Periapical Osteofibrosis

Is it periapical osteofibrosis ?

Post and core with first molar

Post and core with first molar : - 

This the RVG of the female patient age 23 years giving history of hemisection with post and core with lower left first molar one and half year ago .Now she is having pain and swelling clinically . Radigraphically there is periapical abscess seen with distal canal which  is not obturated in middle and apical third .Probably the same tooth will for the extraction after working for one and half year with sacrifice of  enamel of adjacent molar for additional support .

dental management information systems (DMIS)

dental management information systems (DMIS)

What is a turnkey software application?
There are basically two types of software systems: turnkey systems, which
attempt to provide all of the necessary functions of a DMIS, and modular systems,
which allow the addition of functions as the needs demand. Dentrix, Softdent, and
PracticeWorks are examples of popular turnkey systems. Modular systems depend
on the interaction with commercially software to provide the desirable functions of
a DMIS. This approach saves initial software cost but requires learning several
different programs.


What are the major guidelines for choosing a software vendor?
• How long has the company been in business?
• How long has the software been in use?
• How many installations are there?
• Can it integrate with commercial software?
• Is technical support responsive? How long is the response time?
• Does the vendor offer installation, training, and data conversion?
• How often are updates provided, and will the vendor make changes on an
individual basis?
• Will the vendor supply a list of current users?
• Are service contracts available?


How can a DMIS benefit a dental practice?
• Daily office management
• Business planning resource
• Chairside clinical support system
• Quality assurance management
• Risk management assessment
• Research tool for clinical studies


How can a computer function as an analytical tool for practice
analysis and business planning?
As an analytical tool the computer is unsurpassed. The DMIS software builds
databases in a variety of categories:
1. Registration data (e.g., name, address, phone numbers, date of birth,
insurance plans, Social Security number)
2. Patient medical history data (e.g., all significant positive elements,
medications)
3. Production data by category (e.g., provider, ADA code, insurance plan)
4. Laboratory fee data by laboratory, patient, and provider
5. Inventory usage data
6. Equipment maintenance logs
By allowing rapid retrieval of data in a meaningful way, the computer helps
with management decisions, business planning, and quality assurance
assessments and analyzes treatment outcomes and morbidity. Often a report can
be generated by category or key word searching to allow solving a variety of
interesting problems. Consider answering the following questions:

• How should a fee schedule be adjusted to account for a 5% increase in
laboratory costs and a 7.5% increase in consumables? How will this affect net
production?
• How many patients have insurance plan B? What is the income from this
group? What would be the impact on production figures if they left the practice?
• How does the productivity of each practice hygienist compare? How
should their fees be adjusted to allow a 7.5% salary increase?
• What is the cancellation (broken appointment) rate for each of the
operators? What time of day has the highest rates?
Such data are difficult and time-consuming to retrieve and calculate
manually. If the DMIS is properly designed, such data are retrievable at will, with
no extra effort, because the relevant data are entered routinely for every patient
and continually updated. Projections can be easily made by applying the data
received to a spreadsheet analysis.

Todays Obturation

Todays Obturation 

Follow up of root canal patient

Follow up of root canal patient

Before treatment

Immediately After Treatment

Eight months After Treatment

Todays case with unerrupted parapremolar with obturation with lower first molar

Todays case with unerrupted parapremolar with obturation with lower first molar

Bone density classification

Bone density classification

   1. dense compact (D-1) bone

   2. dense to thick porous compact and coarse trabecular (D-2) bone

   3. porous compact and         fine trabecular (D-3) bone

   4. fine trabecular (D-4) bone

Division of available bone

Surgical technique

Surgical technique

   Patient sedation, local anesthesia, and preparation of an aseptic environment

   Antiseptic mouth rinse : Chlorhexidine scrub and rinse may be used

   Iodophor compounds ( Betadine ) are a most effective antiseptic, but inhibit the osteoinduction of demineralized bone

Regional anesthesia

   Blocking maxillary nerve (v2 ) : 1.8 ml

   Hemimaxilla, side of nose, cheek, lip, sinus area

   Long-acting anesthetic : Bupivacaine 0.5 % or Etidocaine 1.5 % with EPI 1:200,000

Local infiltration

   Labial mucosa and palatal region

   Complete hemostasis

   Lidocaine 2 % with EPI 1:100,000   

Patient evaluation treatment planning for edentulous posterior maxilla

Patient evaluation treatment planning for edentulous posterior maxilla

   The SA-2 to SA-4 surgical procedures the sinus should be free of infection

   In addition, a thorough history and clinical evaluation of the maxillary sinus are conducted.

   Potential infection in the region of the sinuses may result in extremely severe complication

   Physical examination

   Radiography

   Conventional :OPG, water’s view

   CT

   MRI

   CT is currently the modality of choice

   Any sign of acute sinusitis, root tips, cysts or tumors complicate the procedure and mandate further evaluation

   Known diseases of the antrum should be treated before sinus grafts

Treatment planning for edentulous posterior maxilla

   The maxillary ostium opening in the medial wall                            and near the superior aspect of the sinus

   The cilia beat toward the ostium at 15 cycles/minute

   Adequate manipulation of the membrane and placement of graft material are possible without impeding the drainage of the sinus

Treatment planning for edentulous posterior maxilla

Maxillary Sinus Anatomy & Sinus membrane

Maxillary Sinus Anatomy

Pyramidal shape

Roof                : floor of orbit

Floor               : alveolar bone and palatine process

Anterior wall  : facial surface of maxilla

Posterior wall : infratemporal  surface

Medial wall        : lateral wall of  nasal cavity

Sinus membrane

Schneiderian membrane

Mucoperiosteum cansists 3 layers

1.Epithelium lining : pseudostratified columnar ciliated epithelium

2.Lamina propria           can stripped easily from

3.periosteum                         underlying bone

There are numerous globlet cell

Most of the serous and mucous glands found in the lining are located near the maxillary ostium 

Maxillary Sinus Bone Graft & Nreve , blood supply of Maxillary Sinus

Neurovascular supply

Blood supply is mainly derived from nose

   Sphenopalatine artery

   Anterior & posterior nasal artery

   Infraorbital artery

   Posterior & middle superior alveolar artery

   Facial artery

   Palatine artery

Venous drainage

   Anterior facial vein

   Pterygoid veinous plexus

Lymphatic drainage

   Submandibular lymphnode

Nerve supply

   Maxillary division of trigeminal nerve (V2)