Dr. Galil’S Perio Questions

Front 1

"The mandibular canal, occupied by the inferior alveolar nerve and vessels, begins at the mandibular foramen on the medial surface of the mandibular Ramus and curves downward and forward"

Back 1

True

Front 2

"Some times the mandibular canals bifurcate in the body of the mandible, resulting in two canals and two mental foramen!"

Back 2

True

Front 3

"The mental foramen, from which the mental nerve and vessels emerge, is located on the Lingual surface of the mandible below the apices of the premolars, sometimes closer to the second premolar and usually halfway between the lower border of the mandible and the alveolar margin"

Back 3

"False the mental foramen opens on the buccal surface"

Front 4

"In the premolar area, the mandibular canal divides in two branches, with one exiting the mandible and the other continuing anteriorly: the incisive canal, which continues horizontally to the midline, and the mental canal, which turns upward and opens in the mental foramen"

Back 4

True

Front 5

"The opening of the mental foramen, which may be oval or round in shape, typically faces upward and Mesially , with its postero superior border slanting gradually to the bone surface. An “anterior loop” of the mental foramen has been described, using cadaver dissection, as a reverse turn and looping back of "

Back 5

"False the foramen opens distally"

Front 6

"An “anterior loop” of the mental foramen has been described, using cadaver dissection, as a reverse turn and looping back of the mental nerve before its exit out of the mental foramen with lengths ranging using cone beam scans and cadaveric dissection reported this loop extension to range from 0.0 to 9.0 mm."

Back 6

True

Front 7

"Surgical trauma (e.g., pressure, manipulation, and postsurgical swelling) to the mental nerve can produce paresthesia of the lip, which recovers slowly"

Back 7

True

Front 8

Partial or complete cutting of the nerve can result in permanent paresthesia

Back 8

True

Front 9

Familiarity with the location and appearance of the mental nerve reduces the likelihood of injury

Back 9

True

Front 10

"In partially or totally edentulous jaws, the disappearance of the alveolar portion of the mandible brings the mandibular canal and mental foramen closer to the superior border"

Back 10

True

Front 11

"When these patients are evaluated for placement of implants, the distance between the canal and the superior surface of the bone, as well as the location of the mental foramen, must be carefully determined to avoid surgical injury to the nerve"

Back 11

True

Front 12

"The lingual nerve, along with the inferior alveolar nerve, is a branch of the posterior division of the mandibular nerve and descends along the mandibular Ramus medial to and in front of the inferior alveolar nerve. "

Back 12

True

Front 13

The lingual nerve lies close to the surface of the oral mucosa in the third molar area and goes deeper as it travels forward

Back 13

True

Front 14

The lingual nerve can be damaged during anesthetic injections and during oral surgery procedures such as third molar extractions

Back 14

true

Front 15

Partial thickness flaps (periodontal) for third molar area are less likely to injure the lingual nerve

Back 15

True

Front 16

Resective osseous therapy at the area of the External oblique ridge does not constitute problems

Back 16

"False osseous surgery may be difficult or impossible in this area because of the amount of bone that must be removed distally toward the Ramus to achieve resection of a periodontal osseous defect on the distal aspect of the mandibular second/third molar."

Front 17

"The retro molar triangle this region is occupied by glandular and adipose tissue and covered by unattached, non keratinized mucosa"

Back 17

True

Front 18

"If sufficient space exists distal to the last molar (retro molar area), a band of attached gingiva may be present; only in such a case can a distal flap procedure be performed effectively"

Back 18

True

Front 19

"The mylohyoid muscle inserts along this ridge and separates the sublingual space, located above or more anteriorly and superiorly, from the sub mandibular space, located below or more posteriorly and inferiorly"

Back 19

True

Front 20

An infected incision deep on the lingual surface of the mandible close to the third molar area can lead to either sublingual or sub mandibular space involvement or both

Back 20

True

Front 21

The terminal branches of the nasopalatine nerve and vessels pass through the incisive canal an area covered by the incisive papilla

Back 21

True

Front 22

"The Naso palatine nerve is a branch of the ophthalmic nerve, hence infections to the eye are possible through this nerve"

Back 22

"False The Naso palatine nerve is a branch of the maxillary nerve"

Front 23

During periodontal surgery or implant surgery it is possible to sacrifice the Naso palatine nerve and vessels”

Back 23

yes

Front 24

one way to preserve the Naso palatine neuro vascular bundle during periodontal surgery is to perform a partial thickness flap of the area will preserve it”

Back 24

yes

Front 25

The greater palatine foramen opens 3 to 4 mm anterior to the posterior border of the hard palate

Back 25

True

Front 26

The greater palatine nerve and vessels emerge through the foramen and run anteriorly in the mucosa of the palate

Back 26

"False Reason it runs in the Sub mucosa of the palate"

Front 27

The greater palatine nerve and vessels emerge through the foramen and run anteriorly in the mucosa of the palate on the alveolar processes

Back 27

"Answer: wrong The artery runs at the junction of the palate and alveolar process"

Front 28

Vertical incisions in the third molar areas of the palate are encouraged to obtain access

Back 28

"False These incisions will severe the greater palatine artery"

Front 29

It is easy to ligate the greater palatine artery when it is severed

Back 29

"Answer; false It is difficult to suture the artery since it is embedded in the junction between palate and alveolar process"

Front 30

"what is the most common method should you use during periodontal surgery if the greater palatine artery was severed Are there other methods you can use?"

Back 30

"pressure Cauterization, ferric sulfate, bone wax and pressure

Front 31

Severing the greater palatine artery close to its exit should not constitute an alarm during periodontal surgery

Back 31

"False The artery will retract into the foramen and be difficult to control"

Front 32

what drastic measure can be used if the greater palatine artery is severed close to the foramen

Back 32

Answer. Beside all the previous answers crushing of the bone is a possible way of stopping the artery

Front 33

The mucous membrane of the palate is easy to reflect because it is made of non keratinized epithelium

Back 33

"Answer: false. The mucosa is keratinized and adherent and firmly attached to the bone"

Front 34

"When performing distal wedge or flap on the maxillary tubersoity close to the medial side, there is a possibility of injuring the tensor palate muscle"

Back 34

"Answer true The tensor palate forms part of the tensor muscles and its tendon is located medially in that location "

Front 35

"The maxillary sinus, which is the smallest of the Paranasal sinuses, is trapezoidal in shape, with its apex in the zygomatic arch and its base at the lateral wall of the nasal cavity."

Back 35

"Answer False: The maxillary sinus is the largest of the Para nasal sinuses and is pyramidal in shape and its apex in the zygomatic arch and its base at the lateral wall of the nasal cavity. "

Front 36

the opening of the maxillary sinus is in the inferior meatus to help its drainage.

Back 36

"Answer false; The maxillary sinus opens in the middle meatus"

Front 37

as you get old the sinuses generally enlarge

Back 37

true

Front 38

"the contiguous enlargement of the sinuses are called Skeletal Pneumaticity or, Pneumatization"

Back 38

Pneumatization (both are same)

Front 39

"With increasing age the maxillary sinus expands, becoming more and more pneumatized down around the roots of the maxillary teeth"

Back 39

true

Front 40

what is the common name for the maxillary sinus lining mucosa

Back 40

Schneiderian membrane

Front 41

CT scans are the preferred method for detecting septa in the maxillary sinus because panoramic radiographs are not reliable (26.5% false diagnosis of the presence or absence of septa)

Back 41

true

Front 42

"which tooth is most likely to be directly related t the maxillary sinus involvement, 1st molar, canine, premolars "

Back 42

1st molar

Front 43

"following periodontal or implant surgery and infection of the sinus, the drainage is hampered "

Back 43

true

Front 44

why is the drainage hampered following a sinus infection is it because the draining is in the superior meatus

Back 44

"Answer: false; The drainage is hampered because the swelling around the orifices of the sinus prevents drainage furthermore the sinus opens in the middle meatus not the superior meatus."

Front 45

"The maxillary artery, a large terminal branch of the internal carotid artery, gives off many branches to supply the maxillary sinus, including the infraorbital artery, which travels superiorly and anteriorly and gives off the anterior superior alveolar artery"

Back 45

"Answer false; The its large terminal branch of the external carotid not the internal carotid"

Front 46

"- Knowledge of the arterial blood supply is particularly important when considering a lateral window approach to sinus floor elevation (sinus elevation) and bone augmentation -explain your answer"

Back 46

"true Intraosseous vessels are present in the lower two thirds of the anterolateral wall of the maxillary sinus and any sinus augmentation presents a risk for bleeding complications in some cases’ "

Front 47

maxillary and mandibular Tori can cause a problem to the patient during periodontal surgery and has to be removed some time

Back 47

true

Front 48

What problems a Tori can cause

Back 48

"Answer. Adherent Mucosa. interference with the incision ,lack of accessibility of the area and difficult in oral hygiene ."

Front 49

List some of the facial muscles which can interfere with periodontal surgery or Mucogingival surgery or implant surgery

Back 49

"Answer: These are the mentalis, depressor Anguli Oris, depressor labii inferioris, levator labii superioris, levator Anguli Oris, and buccinator muscles."

Front 50

"why are these facial muscles of concern during periodontal surgery? mentalis, depressor Anguli Oris, depressor labii inferioris, levator labii superioris, levator Anguli Oris, and buccinator muscles"

Back 50

"their origin is in the facial bone and their insertion is n the lip and cheek Furthermore these muscles are very proximal to the anatomic spaces and an infection there can lead to expansion of the infection into these subcutaneous areas leading to swelling and further complications hemorrhage "

Front 51

list some of the anatomical spaces and the consequence of invading these spaces

Back 51

"- Canine fossa leads to swelling of the upper lip, obliterating the nasolabial fold, and of the upper and lower eyelids, closing the eye. - Buccal space relates to the masseter, buccinators infection her leads to massetric, or infratemporal or sub mandibular space - Mental, or mentalis, space relates to mental muscles i.e., depressor muscle of the lower lip, and depressor muscle of the corner of the mouth are attached to bone. Infection of this area results in large swelling of the chin, which extend downward The masticator space contains the masseter muscle, Pterygoid muscles, tendon of insertion of the temporalis muscle, and mandibular Ramus and posterior part of the body of the mandible. Infection of this area results in swelling of the face and severe trismus and pain. If the abscess occupies the deepest part of this compartment, facial swelling may not be obvious, but the patient may complain of pain and trismus. Patients may also have difficulty and discomfort when moving the tongue and swallowing. The sublingual space is located below the oral mucosa in the anterior part of the floor of the mouth. It contains the sublingual gland and its excretory duct, the sub mandibular or Wharton's duct, and is traversed by the lingual nerve and vessels and hypoglossal nerve its boundaries are the Geniohyoid and genioglossus muscles medially and the lingual surface of the mandible and below by the Mylohyoid muscle laterally and anteriorly. Infection of this area raises the floor of the mouth and displaces the tongue, resulting in pain and difficulty in swallowing but little facial swelling."

Front 52

It is safe to perforate the lingual plate of the lower anterior part of the mandible during placement of an implant

Back 52

"False Reason: there exists the possibility of severe hemorrhages in that area"

Front 53

"Which of the following arteries are of concern to you during placement of an implant in the lower anterior lingual area close to the mental tubercle (spine)? Temporal, internal carotid, ascending pharyngeal, superficial temporal"

Back 53

False - none of the above

Front 54

The facial and lingual artery gives what specific branches to the area of the lingual plate of the lower mandible close to the mental spine

Back 54

Sub Mandibular branch of the facial artery and sublingual branch of the facial artery

Front 55

A Patient with bleeding from the sublingual or sub mandibular branch how would he present himself to you in the morning after placement of an implant

Back 55

Answer; swelling of the Sub mandibular space with a huge hematoma

Front 56

"A Patient with bleeding from the sublingual or sub mandibular branch how would he present himself to you in the morning after placement of an implant why is the bleeding of the utmost importance?"

Back 56

the possibility of suffocation

Front 57

"A Patient with bleeding from the sublingual or sub mandibular branch how would he present himself to you in the morning after placement of an implant what is the emergency procedure in this case?"

Back 57

tracheotomy

Front 58

"A Patient with bleeding from the sublingual or sub mandibular branch how would he present himself to you in the morning after placement of an implant what is the best method to avoid any disaster"

Back 58

"Inspect the surgical area following the surgery, avoid perforating the lingual plate, and use pressure to minimize bleeding, and follow up the patient"