacey pattern to it and it can’t be scraped off. What is the most likely diagnosis? SHORTANSWER


Q82 Answer ď‚— Patient has a white lesion on buccal mucosa with a

white lacey pattern to it and it can’t be scraped off. What is the most likely diagnosis? wickham striae


83. Guided tissue regeneration membrane serves primarily to: A. discourage epithelial growth B. discourage migration of the osseous graft C. discourage wound dehiscence D. encourage vascularity


Q83 Explanation ď‚— Discourage epithelial growth

ď‚— The concept defining guided tissue regeneration is to

exclude the rapidly generative tissues. Epithelium or connective tissue by use of a barrier allows differentiation and migration of potential cells from the periodontal ligament and alveolus into the defect. This would be especially applicable to the dehised implant surface, in which endosteal implant surgical placement may result in facial or lingual osseous dehiscence.


84. Titanium is toxic to bacteria and this the crevicular sulcus around an implant is sterile. A. True B. False C. Both in the ailing patient D. None of the above


85. Peri-implantitis and a mobility of +2 exists for an HA coated root form implant. The preferred management is:

A. treatment with hydrochloric acid B. treatment with bone grafting C. suture over it after placing a new healing screw D. removal of the implant


Q85 Answer ď‚— Peri-implantitis and a mobility of +2 exists for an HA

coated root form implant. The preferred management is: A) treatment with hydrochloric acid B) treatment with bone grafting C) suture over it after placing a new healing screw D) removal of the implant – Study Guide p. 1


86. What is the initial host response to bacteria that gets into the gingival tissue?

A. formation of specific antibodies B. induction of killer T-lymphocytes C. phagocytosis by PMN’s D. inactivation by gamma interferon


Q86 Answer  What is the initial host response to bacteria that gets

into the gingival tissue? A) formation of specific antibodies B) induction of killer T-lymphocytes C) phagocytosis by PMN’s – Study Guide p.91 D) inactivation by gamma interferon


87. Connective tissue may provide a needed function to facilitate implant success. Which of the following responses suggests why connective tissue in the permucosal area may be especially important for the success of osseointegrating implants?

A.

Supports the keratinized epithelium, which also can prevent epithelial down growth

B.

It may migrate to an implant body and act as a periodontal ligament

C.

It stimulates blood supply to the bone around the implant

D. It is attached to the implant with hemidesmosomes


Q87 Explanation ď‚— James and Keller were first to begin a systematic scientific study

to investigate the biological seal phenomenon of the soft tissue around dental implants. Hemidesmosomes help form a basal lamina-like structure on the implant, which can act as a biological seal. However, collagenous components of the linear body cannot physiologically adhere to or become embedded into the implant body as they do in the cementum of the tooth (67). The hemidesmosomal seal only has a circumferential band of gingival tissue to provide mechanical protection against tearing. pp.75 Misch, 3rd ed.


88. The accumulation of plaque around dental implants will initiate gingivitis in the same manner and the same rate as in natural dentition.

A. True B. False C. Not true in medically compromised patients D. Only true in diabetic patients


Q88 Answer ď‚— The accumulation of plaque around dental implants

will initiate gingivitis in the same manner and the same rate as in natural dentition. A) True B) False - CID C) Not true in medically compromised patients D) Only true in diabetic patients


Q88 Explanation The differences between tooth and implant biologies make dental implants more susceptible to inflammation and bone loss in the presence of bacterial plaque accumulation. Biofilms are the primary causative factor of periodontal disease processes. Sticky masses of bacteria with a polysaccharide matrix, water, and bacteria accumulate on hard and soft surfaces in the oral cavity and can be disturbed and removed with mechanical or chemical obliteration. If undisturbed, mature plaque will form. Current chemotherapeutics cannot penetrate thick biofilm, and rough surfaces have been found to hold more biofilm (9) than smooth surfaces Misch 3rd ed pp. 1074


89. All of the following except one can be associated with either failing or ailing implants, which one is the exception? A.

increase in subgingival spirochetes

B.

increase in subgingival black pigmented macrolids

C.

increase in subgingival anaerobic gram-negative bacteria

D. increase in subgingival strep mutans E.

increase in the progression of pathology when the HA coating is contaminated


Q89 Explanation


90. Gingival tissue can attach to metal. This can be seen by the presence of: 1. Muccopolysaccarides 2. Hemidesmosomes 3. The tearing of epithelium away from the underlying connective tissue after cryo-fracture 4. The loss of epithelium thickness on scanning electron microscopy.

A. 1,2,3 B. 1,3,4 C. 2,3,4 D. All of the above


Q90 Answer ď‚— Gingival tissue can attach to metal. This can be seen by the presence of:

1. Muccopolysaccarides - yes 2. Hemidesmosomes - yes 3. The tearing of epithelium away from the underlying connective tissue after cryo-fracture - ???? 4. The loss of epithelium thickness on scanning electron microscopy.

A) 1,2,3 B) 1,3,4 C) 2,3,4 D) All of the above

Glycosaminoglycans GAGs) or mucopolysaccharides are long unbranched polysaccharides consisting of a repeating disaccharide unit. GAGs form an important component of connective tissues. GAG chains may be covalently linked to a protein to form proteoglycans. Water sticks to GAGs, this is where the resistance to pressure comes from.


91. The flora around implants in edentulous subjects is different from the flora around implants with teeth.

A.

The statement is true. Implants in partially edentulous cases appear to be at greater risk for periodontitis and perio-implantitis than in completely or fully edentulous cases.

B.

The statement is false. The micro-flora of implants is the same whether in an edentulous arch or in a partially edentulous area.


92. Which of the following statements is true as documented by studies of the flora associated with healthy stable implants?

A.

It has been demonstrated that the bacteria found in the implant crevice in the successful implant cases are basically the same flora as found in the natural tooth crevice/sulcus in a state of health

B.

It has been demonstrated that the bacteria found in the implant crevice in the successful implant cases are different than the flora associated with that of natural teeth


Q92 Answer ď‚— Which of the following statements is true as documented by studies

of the flora associated with healthy stable implants? A)It has been demonstrated that the bacteria found in the implant crevice in the successful implant cases are basically the same flora as found in the natural tooth crevice/sulcus in a state of health - P1075 CID MISCH B) It has been demonstrated that the bacteria found in the implant crevice in the successful implant cases are different than the flora associated with that of natural teeth


93. The most common situation necessary to fabricate a mandibular overdenture for a ramus frame implant is:

A. Bilateral balanced occlusion B. Canine guided occlusion C. Second molar occlusion D. Eliminate second molar occlusion E. Definite anterior guidance


Q93 Answer - ?? ď‚— The most common situation necessary to fabricate a

mandibular overdenture for a ramus frame implant is: A) Bilateral balanced occlusion? B) Canine guided occlusion C) Second molar occlusion D) Eliminate second molar occlusion E) Definite anterior guidance


94. What are three types of prosthesis that are used for restoration of implants? SHORTANSWER


Q94 Answer

ď‚— What are three types of prosthesis that are used for

restoration of implants? Fixed, Hybrid, and Removable


95. Why would someone have a swallowing difficulty after implant supported overdenture is placed?

A. CR-Wrong B. Maxillary denture teeth placed to palatal C. Maxillary denture teeth placed to buccal


96. Severely reabsorbed maxilla with existing overdenture. What is maximum angle of implants placement in maxilla in this case?

A. 45 B. 35 C. 20 D. 15


97. A patient has 5 symphyseal implants in molar mastication (occlusion). The middle implant is in:

A. Compression B. Tension C. Shear D. Tensil


Q97 Answer & Explanation ď‚— A patient has 5 symphyseal implants in molar

mastication (occlusion). The middle implant is in: A) Compression B) Tension C) Shear D) Tensil


98. For a single implant, the minimum acceptable inter arch space for a fixed restoration is?

A. 7 mm in the posterior area B. 8-10 mm in the anterior area


99. For greatest reduction of shear forces use:

A. Square Screw Implant B. V-Screw Implant C. Round Implant


Q99 Answer  For greatest reduction of shear forces use:

A) Square Screw Implant – SG 143 B) V-Screw Implant C) Round Implant


Question 100

ď‚— To reduce lateral forces at the bone-implant surface:

A) Place parallel implants B) Place staggered implants


100. To reduce lateral forces at the boneimplant surface:

A. Place parallel implants B. Place staggered implants


Q100 Answer

ď‚— To reduce lateral forces at the bone-implant surface:

A) Place parallel implants B) Place staggered implants – Misch CID


101. The best way to insure accurate coping placement is: A. Proper placement of transfer pin into impression B. Rigid impression material C. Epoxy impression material


102. What do you do to reduce lateral forces? A. Narrow occlusal table B. Parallel placement of implants


Q102 Answer - ??

ď‚— What do you do to reduce lateral forces?

A) Narrow occlusal table? B) Parallel placement of implants – Corrected Tests??


103. Patient has anterior bar retained denture and has pain and bone resorption. What would you do?

A. Antibiotic treatment B. Decrease anterior bite force


104. 2 mm bone loss around all 5 lower anterior implants and inflammation around one of them. What is happening?

A. Bar flexes B. Bar doesn’t fit properly


105. 5 mandibular implants in edentulous area with a fixed bridge. What is the force applied? A. Compression B. Tension C. Shear


106. When an implant is exposed, tissue is sore and the patient is in a surgical denture, what is the approach?

SHORTANSWER


Q106 Answer ď‚— When an implant is exposed, tissue is sore and the

patient is in a surgical denture, what is the approach? Relieve denture


107. Concerning A-P distance, what is the worst palate shape? A. Tapered B. Square C. U-shape


Q107 Answer ď‚— Concerning A-P distance, what is the worst palate

shape? A) Tapered – Dr Mills B) Square C) U-shape


108. Occlusion on an overdenture is ideally in:

A. Group function B. Cuspid protected


109. The best practical way to increase amount of force distribution on a root form implant?

A. Increase length B. Surface area


Q109 Answer ď‚— The best practical way to increase amount of force

distribution on a root form implant? A) Increase length B) Surface area - CID


110. When do you load D1 bone? A. As soon as possible B. Progressively


Q110 Answer & Explanation ď‚— When do you load D1 bone?

A) As soon as possible - (Misch p.647 Immediate load is over 94% successful) B) Progressively ď‚— For complete regeneration of vital bone in this dense structure, 5 months healing

time may be required. However because of the load bearing capability of the bone and the excellent bone implant contact and prosthetic loading of D1 bone may start at a very early stage. Conditions that contribute to no movement during healing are a primary factor for a direct bone to implant interface. D1 bone is stronger and often able to resist movement regardless of when an implant is loaded. As a result immediate implant loading is often possible when multiple implants are splinted together without compromise.


111. A patient presents missing #20. There has been bone loss in the buccal-lingual dimension. You discuss with an orthodontist distalizing the #21 position. What bone dimension can you expect in the #21 position?

A. Loss of buccal bone only B. Loss of lingual bone only C. Loss of vertical height only D. There should be no loss of buccal,

lingual or vertical bone


112. What minimum amount of space is needed between implants and implants and natural tooth?

Implant to Implant

Implant to Tooth

A.

3

2

B.

3

1

C.

4

2

D.

2

3


Q112 Answer ď‚— What minimum amount of space is needed between

implants and implants and natural tooth?

Implant to Implant

A)

Implant to Tooth

3

2

B)

3

1 (Misch says 1.5)

C)

4

2

D)

2

3


113. A patient presents with supraerupted maxillary molars below the plane of occlusion. In order to place mandibular implants the BEST method to correct this problem would be:

A. Occlusion Adjustment B. Lefort 1 and Reposition C. Endodontic and Crown D. Enbloc Segmental Osteotomy


Q113 Answer - ??

ď‚— A patient presents with supraerupted maxillary molars

below the plane of occlusion. In order to place mandibular implants the BEST method to correct this problem would be:

A) Occlusion Adjustment??? B) Lefort 1 and Reposition C) Endodontic and Crown?? D) Enbloc Segmental Osteotomy


114. When patient appears for 1 day post-op appointment the dentist notes that the implant cover screw and a 4X2 mm area of surrounding bone are exposed. The patient is asymptomatic otherwise. The best treatment for this situation is? A.

Place the patient on antibiotic therapy

B.

Freshen the edges with a scalpel and resuture

C.

Allow the area to heal by secondary intention

D. Gain primary closure and resuture


Q114 Answer - ??

ď‚— When patient appears for 1 day post-op appointment the

dentist notes that the implant cover screw and a 4X2 mm area of surrounding bone are exposed. The patient is asymptomatic otherwise. The best treatment for this situation is?

A) Place the patient on antibiotic therapy B) Freshen the edges with a scalpel and resuture?? C) Allow the area to heal by secondary intention D) Gain primary closure and resuture


Question 115 ď‚— A 50 year old female patient. Six root form implants placed

one year ago for a maxillary overdenture. Patient states that bar has loosened every 4-6 weeks since placement and two screws have broken. What is the possible cause? A) Inadequate preload B) Cantilever is too long C) Bar doesn’t have passive fit D) Bar flexes


Q115 Answer ď‚— A 50 year old female patient. Six root form implants placed

one year ago for a maxillary overdenture. Patient states that bar has loosened every 4-6 weeks since placement and two screws have broken. What is the possible cause? A) Inadequate preload B) Cantilever is too long C) Bar doesn’t have passive fit D) Bar flexes


116. A 50 year old female patient. Six root form implants placed one year ago for a maxillary overdenture. Patient states that bar has loosened every 4-6 weeks since placement and two screws have broken. What is the possible cause?

A. Inadequate preload B. Cantilever is too long C. Bar doesn’t have passive fit D. Bar flexes


Q116 Answer - ?? ď‚— Lowering mechanical stress to the crestal bone and

implant interface can best be accomplished by: A) Increasing implant diameter B) Increasing implant length C) Vertical alignment D) Thread pitch


117. All of the following statements correctly relate to restoration of the totally edentulous arch, with five anteriorly placed root form implants, supporting and implant supported screw retained prosthesis except one. Which one is the exception? A.

Two stage implants provide a distinct advantage and convenience of protected healing with a temporary prosthetic appliance.

B.

The magnitude of cantilever mechanics must be considered.

C.

A protective occlusion with cuspid rise disclussion is recommended.


Q117 Answer ď‚— All of the following statements correctly relate to restoration of the

totally edentulous arch, with five anteriorly placed root form implants, supporting and implant supported screw retained prosthesis except one. Which one is the exception? A) Two stage implants provide a distinct advantage and convenience of protected healing with a temporary prosthetic appliance. B) The magnitude of cantilever mechanics must be considered. C) A protective occlusion with cuspid rise is recommended. – Group Function

disclussion


118. What is the best treatment when loosing an abutment screw?

A. Use lock tight on screw B. Retighten after initial tightening


119. You are planning a 3.25 mm implant. During surgery you discover you can place a 4.0 mm fixture. Using the larger fixture will increase surface area by:

A. 12% B. 15% C. 24% D. 30%


Q119 Answer ď‚— You are planning a 3.25 mm implant. During surgery

you discover you can place a 4.0 mm fixture. Using the larger fixture will increase surface area by: A) 12% B) 15% C) 24% D) 30%


120. Splinted mandibular implants can cause pain due to what?

SHORTANSWER


Q120 Answer ď‚— Splinted mandibular implants can cause pain due to

what? flexure of mandible


121. All of the following statements correctly relate to restoration of the totally edentulous arch, with five anteriorly placed root form implants, supporting implant and implant supported screw retained prosthesis except one. Which on is the exception? A.

Two stage implants provide a distinct advantage and convenience of protected healing with a temporary prosthetic appliance.

B.

The magnitude of cantilever mechanics must be considered

C.

A protective occlusion with cuspid rise disclussion is recommended


Q121 Answer ď‚— All of the following statements correctly relate to restoration of the totally

edentulous arch, with five anteriorly placed root form implants, supporting implant and implant supported screw retained prosthesis except one. Which on is the exception?

A) Two stage implants provide a distinct advantage and convenience of protected healing with a temporary prosthetic appliance. B) The magnitude of cantilever mechanics must be C) A protective occlusion with cuspid rise is recommended – Group Function

considered disclussion


122. The minimum required space between the crest of the bone and the occlusal plane for a mesobar and overdenture is:

A. 7 mm B. 9-13 mm C. 18 mm D. 20 mm


Q122 Answer ď‚— The minimum required space between the crest of

the bone and the occlusal plane for a mesobar and overdenture is: A) 7mm B) 9-13 mm – Dr. Mills C) 18 mm D) 20 mm


123. Which one of the following occlusal arrangements provide optimal occlusal relationships and force distribution on a fixed prosthesis connecting a natural tooth to an implant anteriorly? A.

Equally heavy contacts on natural teeth and implants in centric contact with heavy bite force

B.

Lateral forces can be present on natural teeth in lateral movements, but no lateral forces should be placed on implants.

C.

Light contact similar on implants and natural teeth in centric bite

D. Heavy contacts not as important on anterior teeth

in centric occlusion as posterior teeth


Q123 Answer - ?? ď‚— Which one of the following occlusal arrangements provide optimal

occlusal relationships and force distribution on a fixed prosthesis connecting a natural tooth to an implant anteriorly? A) Equally heavy contacts on natural teeth and implants in contact with heavy bite force

centric

B) Lateral forces can be present on natural teeth in lateral movements, but no lateral forces should be placed on implants. C) Light contact similar on implants and natural teeth in centric bite D) Heavy contacts not as important on anterior teeth in occlusion as posterior teeth

centric


124. Implants on 12, 13, and pontic on 14. If biting force was placed on the center of 14, what are the forces on 12 and 13? A. 12 tensile, 13 compression B. 12 compression, 13 tensile C. 12 and 13 compression D. 12 and 13 tensile


125. A 50 year old man has been edentulous for a long time. What is the main consideration when you are treatment planning implants in the symphyseal area of this patient?

A. Mesio-distal relation B. A-P spread C. Crown to root ratio D. Distal cantilever


Q125 Answer ď‚— A 50 year old man has been edentulous for a long time.

What is the main consideration when you are treatment planning implants in the symphyseal area of this patient? A) Mesio-distal relation B) A-P spread C) Crown to root ratio D) Distal cantilever


126. When fabricating an implant supported overdenture, which of the following is important? A. The prosthesis should be cuspid guided B. The patient should be restored into group function C. The patient should have balanced occlusion D. Occlusion is not important with an implant

supported overdenture


127. When doing a complete maxillary fixed prosthesis, what is of most concern?

A. Esthetics B. Hygiene considerations C. Passivity of the prosthesis


128. What is the most important consideration in implant occlusion? A. Narrow occ table B. Wide occ table C. Lingualized occ D. Axially directed loads


129. A 55 year old patient has been edentulous for 15 years. What is the greatest influence on development of excessive force on implant?

A. crown: implant ratio B. length of most distal implant C. implant diameter D. length of distal cantilever


130. A 50 year old patient is currently wearing a denture. He desires an implant-supported restoration in the mandible. Old denture is 2 years old and demonstrates severe wear. On exam, only parasymphyseal region has adequate bone. The patient wants a fixed restoration. For treatment planning purposes, the dentist must consider:

A.

Esthetics

B.

Cantilever length

C.

Bar retained overdenture

D. Accessibility for hygiene


131. Your patient has three splinted root form implants. The best way to decrease lateral forces in the crestal area is:

A. parallel implant placement B. acrylic occlusals C. staggered implant placement D. decrease height


Q131 Answer ď‚— Your patient has three splinted root form implants.

The best way to decrease lateral forces in the crestal area is: A) parallel implant placement B) acrylic occlusals C) staggered implant placement – page 622 CID D) decrease height


132. When restoring the edentulous mandible with an implant supported round house, what must you consider? SHORTANSWER


Q132 Answer ď‚— When restoring the edentulous mandible with an

implant supported round house, what must you consider? Bucco-lingual flexure and torsion


133. The resulting maxillo-mandibular relation following severe resorption:

A. class II made worse B. normal class II C. class I D. pseudo class III


134. When placing a mandibular endosseous implant, the minimum interocclusal distance is:

A. 3 mm B. 5 mm C. 7 mm D. 9 mm


Q134 Answer ď‚— When placing a mandibular endosseous implant, the

minimum interocclusal distance is: A) 3 mm B) 5 mm C) 7 mm – CID 249 D) 9 mm


135. Three weeks ago you torqued the final abutment and cemented a crown. The patient appears at your office complaining of loose crown. What is the most likely cause?

A. failed cement bond B. fractured screw C. inadequate torque D. excessive protrusive force


Q135 Answer - ??

ď‚— Three weeks ago you torqued the final abutment and

cemented a crown. The patient appears at your office complaining of loose crown. What is the most likely cause? A) failed cement bond B) fractured screw C) inadequate torque? D) excessive protrusive force


136. In consideration of long standing edentulism and enlargement of the tongue, which of the following is important to consider?

A. effect on speech B. lateral forces on implants


137. The advantage of a conventional fixed restoration over a bar retained overdenture is: A. more even distribution of stress B. better lip support C. may be in the psychological expectation of the

patient D. better esthetics


Q137 Answer ď‚— The advantage of a conventional fixed restoration

over a bar retained overdenture is: A) more even distribution of stress B) better lip support C) may be in the psychological expectation of the patient – Dr. Mills D) better esthetics


138. You are planning a cement retained implant supported single tooth restoration of tooth 8. The osteotomy should be:

A. aligned with the incisal edge of 9 B. aligned with the cingulum of 9 C. forward of the facial edge D. slightly distal to the edentulous space


Q138 Answer - ??

ď‚— You are planning a cement retained implant supported

single tooth restoration of tooth 8. The osteotomy should be: A) aligned with the incisal edge of 9 – CID 744, 745 B) aligned with the cingulum of 9 C) forward of the facial edge D) slightly distal to the edentulous space


139. An implant demonstrates progressive bone loss of 30% with exudates. A. remove the implant B. remove the prosthetics and replace the cover screw C. degranulate, detoxify, and graft D. prescribe antibiotics


Q139 Answer ď‚— An implant demonstrates progressive bone loss of 30%

with exudates. A) remove the implant B) remove the prosthetics and replace the cover screw C) degranulate, detoxify, and graft – SG. As long as there is no mobility D) prescribe antibiotics


140. In pretreatment planning for a maxillary posterior implant with severe buccal ridge resorption, the dentist determines a need for angled abutment. The maximum angle allowable is: A. 10 B. 25 C. 35 D. 45


141. What does the incisal guide table of the articulator mimic?

A. Anterior guidance of anterior teeth and vertical

horizontal difference of incisors B. Proper esthetic contours of maxillary anterior teeth


Ramus Frame

Practice Exam Questions

RAMUS FRAME IMPLANT http://www.dentalimplantgroup.co.uk/ramus_frame_implants.htm http://www.colgate.com/app/Colgate/US/OC/Information/OralHea http://laimplants.net/FredStalley_DI_Types.htm Tatum Custom Ramus Frame Implant: Multiple Options Including Treatment for Combination Syndrome, JOI, 1992, Beals R, Lefkove M. Restoration of the Atrophic Edentulous Mandible , JOI, 1994, Tatum, H et al.


 The “original” Ramus Frame Implant was developed by Harold Roberts in 1970. The original was made of surgical steel ASTM 316-L. Due to the corrosive nature

of stainless steel, a fibrous interface often formed rather than bone, causing mobility and settling of the anterior foot. Tatum and Roberts both changed their designs to CP Ti in the mid 80's which decreased settling, encapsulation and better surface characteristics allowing better integration. A large flaw in the original design is that it had a short penetration in the ramus (12mm). This short penetration did not allow enough bone support and contributed to movement and settling of the anterior foot.  In 1982 Hilt Tatum modified the original Ramus Frame, they were CP Ti, Custom Made for each patient, had extended posterior arms (30-60mm) in the ramus.

This improvement in particular is the most important due to the increased bone support. This frame can be used well to treat combination syndrome, and the anterior foot can be placed immediately in the extraction areas. Class II occlusions are also fine with a small bend in the neck of the anterior foot. 3 separate incisions are made, slots in bone prepared and the frame is tapped subcrestal, bone can be augmented immediately with particulate and HA. Immediate dentures are placed. The frames are a better alternative to get occlusal stress to the posterior areas. Disadvantages are that the procedure is difficult. Occlusion should be balanced bilaterally. Fractures areas can be reattached to the remaining implant with intra-oral Ti welding.


 Failures have occurred due to psychological reasons,

infection, fracture frame and mandible, pocketing and soft tissue encapsulation.  Both RA frames and Modified Tatum frames are

technically endosseous, both are immediately loaded and the patient uses a soft diet. Both are all implant supported (no soft tissue support)  The Ramus Frame Implant is a one-piece rail,

suspended just above your gum tissue.


Harold & Ralph Roberts “Original” Ramus Frame (1970): 1. Made of 316L Surgical stainless steel (which was corrosive in nature and led to fibrous encapsulation & failure) 2. Had a “shallow” penetration of the ramus (appx 12mm) 3. This shallow ramus penetration often contributed to movement and vertical settling of the anterior foot 4. Came in a limited # of sizes

Hilt Tatum Modified Ramus Frame (1982): 1. 2. 3. 4.

Newer Design allows for greater BIC (Thus better survival rate) Extended the posterior arms (30-60mm long osteotomy in the ramus) Changed to CP Titanium (Roberts did too in 1980) Came in 3 different lengths, 7 different heights (5-20mm) and 2 thicknesses for

a total of 42 choices. 5. Great choice for combination syndrome (Can be placed immediately upon extraction of mandibular anterior teeth)


Hilt Tatum Modified Ramus Frame (1982): Advantages 1. 2. 3. 4. 5. 6.

Place in 1 visit Immediate Load (but with soft foods) Limited incisions Cost efficient Less surgical time Supports posterior occlusion better than root forms 7. (Great for combination syndrome) Indications 1. Atrophic Mandible 2. Patient cannot tolerate dentures

Disadvantages 1. The surgery is difficult

Contraindications 1. Patients has adequate alveolar bone 2. Inter-arch space is inadequate for room for the bar and denture 3. Radiated Mandible 4. Psychotic patient (Misch, 1982)


142. Ramus frame overdentures are retained by (main forms of retention): A. ERA attachment B. O-rings C. Lew attachment D. Hader attachment


Q142 Answer ď‚— Ramus frame overdentures are retained by (main forms of retention):

A)ERA attachment B) O-rings C) Lew attachment: Tatum, Parkell Dental D) Hader attachment

** Ramus frames are all implant supported but can be fixed or removable.


143. How soon can you load a ramus frame? A. Immediately B. No functional forces for 17 weeks C. Load after 30 days


Q143 Answer ď‚— How soon can you load a ramus frame?

A) Immediately (Tatum custom ramus frames by Beals, Lefcove, 1992) B) No functional forces for 17 weeks C) Load after 30 days


144. All of the following are modifications of the original ramus frame except one. Which one is the exception?

A. Addition of anti-settling tabs B. Enlargement of the anterior foot C. Expansion of the inter-ramus bar D. Changing to titanium alloy E. Utilization of the external oblique area of bone


Q144 Answer ď‚— All of the following are modifications of the original ramus

frame except one. Which one is the exception? (Tatum, Lebowitz JOI, 1989) – Atrophic mandible A) Addition of anti-settling tabs B) Enlargement of the anterior foot ? C) Expansion of the inter-ramus bar Y D) Changing to titanium alloy Y E) Utilization of the external oblique area of bone Y


145. All of the following characteristics describe a ramus frame implant except one. Which one is the exception? A.

Transosseous

B.

Endosseous

C.

Indicated for class I jaw relationships

D.

Indicated for class II jaw relationships

E.

Indicated for class III jaw relationships


Q145 Answer ď‚— All of the following characteristics describe a ramus

frame implant except one. Which one is the exception? A) Transosseous B) Endosseous C) Indicated for class I jaw relationships D) Indicated for class II jaw relationships E) Indicated for class III jaw relationships


146. A post-mortem histological evaluation of a 10 year old ramus frame implant reveals small islands of an epithelial lining one or two cells thick in the radicular anterior foot area with hemidesmosomes at the first permucosal area. What is the condition of the implant?

A.

It is a failure

B.

It is failing

C.

It is in hyperfunction

D. It is functioning satisfactorily E.

It was in hypofunction


Q146 Answer ď‚— A post-mortem histological evaluation of a 10 year old ramus

frame implant reveals small islands of an epithelial lining one or two cells thick in the radicular anterior foot area with hemidesmosomes at the first permucosal area. What is the condition of the implant? A) It is a failure B) It is failing C) It is in hyperfunction D) It is functioning satisfactorily E) It was in hypofunction


147. The most common situation necessary to fabricate a mandibular overdenture for a ramus frame implant is:

A. Canine guided occlusion B. Second molar occlusion C. Eliminate second molar occlusion D. Definite anterior guidance E. Bilateral balanced occlusion


Q147 Answer ď‚— The most common situation necessary to fabricate a mandibular

overdenture for a ramus frame implant is: A) Canine guided occlusion B) Second molar occlusion C) Eliminate second molar occlusion D) Definite anterior guidance E) Bilateral balanced occlusion (Tatum 1992, advantage over root form w/ bar is bilateral posterior occlusion)


Sinus, bone graft


148. Which of the following materials is described as an allograft? A. Bone graft derived from the same genotype B. Bone graft derived from another species C. Demineralized freeze dried bovine bone D. Bone morphogenic protein from cadavers E. Autogenous cortical bone graft


Q148 Answer ď‚— Which of the following materials is described as an

allograft? (same species different genotype) A) Bone graft derived from the same genotype B) Bone graft derived from another species C) Demineralized freeze dried bovine bone D) Bone morphogenic protein from cadavers E) Autogenous cortical bone graft


149. Osteoclastic cells are derived from which precursor cell? A. Monocytes B. Motor nucleosites C. Lymphocytes D. Fibroblast E. Osteocytes


Q149 Answer ď‚— Osteoclastic cells are derived from which precursor cell?

A) monocytes (monocyte-macrophage cell line) B) motor nucleosites C) lymphocytes D) fibroblast E) osteocytes


150. A poorly fitted subperiosteal implant: A. must be discarded B. must only be altered extra-orally C. should have bone grafting completed around

secondary struts


Q150 Answer ď‚— A poorly fitted subperiosteal implant:

A) must be discarded (Mills) B) must only be altered extra-orally C) should have bone grafting completed around secondary struts


151. When performing a sinus floor elevation at least how many mm of bone are required if implants are to be placed at the same time?

SHORTANSWER


Q151 Answer ď‚— When performing a sinus floor elevation at least how

many mm of bone are required if implants are to be placed at the same time? ď‚Ą5

mm high, 6mm wide (Misch CID p949)


152. The lateral approach to sinus elevation is

similar to:

A. lefort I B. lefort II C. caldwell luc D. summers


Q152 Answer ď‚— The lateral approach to sinus elevation is similar to:

A) lefort I B) lefort II C) caldwell luc (anterior wall, Misch CID, p929) D) summers (crestal approach, 1994)


153. You are planning bone expansion for congenitally missing tooth 10. You may expect: A. blood supply predominantly derived from

haversion canals B. equal expansion of the buccal and palatal cortex C. primary blood supply from periosteum


154. Which of the following terms describes the transient burst of localized remodeling following the surgical wounding of cortical bone?

A. fine cancellous compaction B. rapid remodeling phase C. regional acceleratory phenomenon (RAP) D. lamellar compaction E. osteogenesis


Anatomy Practice Exam Questions


155. Which of the following statements is true regarding maxillary sinus anatomy? A.

The sinus mucosa is stratified squamous epithelium.

B.

The maxillary sinus drains into the anterior inferior muscles of the nasal cavity.

C.

The osteum is located in the anterior superior aspect of the maxillary sinus.

D.

The radiopaque inanimate line found on the radiograph of the maxillary sinus is due to the internal bony buttresses within the sinus cavity.

E.

The maxillary artery is located behind the posterior wall of the maxillary sinus.


156. Which of the following statements regarding the mental foramen and associated neurovascular bundle is correct? A.

They should be routinely relocated in the severely resorbed posterior mandible.

B.

Osteotomies anterior to the foramen do not place the bundle at risk

C.

Subperiosteal implant procedures are indicated to avoid surgical risk to the bundle.


157. Which of the following statements is correct regarding oral muscles? A.

All muscles involved in swallowing are attached to the hyoid bone.

B.

The genial tubercle is the attachment of the genioglossus and the mylohyoid muscle.

C.

The medial pterygoid muscle can be described as the internal component of the masseter muscle.


158. All of the following nerve braches are affected when the sphenopalatine or pterygopalatine ganglion is blocked with local anesthetic except one, which on is the exception? A. Infraorbital and nasal B. PSA C. Greater and middle palatine D. Nasociliary E. Mental


159. All of the following statements describe the trigeminal nerve except which one? A.

The trigeminal nerve is the largest cranial nerve.

B.

The trigeminal nerve is the great sensory nerve of the deep and superficial portions of the head.

C.

The trigeminal nerve is comprised of eight cranial nuclei.

D. The trigeminal nerve is the motor nerve of the muscles of

mastication.


160. The retromolar pad contains which of the following structures? A. Fibers of the superior constrictor muscle B. Temporal tendon C. Ptergomandibular raphe D. Temporalis muscle


161. Which muscle is responsible for the protrusion of the tongue? A. The genioglossus B. The palatoglossus C. The styloglossus D. The hyoid


162. The mucosa covering the hard palate is innervated by one or more of the following nerves.

A. Lesser Palatine B. Greater Palatine C. Nasopalatine D. A & B E. B & C


163. Why shouldn’t you detach the mentalis muscle? A. It will never re-attach. B. It is hard to re-attach and causes ptosis.


164. Swelling of the lateral face and tissue involves which anatomic space? A. Masseteric space B. Temporalis space C. Buccal D. Submandibular


165. A blocked airway caused by perforation of lingual undercut is caused by?

SHORTANSWER


Q165 Answer ď‚— A blocked airway caused by perforation of lingual

undercut is caused by? Blood moving through facial spaces


166. After successful bilateral mandibular blocks, patient still feels pain while drilling in symphysis, where is it coming from?

A. Mylohyoid B. C3-C4 C. Lingual D. Sublingual


167. Buccal swelling occurs after an implant is placed in the mandibular 1st molar area. Where did it come from?

A. Below buccinator attachment B. Above buccinator attachment


168. To achieve profound anesthesia for a sinus graft procedure, the secondary division of the maxillary nerve (V2) should be anesthetized. A V2 block is carried out by inserting the needle into what foramen? A. Nasopalatine B. Pterygomaxillary C. Ovale D. Greater palatine E. Lesser palatine


169. A life threatening effect of mandibular anteriorosteotomy prep, the greatest risk in: A. Lingual artery B. Facial artery C. Air emphysema D. Edema


Q169 Answer ď‚— A life threatening effect of mandibular anterior-

osteotomy prep, the greatest risk in: A) Lingual artery – sublingual, mylohyod, submental B) Facial artery C) Air emphysema D) Edema


170. Which wall of the maxillary sinus, if perforated during surgery, can cause a serious bleeding complication from the pterygoid plexus and internal maxillary artery? A. Medial B. Lateral C. Anterior D. Posterior E. Superior


171. What type of bone would heal in the shortest amount of time? A. Course trabecular bone B. Bone with dense cortex or cortical bone


Q171 Answer - ?? ď‚— What type of bone would heal in the shortest amount

of time? A) Course trabecular bone B) Bone with dense cortex or cortical bone


172. Which muscle of mastication is always in function during eccentric movement? A. Medial pterygoid muscle B. Masseter muscle C. Lateral pterygoid muscle D. Temporal muscle


173. If you had a retropharyngeal infection where would it drain? A. Thoracic mediastinum B. Submandibular space


174. Life threatening infections occur through which area of the head? A. Infratemporal fossa B. Retropharyngeal space C. Submandibular space


175. The anatomic structure most problematic to placing an implant in the maxillary incisor area. A. Midpalatine suture B. Nasal floor C. Maxillary sinus D. Nasopalatine canal


176. The zone of safety is defined as an area in which implants may be placed 100% of the time: A.

Anterior to the middle of the mandibular second molar

B.

Anterior to the mesial of the mandibular second molar

C.

Anterior to the middle of the mandibular first molar

D. Anterior to the mesial of the mandibular first molar E.

Anterior to the mesial of the mandibular second premolar


177. Insertion too deep into the foramen when administering a V2 block can result in which of the following complications?

A. Transient loss of vision B. Retrobulbar hemorrhage C. Proptosis D. Periorbital swelling E. All of the above F. None of the above


Q177 Answer - ?? ď‚— Insertion too deep into the foramen when administering a V2

block can result in which of the following complications? A) Transient loss of vision B) Retrobulbar hemorrhage C) Proptosis D) Periorbital swelling E) All of the above F) None of the above


178. Septa within the maxillary sinus are a benefit to bone formation in that they act like an additional wall of bone for blood vessels to grow into the graft and also can enhance initial stability of the implants.

A. True B. False


Q178 Answer - ?? ď‚— Septa within the maxillary sinus are a benefit to bone

formation in that they act like an additional wall of bone for blood vessels to grow into the graft and also can enhance initial stability of the implants. A) True B) False


179. Upon panoramic radiographic examination of a patient for treatment planning of the maxillary posterior region, you not that there exists no posterior wall of the maxillary sinus. What would your most likely diagnosis be? A.

Poor panoramic positioning

B.

Overlapping of osseous structures

C.

Chronic sinusitis

D. Pathologic disease E.

Osseous destruction from previous 3rd molar extraction


180. To anesthetize the mucosa covering the soft palate, one has to block one ore more of the following nerves:

A. Lesser Palatine B. Greater Palatine C. Nasopalatine D. A & B E. B & C


181. When making an incision in the posterior maxilla through the mucosa for the maxillary tuberosity and hamular notch area, which is the main muscle you are incising through? A. Buccinator B. Medial Pterygoid C. Lateral Pterygoid D. Levator Anguli Oris E. Levator Labii Superiosis


182. A needle was inserted into the skin inferior to the zygomatic arch while the patient had his mouth open. The needle was passed through the sigmoid notch of the mandible until it was stopped by the lateral plate of the pterygoid process. The first muscle the needle passed through is called: A.

Temporalis

B.

Superficial and deep portions of the masseter muscle

C.

Only deep portion of the masseter muscle

D. All of the above


183. A needle was inserted into the skin inferior to the zygomatic arch while the patient had his mouth open. The needle was passed through the sigmoid notch of the mandible until it was stopped by the lateral plate of the pterygoid process. The second muscle that the needle passed through before touching the lateral surface of the pterygoid plate was the: A. Medial Pterygoid B. Tensor Veli Palatini C. Superior head of Lateral

Pterygoid D. Inferior head of the Lateral

Pterygoid


184. A needle was inserted into the skin inferior to the zygomatic arch while the patient had his mouth open. The needle was passed through the sigmoid notch of the mandible until it was stopped by the lateral plate of the pterygoid process. If the needle is withdrawn slightly after touching the bone and the introduced 3-5 mm anteromedially, it should end in one of the following regions of the head:

A.

Pterygopalatine Fossa

B.

Orbit

C.

Nasal Cavity

D. Oral Cavity


185. Patient has loss of sensation of the skin anterior to the ear. Which structure(s) has/have been injured?

A. Zygomaticotemporal nerve B. Auriculotemporal nerve C. Supraorbital nerve D. Facial nerve


186. Patient has loss of sensation of the mucous membrane lining the upper lip. Which structure(s) has/have been injured?

A. Mental nerve B. Palatine nerve C. Long buccal nerve D. Infraorbital nerve


187. Patient has loss of taste sensation from anterior 2/3 of the tongue. Which structure(s) has/have been injured?

A. Glossopharyngeal nerve B. Hypoglossal nerve C. Chorda tympani nerve D. Sphenopalatine nerve


188. Patient has reduction in salivary secretion by the parotid gland on one side. Which structure(s) has/have been injured?

A. Greater superficial petrosal nerve B. Lesser superficial petrosal nerve C. Deep petrosal nerve D. All of the above


189. The artery which runs close to the inferior head of the lateral pterygoid muscle and supplies it is called the:

A. External carotid artery B. Internal carotid artery C. Superficial temporal artery D. Maxillary artery


190. The artery which runs close to the submandibular gland and supplies it is called: A. Facial artery B. Submental artery C. Lingual artery D. Maxillary artery


191. The muscles which form the floor of the submandibular (digastric) triangle are the: A. Mylohyoid B. Superior constrictor of the pharynx C. Middle constrictor of the pharynx D. Stylohyoid E. Hyoglossus


Q191 Answer ď‚— The muscles which form the floor of the

submandibular (digastric) triangle are the: A) Mylohyoid p235 B) Superior constrictor of the pharynx C) Middle constrictor of the pharynx E) Stylohyoid F) Hyoglossus


192. The branch of the lingual artery which is/are susceptible to injury if the dorsum of the tongue is traumatized is/are called:

A. Sublingual artery B. Dorsal lingual artery C. Lingual profunda artery D. Both A and B


193. All of the muscles of the tongue are innervated by the hypoglossal nerve except one. Select the tongue muscle that is not innervated by XII. A. Styloglossus B. Hyoglossus C. Genioglossus D. Palatoglossus


194. During a clinical examination, the patient’s tongue was found to deviate to the right side on protrusion. The dentist suspected paralysis of one of the following: A. Right genioglossus muscle B. Left genioglossus muscle C. Right styloglossus D. Left styloglossus


195. An injured bleeding tongue should stop hemorrhaging if it is pulled out of the mouth. The reason is one or more of the following:

A.

The lingual artery is pressured by the stylglossus muscle.

B.

The lingual artery is pressured against the great horn of the hyoid bone.

C.

The lingual artery runs deep to the hyoglossus muscle, which pressures the artery against the hyoid bone when the tongue is pulled out.

D. Both A and C E.

None of the above.


Q195 Answer ď‚— An injured bleeding tongue should stop hemorrhaging if it is pulled out of

the mouth. The reason is one or more of the following: A) The lingual artery is pressured by the stylglossus muscle. B) The lingual artery is pressured against the great horn of bone.

the hyoid

C) The lingual artery runs deep to the hyoglossus muscle, which pressures the artery against the hyoid bone when the tongue is pulled out. And Genioglossus. D) Both A and C E) None of the above.


196. Three or more of the following structures crosssuperficial to the hyoglossus muscle before they enter the floor of the mouth. A. Lingual nerve B. Lingual artery C. Submandibular autonomic ganglion D. Hypoglossal nerve E. Wharton’s duct


197. If one introduced an artery forceps into the midline raphe of the mylohyoid muscles and forced it up into the floor of the mouth, one or more of the following vital structures would be injured.

A. Geniohyoid B. Genioglossus C. Hypoglossal nerve D. A & B E. None of the above


198. In a venous angiogram, the common facial vein was found to be formed by the junction of branches of the ______ and ______ veins.

A. Posterior auricular and retromandibular B. Posterior auricular and external jugular C. Retromandibular and facial D. Internal jugular and anterior jugular


199. In a venous angiogram, the cavernous venous sinuses were found to communicate directly with one or more of the following veins: A. Superior ophthalmic veins B. Inferior ophthalmic veins C. Emissary veins D. Facial veins


200. A patient developed an abscess related to an endosseous implant that replaced the lower right first molar tooth. For the infection to reach the sublingual surgical space, the pus has to perforate the mandible: A.

Above the mylohyoid muscle attachment

B.

Below the mylohyoid muscle attachment

C.

Above the internal oblique ridge

D. A & C E.

None of the above


201. A patient developed an abscess related to an endosseous implant that replaced the lower right first molar tooth. For the infection to reach the submandibular space the pus must perforate: A.

The mandible below the mylohyoid muscle attachment

B.

The mandible above the mylohyoid muscle and then migrates on the surface of the muscle posteriorly to reach the submandibular space

C.

A&B

D.

None of the above


Pharmacology Practice Exam Questions


202. Erythromycin has a proclivity for elevating serum levels of: A. Carbamazepine B. Digoxin theophylline C. Both carbamazepine and digoxin theophylline


203. Which antibiotic chelates calcium and arrests bone growth? A. Amoxicillin B. Penicillin C. Ceflaxin D. Tetracycline


204. Clindamycin was used after bone graft was completed and now a new fistula was found. A. switch to amoxicillin plus a form of steroid B. lab test


Q204 Answer

 Clindamycin was used after bone graft was

completed and now a new fistula was found. – Usually if allergy to PenV

A) switch to amoxicillin plus a form of steroid – No if Allergy to PenV B) lab test


205. Which class of drugs are those that are noncontributory to gingival hyperplasia? A. Beta blockers B. Ca blockers


Q205 Answer ď‚— Which class of drugs are those that are non-

contributory to gingival hyperplasia? A) Beta blockers-TRUE B) Ca blockers -- FALSE


206. Which of the following is not an advantage of Halcion (Triazolam) over Valium (Diazepam) and Ativan (Lorazepam)?

A. No active metabolites B. Shorter elimination ½ life C. Shorter initial onset time D. Shorter peak onset time E. Longer duration of action


207. After sedating you patient with a benzodiazepine, you notice that the patient is in respiratory depression. What drug would be given to reverse the effects of the benzodiazepine? A. Oxymetazoline B. Epinephrine C. Flumazenil D. O2 E. Bronchodilator


Q207 Answer ď‚— After sedating you patient with a benzodiazepine, you

notice that the patient is in respiratory depression. What drug would be given to reverse the effects of the benzodiazepine? A) Oxymetazoline B) Epinephrine C) Flumazenil WITIPEKIA D) O2 E) Bronchodilator


208. The patient should follow instructions most strictly when taking which form of antibiotic? A. bactericidal B. mixed cidal and static C. bacteriostatic


Q208 Answer ď‚— The patient should follow instructions most strictly when taking

which form of antibiotic? A) bactericidal ? B) mixed cidal and static – no benefits-Rutkowsky notes-more toxic=higher rate of spontaneous re-infection combination helps prevent resistant strains

C) bacteriostatic ** Bactericidal drugs kill the bacteria. Bacteriostatic drugs only inhibit growth & reproduction of bacteria


209. You are performing surgery on a patient who has mitral valve prolapse with regurgitation and an allergy to penicillin. Which of the following would be an acceptable alternative to amoxicillin?

A. Clindamycin- 300mg one hour before surgery B. Tetracycline- 600mg one hour before surgery C. Keflex-2 grams one hour before surgery D. Clarithromycin- 250mg one hour before surgery E. Clindamycin- 500mg one hour before surgery


210. Which antibiotics would you give to a patient who is having a pre-maxilla augmentation? A. 2000 mg of amoxicillin 1 hour pre-op2g. B. Clindamycin 600 mg 1 hour pre-op


Q210 Answer  Which antibiotics would you give to a patient who is

having a pre-maxilla augmentation? A)2000 mg of amoxicillin 1 hour pre-op2g. B)Cindamycin 600 mg 1 hour pre-op  if patient is allergic to penicillin - BEST FOR BONE GRAFTING - Rutkowski notes


211. What is nystatin used for? A. Candida infections B. Sinus infections


212. The use on non-steroidal anti-inflammatory drugs and glucosteroids are helpful in reducing postoperative edema. Which of the following statements is true regarding their primary mechanism of action? A.

NSAIDs block the release of histamine.

B.

NSAIDs act upon the cellular phospholipids and glucosteroids act upon the cyclo-oxygenase pathway.

C.

Both drugs act upon the metabolism of arachodonic acid.

D. NSAIDs act upon the cyclo-oxygenase pathway

and glucosteroids block the release of histamine from mast cells.

E.

NSAIDs should not be given concurrently with glucosteroids


Q212 Answer ď‚— The use on non-steroidal anti-inflammatory drugs and glucosteroids are

helpful in reducing post-operative edema. Which of the following statements is true regarding their primary mechanism of action? A) NSAIDs block the release of histamine.

B) NSAIDs act upon the cellular phospholipids and glucosteroids act upon the cyclo-oxygenase pathway. C) Both drugs act upon the metabolism of arachodonic acid. D) NSAIDs act upon the cyclo-oxygenase pathway and glucosteroids block the release of histamine from mast cells. from lecture E) NSAIDs should not be given concurrently with glucosteroids


213. Seldane may cause what kind of reaction in patients taking detoconzelon?

SHORTANSWER


Q213 Answer

ď‚— Seldane may cause what kind of reaction in patients

taking detoconzelon? ď‚— Ventricular arrhythmias


214. All of the following suggest that efficacious use of anti-inflammatory analgesics with implant surgeries except which one? A.

NSAID’s are a class of drugs indicated prophylactically before implant surgery.

B.

Anti-inflammatory analgesics repeatedly perform better in the dental pain relied model than single entity narcotics.

C.

Combinations of analgesics that can surpass the analgesic ceiling of individual agents alone can control severe pain.

D. Anti-inflammatory and non-narcotic analgesics

have a direct relationship in their effectiveness to reduce inflammation and control pain.


215. A patient who was given penicillin post-op 24 hours after oral administration complains of itching and mild rash. In addition to instructing the patient to discontinue the penicillin prescription, which of the following would be beneficial? A. Aspirin B. Erythromycin C. Dilantin D. Benadryl


216. What is the rational for not prescribing aspirin for patients who are taking NSAID? A. Increase the NSAID duration of action B. Displace some of the NSAID from its protein

binding sites C. Decrease the absorption of NSAID D. Decrease the effectiveness of the NSAID


217. NSAIDs are contraindicated when a dental patient is taking which of the following medications?

A. Appresoline B. Diuretic C. Indural D. Low sodium diet


218. Which of the following is the major difference between aspirin and the newest NSAIDs? A. inhibits cyclo-oxygenase B. augmenting analgesia of opioids C. absorbing following oral administration D. regulated by law


Q218 Answer - ??

ď‚— Which of the following is the major difference between

aspirin and the newest NSAIDs? A) inhibits cyclo-oxygenase ?? B) augmenting analgesia of opioids C) absorbing following oral administration D) regulated by law ?


219. Which of the following penicillin is also specifically indicated for gram-negative organisms?

A. amoxicillin and ampicillin B. penicillin G C. penicillin V


220. If a patient was taking phenothiazine, what side effect would the patient complain about?

A. dry mouth B. mucosal change C. uncontrolled motor twitches D. constipation


Q220 Answer - ??

ď‚— If a patient was taking phenothiazine, what side effect

would the patient complain about? A) dry mouth ? B) mucosal change C) uncontrolled motor twitches ?? D) constipation


221. According to the American Heart Association, which of the following is the correct dose in administration of erythromycin ethyl succinate in SBE prophylaxis? A. 800mg two hours before, 400mg six hours

after B. One gram orally two hours before, half gram

six hours later C. 300mg one hour before, 150mg six hours

later D. 800mg one hour before, 400mg q6h for two

days


Q221 Answer - ?? ď‚— According to the American Heart Association, which of the

following is the correct dose in administration of erythromycin ethyl succinate in SBE prophylaxis? ď‚— Old Answers

A) 800mg two hours before, 400mg six hours after ?? B) One gram orally two hours before, half gram six hours later C) 300mg one hour before, 150mg six hours later D) 800mg one hour before, 400mg q6h for two days


222. All of the following hypertension medications alter peripheral resistance except which one?

A. ace inhibitors B. beta blockers C. calcium channel blockers D. alpha blockers E. thiozide


Q222 Answer - ??  All of the following hypertension medications alter peripheral

resistance except which one? A) ace inhibitors - True-acts on angiotensin to reduce peripheral resistance

B) beta blockers - LESS CARDIAC STIMULATION, DECREASE B.P. C) calcium channel blockers ?? -

DECREASE HEART

STIMULATION, Decrease B.P.

D) alpha blockers E) thiozide – diuretic\HBP med.\acts on Blocking Na\K channel


223. Beta blockers cause the pulse to?

A. increase in rate B. decrease in rate C. become weaker D. become stronger


Q223 Answer  Beta blockers cause the pulse to?  PULSE=dependent

on heart rate/RATE OF SYSTOLIC BLOOD EXPULSION IS DEPENDENT on HR AND ON DIAMETER OF THE ARTERY OR ARTERIAL RESISTANCE. Beta blockers cause decreased heart rate B-1 BLOCKERS B-2 BLOCKERS CAUSE VASOCONSTRICTION SO

 THE NET RESULT

A) increase in rate B) decrease in RATE -TRUE C) become weaker - true D) become stronger


224. A patient with which of the following would contraindicate the use of epinephrine in the dental anesthetic? A. non-selective beta blocker B. Hypothyroid C. Chron’s D. stomach ulcers


225. You are performing a surgery on a 72 year old female with hypertension controlled by medication. The patient is orally sedated. 40 minutes into your surgery she stops breathing and experiences a rapid drop in blood pressure. The proper drug is:

A. Atropine B. Epinephrine C. Aminophylin D. Ephedrine


Q225 Answer ď‚— You are performing a surgery on a 72 year old female

with hypertension controlled by medication. The patient is orally sedated. 40 minutes into your surgery she stops breathing and experiences a rapid drop in blood pressure. The proper drug is: A) atropine - no vasodilator B) epinephrine C) aminophylin- NO smooth muscle relaxant D) ephedrine


226. What condition may occur when prescribing sedatives for patients on hypertensive drugs?

A. Hypertension B. Hypotension C. Endocarditis D. Nausea


227. All of the following medications are contained in an emergency kit to treat anaphylaxis except:

A. Narcan B. Epinephrine C. Aminophylline D. Hydrocortisone E. Phenergan


Q227 Answer  All of the following medications are contained in an

emergency kit to treat anaphylaxis except: A) Narcan - OPIATE ANTAGONIST,MAY REVERSE THE EFFECT OF RESPIRATORY DEPRESSION IN OPIATE USERS\HAS BEEN USED IN CASES OF SEPTIC SHOCK B) Epinephrine - true EPI PEN C) Aminophylline - TRUE tx OF BRONCHIAL ASTHMA D) Hydrocortisone - MED FOR ARHRITIS AND JOINT PAINREDUCES INFLAMMMATION E) Phenergan – TRUE - ANTIHISTAMINE


Q227 Explanation ** Corticosteroids are used to treat allergic reactions. They may not be of immediate benefit

but they help with the later phases of Anaphylaxis & they help with capillary permeability. The typical definitive treatment for anaphylaxis is a H1 & H2 antihistamine plus a corticosteroid with epinephrine (or any other catecholamine) & fluid boluses used as needed. This is from NIH web site: http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=1281 NARCAN has been shown in some cases of septic shock to produce a rise in blood pressure that may last up to several hours; however, this pressor response has not been demonstrated to improve patient survival. In some studies, treatment with NARCAN in the setting of septic shock has been associated with adverse effects, including agitation, nausea and vomiting, pulmonary edema, hypotension, cardiac arrhythmias, and seizures. The decision to use NARCAN in septic shock should be exercised with caution, particularly in patients who may have underlying pain or have previously received opioid therapy and may have developed opioid tolerance. Because of the limited number of patients who have been treated, optimal dosage and treatment regimens have not been established.


228. All of the following medications are contained in an emergency kit for cardiac arrest except:

A. Epinephrine B. Aminophylline C. Hydrocortisone D. Meperidine E. Isoprotenerol


Q228 Answer - ?? All of the following medications are contained in an emergency kit for cardiac arrest except:

A) Epinephrine – Acts on alpha receptors /causing vasoconstriction/increases HR B) Aminophylline – true-used in bronchoasthma\ bronchodilator\cardiac stimulator\used in Anaphylactic shock

C) Hydrocortisone? – TRUE - SUPPRESSES MOST INFLAMMATORY RESPONSE OF AN

ALLERGIC,BACTERIAL,TRAUMATIC OR ANAPHYLACTIC ORIGIN

D) Meperidine ? – OPIATE DERIVATIVE/ RESP. DEPRESSION/BLOCKS SERATONIN

RELEASE/NEVER WITH MAO INHIBITORS

E) Isoprotenerol – IS A SYNTHETIC CATECHOLAMINE that stimulates both B-1 and B-2

ADRENERGIC RECEPTORS-INCREASES HR\INCREASES BRONCHODILATION USED IN THE BTxBRONCHOASTHMA/bronchoSPASM/CAUSES ARTERIAL DILATION TERIAL


229. When vancomycin IV is used for pre-operative prophylaxis, it should be administered in doses of no less than two grams: A. rapidly to avoid stomach irritation B. on an empty stomach C. slowly over time period of one hour D. only when mixed with dental water


230. What are the characteristics of bactericidal antibiotics? A. ability to kill or destroy bacteria B. ability to stimulate body defenses against bacteria C. ability to arrest bacterial growth D. ability to prevent spore maturation


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