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ortho

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ffiEndodontics from the Greek endo inside"; and odons tooth") s one ofthe dental specialties hich deals with

the ooth pulp and le tissues urrounding he root ofa tooth.Endodontists erfomra variety ofprocedures ncluding ootcanal herapy, eldodontic treatonent, urgery, reating cracked eeth, and reating dental rauma. Root canal herapy s oneof the rnost cotrrmon rocedures. f the pulp (containing erves, rterioles, enules, yrnphatic issue, nd ibrous issue)becomes iseased r injured, endodontic reatment s required o save he tooth. Endodontic herapy s a sequence f

treatment or the pulp of a tooth which results n the elimination of iufectiol and protection ofthe decontaminated ooflrfrom future microbial invasion. This set of procedures s commonly eferred o as a "root canal." Root canals and theirassociated ulp chamber are he physical hollows within a tootl that are naturally nhabited by nerve issue, blood vesselsand other cellular entities. Endodontic lerapy involves he removal ofthese structures, he subsequent leaning, shapilgand decontamination of the hollows with tiny files and irrigating solutions, and the obturation (filling) of thedecontamilated anals with an nert filling such as gutta percha.

During the iast tluee decades, esearch n the field of endodontics as modified he approach o treafnent. Lesiorsof endodontics rigin which appear adiographically as areas of radiolucency around he apices of lateral aspects f theroots of teeth are, n majority of cases, terile. The areas are caused y toxins produced by microorganisrns ying withintle root canal system. This finding suggests hat the remove of microorganisms i'om tle root canal followed by rootfilling is the first treatunent f choice and the apicectomy with a retrograde rlling can only be second best. Apicectomywith a retrograde illing at the aplex is carried out in the hope of merely ncarcerating microorganisms within ttre tooth,but does not take into account he fact that approximately 50/o of teeth have at least one lateral canal. The long termsuccess ate of apicectomy must nevitable be lower than orthograde oot treatrnent.

. Research nto morphology f the pulp has shown he wide variety of shapes, nd he occurrence f two or eventhree canals n a single oot. There s a high ncidence f fins which un longitudinally ithin the wall of the canal and anetwork of communications between canals ying within the same oot. The many nooks and crannies within the rootcalal system make t impossible or any known technique, ither chemical or mechanical, o render t sterile. Stongintracanal medicaments uch as paraformaldehyde ill not only fail to produce sterilization but may percolate nto theperiradicular issue and damage vital healthy issue, hus delaying healing. The current feeling is to rely on mechanicalcleaning f the canal alone, r on tre use of mild medicaments hich do not damage issue.

Other areas of research have had the significant effect of changing he approach o endodidontic reatment. Thehollow tube theory postulated hat tissue luids entering he root canal stagnated nd formed toxic breakdown productswhich then passed ut into the periapical issues. The theory, het dead spaces within the body must be obturated, onnedthe basis or filling root canals. However, more recently ,a variety of different studies have demonstrated hat, on thecoutrary, hollow tubes are tolerated by the body. As a result of this work there are currently two indications or filling aroot canal: lrst. To prevent micro-organisms rom entering he canal system rom the oral cavity or via the blood stream(anachoresis), ud, secondly, o stop he ingtess f tissue luid which would provide a culture medium or any residualbacteria within the tooth.

All root canal sealers are soluble and their only function is to filI the minute spaces etween he wall of the rootcanal and he root filling material. Their importance, udged by the number of products advertised n tlie dental press, hasbeen overemphasized. espite much research, gutta percha emains he root filling of choise, although, t is recognizedthat a biologically nert, nsoluble and njectable astewould be better uited or obturation f the root canal.Most of thenew root canal illing techriiques re concerned ith methods f heating utta-percha, hich makes t softer and easier oadapt o the negular shape f ttrecanal wall.

a. Root canal issue annot e damaged uring cleaning.b. Fluids which stagnate n the moutl may each periapical issues.c. Empty tubes are never olerated by the body.d. Sealers an eplace oot canal ill ing.e. Gutta percha s no longer used or canal illing.In sumrnary, he principles of modern endodontic reatment are:Clean: reurove microorgalisms and pulpal debris rom the root canal systemShape: produce a gradual smooth aper n the root canal with the widest paft coronal and he narrowest part lmmshort ofthe apex.Fill: Obturate he calal system with an inert, nsoluble illing rnaterial.

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The nature of dental practice determines high degree of stress and iredness ordentists, which is why stress should be reduced. The dentist must concentrate n his

work, to make sure hat his services are of high quality. To all that other requirements readded: to settle appointments and to run the dental surgery. This is the reason whymodem stomatology s based on the "four hands stomatology" concept, which meals thalthe assistant's ands re added o those ofthe dentist's o take care of the patient.

After the functional aspects of the surgery were included in the design, heenvironment should be considered. Environment includes colours, the lighting, thewindows, ttre sound system, because both the patient and the dental professional eammust benefit the psychological effect of the "set". The stomatologist s obliged throughlaw to offer an obstacle-free place for invalid patients, even if the patient is in awheelchair. The idea that only one kind of equipment s favourable o '1he four handsstomatology" s a hazardous one, ust like the idea that one type of car suits all drivers.Nevertheless, here are some desigrr eatures which are essential o allow tie team towork in good conditions. Some necessary elements o endow a dental surgery are: adental chair, a dental unit, lockers for different instruments; an air-water syringe, an oralinhalator, a special overhead amp, an X-ray unit.

The center of activity for any manouevre s the stomatological chair. Its mainfeature s that it offors access l the patient's oral cavity. An ideai chair should nclude atleast he following featues: o allow the patient o lie down, o be comfortable or thepatient and dentist to have the control buttons placed so that both the assistant nd thestomatologist have easy access o them.

The dental unit is the control centre or the hand parts. ts maia role is to controlthe air and water flow and o offer support or the team. Dental units vary through shapeand nstruments configuration. Some of them contain besides he handparts lements ike:the oral inhalator, he air-water syringe, he optic fibre light.

The handparts are controlled thrbugh two buttons: one is fixed in the unit ardprograinmes which handpart will be used, and he other one, activated by foot, is used bythe dentist o establish he drill rotation speed.

The chair for the assistant must be chosen arefidly he decisive actor beingcomfort, but the shape and ts positioning must contdbute o visibility.

The instruments and the auxiliary materials n the ockers available ontributeto work efficacity. Only the materials hat are frequentiy used must be kept at hand; allthe others should be kept in a storage pace.

The cabinets have two kilds of lockers: some fixed, attached o the wall andsome mobile. The fixed lockers usually house he articles used or surgery, nstrumentsand nstrument cases, as well as single use articles.

The mobile lockers can be moved all over he place and are used o store articlesnecessary or treatment: gauze pads, cotton buffers, filling materials, special plates formixfures, rugs.The air-water syringe can supply an airjet to dry preparations nd a water et to rinse hepatient's mouth. The syringe has a pistol shape which allows easy handling.

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The surgical and the saliva nhalator are nstruments sed o remove salivadebris rom the oral cavity. The oral exhaust s the assistant's esponsibility.

The X-ray device s essential or a dental surgery because t offer; very importantinformadon o establish iagnosis nd saves ime. II is possibre, f course, o ,ef", thepatient o a specialized urgery or X-ray.

The variety of instruments and materials n a dental surgery ncreases according othe scientific development, but should match the type of activities performed in -thesurgery. Dental instruments are the tools that dental professionals use to provide dentaltreaftnent. They include tools to examine, manipulate, restore and remove teeth andsurrounding oral structures. ome instruments always ound n the dental surgery are: hedrill, usually made of stainless metals or even diamond, used o cut the teeth-or rush theoral structure surface; he dental mirrors used or indirect view; the dental probe, whichallows the dentist to feel the irregularities of the teeth surfaces; t also -removes thematerial- n excess and help shape he filling; the clip, used to place or remove smallobjects om the oral cavity;polishing nstruments, sed o smoothen he frlling surfaces;surgicalgloves, rotective lasses goggles) are he main physical obstacle Jtween hepatient and he dental eam against spreadilg infection.

Standard instruments are he instruments sed o examine, estore and extractleeth and manipulate tissues. Examination nstruments allow the dental orofessional omanipulate issues, o allow better visrral access during treatrnent or during dentalexamination. Dental mirrors are used by the dentist or dental auxiliary to view -a mirrorimage of the teeth in locations of the mouth where visibility is diffi;uit or impossible.They also are useful for reflecting light onto desired surfaces, and with retraction of softtissues o improve access r vision, used o check dental illings.

Probes are divided nto sickle probe or dental expiorer, and periodontal probe.Retractors are: cheek etractor, ongue etractor, and ip retractor. -Dental drills. Dental handpieces ome n many varying types which include:

High speed air driven, also known as an airotor), slow speed, riction grip,surgical handpiece, straight handpiece with a sharp bur

Burs. Dental Burs cutting surface are either made of a multifluted tunsstencarbide, a diamond coated ip or a stailless steel multi fluted rosehead. Burs are-alsoclassified by the type of shank. For instance a latch type, or right angle bur is only used nthe-slow speed handpiece with contra-angle attachment. ong shank or shaft s only usedin the slow speed when the contra-angle s not in use, and rn-ally a friction grip bw whichis a small bur used only in the high-speed andpiece.There are many bur shapes hat are utilized in various specific procedures.

Operative burs. Flat fissure, pear-shaped,footbali,

round, tapered, flame,chamfer, bevel, bud bw, steel, nverted cone, diamond.

Restorative nstruments: Excavators-spoon xcavator:which s used o removesoft carious decay; half hollenbach sed o test or overhangs r flash; chisels: straight

bevels he cavosurface margin and used n 3, 4 and 5 classifications f cavities o;themaxillary. wedelstaedt only used n the anterior or classes , 4 and.5 as well. BrnAngle --this s held n a pen grasp and used or class 2 maxiilaryonly.

Burnishers can be flat plastic, ba bumisher, beaverta burnisher. conebumisher, Bumisher, ear shaped umisher.

Pluggers are also known as amalgam condensers.

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Plastic surgery is a medical specialty concemed with the correction or restoration of formfunction. While famous for aesthetic surgery, plastic surgery also includes many typesreconstructive surgery, hand surgery, microsurgery, and the treatrnent of bums. The word "pderives rom tlte Greek plastikos" meaning o mould or to shape,Vascular urgery s a specialty of surgery n iryhichdiseases f the vascular system, or aderies andveins, are managed by medical therapy, minimally-invasive catheter procedures, nd surgicalreconstfl.lction. he specialty evolved rom genelal and cardiac surgery. The vascular surgeon strained n the diagnosis and management f diseases ffecting all parts of the vascular systemexcept hat ofthe heart and brain. Cardio*roracic urgeons manage ugical disease fthe heart andits vessels. Neurosurgeons manage surgical disease f the vessels n the brain (e.g. intraclanialaneurysms).Transplant urgery s the division of medicine hat surgically eplaces an orgar that is no longerfunctioning with an organ from a donor that does function. Organs are donated by living anddeceased onors n order o save he life of a recipient. Tralsplant surgeons may also care or thepatient prior to their transplant, and continue to care for the patient after transplant surgery. Thereare many types of transplants n medicine, however, ransplant surgery s the only division ofsurgery hat is concerned with organs. Other surgical specialties uch as dentistry and orthopedicswill use human issue o repair njuries and defects, ut that is not oonsidered traasplant urgery"but the use ofa "tissue ransplanf'.Trauma surgery Trauma surgeons are physicians who have completed esidency raining in general

surgery and often fellowship training in fauma or surgical critical care. The trauma surgeon sresponsible or the initial resuscitation and sfabilization of the patient, as well as ongoingevaluation. The attending rauma surgeon also leads he trauma team, which typically includesnurses, esident physicians, nd support staff.Breast surgery is a form of surgery performed on the breast. Types include: breast reductionsurgery, augmentation mammoplasty, mastectomy, umpectorny, breast-conserving surgery, a lessradical cancer surgery han mastectomy, mastopexy, or breast ift surgery.Surgical oncologt is the branch of surgery which focuses on the surgical management of cancer.The specialty of surgical oncology has evolved n steps similar to medical oncology, which gewout of hematology, nd adiation oncology, which grew out.ofradiology.Endocrine surgery s a surgical procedure hat s performed o achieve a hormonal or anti-hormonal

effect in the body. The commonest operation is thyroidectomy. Most thyroidectomies areperformed hrorigh a l.5-inch incision. This is called minirnally nvasive hyroid surgery. However,orchiectomy remains a common approach or the homonal managemenl of prostate cancer becauseof the simplicity of the procedure, ts immediate ffect, and he ack of side effects associated iththe drugs used o achieve he same hormonal suppression.Skin surgery Dermatology s the branch of medicine dealing with the skin and ts diseases, uniquespecialty with both medical and surgical aspects. A dennatologist akes care of diseases, n tlrewidest sense, nd some oosmetic roblems of the skin, scalp, hair, and nails.

Otolaryngology or ENT (ear, nose and throat) is the branch of medicine that specializes n thediagnosis and treatment of ear, nose, lu'oat, and head and neck disorders. The full name of thespecialty s otolaryngology-head nd neck surgery. Practitioners re called otolaryngologists-headand neck surgeons, l sornetimes torhinolaryngologists ORL). Otolaryngology s one of the mostcompetitive specialties o enter or physicians.Oral and maxillofacial surgery is surgery o correct a wide spectrum of diseases, njuries anddefects iD the head, neck, face; jaws and the hard and soft tissues of the oral and rnaxillofacialregion. t is a lecognized nternational wgical specialty.Orthopaedic surgery or orthopedics (also spelled orthopaedics) is the branch of surgeryconcerned with conditions nvolving the rnusculoskeletal ystem. Or'thopedic urgeons se bothsurgical ar,d non-surgical means to treat musculoskeletal rauma, sports injuries, degenerativediseases, nfections, tumors, and congenital disorders. Nicholas Andry coined the word"orthopaedicsl', elived from Grcek words for orthos "con'eet", sh?ight") and paideion "child"),

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. : t. .

,,ffih" l"ltirhed Orthopaedia: r the Ait of Cotrecti:rg nd Preveating efcnnitles n Children a

I.r'eurosnrgery s the surgeg, ocused on treatin-e fi-uctural iseases rid spinal columrl he centralBervous ys-rem> nd peripheral nervous systm amenable o surgical nterventioa. eurosurgeonsfieat all of the same probiems hat orthopedic spine surgeons reai. The differeaces :: the twospeciiillsts with regard to spine surgery bave to do wi'rh tbe detailed micro-sr.rgical pprcachleanred n a neurosurgical raini:rg program. Newosurgery enerllly has he ongesi rainingperiodof all the medical specialties; n.Americ4 tlie neurosurgeoa usc.complete he eight years of pre-

medical and medical education, one year-long surgical ntemship where his is not a pafi of theresidency), and five to seven years of neurosurgery esidency. Many neurosurgeols. ul:sue nadditional oBe o th-rea ears of training in a subspecialty ellowship (likepediatic neurosurgeryepilepsy, 'er:or, or stroke ("functiona1").neurosurgery icroneurosurgery, ndovascular r openvascular eurosurgery or neuro-oncological urgery),Optthalmology is a bra:rch of medidine v'hich deals adth he diseases nd surgery of the visualpathways, ncluding he eye, hairs, and areas urroulding he eyg such as he lacrimal system ndeyelids. The term ophthalaologist is an eye specialist or medical and surgical problems. Sinceophthalmologists erform operations n eyes, hey are considered o be both a surgical aridmedicalspecialty. The word ophthalmology comes &om the Greek oots "ophthalmos" meaaing eye and"logos" dear,ing word, thought or.disoourse; phthabaoiogy iterally means the scielce of eyes".

Podiatric surgery is a branoh of mediciae devoted o the sndy, diamosjs atrd eatnent ofdisorders f the foo alkle and ower leg. Within the field of podiatry, practidoners an ocus onmaly different specialty areas, fucluding surgery, sports mediciae; biomechanics, eriatics,pediatics,. rthopedics r pdrnary care. n many English-speaki:rg ounfies, he older.title of"chiropodist" may still be used by so'me linicia::sbut.is gradually alling out of use, n manynon-English-speaki:rg ormfies of Eiuope, the title used n$ead of podiatrist may be 'lodologisf' or"podolog".Tbe eve1and scope of praotice may vary a these oounties as compared n the US.Urology (fiom Greak otroq 'lurj::e" aad -logia "snrdy of) is the surgical pecially hat focuses ntbe urinaryhacts of males .and females, and oa tle reproductive system of inales' Medicalprofessionals peciaiizing n the fie1d of urology are called wologists and are ained to diagnose,fea and manage atieirtswith urological disorders. oth Urologists aud General Sugeons pdiateon the adrenal glands. Urology combines management f medical i.e. on-surgioal) problems uchas urinarry act nfections and benign prostatic hyperplasi4 as well as surgical roblems uchas tesurgical management f caacers, be correction of congenital bnormalities, ld cbreCting stessigcontinence. roiogy is closely relatod o, aad n somi casei overlaps with, the medical ielfu'ofoncologt, nephrology, gyneeologr, andr'ology, pediatic sulge.ry, gasfoenterolory, and-- ,1^^-i-^lnmrluwr uvrvE r.

is dfteu .done n an operatiag heater using surgical instruments, anoperating able or the patien and other.equipment. he environment nd procedules sod n surgery regov-tnud by th" pii:rciples of aseptic ech::ique: he strict separaliol of "sterile" (fiee of microorganisms)things ftom "uGerile' or "contaminated" hings. A1t surgical nstruments must be sterilized, and an

insnirment mjlst be replaced or re-sterilized if it becomei contaminated i.e. handled n alunsterile

manne1; r aliorved o touch an unsterile surface). Operating oom staff rnust wear sterile atiire (scrubs,bcrub cap, a sterile surgical gorvn, sterile atex or non-latex poljmer gioves and a surgical nask)' and heymust sclub hands and arms with an approved disinGotant gentbefore each rocedure'

Prior o surgery, i:e patielt is given a rnedical examination ndcertain pre-operati'le ests. f theseresults are satisfactory, he patient signs a consent orm and s given a surgical clearance. fthe procedureis expected o result n significant blood oss, an autologous lood donationmay be made sone wesl(s

' prior to surgery. f the surgery nvolves the digistive systern, he patient mdy be instructed o perform atowel prep by-drinjcinga solution of polyetlyiene glycoi he niglit before treprocedrile. atiints arc also

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lody except or the surgical site and he patient:s:head; he drapei are clipped o a pair ofpoles near hehead of the bed o form an "ether screen", which separates he anesthetist/anesthesioloeist's orking area(unsterile) rom the surgical site (sterile);

Aaesthesia s ad:linistered_to revent pain from incision, issue manipulalion and suturing.Basedon the procedure, nestlesia may be provided ocally or as general anesthesia. pinalanesttresia ay beused when the surgical site.is too

iarge or'deep for a local block, but general anesthesia -uy troi b.desirable. Witl local and spinal anesthesi4 he surgical site is anesthetiied, ut the patient can remainconscious or minimaliy sedated. n conrast, general anesthesia enders he patient unconscious adparallzed dwing surgery. The patient s intubated nd s placed on a mechanical entilator, and anesthesiais produced by a combination finjected and nlaled agents.' An incision s made o access he surgical site. Blood vessels may be clamped o prevent bleedingand .etactors may be used o expose he site or keep he incision open. The applgboh b tle surgical siiemay involve several ayers of incision and dissection, s in abdominal urgery, where he incision musttraverse skin, subcutaneoxs issue, hree ayers of muscle and heu peritoneum. n cenain cases,.bone aybe cut to further acoess h9 interior ofthe body; or example, utting he skull for brain surgery or.cuttingthe stemum or.thoracic chest) surgery o operiup the rib cage.Work to con'ect he problem a body hen proceeds. hisworkmay nvolve:

. excision - cutting out an organ, umor; or other issue.reseetion - partial removal ofan organ or other bodiiy stucturereconnecfion of organs, issues, particularly f severed. Resection of orgaris such as ntestines nvolvesreoonnection. nterral suturing or stapling may be used. Surgical connection etq,een lood vessels rother tubular or holiow stuotures such as oops of intestine s called anastomosis.Iigation - tyingoffblood vessels, ucts, r "tubes".grafts - may be severed ieoes oftissue cut from the same or different)body or flaps of tissue still partlycoraected to the body but resewn or rearraagipg or restructuring of the area of the body in question.AJthough grafting s often used l cosmetic urgery, t is also used n othersurgery.inserfion of prosthetic parts when needed. ins or screws o set ald hold bones may be used. Sections fbole may be rcplaced with prosthetic ods or other parts. Sometime a plate is inserted o replace adamaged area of skuil, Artificial.hip replao€merf as become nore cornmon.Heart pacemakers i valvesmay be inserted. Many other ypes oftrnostheseS reused.creation of a sto .a, a pernanent or semi-perrnanent pening n the body.arth.rodesls s'lrgcal connection f adjacent ones so he bones an grow ogether nto one. Spinal usionis an example f adjacent eltebrae onnected liowingtrem o grow ogetber nto one piece..

i .Idpairofa fistula, hernia, or prolapse.-bthel.procedures,including:

...: . clearing logged ucts, loodor other essels ..,/..,,:.... ,

room, fhe skin surface to be operated on is: bi .and prepared by applying an antiseptic suchle€chlorhexidine gluconate or povidone-iodine to: tlie possibilitl of iafection..If hair is present at thesurgical ite,iis_ciippedffprior o pt"pupr:i"uil;.;Lil;;;#;.;;;;;;";i;ffi;il;;;

. removal of.calculi (stor-res)

. drainine of accumulated luids

. debridement- emoval ofdead., amaged" r diseased issueBlood or blood expanders may be adminislered o compensate or blood ost dwing surgery. Once he

procedure s complete, utues or staples are used o close he incision Once he incision s closed, heanesthetic agents ar€ stopped and/or eversed, and the patient s taken off ventilation ald extubated ifgeneral anesthesia as administered).

After oompletion of surgery, he patient s tansferred to the post anesftesja are unit and closelymonitored. When he patient s udged o have ecovered rom the anesthesi4 e/she s either ransferred oa surgical ward elsewhere n the hospital or discharged ome. During, he post-oper tiveperiod,.thepatient's general unction is assessed he outcorne of the prccedure s assessed nd he surgical site ischecked for signs of infection. Post-opemtive herapy may include adjuVant reatlnent such aschemotherapy, adiation therapy, or administration f medicatior: such as anti-rejection medication ortarsplants. Other follorn up studies or rehabilitation may be prescribed uring and after the recoveryperiod

.+.-*:'. .,\+::,.?:i **+iti',s1r...

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To treat a cavity, he dentist will remove he decayed ofiionof the toothand hen ill thearea n he ooth where he decayed aterial as emoved. illings re also used o repair racked rbroken eeth nd eeth hat have been worn down from misuse such as from nail-biting r toothgrinding).

Steps nvolved n fillinga tooth

First, he dentist will use a localanesthetic o numb he area around he tooth o be filled.Next, a drill, air abrasion nstrument, r laserwill be used o remove he decayed rea. he choice finstrument epends n the individual dentist's omfort level, raining, and investment n theparticular iece fequipment s well as ocation nd extenl fthe decay.

Next, he dentist will probeor test he area o determine f all the decay has been emoveq.once he decay as been emoved, he dentist will prepare he space or the illing by cleaning hecavityof bacteria nd debris. f the decay s near he root, he dentistmay irst put n a liner made fglass onomer, omposite esin, r other material o protect he nerve. Generally, fter he illing sin. he dentis t i l l inish ndoolish t .

Several dditional teps re required or looth-colored illingsand are as follows: after hedentist as emoved he decay nd cleaned he area, he ooth-colored aterial s applied n rayers;next, a special ight hat "cures" r hardens ach ayer s applied; hen he multilayering rocess scompleted, he dentist will shape he composite aterial o the desired esult, tim off any excessmaterial, ndpolish he inal estoration.

Types of filling materials Today, everal ental illingmaterials re available. eeth an befilled with gold; porcelain; ilveramalganr whichconsists f mercury nixedwith silver, in, zrnc,and copper); r tooth-colored, lastic nd materials alled omposite esin illings. There s also amaterial hat contains lass pafticles nd s known as glass onomer. his material s used n wayssirnilar o the use of composite esin illings. The location nd extent of the decay, ost of fillingmaterial nd he dentist's ecommendation ssist n determining he ypeoffilling best or he patient.

Indirect Fillingsare similar o composite r tooth-colored illingsexcept hey are made n adental aboratory nd equire wo visitsbefbre eing laced. ndirect illingsare considered hen notenough ootltstructure emains o support lilling but he ooth s not so severely arnaged hat t

needs crown.During he irst visit,decay r an old filling s removed. n impression s taken o record heshape fthe tooth being epaired nd he eeth round t. The rnpression s sent o a dental ab hatwill make he ndirect illing. A temporary illing is placed o protect he ooth while he estoratlonis being made. During he second isit, he emporary illing s removed, nd he dentist will checkthe it of the ndirect estoration. rovided he it is acceptable, t will be perrnanently emented ntoo ace.

There re wo types f indirect illings: nlays ndonlays.Inlays re similar o fillings but he entireworl< ieswithin he cusps bumps) n he chewing

surface f the ooth.Onlays re more extensive han nlays, overing ne or utore cusps. Onlays are sometimes

called artial rowns.Inlays nd onlays are more durable nd ast much onger han raditional illings,up to 30

years. They can be made of tooth-colored orrposite esin. porcelain r gold. nlays and onraysweaken he ooth tructure, ut do so o a much ower extent han raditional illings.

Another ype of inlay and onlay. direct nlays and onlays, ollow similar processes ndprocedures s he ndirect, ut the difference s that direct nlays nd onlays re rnade n the dentalofficeand can be placed n one visit.The ype of inlay or onlay used epends n how much soundtooth tructure emains nd consideration f anycosmetic oncerns.

Temporary Filling are used nder he ollowing ircumstances:o For illings hat require more han one appointment: or example, efore lacement f gold

fillings nd or certain illingprocedures called ndirect illings) hat use omposite aterialso Followins root canal

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. To al low a tooth's nerve o "settle oCJryd;iltbB.qlll8 ecame rritated

. lfemergency ental reatment s needed such s o address toothache)The safety of amalgam-type tllingsOver he past everal ears, oncerns avebeen aised

about silver-colored illings,otherwise alledamalgam illings.Because hese illings contain hetoxic substance ercury ome people hink hey are esponsible or causing number f diseases,including utism, lzheimer's isease, nd multiple clerosis.

The AmericanDentalAssociation ADA), he FDA, and numerous ublichealth gencies aythere s no proof hat dental illingscause arm o consumers. he causes f aut ism, Alzheimer'sdisease. ndmult iple clerosis emain nknown. ddit ional ly,here s no solid, cient if icvidenceoback up he claim hat fa person as amalgam illings emoved, e or she will be cured fthese orany other iseases.

Althoughamalgams o contain mercury, when hey are mixed with other metals, uch assilver, opper, in, and zinc, hey orrna stable lloy hat dentists ave used br more han 100 yearsto fill andpreserve undreds f millions fdecayed eeth.

Problems with dental illingsTooth Pain and Sensitivitlt ooth sensitivity ollolving placement f a filling is fairly

con.lmon. tooth may be sensitive o pressure, ir, sweet oods, or temperature. sually, hesensitivity esolves n its own withina f'ewweeks. During his ime, one should void hose hingsthatare causing he sensitivity. ain elievers regenerally ot equired.

One should ontact is/her entist f the sensitivity oes rot ubside ithin wo to four weeksor if his/her ooth s extremely ensitive. he dentist ray ecommend desensitizingoothpaste, ayapplya desensitizing gent o the ooth, r possibly uggest rootcanal rocedure.

Pain around he illings can also occur. f one experiences airrwhen he/she ites, he illingmay be interfering ith lris/her ite. He or she will need o feturn o his/her entist nd have het i l l ing eshaped. f one experiences ain vhen ne 's eeth ouch, he pain s l ikelycaLrsed y thetouching f two differentmetal urfaces for example, lresilveramalganr n a newly illed ooth anda gold Jrowl on another ooth with which t touches). his pain should esolve n its own within ashort eriod f time.

Ifthe decaywas very deep r close o the pulpofthe tooth, ne may experience "toothache-type', ain.This toothache" esponse ay ndicate his issue s no onger ealthy. f this s he case,

root canal l'rerapy ay be equired.Sornetimes eople xperience vhat s known as refbrred ain, pain or sensitivity n otherteeth esides he one hat eceived he illing. With his palticular ain. here s Iikelynothingwrongwith one's eeth. he illed ooth s simply passirrg long pain signals" t's eceiving o other eetll.This pain should ecrease n ts own over to 2 weeks.

Filling Altergies Allergic reactions o silver illings are rare. Fewer han 100 cases ave everbeen eported, ccording o the ADA. In these are ircumstances, ercury r one ofthe metals sedin an amalgam estoration s hought o trigger he allergic esponse. Symptoms of amalgamallergy re sirrilar o those xperienced n a typical kin allergy nd nclude kin rashesand tching.pat ients ho suffer amalganr l lergiesypical ly ' ave a medical r family history f al lergiestometals. nce nallergy s confirmed, nother estorative naterial an be used.

Deteriorating Fitlings Constant pressure rom chewing, grinding or cleflching can causedental illings o wear away, chip or crack. Altlrough ne may not be able o tell that a filling iswearing own,his/her entist an dentifyweaknesses n them duringa regular heck-up.

If the seal between he ooth enamel nd he illingbreaks own, ood particles nd decay-causing acteria an work heirway under he illing.One hen uns he isk ofdeveloping dditionaldecay n that ooth. Decay hat s left untreated an progress o infect lie dental ulpand may causean abscessed ooth. f the illing is arge r the ecurfent ecay s extensive, heremay not be enoughtootl'lStructure emaining o suppoft replacernent illing. ln these ases, he dentist may need oreplacehe il l ingwitha crown.

New fillings hat fall out may be the result of irnproper avity preparatioll, ontaminationbefore he illing i placed, r a fracture fthe filling rom bite or chewing rauma. lder estorationswill generally e ost due o decay r fracturing fthe remaining ooth

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DECIDUOUSANDPERMANENTDENTITION

permanent e€th. For example, a person aged 70 bpbnds about 97Yoof thpir life eating with the helpof theft permanent dentition :as compared o only 6%o ith the deciduous dentition.

The role of the deciduous eeth s crucial or the person's overall health, although hey arereplaced over time. They ensure he proper aligament, spacing, and occlusion of the permanentteeth.

The time each type of milk tooth is used varies: the deciduous lcisors are fi:nctional forapproxirnately ive years, while the deciduous molars are used for about 9 years. The prematureloss of the second deciduous molar can be extremely detrimental o the alignment of the permanentteeth.

Formation and eyuption of deciduous dentition. The process f calcification egins duringthe'fouth month of pregnancy nd by the end of the 6R month every single deciduous ooth hasbegun calcification; this faet emphasizes he importance of proper nutrition during pregnancy.lnterestingly; the first permanent molars have also begun calcification at the time of birth.'

Scientists have noticed the existenc6 ofaa eruption pattern which can be described s ollows:teeth have he tendency o erupt n pairs;the fust to enrpt are the lower deciduous teelh, more specifically the lower

deciduous cenlral incisors.- The eruption of the deciduous econdmolars completes he deciduous entitionby

the age of2-2 Y,. -Enrption dates are not fixed, they vary aocording o maay criteria" nciuding race, sex and mother'ssocial stancling.'If he teeth appear unusually early or late, the paediatrician or the

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the "six-year molars" and are among he "extra" permanent eeth because hey don't replace aayexisting primary teeth. They ar.e he most important teeth for the correct development of aauirdentition since hey help determine he shape of the lower face and affect tbe position aad heatth ofother permanent eeth: The mixed dentition exists rom approxiFffiEfy ff.H of age o 12 years ofage- During tbis period all the pfmary teeth oosen and fall out while the permanent eeth comethrough.in theii place. Ua to the age of 13 years 28 out of the 32 permanent eeth will haveappeared. The .rll dentition of adult human teeth. s completed much later. The 4 last aduit teeth('third molarrl'), one at theobac.k f every side of each aw will appear between i-21 years. Due totheir late eruption these Plimaaenl teeth are also called wisdom teet[ Because heir position inthe mouth, third molars ofteii"4re not needed or chewing ancl are diffcult to keep clean. Dentistsmay sometime.s ecommend heir removal to prevent potential complications when hird molars areerupted partially or are impabted

P,"iT"j tleriti.rlonconsists of 32 teeth (sixteen at the top and sixteen at the bottom jriw),classified nto four diffetent teeth types

8 incisois- { ganine5

8 premolars- 12 molars.

The.bones of the face grow during the period of tooth development. The awbone normaliy growsin size o accommodate he extra teeth. The awi grow at a faller rate than the rest of the fu"q *aeventually m̂easure up to 1/3 ofthe size ofthe face"This is a dramatic ncrease rom the proportion

' at birth' If the aws do not grow sufftciently, the phenomenon of crowdine or impacted eetli wiuresult. crowding refers to the bunching together of teeth cutside their normai aii_enment,

--usingthem to be irregular or crooked. This can affect the fror.t or back teetb and can spoil facij

. appearance and the smile, causing embarrassmenl and affecting the .person's ability to feednormally and even o speak properly.There are several causes or crowding, such as:

- early ioss of a deciduous ooth, that is, before the pennanent eplacement ooth isready o take ts place, in which case an open space s left;

-. ^ -an adjacent ooth can drift into the open space, and cause an obstruction n the path

of the erupting permdrelt tooth; the latter one t will then be forced to grow and remain outsidi ofits uormal position;

a mismatch of tooth and jaw size signifying that the teeth are too big for theavailabie pace;

the developmetr-t f srtpemumerary eeth.

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Curs de Lb. Engleza ptr Facultatea de StomatologiePorcelain is considered by many to be without peer as a material for restoring he crowns ofnterior eerh' and also u"r,-116"i"rr

"iu.iae" n"*#*. which contact he gingivaiisue. Highlyrazed orcelain s probably more compatible 'irtt oiur't rro" tiranany other

dentarmaterial and slsoone ofttre most esthetic n appearance., porcerain is a ceramic material made by heating serected nd refured materials, often including cray, to high emperatur"r. Th" ,"* *ut'"riatJror poroerain, hen mixedwith water, orm prastic body hat can be worked o

"t"qritJr'"p"1.i*e firing in a kiia at temperatures etween200"c and 1400"c' hoperrie:-i:r-"_"t*o

ttth-p;*.r;" incrude ow permeab'itv, high srrenerh,ardness, igh durabirity,whiteness, ranslr""*., i=*o"n"", brittreness, igh resistance o theassage felectricity'high resistance o"r't"ri.ui uit*t, high esistanceo thermal hock ndhigh

Conposition and Characteristics f porcelainDental poroelain s made up of several orms of silica, notably kaolin (aluminum ilicate)ad feldspar (potasssius luminum jt1""t9rg"ts i"ai, certain inders nd pigmenls r cororing

:ffi* f#frHtr;-lffi.is combinedith ;Jil"lwateroaputryrikeonsistencyhichsWlen the matrix

_with ft,,.y.n^.o of porcelain s- fired in the furnace at a prescribedemperature, reaction occurs.which nrses t into a very har.d mass. A notable characteristic foroelain s the fact *t r:^:T,*r^1r_1"r11, ^+ti0"1

*"t of irs volume when r is .,tued,, in theumace. Unless his shrinftage s compensated or in the technique, he rcstorationmay be short athe margins nd here mavbe.air paces f voiarli tr.r i*a p..r.i;;.-'--*'*'*' '"-'

This is one reason -t-i:built up to *oro* g.ududry una nieo s"*rat times n the process.ood echnique equires hat he pot""tuin "ruiro -*"t a*iog itsmanipulation, 't after t hasbeenix**4r1" -**

asmuchwarer sposritr. musie iemovedo nsure ard ense orcerainreeTo fi'ther remove

moistrire, he matrix with newly applied porcblain s. alrowed o set nronr ofttre oven or a few minutes before t i;;lu;;; i";" ou"n.Another haracteristic f.porcelain s inat t tia,"'"r".t

or craze f it is subiected o add en emperature hange..For his.."uron t is eu"rl.r"u"a olr*riy ;; dr, ;;" # oooted ooom emperature' nstead he oven s.coored own o approximatery 000 egrees at which pointhe croi'rn s removed-u :::.t:,1y09, "

p',;* ;;ril. Tliis markedly slows he rate of cooling andinimizes thepossibility of crazing.Tlpes of Dental Porcelain

Porcelain s classified-as ow, medium, or high fi:siq-gased on the temperature equired ofirse it' Iow fising (i600-2000 aegrees ) ir-"r"i'J"r"iv.r", builcting p coniacts ndmodifingthe contours of porcelain pontics which rruu" p."oio*iu. been compretery used. Medium usingorcelainwhich irses etweer 000 and 2a00 and

igi,n ring porcerain bove 400degreesre both used or the fabricationof crowns, ntays anJ rioges.-s"J;;r;. ffii,opou*."equired o fuseporcelain special venwith"xremeryaccurate emperatue onfols s required.Porcelain_Glaze 'v''Hvr 4rw v

when porcelain s brought up to its firsing emDeraturet acquires grazed anslucentsurface' his highlyglazed urface i often ost wh?na forcelain oothor facing mustbe ground.{hen thp. lannens he original highly glazed surface an'be estored ith a specially manufacturedgraze, hich s made or this. pcificpurpose. he cr"""l;;;;ffi';';,;iffiili#i'iurated toeriminate he brush marks, and fired at ti.re emperaturJie"ommena"a by the manufacturer.Porcelain Stains.

special stains are marketed which can be used o produce ifelike stains n porcelain rom.They are ava'abre in a wide range of corors, rrotn opuq,ri-to black. The powdersare blended wi*r

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liquids provided by the manufacfurer o produce he _desired ffdct. This ispainted on the crown

;fr;;;iht i or fural bake, and ired in the fumace at the recommended emperaftre.

FINE STRUCTI]RES OF TTTF'- ENTAL PIILP

Curs de Lb' Engteza tr Facaltatea e Stomatologie

Thedentalpulpisthesoftt issueofthetooth,whichdevelops$otm","o.nn""l]etissueofth" dp;;6illi. riritrt6 the crown, the ohamber ontaining hi dental pulp

is cailed the pulp

chaniber. The pulp oonturnJtooa vessels and l9ryes t1* enier through heapical foramen. The

"*""JpJp t, *iihin *re crown' Within the root is ttre radicular pulp'

Each person r* u tot r oi sz p"rp "rg*r,gz.q t: permanent nd

20_n the primary teetl.

The total volumes of a[ trre ,erm*rrirt ti"trt-*g*q is 0..3 ccancl he mean volumeof a single adult

human pulp is 0.02cc. Vfifiu.y- o"nt a inci# has. hovel shaped oronalpulp with t}ree shof

ffi#;'" ""r*"ii."r*J-r'itg"ilir cross ection.uspictas the ongest ulpwittrelliptical

"rorrt"tti*. Crowns of the eeth contain coronal pulp'*-"

d;;;;Ap"rp r.* ,i* rutru""r, the occiusa, the mesial, he buccal, he lingual and he

floor. Because f continuous eposition of dentin, he puip becomos mallerwith age. This is notuniform throughout te ""tonJ

pluip ut p*gt.tt"t fuster on the floor than on he roof or side walls'

Radioular pulp is that pulp ""i"i.Aiigt'om it" oervical egion of the crown o the root apel They

*" nJ"f#"vt

tttaight bui vary in shape size and number'. The radicof* portion J *"tin"ous with the periapioal issues hrough

he apical oramen or

t"ru-ioa. api""f foramen rA; ;""itg of the radicular pulp nto theperiapical.conneotive issue'

il;;;;;';t; is O.g q O.a-urm' n diameter. There can be two or moreforamina separated v a

portion of dentin *a""rn"oi* ".

ty ;;""1"- olly. Most infections spread kough the apical

i"1#* t"* a. p"riupi"ui iirr* to *re pulp or fiom. the pulp to periapicalissue' Accessory

oanals are pathways ont tfrJ radicular iuli , -extending aterally throughthe dentin to the

periodontalissue een speciallyn the apical hird ofthe root'. Interrelationship of ,r"*"t *a blood vessels can be studied n the dental pulp with littleinterfersnoe rom other tittu" "r"*""tt.

Pulp tissue contains numerous nerves and vessels of

varying size suspended o I r,trou, and sparsely cellulargelatinous matrix .Graf made a

ouantitative study of the typ., oi n"*o in ttri iruman dental pulp andreponed hat a pulp cross

ffii;;;;ilil'uppro"i-"t rv one thousand eparate erve oers, varvingbetween 1 and 10 in

diameter. The maximum J"'oiu.t"riot"s in dintal luln hg beenmiasured by Provenza' who

. reportocl diameters -n"*-.0-

* loo. rn" uaneniitii of tbe arterioies, metaarterioles, nd

;H;pid;'*"i" otrii#"i'Uv a#" mat"r oi n"*"fibersandby the adjacent nterstitial

tissue.smooth nerval nnervation by autonomic ibers s generally described

f light microscoPists

as a plexus of unmyelinateJ nerves frat terminate on th"esurface orwithin the sarcoplasm f the

muscie fibers, Corrn""tioi U"t*een the nervous and muscular elements n mammalianurinary

bladderandintheu,**","examinedwiththeelectrgnmicroscopebyGeaser 'Theseneuromusoular tru"to.", "onrirt"o

of simple coatacts etween he cytolemmi of the smooth musole

and he lemnoblast of autonomic ibers. S'moothmuscle issire n tGsepreparations as seen o be

"afJ* ""a,"evidence as obtained n support fa syncytial rangement'

Eleotrophysiologi" o pr-tu""u*togio .data ndicate the vasomotorule of the autonomlc

fibres, but they do not ftH;;;;;rri.i;er" g1;* for thevasodilator and vasoconstrictor

rneohanisms. utu t uu" u"rn collected'in trrit ruuoiuto.y whichindicates the presence of

;;;;;; ";";onstiictorfibers n the maridibular erve'

The present nvertilati", * r", the electron microscope or thestudy of sfiuctures n the

dentat putp and p.rri*l*ly;;;;;;1A" gr""J " .r"1nerve complex.Th9 ine structwe of rerve

tvnes was examih"d n un'ltt"*pt to define he stuctures which mediate asomotorone'

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'*"KJo{, #::{"W{tr;The development foccrusion egins ith the eruption f theprimary eeth. sua y the irsteetl ro erupt are the centar incisorsl with trt" n,unliilur*

teeth erupting slightly before hemaxillary. The eruption of the ateral ncisors,which occurs ext, ollow, A".;;;;;;i;.At 16 months he orimary molars erupt. The primarv-moiars stabllsh lr, ""ji."Jirigfrt "fhe primaryocclusion' Tire a.vltopmnrt oiti"

"."-r,ir"ilJ r".aer influenced y hereditary acrorssuch as- o-ngenita'y missing -e-eth,mpacted ""*r, oitrr" size and shape of muscre nd bone.contollable faotors bat also affect occiusar "ueropm*i;clude the premature oss of deciduousteeth, decayed eetl t}latwhere estored andharmfuihabits.Hor zoniul al gtnt ent.After the eeth erupt ntg th:ora] cavity, he ongue acts. s a huge nternal orce, pushing heteeth. oward he lip and cheeks. he balancl'or erati've quilibri"."b#;;;h;'i*i,"'_a ,r,.faciat muscles llows rrre eeth o be bloy-eht nto pt;;r ;iis"-;;;;; ;i.i"ii"i *,rr"i,proper positions once iey.have erupted. f the barance' f foroes s disturbed,

-Jo."rurio,o. *

'abnomial alignment_ f the teeth w-ithin re dentar ur"rr., "un result. The rip, tongue, and cheekmuscles and heir.relationship o one anotler are not tre onry actors a,ut d#;i; G ligo-"o,of the teeth' The intercuspatiol of the.leth l.rpr p.*r"il"d, deviations. n a uuccal oi rngual**to1 The maxilrary iosterior teeth ruu" u uu",ii unJ a lingual cusp, and when he aws areclosed the buccal cusps of the mandibular osterior eeth are nterlocked etween he buccal andlingual cusps f the maxillary eeth.

Verticalalignmerx. ., .Tlt" teeth are not positioned qaight up and dowir n the mouth. The mandibular osteriorteeth have.a endency o tip their crownJstrai'ghter ut with a slightbuc"ar n"rinjtion, a i,"lt * ulingual inclinationof ttre oot. From a lateral iew, all the eeth, .*il"ry *J **aiilffi,'tt".io,.and posterior, how a slight mesial nclination, *ita trt" porrtr" exception f the.maxillary hirdmolar.

The anterior eetr have a-slight abialprotrusion,-u fro* a fro;tal vie; th;i, ".o-il, ,"".to incline aterally' n otrrerwords, he anterioi eeth ip out o the side and owara he$ont.1. The aetiology f malocclusion iThere s still much o elucidate ndunderstand bout.At a basic evel malocclusion aa occuras a result of generically dererurined actors which are nherited, "r;i.;;;;;i;"rlr.ll,IDo."commonlya combination f both nherited ndenvironmental "to.r uctittg og"u,r. r"i-L."pr",failure of^eruption f.an upper cenfal incisor may arise as a result of dilaceiations ollowing anepisode f trauma uring he deciduous entitionhi"h I.d to "t.uri;;-oidr;-pi;.,y;;;;;.rr"r-

and an example f environmental etiologJl. ailureof eruptionofan upper central ncisorcan alsooccur as a resurt of the presencg fa supemumemry ooth-a scenariowhich upon questioning ayreveal also affected he patient s plrenL ryggesting n inherited problem.Hoi"uer, ir in it"

tutt",example aries an environmental actor) has ed to earlyoss of many ofthe aeciauous eetir, enforwarddriftof the ust permanent oiareethmayar" r"a " ,"pJrr,np"rnr",

"i,i,ljirro"aroblem f crowding.-

-wliile it is relatively straightforward o tace the inheritance f syndromes uchas cleft lipand pa]atq t is more difficult to determinate he aetiology f featwes rri"t *" trr""rr"o""

p.rt ofnorrnal_variation-of the picturq. it is firttrer cornplica:ted y the compensatory echaaisia hatexists' Evidence or the role of inherited actor r the aetiologyof malocclusion as come romstudies of families and twins. The faciar similarityof members f a family, for exampl" heprognathic mandible of the Habsbr.'rg oyal Family can easily appreciated. lr*r"*-r*r,i or*ttestimony s provided n snrdies of twins and aipleis which ndic;ie that skelJal pattern;; il hsize and number re argely enetically eterminid.

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- Examples of environmental nfluences nclude- igit-suciing habits and premature oss ofteetl can also nfluence.tooth ositiol. Crowdi4g s extremely omdon n tle caucasians, ffectingapproximately third of the population. As was mentioned bove he ri"r"itfr";u*,

and eeth aremainly genetically determined; owever, environmental actors, or"*urpL

pr*u*." deciduoustooth loss oan precipitate or exacerbate rowding. n evotutionary erms "*r':"*, ,ir" and oothsize appear o be reducing. Howbver, crowding i much more prevai";th;;d;;;ri#;;;i was

inprehistorical

ime. It has been postuiated hat this is due to the introdriction of a lessabrasive die so that less nterproximal ooth wear occurs during the lifetime of an individual.However this is not the whole story, as a change om a ,orJ-to ; oJ;; rrr"rryr"'.#"rri,pparently ead o an ncrease n crowding after seieral generations.

Although his discussion may at first seem athelr heoretical, le aetiology of malocclusionis a vigorously debated ubject.This is because f one believes hat the basis f malocclusion sgenetically determined, hen t follows that orthodontics s limiteal n what t can"rti;;;.

HJ;;;the. ognoqite. iew point is that every individual has the potential ro. ;a"J'-oi.iurion and thatorthodontic ntervention_is required o eliminate hose environmental actors hat have ed to a,particular malocctusion' |esgarch suggests hat for the _majority f malocclurio;; dt" aetiology smultifactorial, and orthodontic eatrnent can affect ooly limited *aetur cn* ". iherefore, as apatient's skeletal and growth pattern s largely genetioallyetermined, f ".til;ti";atnenr is tobe successful linicians must eoognize nd work within those pararneters r r*.rjty, the aboveis.a brief rIrTW.,. u1 it 9,aq e appreciated hat the aetiotbsr "f

;;";;h;il;-is a comptexsubjec{ much ofwhich is still not fitllyunderstood. he read". s"iking *or" inior.ution is advisedto consult he publications isted n the section of further eadine.2. Classifiing malocilusion

- The categorization of maloctlusion by its salient features s helpful for describing anddoc-umenting patient's occtusion. n addition, classifications nd ndices auow he prevalence famalocclusion within a population o be.recorded nd also aid in the assessment"f

ir"a,'Oim""fryand success f orthodontic reatlent

- . - Malocclusion an be recorded ualitativelyand quantitatively. However he arge number of' classifications nd ndices which have been devised re-testimony o the problems #erent in bothtlese approaches. ll have their lirnitations, and these should e boma n mind when they areapplied.

Two terms are often mentioned n relation o indices:. Validity - can he ndex measure hat t was designed o measure?

, o Reprotlucibility - Does the index give the same esult when recorded on twodifferent occasions, ndby differentexaminers?

a)QUALITATM ASSESSMENT FMALOCCLUSION_. Essentially, a qualitative lsseTm:nt is descriptive and therefore his category ncludes hediagnostic classifications f malocclusion. The main drawback o a qualitative-approach s that

malooclusion s a continuous ariable so hat clear cut-offpoints between ifferentcategories o notalways exist' This can lead,to problems when classi$ing borderline malocclusions. n additiorlalthough a qualitative classification s a helpfirl shorthandmethod of describing he salient eaturesofa malocclusion, t does not provide any ndication ofthe diffioultyoftreanneit.

Qualitative evaluation of malocclusion was attempted Listorically before quantitativeanalySis. One of the better known classifications was deviseal by Angle in 1899, but otherclassifications renow widely used. or example he British Standards nstiirte (1893)classificationof incisor elationship.b)QUANTTTATTVE SSESSMENTOF MALOCCLUSION

ln quantitative ndices wo differing approaches anbe used:-each eature f malocclusion s given a score nd he sum otal s then ecorded e.g. The

PAR Index).-the worst featue of malooclusion s recorded e.g. The Index of Orthodontic Treatrnent

Need).

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Tooth Extraction

When t comes o dental procedures, ooth extraction or having eeth pulled" is amongpatients' ost dreaded rospects. lso referred o as exodontia, ooth extmction nvolves emoving toothfrom its socket n the a* bone. Belore he dentist onsiders xtraction, very ffort will be made o try torepair nd estore he ooth. However, ometimes tooth extraction s necessary. here are several easonsfor extracting tooth. hese nclude:

. Severe Tooth Damage/Trauma: ome eeth have such extensive ecay and damage broken rffacked) hat repair s not possible. or example, eeth affected y advanced um (periodontal)disease nayneed o be pulled.As gurr disease orsens, he ooth supported y less urou ndingbone often oosens o such n extent hat ooth extractions the only solution.

. Malpositioned/Nonfunctioning eeth: To avoid possible omplications hat may result n aneventual, egative rrpact on oral health, he dentist may recommend emoving eeth hal arernalaligned nd/or ssentially seless teeth hat have o opposing eeth o biteagainst).

. Orthodontic Treatment: Onhodontic reatment, uch as braces, may require ooth extraction omake needed pace or improved eeth alignment.

. Extra Teeth: Also referred o as supemumerary eeth, extra teeth may block other teeth fromerupting.

. Radiation: Head and neck radiation herapy nay require he extraction f teeth n the field of

radiationn order o help avoidpossible omplicatiorrs.uch s nfection.. Chemotherapy: hemotherapy eakens he mmune ystem, ncreasing he isk oftooth nfections.

heighteninghe isk of extraction.. Organ Transplant: lmmunosuppressive edications rescribed fter organ ransplantation an

inuease he likelihood f tooth nfection. s such, ome eeth equire emoval rior o an organtransDlant.Commonly Extracted TeethWisdom eeth emoval s one of the more comnon categories f tooth extractiolr. any dental

professionals ill recomnrend emovingwisdom eeth third rnolars) efore hey are firlly developedusually n the adolescent ears lo help eliminate otential roblems. ne problem hat could occur sdeveloprnent f an nrpacted ooth hat has urfaced nd ras no room n the mouth o grow. Other problemsassociated ith mpacted eeth nclude nfection, ecay fadjacent eeth, ite nterference ndgum disease.

Extmctions f somepermanent eeth hat have not erupted

such as he canines, hich are alsoknown as angs or eye eeth may be required n order o make space or orthodontic reatment.Types of Tooth Extractions

There are wo types oftooth extractions:. Simple Extractions: hese re perfornred n teeth hat are visible n the mouth. Ceneral entists

commonly o simple xtractions. ndmost re usually one under local anesthetic, ith or withoutanti-anxiety edications r sedatron.

. Surgical Extractions: hese nvolve eeth hat cannot asily e seen r reached n the mouth, itherbecause hey have broken ffat the gunr ineor hey have ot ully erupted. erformed y dentists roral surgeons, urgical xtractions equire ome ype of surgical rocedure, uchas bone emoval,removing nd/or iftingand oldingbackall or partofthe gum issue o expose he ooth, r breakingthe ooth nto pieces called oothsectioning). urgical xtractions an be done with localanesthesiaand/or onscions edation. atients ith special nedical onditions nd young childrenmay eceivegeneral nesthesia.

Prepa ing for Tooth ExtractionPrior o a tooth extraction, he dentist r oral surgeon ill discuss he patient'smedical nd dental

histories nd ake X-rays. Some dental rofessionals ill prescribe ntibioticso be aken before nd aftersurgery. ntibiotics re more ikely o be given o patients ith infection r weakened mmune ystems tthe ime ofsurgery, hose ndergoing onger urgeries, r young r elderly eople.

To avoid possible omplications, ne should nfonn his de ntist about all the medication sprescriptions, ver-the-counterOTC) and herbal he is taking. For example, spirin lows he blood-clotting rocess; ingkobiloba nd ginseng lsoalfect lotting.

Many people ike to be sedated or a tooth extraction. ossible edation entistry ptions ncludenitrous xide "laughing as"). an oral sedative such as a Val iLrm ill) or an ntravenous edative hat sadminisrerednto he veins v niec t ior r.

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What to Expect During a Tooth ExtractionAt the extraction ppointment, hld€itilt W ffiffiir anestherize,he oorh o be extracred, s wetl

as the awbone and gums surrounding t. Typically, local anesthetic uch as novocaine r lidocaine sinjected o elirninate iscomfort.

Simple Extraction: The dentistwill grasp he ooth with specialized liers alled xtraction orcepsand move hem back and forth to loosen he tooth before emoving t. Sometines, surgical uttinginstrument alled luxator which its between he ooth and he gum is used o help oosin he ooth.Dentists lsouse elevators," hich are evers hat ook sirnilar 0small crewdrivers. sually dentistwillfirst use an elevator o wedge between he ooth and he surrounding one. he elevator la;es pressure nthe ooth, whichhelps o expand he ooth's ocket nd separate ts igament.

Surgical Extractions: hese rocedures enerally re more complicated, o he dentistmay sedatethe patient efore umbing is ooth, hen use a dental rill, apply pressure o his ooth with an elevator rextraction orceps, nd remove he tooth. Creater urgical effort rnay be needed n other cases. or insrance,gum and/or one issue may cover or surround tooth Il a way hat makes t difficult or the dentist o vrewand/or ccess t lfso, the dentistwill need o cut and ift backor rernove his issue. olnetimes toottr s sofirmlyanchored n its socket hat he dentistmust cut he ooth nto pieces n order o remove achoortronindividually.

The dentistmay need o place titches nd/or dd bone natural r synthetic) n the extraction it eaftel he procedure. ome titches reabsorbable nd will disintegrate n their own; others equire emovalby he dentist, sually bout week after he extraction.

Modern Tooth ExtractiorlWhilesurgical utting nstruments ike scalpels rrd ental rillsare still commonly sed n surgical

extractions,he use ofdental asers ndelectrosurgeryn such procedures s growing.Lasers se high-energy ight beams o cut, whileelectrosurgery ses ontrolled eat o cr"rt. enefits

of laser urgery nd electrosurgery s an aid in tooth extraction ompared o tmditional calDels nd dentaldrills nclude reater recision, ess hance f damage o adjacent tructures,ess bleeding nd discomfort,and quicker ealing ime. However, he disadvantages ftheir use nclude igher osts, he smell ofburningflesh uring he procedure, nd he nability o r"rselrern o directly xtract eeth.

Tooth Extraction AftercarcSince leeding s normal fteran extlaction, he dentistwill have he patient iteon a piece fgauze

for about 5 minutes o ptltpressure n the area nd allow he blood o clot. Some welline nd disconrfortare norrnal ftera toothextraction.

Cold compresses r ice packs an help decrease he swelling. f the aw is sore and stifl after neswellingdissipates, ne should apply warrn compresses. leepingwith the head ace upward o relievepressure n the aw, and keeping he head levated ith extrapillowsalso nay help. n addition, he dentistmay recommend aking an OTC pain eliever uch as buprofen Motrin or Advil) for several ays. Withsurgical extractions which generally ause more pain afterwards the dentist may presgibe aprescriptionain nedcat on.

Other ftercare ios nclude:. Do not inse our mouth or he irst 24 hours ,rrr.rediatelyollowing ooth extraction.. Sticli o a soft or liquiddiet milk, ce cream, nashed otatoes. udding) he clay fand he day after

a tooth extraction, radually rogressirrgo eating ther easy-to-chew oods. Chew with teeth ha tare ar rom he extraction ite.

. Brush nd loss he other eetlt s usual, ut avoid he eeth ndgum next o the extraction ocket.' After he irst 24 hours, or at least ive days afterextractior, ently inse he socket with wann salt

water 1/2 easpoon fsalt n a cup ofwater) afterneals nd before ed.Things o Avoid After Tooth Extraction

ln addition o the aforetrentioned ftercare onsiderations.ooth extraction ftercare lso nvolvesavoiding ertain oods nd activities.

r Avoidanything hat night islodge he blood lotand delay r prevent onnal healing.. Do not smoke, igorously inse r spit,engage n strenuous ctivities, r drink hrough straw or at

least wo days afteran extraction.. Stay away rorn hot liquids, bods hat are crunchy r contain eeds r small grains, lcohol, nd

carbonated oftdrinks or two o three ays fter ooth extractions.' Do not brush our gums r use an OTC mouth inse you can Lrseromemade ater-and-salt asnes,,

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Possible ooth Extraction ComplicationsThere are several otential omplications hat nay occur as a result of a tooth extraction. hese

complications ay nclude:. Accidental amage o adjacent eeth.. Incomplete xtraction,n which a ooth oot emains n the aw. The dentist sually emoves he oo t

to prevent nfection, ut sometimes t's ess isky o leave n a small oot ip.. Alignrnent roblems ssociated ith chewing bility or jaw joint function.Misaligned eeth may

causeain,

eethrinding bruxisrr) nd cracking r splintering fteeth withstandinghe orce fthe

jaw. Additionally, nisalignedeeth an rap ood and be harder o clean, hereby ncreasing he iskfor oolh decay nd gum disease.

. Fractured aw (most often occurring n older people with osteoporosis f the aw) caused y thepressure ut on hejaw dLlring xtraction.

. lf an upper ooth was extracted, hole may have een made nto one ofthe sinus reas. orrnally, twilt healquicklyon ts ownl bul f it doesn't, ne may need o return o his dentist.

. Infection, hile rare, oes ccasionally ccur. he dentistmay prescribe ntibiotics efore nd afterthe extraction f deterrnined ou may be at risk of infection.

. Nerve njury while primarily n ssue with extractions f lowerwisdorn eeth can occur withthe emoval fany tooth f the nerve s near he extraction ite.Typically aused y damage rom asurgical rill,nerve njuries re are and usually emporary.

. Bisphosphonates drugs used o prevent/treat steoporosis, ultiplemyelorna, one cancer nd

bone metastasis rom other cancers may put patients who undergo ooth extractions t risk fordeveloping steonecrosis fthejaw (a rottingofthejaw bones). t is thought hat bisphosphonatesattack he teeth and bone, and may prevent ells hat break down bone rom working. f you ar etaking n osteoporosis edication uchas Fosamax, ry o avoidextraction henever ossible, atherthan pt or removal fthe tooth/teeth.

. Without n opposing ooth. lre ooth above r below he extraction ocketwill. over im e. move utoijts socket, ikely exposing ts roots and becorning ensitive o temperature hanges. articularlywllen several eeth have been extracted, nother ossible ong-term roblem s thinning of th eiawbone. hich hen becomes asier o break.

. Tooth extractions particLrlaflyf front eeth lnay negatively ffect ne's appearance.Uriiess t is a wisdor11 ooth, he dentist il(elywill advise eplacing ny extracted ooth o avoid

possible ofirplications,uch as shifting f the eetlr, um recession nd bone oss. Dental mplants re heideal ooth

.repacetnent; ental ridges nd dentures reother ptions

DfJ SocketDEy ocket, common omplication ftera tooth extraction, ccurswhen a blood clot has ailed o

form n the.socket, r the blood clot hat did form has been islodged. his eaves he underlying one ndnerves xposed o air and food. Often quite painful, dry socket ypically appears wo to five days afterextraction nd can cause bad odor or taste.

Dry socket s most requently ssociated ith difficultor traumatic ooth extractions, uchas heextraction f lower wisdoflr eeth. t occurs rore ften with people ver he age of i0, smokers, hosewithpoor oral hygiene abits and women particLrlarlyhose aking oml contraceptives). nless here s anentergency. xperts ecommend lratwomen using oral contraceptives chedule heir exhactions uring heIastweek oftheir menstrual ycle.when estrogen evels re ower.

In most cases, f you develop ry socket, our dentist ill place medicated ressing nto he socketto soothe he pain and encourage ealing. he dressing s replaced very 4 hours ntil he symptoms fdry

socket essen about ive o seven ays).Healing Time for Tooth ExtractionsHealing rom a tooth extractiou al(es bout ive o seven ays. he gum area hould e ully healed

in three o fburweeks. f the aw is darnaged uring oothextraction, ull healingmay ake up o six months.

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EMERGENCIES N THE DENTAL SURGERY

P ev ent o n of ente genc e sMedical mergencies re best prevented. ll members f the dental eam should e rained

to be watchful or signs fpatient ollapse forexample, weating nd skinpallor) n all areas fthepractice, ncluding non-clinical reas. Additionally, mergencies ay be prevented y carefulurr.5.ent ofthe patient rior o and during reatment. ll members fthe team should nowho w

to clear and maintain he airway and be competent n carrying ut cardiopulmonary esuscitation(CPR).Records f initial raining nd update ourses annual r rnore requent efresher ourses reappropriate) hould be kept. Additionally, entists hould be able to perform venipuncture.Mediially compromised atients houldbe identified y ascertaining heir medical istory.Newpatients hould omplete comprehensive ritten medical history and this should be verifiedverbally, with the medical history updated t each subsequent ourse of treatment. ll dentalpractices hould ave lear protocols or the reatment f rnedical mergencies hich may arise, oruse n staff raining.

Common auses f collapse n the dental urgery:FaintingFaintingmay be caused y anxiety/fear, ain, atigLre. asting and high temperature nd

hurnidi ty. he pat ient i l l feelweakor nauseated, kinpal lorwil l beevident nd he skinwil lbe

cold and nroist.The pulse will be slow initially, hen f'ast and full, and the patient may loseconsciousness. reatment s by lowering he head and loosening ight clothing. Recovery snormally apid; f not, other auses fcollapse hould e considered. glucose rinkor tabletma ybe given fthe patient as not eaten, nd oxygen dministeredo medically ompromised atients.

AnginaAngina s caused by a reduction n oxygen o the heaft hrough narrowing of the coronary

arteries, r high blood pressure hich e ads o increased xygen emand ndmay ncrease he sizeofthe heart . he pat ient i l l experience severe 'crushing 'pain hichmay adiate own he eftarm: t will be brought on by exertion, nxielyor during digestion f a large meal and will berelieved by rest. Treatment s by stopping ctivityor treatment, dministering lyceryltrinitritetablets r spray sublingually, nd providing xygen. f the symptoms o not subside n 10-15

minutes, he patient iagnosis lrould e evised o coronaryhrombosis.

Co o nary thro mbos s/myocardial infarctA rnyocirdial nfarct occurs when a branch f the coronary rtery s blocked by a clot

causing eath f the muscles upplied y that artery. he patientwill experience ain n the chest,radiating own he eft arrr.r, ith the pain of much onger uration han angina. here will besignsofshock, uch s coldclamrny kinand ow blood ressule. hese ymptotrs may occur n a patientwith no previous ardiac history. Management s first by calling or help from the emergencyservices witlra view to obtaining dmission o hospital), lacing he patient n a comfortableposition, dministering xygenat 2-4 litres per minute. n cases f cardiac rrest, CPR should e

commenced.EpilepsyTjris s a convulsive isorder, ith he anack eing haracterised y an aura, tonicphase n

which he patient oses onsciousness, ay stop breathing nd become igid.This s followed y aclonicphase n which convulsions ccur.The patientmay raurnatise heir ongue n either phase.Management s by stopping reatment, ttemptingo prevent he patient rom harming im/herself,and placing he patient n the recovery position after the cloni c phase. Fits generally topspontaneouily. fter the fit, the patient may feel drowsy and should be accompanied ome.Prevention s by ensuring hat patients ake heirmedication s usual rior o treatment.

Co lapse of patient taking steroidsSteroids ie-prescribedor a wide range f rnedical orrditions nd adrenal unctionmay be

depressed n patients aking steroids or one month or more Symptorrs ncludeweakness, auseaand pallor,weak and apid pulse nd oss of consciousness. anagement s by placing he patient

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at, administering xygen. summoning ssistance nd giving 100 mg Hydrocortisone odiumuccinate V and ob6ifiiig iiiE"ehtlrrihspolttb'trtspiml:?fCvd-ift16?fiffpically by pre-operativelyoubling he dosage f medication or patients aking ess han 7.5 mg prednisolone er day whoequire urgery r extended reatment. t is advisable o liaisewith the prescribing hysician.

AnaphylaxisThis is a severe llergic eaction haracterised y a sudden nd catastrophic elease f

istamine. n the dental urgery,most colnmon auses re penicillinor latex allergy. Symptomsnclude acial oedema, ronchospasm nd difficulty n breathing/wheezing,evere hock, nauseand vomiting and progressive oss of consciousness. anagement s by laying he patient lat,ummoning rgent ss is tance, iving0.5-l rnl l :1000 adrerral ineM (srnal ler oses or youngeratients), epeating his dose every 5 minutes, ydrocortisone 00-200mg lM slowly, 0-20 mgh orpheniramne maleate Piriton) 0 mg/l ml slowly IV, adrninistering xygen and obtainingrgent ransport o hospital.

AsthmaAn acute asthmatic ttack may be triggered y the stress f a visit to a .dental urgery,

nfection r allergens. ymptoms nclude breathlessness, xpiratorywheezing nd a rapid pulse.reatment s by reassurance nd he administration f the anti-asthma rugs

normally aken by theatient, uchas a salbutamol ebulizer, hich he patient hould e asked o bring when attendinghe dental urgery. fthe attack s severe, ssistance hould e requested nd200 mg.hydrocortisoneV administered.

HypoglycaemiaThe nsu in-dependent iabeticmay develop ypoglycaernia y rnissing meal while aking

heir normal ose of insulin.Emotional tressmay also cornpound he problern. ymptoms ncluderowsiness, xcitabilityand aggression, weating nd trenrblingand a full and rapid pulse.

Management s by laying he patient lat, givingsugar rally f the patient s conscious ndl mglucagon n I ml sterile water M if the patient s unconscious. he unconscious atient hould eansferredo hosoital.

HypervenlilationHyperventilation ay occur n cases f anxious r hysterical verbreathirrg. ymptoms

nclude ightheadedness, gitation nd paraesthesia. anagernent s by reassurance, nd breathingnto a bag. f the hyperventilation s severe nd the patient does not respond o the measuresutlined bove, hen t may be necessary o give 0 mg diazeparn V.

Ce e bral vasc ular accide nt (Stroke)This may occur with a cerebral hrombosis, aemorrhage r embolus. ymptoms nclude

oss f consc ousness, eadache, eep nd noisybreathing,ncontinence ndparalysis fone side fhe body. Management n the dental urgery s by maintenance f the airway, administration fxygen nd ransf-er o hospital t he earliest ppoftunity.

Inhaled or swallowed bjectForeign bodies, uch as teeth, crowns or root canal nstruments, nay be swallowed r

nhaled.A patient n'rayexhale he fbreign body without stimulating he cough eflex. If it isuspected hat a foreign body has been wallowed r inhaled, he patient hould e transferred oospital br a chest r abdominal -ray. Furthermanagenent epends ponwhether he object s inhe ungs r gut, and whether t is sharp r blunt.The Heimlich Manoeuvre ay be performed f theatient s choking nd unable o cough ut he breign ody.

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ADAJonnal

Dental rnplants are artificial titaoium ixtures, similar o those used a ortbopedics.niiich areplaced surgically nto thejav' bo'e to subs-rituteor a missing ooth and ts root.

lmplants are very durable aad wiii lasr mary years. They can help restore alrnostanlone'ssrrrileeven f aatffal 'reeth ave been ost o injury or disease,

'' A vely common eason why implants are becomi',g mote anci more nidely used s becauseslidiag lower denture makes ohewing nd aiking difrcult. laplants can eplace ndividuai eeth aadpaltial bridges :r both tlte upper and ower aws. Their succiss ate s remarkable: 8 per cent or16s'e1 mllants and 91 per cent or upper mplants.

The oss ofone or seve.ral eeth generally iggers variouschanges ver ime. The irst may bet&at the person does not smile, as m-uch r as widely as they used o. Tben hey may realize hatchewing apples, crackers or, other ood is a thing of the past. Lastly, and ot*^ily nttioed by thedeltal professional rather than flre patien teeth begin to shift. When the whole tooth is lostshrinkage of the awbone may occur making h face ook oldei. Sometimes his is alsb associatedwith muscle bai::. he nabiiity o speak learly, ndheadaches.

Effects of tooth ]ossThe effect of tooth Ioss varies rom person o person and depends n v,hat exactly has been

'. los't. Losing tre crowl for instanoe, mans osing he visible, outer part.of he ooth whereas osingthe root means osing tbe unseeq nner part of the ooth.

The root anchors he tooth n the awbong pror"iding table upport or tbe crown: Without herool tlie bone arould the lost tooth may gradualiy ecedi, remainhg eeth shift and chewlngmaybecome more difficult with time.

There s a variety of ways o replace ooth crowns. But for teplaci:rg he entire ooth - crormand root - the most obvious option s the dental mplant.

Short historytQuite interestingly, dental implants are not as new as we might thjnk; they have been

. performed or thousands f years. Egyptian mummies.have een ound with gold wire impiants n' the jawbone. Pre-Coiumbian keletal emains xhibit dental mpiantsmade of semi-precious tones.

Recenfly, a Roman soldier with an iroa. dental mplant n hiS iawbone was unearthod a- E$ibpe:'':Iii-tlieMiddle 'Eirsq-rrnplants nade of ivory have been discov-eredin skeletons iom tleMiddleAges.

.Modern mplantology dates back at the beginning of the 20th century. However, t becaniepopular ia the 1980s with the incieased ucoess fthe titanium cylinder. Since ltenmaay ypes of

. implants, with minor variations, have been l use.

Advantages of dental implants

Dentai implanls are said to have many adl,antages ver other types of restorative work.Fintly; they can be applied o anyone, nespective f age as ong as here s enough one available. n which to place he impiaats. Of course, lre better he qualityof the bo.ne lie $eater be chanoe flong-term uccess.

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Motch the terms with the definitions

l,abrasion

2.abscess

3.abutment

4.alveolar one

5.analgesia

6.anesthesia

T.attrition

S.biopsy9.bleaching

I0.braces

j. devices used by orthodontists oaiignment

gradually reposition teeth to a more favorabie

' a' loss of tooth skucture caused y a hard toothbrush, oor brushing echnique, rbruxism (grinding or clenchinghe 6eth)

e. a state ofpain relief; an agent essening ain

i. chemical or laser reatment of natural eeth or whitening effect

b. an nfection of a tooth, soft issue or bone

c. tooth or teeth hat support fixed or removabie ridge

h. removal of a small piece of tissue or microscopic xamination

d. thejaw bone hat anchors he oots ofteeth

g. loss of skuctwe due o nafuralwear

I nrttiut or complete elirnination f pain sensation; umbing a tooth s an example flocal anesthesia; enerar nesthesia rbduces artiaror complete "onr.iourn.r, '

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1. Match the terms with the descriptions

a. Dilaceration

b. Scaling

c. Nightguard

d. Inlay

e. Debridement

f. Crown

g. Abscess

h. Dental bridge

i. Apical foramen

j. Anodontia

l. A collection fpus that has accumulated n a cavi8formed by the issue n which he pus esides n thebasis ofan infectious rocess r otler foreignmaterials

2. A rare genetic disorder characterized y thecongenital absence fall primary or permanent eeth

3. Opening at the apex ofthe root ofa tooth throuehwhich he nerveand blood vessels hat supply he

dental pulp pass4. Dental restoration used o replace a missing ooth byjoining permanently o adjacent eeth or dentalimplants. Also known as ixed partial denture

5. A type of dental estoration which completely capsor encircles a tooth or dental mplant. Often used oimprove the shength or appearance fteeth

6. Medical removal ofa patienfs dead, damaged, rinfected issue o improve the healing potential oftheremaining healthy issue. Removal may be surgical,mechanical. hemical

7. A developmental isturbance n shape ofteeth. Itrefers o an angulation, or a sharp bend or curve, n theroot or crown ofa formed ooth

8. Indirect estoration filling)consisting fa solidsubstance as gold or porcelain) fitted to a cavity in atooth and cemented nto place

9. A protective device for the mouth that covers heteeth and gums during the night to prevent and reduceinjury to the teeth, arches, ips and gums. t is used asa treatment ol bruxisrn.

10.The removal fplaquq calculus nd stain rom thecrown and root sudac€s ofteeth. It can be performedwith hand nstruments r.with an ultrasonic evice

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A. Mouth mirror

B. Scissors

C. Periodontal robe

D.Tongue Retractors

E. Probe

F. Dental orceps

G. Spatula

H. Scalpel

I. Drill

J, Cheek etractor

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T0qFL OOEL ESTS

I qr$in{ocls l{$ilicd?

0y lfr-cnvimnriient n rvhich trcvy thc cnvironmenr n \'hich rhcy il,eny Ulc ood lrcyeatIly thc skuclurc offtc moudrBy c nlnllbcr lnd ype ofwings

is thc puqlose ftlla maxillile?

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lnlerest Priricipal Rsre (Tinte

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(A)Colo[ies fprobzorns (A) A class fprotozoantB) t,tasrigophoia- (B) The ubsrancchar orms he celtofa(c) Moriliryn protozo. pro(ozoan'(D)chsricirriJic; ;l io,oro, (c) A?rimirive nimal inril&oa proro-

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(A) t\listigophon(B)Cilirra

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(A) Torcspqrd t9 dE ocod or r.tcwschaol.

:lt#:f:#,'il#:iilxfil.

(D) To nflucnccthc pronunciationofrl|cEnSIsn anguagc

' f,iffiilr;:jffi#,1:ff;;:;r;(A) One volumc(B) Ttr:o otumcs(C) Thrcqvolhcs(D) Fourvolumcs

43. Along thc San Andrcas Fauh, ucmors are(A) imall and nsitnilicanr(rr) rarc, butAisastrous(C). frequent cvcnrs(D) vcry unprcdicrablc

44. Haowrdocshc au6ordcfinc rhc San Andreas

46. Whar s rhc purposc flhis passagc?(A) To cornplain(B) To pcrsudc(C) To cnrcnain(D) To inform

;r;n, ,iiiilli,l"iJ .t0, Whcrc4ocs hc autr ic?(A):Easr f tilcculfof califomia(B) Wcsr frhe Cutf of Califomia(C) llonh of rhc cutfofCatifomia(D) Foqrh of rhc Gulfof Catifomia

I t, tn which dircctiondocs hc wcsrem ide o[tnc aul movc?

(A) W.sr(B) Easr

lC) Nonh(D)Sourh

' (A) 18t7' ' (Bir80?. (c) r8?8(D) 8? 4

:f$iffij'h'i,lill]''ff:n'x'"7(B) The.nrc(C) C

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lOEFL MOOEI TESTS

m'ro",lee .9 11$-t reu abooksan mpor- 26. bgistalors arc considering hether hlr"* .,n*.*.r."-J.lTr*l""ilti^:A)sftim(D)summarizc(C)ourtine(D)pa'-dphmsi

4\^.\r,;;1,:'l'-':'y :t retativiryeemed

.__.-.-qqr d, nrc omc rhat hc irst ntroduccd

(A) unbdliev4ble(B) compticared

(C) brittianr(D) famous

,''ff;'il;:

** ** ro,epcarhe rohibi_

(A)willing(B) urgea(C) retucranr(D)supposed

l;".1;:l*::::ll:: :\ a,iened.v noisvifl,o^,1.1::-y:lon,.:",r,"ur,i,J,id;t,rwn oproresr ispoticies.(A)jocular(B)clamorous(Q gigunti"(D)capricious

-iij?:l*i{rjl,lrruffirn:r(A) decelcy(B)obirny(C) esourccs(D)courage

1t1",',n,::hqootou. rui,,EmilyDickin-';n,r,".ut"*+*+odEffilyllr{4ssachuserrc-1;1.1i,;11ry-;a;rr=;,i#ffi(A) a hiroine(8) a belgar(C) 4 ecluse(D) m nyalid

(A.) ague(B) hanh(C) divcrse(D) ioven

27. The Rciotutionary forces sd o must..norgr,"ou*g.,opp;,;;;r,i*ffi.

(A) pledge

(B) fatc .(C) disptay(D) Barhcr

"n'r:,ir,"tj.::'.',:."Tj1***#ffi,,:(A)punch(B)at e(C) cider(D)soda

SiDce

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l-lqr crch srnlcnce .rs n underlincd ord or phrase.. eloweach cnrence .

iir;illl-jl*llll;j"'.1,1l?l:J::::: :1*.;r'". *".j"'pr'."li

i:i,ffi'i,Ti;;:T[:i:J"il:Tf1:tl;::::gr:;j;i:iilli,f

Part A

iO hc spacc so rhar hc lelrer in5ide rhe oval cqnnor ht seen.

as ooe of th e

' :+. . . r, ' : . i i i , . . , . . . : r ' - ---------- ; : : : - _rry. ,EIaln rhc.famous uFcry rhymc about Jack and 14. The cpresenlalives f lhc comJi , Ji rrimbtedowi hchi[ afrer aci.- vc.y altousooceming" *frii..,fJi"o(A) called lhc worlels_(B) fcll (A) ibcrl t(C) ran(D) lerv

(B) Snorrnt(C) responsiblc

9. Ivhen popc.lohn prut visircd Larin Amcri-(D) insctlsilivc

ca. he oncn signaled or lhe ciildren ro 15. The u_limalg ausL f rhe Civit \\,:rr r.r__rtrhcqmc o him; bbmdiiiirc-ir of Fon Sumrer(A) denied(B) adorcd

(A) final

(C) bcckoned(B) only

(D)aroNcd l;i:ffi,.

Section :ry and Reading omprehension

ineq p mcilsufc our comprehension [ shndrrdlhissccrio|l, ]ilh speci:ll irections or each ypc.

sri(en Englirh. 1'herc rc rws

5. Elen rhough hc evidcnce s olcr$hclnting,ifooejuror s t i l lslicptictl. he lre ntusr ,tr rclried-

(A) not presenl(B) nur urpriscd(C) not convinced :(D) not waried

10. Sonrelinrcs. r,,hileiving n a foreign coun-rr\',one Smvcs spccial ish rom home.(A) desircs( B) eats(C) prepafes(D) looks or

his ield,lo

an la5s .

(A) umioous(B) hannlcss(C) adcquare(D) attFcrive

..1

(c)

,, 1i,..1

(.{) cancelii

(A) deal wirh(B) Iook ik e(C) atlow mnigralion from(D) reslricr radewilh

lp. The Sr-rpreme oun has a rcpurltiott foroetnq ust .

(A) srubbom(B) impanial(C) humorous-(D) capricious

(D )

(8.) ppmpriares(C) ransacts(D) mediates

l{

' . . ' . ' . , . .*.

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L MODEL ESTS

$ffi, Lfl$ofus wln snroka houldhrvq dEir

(B) , (c)X'nvcd (crularlY.

(D) '

rhc calr ofgoologisrs ad druwn

ir lltcirno(cbooksnd wretcin ls-o(inc lbrms(ions ,hich hcy

. (c)I qbseNed. hiy relurned o hcir

lo cornpare otcs.

-oi-Kcrtrtedy oqld hrve iled

(A ). llc nrobilbly rlould hnvi won

(c) (D)

It n'its tr rvho cpresented er coutrlr-),inAt, /Rt /a\r (B) q) .

UnitedNotions nd aler bectmc(D )

to 4|e U0ired lntiJ.

rcisonqblc, f [oi more e0sonable. s hose

.1.:tt qonrFqrnblc iscount tores,

IlJ. l( s eltrernelymponanlor xnenEinecl

(A) (U) (c)to hlow lo use a conlDulef.- (l)

l . l . I is toricrl lyhcrr tas ccn nlv lo nrajori (A) (B) ic) (Qi .i facrionsn rhc lepublican itn).-rthc

libernls nd hcconsenatives.

MUUEL I EsI

t5

2'1.

Whilman i,rord ra\"J ry'Gtols as a tribr4l

lo the Civil IVarsoldicrs who had aid on'

.-(A)*

battlelield$ nd $honr he had seel-(Bj- -(ci -lgjggllg 49an rmy nunc.

3 Th9shqrc paBal las fouFJ he bady af a(A )man xho tcY bclicvc o trc rhc 4$lIE' iB) (c) (D)marinc iologisl.

3 . Ledurcs .or hc wcckof li,larch 2-26,' (Al

{ ill includehc otlo* ng:The Causeioflhe-- (B)' --(c)civil wer. The EconomY frh: sourh'

Badc lp"Egics. anq h,. 4f=jilargip )

Lincoln.

31. Despilc fmany attcmPcso cnoduce---i5- (Brf (c)univqrsrl angu4ge. otrSly Esperanto nd

. ldiomNcuuzl rhccffon has Elctwithv'ry

. 14. As ctery othei nqtion, fr: Uni:cdStatcs(.-\) (B) .

.. used o defitE rs unitbf cutre rcy, hc dollatitel ,-i6

- .in crms fthe gald sler'lard"l

Ir s necessary hat ncmer iirhaludgc(,\)

bcforc sicnin[ lhc firtalpairrs for a divorcc.- dti----]o- (D)' 16. Unlil leccnllv. womcn scrc fotbiddcn

i ---lAt.* (B)by rw fromowning roPcnY.T--@t

l?, Accotding o the Emduatc llaloE' sludcot

(A )housinq s more cheiper han housing ff

iBt- te l is tcrmpus,

38. John Diwey rhought. hat children will lcam-IAr. befler hrough pMicipating n erperienccs

(B )rather han hrouah istenin