osce guide

Public Health-Mas

Informed consent

• Informed is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention.

• In the communications process, you, as the physician discuss with your patient:– patient's diagnosis, if known– nature and purpose of a proposed treatment– risks and benefits of a proposed treatment– Alternatives treatment– risks and benefits of the alternative treatment or procedure– The risks and benefits of not receiving or undergoing a treatment or

procedure

• patient should have an opportunity to ask questions to elicit a better understanding of the treatment or procedure, so that he or she can make an informed decision to proceed or to refuse a particular course of medical intervention.

Komplikasi pencabutan gigi

Intra operasi Post operasi

Fraktur mahkota/akarFraktur tlg alveolar dan tuberositas maksilarisFraktur mandibularTrauma pd jaringan lunak dan sekitarnyaPendarahan primerDisplacement gigi dan fragmennyaFistula oroantralDislokasi tmjEmphysemaTraima pd sarafSinkop dan syok anafilaktik

Dry soketpendarahan sekunderInfeksi dan penyembuhan lambatNekrosis jaringan lunakPembengkakan dan trismusSakit yg menetap

Instruksi pasca pencabutan

• Gigit tampon 1- ½ jam• Jgn sering berkumur• Jgn sering meludah• Jgn mempermainkan bekas luka dgn lidah• Jgn menghisap luka• Jgn merokok• Mkn pada sisi berlawanan• Jgn mkn /minum yg panas• Kontrol segera jika ada keluhan atau alergi obat

Conservative Dentistry-Tjin, Niro

Black’s Classification

• Class I—occlusal areas and buccal or lingual pits

• Class II—posterior interproximal

• Class III—anterior interproximal

• Class IV—anterior interproximal including the incisal corner

• Class V—gingival at facial or lingual

• (Class VI—cusp tip)

Cement Base

• Choose a cold large slab

• Put a scoop of powder on the slab &divide it into 6

• Two drops of liquid

• Mix powder to one drop of liquid. Adding more powder if needed or liquid to the mixture

• Mix in a large circular motion and folding motion

Definition of Class II Amalgam Restoration

• Amalgam restoration that restore one or both of the proximal surface of a posterior teeth

Matrix Placement

• Observe the video for better understanding

• http://www.youtube.com/watch?v=an5hdF-8Rl8&feature=related

• AND DOC AYU’s SLIDES

Instrumentation for amalgam placement

1. Tofflemaire Matrix Retainer

2. Wedge (made of wood if got, if not made from plastic)

3. Matrix Band (normal straight band)

4. Burnisher

Burnisher

Steps in Matrix Placement

Try the wedge.

Burnish the matrix band.

Place the matrix band into the retainer.

Fit the matrix onto the tooth.

Place the wedge.

Tighten the matrix band around the tooth

Class II Restoration (Focused)

• The wedge placement

– For MO : wedge will be placed at the mesial side of the teeth from palatal/lingual to buccal

– For DO : Wedge will be placed at the distal side of the teeth from the buccal to palatal/lingual

– For MOD: wedge placed on both mesial and distal of the teeth like above

Remember

• The open end of the U-shaped head must be always face the gingiva

• The long knob and short knob end should be facing out of the mouth.

LOCAL ANESTHESIA-Diyana

Pre-injection proceduresFisher technique

Plus+Maxillary injection tech

Mandibular injection tech

http://www.nysora.com/peripheral_nerve_blocks/head_and_neck_block/3062-oral_maxillofacial_regional_anesthesia.html

Sila chekkidout

Wash hands

Open syringe package

drop on sterilized tray

Clean ampule with alcohol place on

sterilized tray

Wear mask

Wash hands

Wear gloves

Break ampule

Fill syringe with

anestetikum

Recap syringe

Oles betadine on mucosal tissue to

be injected

Fisher Technique1ST POSITION• Locate linea obliqua externa geser median to locate linea

obliqua interna (melalui trigonum retromolar)• Punggung jari menyentuh buccoocclusal gigi terakhir• Syringe at premolar region• Tengah2 lengkung kuku penetrate until contact with bone

2ND POSITION• Syringe now sejajar dataran occlusal• Penetrate 6mm, ASPIRATE• Aspiration –ve, 0.5cc N.Lingualis

3RD POSITION• Syringe now at canine region• Penetrate 10-15mm until contact with bone hilang• ASPIRATE, -ve, 1cc N. Alveolarius Inferior

1

2

3

MAXILLA

Nasopatinenerve

Greater palatine nerve

Lesser palatine nerve

• Supraperiosteal• Blok N. Palatinus

Mayus• Blok N.

Nasopalatinus• Infiltrasi palatum

Supraperiosteal/ local infiltration• Tarik pipi n bibir sehingga

jaringan tegang• Tusuk pada lipatan

mukobukal• Jarum tusuk ke arah apeks .

Jarum dimasukkan sampaiujung jarum di daerahapeks gigi

• Aspirate, 0.6-1cc slowly (20sec)

Blok N. Palatinus Mayus• Baal sampai canine• Foramen at distal 2nd molar

(pertemuan palatumdurum n processusalveolaris)

• Jarum tusuk slowly 0.5mm 0.5cc-0.75cc

Blok N. Nasopalatinus• Jarum inserted thru papila

nasopalatinus sampai jalanmasuk canalis incisivum

• Contact dgn tulang jarumkeluarkan lagi 0.5-1mm, anestetikum 0.1cc-0.2cc slowly

Infiltrasi palatum• Tujuan: jaringan gusi

5-10mm dr gingival margin

• Jarum 45degree• Anestetikum 0.2-

0.3cc

MANDIBLE

• Fisher blok• Buccal Nerve Block

Buccal Nerve Block• Dilakukan pd coronoid

notch (median frm lineaobliqua . Mukosa bukalditarik.)

• Jarum tusuk lateral and distal gigi gerahamterakhir setinggi oklusal2-3mm, aspirate, 0.5cc

Microbe-Fit

Hand Washing Technique

• To wash hands properly, rub all parts of the hands and wrists with soap and water or an alcohol-based hand rub.

• Wash hands for at least 15 seconds or more.

• Pay special attention to fingertips, between fingers, backs of hands and base of the thumbs.

• Keep nails short

• Wash wrists and forearms if they are likely to have

• Remove watches, rings and bracelets been contaminated

• Do not use artificial nails

• Make sure that sleeves are rolled up and do not get

• Avoid chipped nail varnish wet during washing

Wearing Glove Technique

Putting on Gloves:

1. Wash hands with soap and water, and dry thoroughly- removing jewelry prior to washing hands is highly recommended.

2. Staff wearing jewelry must wear larger sized gloves to ensure proper fit.

3. Before putting gloves on, be sure to examine for dirt or damage (tears or holes). Replace gloves if necessary.

4. Replace gloves before dealing with another patient or if they become heavily soiled.

Removing Gloves:

1. Remove gloves carefully to prevent splattering. Grab the outside wrist of one glove with your other hand. Turn glove inside out as you remove it.

2. Drop the inverted glove into the other hand and slide your bare finger under the second glove to invert it and trap the first glove inside.

3. Wash hands after removing gloves.

ORTHODONTICHani

MEASURE OVERBITE AND OVERJET

OVERBITE

NORMALOVERBITE

HOW TO MEASURE?

•Mark a short line on labial

surface of lower incisor with

sharpened pencil

•Distance from incisive edges

to the mark is measured with

Boiley gauge

OVERJET

•Normal

•MALE 2,2 mm + 0,8 mm

•FEMALE 2,5 mm + 1,1 mm

OverjetEdge to edge/ cusp to cusp

HOW TO MEASURE?

•Measure horizontal distance from

maxillary incisal tip with the labial

surface of mandibular incisor during

centric occlusion

•Big overjet : >3mm

•Instrument : Boiley Gauge

ANGLE’S CLASSIFICATION

•The classifications are based on the relationship of the

MESIOBUCCAL CUSP OF THE MAXILLARY FIRST MOLAR and the

BUCCAL GROOVE OF THE MANDIBULAR FIRST MOLAR

•A normal molar relationship

exists but there is crowding,

misalignment of the teeth,

cross bites etc

•Dewey’s modification:

•Type 1-crowded maxillary

anterior teeth

•Type 2-proclined or

labioversion of maxillary

incisors

•Type 3-linguoversion of

maxillary incisors

•Type 4-incisors and canines

normally positioned

•Type 5-mesioversion of molars

•Molar relationship shows the

buccal groove of the mandibular

first molar distally positioned when

in occlusion with the mesiobuccal

cusp of the maxillary first molar

•Class II division I

•when the maxillary

anterior teeth are

proclined and a large

overjet is present

•Class II division II

•where the maxillary

anterior teeth are

retroclined and a deep

overbite exists

•Molar relationship shows the buccal groove of the mandibular

first molar mesially positioned to the mesiobuccal cusp of the

maxillary first molar when the teeth are in occlusion

•Dewey’s modification:

•Type 1- well-aligned teeth and

dental arches

•Type 2- Crowded mandibular

incisors

•Type 3- Crowded maxillary

incisors

CEPHALOMETRIC LANDMARK

•Nasion (N) – point where

frontonasal and internasal

sutures meet in midline

•Sella (S) – centre of pituitary

fossa or sella turcica

•Basion (Ba) – most posterior

and inferior point in sagital

plane on the anterior rim of

foramen magnum

•A (subspinale) – deepest

point between ANS and

inferior most point in

maxillary alveolar process

•B (supramentale) – deepest

point between pogonion and

superior most point in

mandibular alveolar process

•Pogonion (Pog) – anterior most

point in contour of lateral

shadow of chin

•Gnathion (Gn) – most anterior

and inferior point on lateral

shadow of chin, mid point

between pogonion and menton

•Menton (Me) – inferior most

point in contour of chin

•Gonion (Go) – most

posterior and inferior point

at the angle of mandible

•Porion (Po) – superior most

point of external auditory

meatus

•Orbitale (O)- lowest point

on outline of bony orbit

MODEL ANALYSIS

ANALISIS BOLTONTOOTH SIZE DISCREPANCY

(TSD)

OBJECTIVE

•Evaluates maxillary and mandibular teeth for tooth size

discrepancies

•According to Bolton, there is a relation between combined

width of mandibular and maxillary teeth

Comparing the size of the maxillary teeth the size of the mandibular dentition

There are two measurements:- The ratio of anterior (6 anterior teeth)

- The ratio of total (12 teeth)

Rasio Anterior dan Rasio Total

STAGES

Stage 1:

Measure and record all the mesio-distal tooth size

in mm (such as analysis ALD)

- 6 anterior teeth RA (13-23)

- RB 6 anterior teeth (33-43)

- 12 teeth RA (16-26)

- 12 teeth RB (36-46)

RATIO ANTERIOR

TOTAL RATIO

• Stage 2:

– Calculations with Bolton’s formula

How to calculations using theformula of Bolton:

ANTERIOR RATIO:

mand. “ 6 “ x 100 = ………… %

maks. “ 6 “

(mean = 77.2; SD = 1.65)(Normal = 75.55 to 78.85)

How to calculations using theformula of Bolton:

TOTAL RATIO:

mand. “12“ x 100 = ……… %

maks. “12”

(MEAN = 91,3 ; SD = 1,91)

(NORMAL : 89,39 - 93.21)

-Use the correct size of the maxillary teeth is to see the size of

the teeth mandible should be on the Bolton’s table.

-Measure the mandibular teeth of the patient

-Reduce the size of the mandibular teeth of the table

-The results of this reduction is the difference

between mandibular tooth size excess

IF, anterior ratio> 77,2% total ratio> 91,3%

Then the true size of the maxillary teeth and themandible is too large than it should

STAGE 3

Then the true size of the mandibular teeth, the size of the maxillary teeth are too big than it should

If, anterior ratio < 77,2% total ratio < 91,3 %

•Use the true size of mandibular teeth to measure the size of maxillary teeth that should be in Bolton’s table•Measure the maxillary teeth on patient•Reduce the size of maxillary teeth from the table•Result of reduction is the excess of maxillary tooth

TABEL BOLTON (TSD)

Pasien Seharusnya

(Tabel)

Selisih

Mand “6” ------ mm ------- mm ------ mm

Maks “6” ------ mm ------- mm ------ mm

Mand “12” ------ mm ------- mm ------ mm

Maks “12” ------ mm ------- mm ------ mm

TABEL PENGHITUNGANANALISIS BOLTON (TSD)

CONTOH KASUS

Ukuran 12 gigi RB = 90 mmUkuran 12 gigi RA = 95 mmMenurut Rumus Bolton : 90

---- x 100 = 94,7%95

94,7% kesimpulan geligi madibula yang salah (ukurannyaterlalu besar dibandingkan seharusnya) dan gigi maksilayang benar.Lihat di tabel Bolton angka 95 untuk ukuran gigi maksilayang benar, maka ditemukan ukuran gigi mandibulaseharusnya 86,7 mm.Maka ukuran ”12” gigi mandibula berlebih sebanyak = 90 –86,7= 3,3 mm.

Isi Tabel yang Tersedia di Status

Pasien Seharusnya

(Tabel)

Selisih

Mand “6” ------ mm ------- mm ------ mm

Maks “6” ------ mm ------- mm ------ mm

Mand “12” 90 mm 86,7 mm 3,3 mm

Maks “12” 95 mm - mm - mm

KemungkinanRencana Perawatan

Agar oklusinya baik maka perawatan dapatdilakukan dengan memajukan (ekspansi) gigi

anterior maksila ke anterior sebanyak 1,65 mm

atau

slicing gigi mandibula sebanyak 3,3 mm (?)

atau

cara lainnya

Analisis Howes

Analisis Howes

State of dental crowding (crowding) is not only due to the size of the teeth that are too big but can also be caused by the curved jaw bone is too small.

Notes : only for maxilla

Used as a benchmark measure:

1. Dental arch length = Number of mesiodistal tooth size of 16 to26 teeth

2. Arch width / Width Base Apical = distance betweenthe deepest point canine fossa, measured from the point at the tip apex of tooth 14 to tooth 24

3. Dental arch width = distance between the tip of buccal teeth 14 to 24

Dental arch length = Number of mesiodistal tooth size of 16 to26 teeth

Arch width / Width Base Apical =distance between the deepest

point canine fossa,measured from the point at the tip apex

of tooth 14 to tooth 24

Dental arch width = distance between the tip of buccal teeth 14 to 24

Howes Formula

1. 100 X Apical base 100 X ..… mm________________ = ______________ = ….…%

Total Mesiodistal 16 – 26 … mm

2. Dental arch width (buccal tip14-24) = .........mm

dental arch width (apical base) = .........mm ________________

reduction = mm

ANALYSIS RESULT

1. 44% = INDICATES THAT THE APICAL BASE WIDE ENOUGH FOR ALL TEETH FROM 6 TO 6

2. < 37% =ARCH CURVE IS SMALL UNTIL EXTRACTION NEEDED

3. 37 %-44 % = DOUBTFUL CATEGORY BETWEEN EXTRACTION OR EXPANSION

4. > 44% = JAW ARCH WIDTH> DENTAL ARCH WIDTH UNTIL P1 SO EXPANSION CAN DONE SAFELY

Analisis PONT

The rationale is:greater mesiodistal widths

4 incisive maxillary teeth, the greater the width

dental arch between P1 and M1so that no crowding

1. Mesiodistal width 12 11 21 22

2. Distance of central fossa 14–24 (patient)= ..mm

3. Distance of central fossa 16–26 (patient)=…mm

a. Pont’s index formula for 14 – 24 =

Total mesiodistal 12 11 21 22 x 100 =... mm

80

b. Pont’s index formula for 16 – 26 =

Total mesiodistal 12 11 21 22 x 100 =…. mm

64

PATIENT PONT DIFFERENCE

14 -24 ….. mm …..mm …..mm

16-26 …..mm …..mm …..mm

Pont’s table

• If the result is - (negative) contraction occur

• If the result is + (positive) distractions occur

Oral Surgery-Alyana

-Choose the right tang for extraction -Show extraction procedure

-Write prescription for a case (extraction)-Prescribe: mefenamic acid and amoxicillin

Maxillary forceps

• The S, I, and Z shaped forceps are used on the maxillary arch.

Maxillary forceps no. 150

• maxillary incisors, canine teeth, and premolar teeth

• For maxillary premolar

Forcep No. 150A (Slight variation from 150 for

maxillary premolar only)

to extract maxillary first and second molars

• Smooth, concave surface for the palatal root

• Pointed design that will fit into the buccalbifurcation on the buccal beak.

Based on doc endang’s slide

• Maxillary: lurus mostly

• Only for molars: right and left different

– Buccal part yang lancip

Mandibular forceps

• Forceps which are C and L shaped are used on the mandibular arch

• Bentuk paruh

Forceps No. 151

• for single-rooted teeth the incisors, canines, and premolars

• For mandibular premolar

forceps No. 17

• lower molar forceps

• beaks have bilateral pointed tips in the center to adapt into the bifurcation of the molar teeth.

• the beak adapts well to the bifurcation.

HAWKBILL-TYPE FORCEPS

• Mead #MD3 forceps– For mandibular anteriors and bicuspids

• #13 forceps – For mandibular bicuspids

• #22 forceps – For mandibular first, second, and third molars.

Based on doc endang’s slide

• mandibular: bentuk paruh mostly

• Right left same for all

How to extract

• Anamneses• Extra oral and intra oral exam• Explain what you are going to do• Informed consent!!!• Inject local anesthetic. • Separate the gum from the tooth. • Loosen the tooth - baine• Take out the tooth.

– Right hand: pgg tang– Left hand: fix gigi

• Stop the bleeding – gigit tampon ½ hrs• Suture is must depending on the surgical area• Explain to the person what to do at home to look after the wound.

Put baine at mesiobuccal of tooth that wanted to be extracted

Maxillary region 1 and 2 Extraction

Operator at the right of patient Operator – shoulder length Patient’s face facing to operator if needed

exp: upper left posterior

Way to extract maxillary

• Incisor: luxate then rotate

• Canine: luxate then rotate

• Premolars: luxate

• Molars: luxate

Mandibular region 3 and 4(ant only) Extraction

Operator at patient’s right sideElbow length

Ways to extract mandibular

• Incisor: luxate

• Canine: luxate

• Premolars: luxate then rotate

• Molars: luxate

Mandibular region 4 posterior

Operator at patient’s behind on the right

Use of Cryer Elevator

Here to prescribe (adults)

Patient’s name:

Date:

R/ Amoksicillin 500mg caps No XII

S3 dd1 caps pc

doc’s sign

Patient’s name:

Date:

R/ As Mefanamat 500mg caps No X

S3 dd1 caps pc ah

doc’s sign

Here to prescribe (child)

Patient’s name:

Date:

R/ Amoksicillin syr F1 1

S3 dd2 cth

doc’s sign

Patient’s name: (< 10yrs)

Date:

R/ paracetamol 500 mg tab V

S3 dd ½ tab

doc’s sign

Pedodontics-Fuzah

Question 1

• Anak laki-laki, 5 thun, dtg rsgm bersama ibu

• Gigi kanan atas sakit, ingin dirawat

• Intraoral exam. : caries profunda gigi 55

Diagnosis Cara mendiagnosis Rencana perawatan

Pulpitis irreversible Visual –showing a deep cavity involving the pulp, confirmed using a probe. If the probe is sent deep into the pulp, both pain and hemorrhage would be seen.Radiograph – It may show exposure of the pulp and deep cavity. The periapical area usually is normal, with some widening of the periodontal ligament sometimes.Percussion – Exudate in the pulpal cavity increases the intrapulpal pressure, which leads to tenderness on percussion of the tooth.Vitality test

Pulpotomy + SSC

Question 2

• Anak laki-laki, 7 tahun

• gigi kiri atas(64) berbau (halitosis)

• Makan/minum dingin : xde rasa ape2

Diagnosis Cara mendiagnosis Rencana perawatan

Necrosis pulpa InspectionradiographPalpationPercussion

Pulpectomy + SS crown

• Anak perempuan, 4 tahun

• Mengeluh sakit berdenyut hebat pada 54, menangis dan tak boleh tidur

• Ada pembengkakan pada 54 smpi bwh matakanan

Diagnosis Cara mendiagnosis Rencana perawatan

Abses et cause necrotic pulp

InspectionPalpation Percussion Vitality test

1) Incision and extraction of 54. *adequate drainage is almost impossible to achieved in primary tooth.2) Space maintainer

ORMummifikasi (DSP6 punyerslides by dr inne n dr yetty)

• Anak perempuan, 6 tahun

• Mengeluh sakit gigi kanan bawah (85) bile minum/mkn dingin

• Pt ingin ditambal

Diagnosis Cara mendiagnosis Rencana perawatan

Pulpitis reversible Inspection RadiographPalpationPercussion

Tambalanamalgam/composite

• Ini sgt instant. Kalau ade yg salah or nk tmbh, mangga di benerin nyak!

• Ref:

– Slides doc indri

– Slides doc inne n doc yetty

– Dentistry for child and adolescent (ebook DSP 9)

Radio-Fieka

Radiology

Periapical : Bi-centric technique

Communication

Bila patient masuk :

• Greet patients with salam and senyum mesra

• Suruh patient duduk

• Read status and confirm with patient : nama, alamat pendek, case

• Explain risk secara overview, eg

• Explain procedure to patient

Preparation (1)

• Operator : wear baju kebal, mask and glove

• Patient : position on chairMaxilla – tegak 90*Mandible – sudut mulut to tragus // lantai

• Film position’s principles :White surface faces teethThe dot faces occlusal

Note : 1) film @ palatal/lingual gigi only2) Maxilla : patient pegang dengan thumb

Mandible : patient pegang dengan jari tunjuk3) Anterior : film vertical4) Posterior : film horizontal

Preparation (2)

• Adjust angles and timer based on case

• Set voltage to 6V (standard)

Note : ada juga yang kata 5-6 so tak tau le

Shoot

• Confirm angles based on case

• Check patient’s head and film positions

• Turn the machine on

• Shoot.

Yam

• Class I : Bilateral edentulous areas located posterior to the natural teeth (bilateral free end)

• Class II : A Unilateral edentulous area located posterior to the remaining natural teeth (unilateral berujung bebas(free end unilateral))

• Class III : A Unilateral edentulous area with natural teeth remaining both anterior and posterior to it (gigi bersandaranganda)

• Class IV : A single but bilateral (crossing the midline), edentulous area located anterior to the remaining natural teeth

Applegate’s rule

• Klasifikasi dibuat setelah semua extraction selesai dilakukan

• Bila M3 hilang dan tidak diganti, so tak masuk klasifikasi

• Bila M3 ada dan akan digunakan sebagai gigi penahan, so

masuk dalam klasifikasi.

• Bila M2 dah hilang dan tak akan diganti, so tak masuk dalam

klasifikasi.

• Bagian tak bergigi paling posterior selalu menentukan kelas

utama dlam klasifikasi.

• Daerah tak bergigi yang tak masuk dalam klasifikasi, disebutmodifikasi.

• Jumlah gigi yang hilang tak dipersoalkan; yang dipersoalkanadalah jumlah ruangan gigi yang hilang (untuk dimasukkansebagai klasifikasi atau modifikasi)

• Tidak ada modifikasi untuk kelas IV

Cuba test!

Klasifikasi Soelarko

• Kelas I: berujung bebas

• Kelas II: bersandaran ganda

• Kelas III: gabungan berujung bebas dan bersandaran ganda

Aturan divisi

• Divisi 1: satu sisi

• Divisi 2: dua sisi

• Divisi 3: meliputi garis median

SURVEYING

• Survey model menggunakan surveyor.

• Surveyor adalah alat yang dipakai untuk meninjau kesejajarandari 2 permukaan gigi atau lebih, atau bagian lain dari model.

• Surveyor The Ney

• Kegunaan Surveyor:

Menentukan arah pemasangan

Menentukan garis survey

Menentukan daerah gerong (undercut)

Menentukan guiding plane

Menentukan penempatan cangkolan

Menutup daerah gerong yang tak diperlukan.

• Garis survey merupakan garis singgung yang menunjukkankontur terbesar suatu permukaan (gigi, alv ridge) pada arahpemasangan tertentu.

• Letak model atas meja model dgn zero tilting cari undercut kalau dapat undercut dgn baik, maka arah pemasangansejajar oklusal then buat garis survey pada semuapermukaan ggi sandaran dgn carbon marker kalau takdapat, tilting ke arah ant/ post/ kiri/kanan kalau dpatundercut yg baik, kunci meja model then buat gari survey sebelum melepas model, buat tripoding (untuk mencari ulangposisi terakhir survey)

Design Full Denture

• Retensi

• Stabilisasi

• Estetik

• Arah pemasangan

• Support

• (ni semua baca dekat slide dr. rasmi)

Design partial denture

• RETENTION

• STABILITY

• AESTHETIC

• EXTENSION

• PATH OF INSERTION / REMOVAL

• ORAL HEALTH (SOFT & HARD TISUE)

• (baca dekat slide dr. taufiq)

• Aku bukan malasehhhhhhhhhhhhhhhh…Cuma nanti I copy paste jugak hahahaha

Desain

• Retensi: kemampuan GT bertahan terhadap gaya yang melepaskan (DARI ARAH VERTIKAL) . (retensi untuk GTSL daricangkolan (retainer) pada gigi sandaran)

• Stabilisasi: kemampuan GT agar tidak goncang/bergeser padapemakaian. (dari arah horizontal). (stabilisasi terutamaberhubungan dengan dukungan/support (dari gigi/mukosa) dan dari oklusi

• Estetika: keindahan yang sesuai dgn keperibadian

• Support: kemampuan GT utk menahan tkanan dari arah apikal

• Arah pemasangan

• Tentukan gigi sandaran surveying buatgaris survey tentukan arah pemasangan (drisurveying) tentukan perluasan landasan

Cangkolan

• Cangkolan adalah bagian dari GTSL yang biasanya dibuat darikawat khusus (kawat klamer) atau dari logam cor. Melingkaridan menyentuh sebagian besar, keliling gigi, memberi retensi, stabilisasi dan suport bagi GTSL tersebut.

• Cangkolan C, Cangkolan bukal, Cangkolan E atau CangkolanBola (Ball clasp)

Syarat2 Cangkolan

• 1/3-1/2 ujung lengan retentif berada di daerah gerong danujungnya 1-2 mm diatas tepi gusi.

• 1/3 awal lengan retentif harus berada di daerah non gerong

• Kontak cangkolan dgn permukaan gigi harus kontakberkesinambungan.

• Cangkolan harus beradaptasi dan tidak menekan gigi.

• Bila memakai oklusal rest tidak boleh mengganggu oklusi

• Ujung lengan dibuat sepanjang mungkin

• Ujung lengan dibentuk sehingga tidak tersangkutnya sisamakanan, bibir, pipi serta lidah

• Cangkolan tak boleh cacat bekas tang

• Utk tangan cangkolan yg panjang (misal pd ggi molar) gunakankawat klamer 0.8 mm.

Mengukur

• Yang nak ukur linggir, daerah x bergigi semua tu…I honestly x tau sgt pun…kat buku xde,,secara teorinya…so, I rase basically ape yg kita buat dalam lab…main point is pakai pembaris besiyang mula dari nol tu.

• Nak ukur dari mesial ke distal ke ape ke…I kurang tahu…maafya teman2…kalau ade yg tau.,,nanti kongsi2 kayyy

• Love u alll…awhhhhh gewdixxx

• Raaawwrrrrrrr..

DMT-nina

Alginate

Model cast

• Baca case carefully, and understand the needs..

• Nak impression ke, nak casting ke..etc

• What region..

• wear gloves!

alat2

• Sendok cetak/tray: berlubang, ruang 4-6mm dari gigi.

• RA: sampai daerah AH-line

• RB: sampai molar terakhir/retromolar pads.

• Tak cukup: tambah lilin dgn retensi.

alginate

metode

• Cetakan mukostatis

- Tekanan minimal

- Bahan cetak hidrokoloid

- Indikasi: gigi goyang, byk undercut & diastema

alginate

persiapan

• Mulut: bahu & siku operator• Instruksi pasien nafas ikut hidung.• Oklusal rahang sejajar lantai.• Pasien kumur dahulu.

• Operator bersih + wear gloves.• Cetak Rahang Bawah dulu!• Posisi cetak: -RA – diri depan kanan, masukkan sendok cetak, fix,

pindah ke kanan belakang. -RB – depan kanan.

alginate

persediaan

• RA: 2.5 scoop alginate, 1 sukatan air• RB: 2 scoop alginate, ¾ sukatan air• Guna air dingin – lengthen working time• Masuk air dalam bowl• Shake powder dalam beg – ambil, ratakan pakai

spatula• If ada kertas disediakan -> tempat letak powder.• Bubuk -> air• Sediakan another bowl of air utk ratakan

impression

alginate

pengadukan

• Aduk sampai semua terbasahi

• 1 minit/ 45-60 saat

• Menekan ke dinding bowl – alginat larut, buang udara, homogen

• Isi sendok posterior ke anterior

• Ratakan pakai jari basah.

• Work quickly before color changed.

alginate

mencetak

- RB dulu!

-telunjuk kiri tarik sudutmulut pasien

- kanan sendok cetakmasuk dulu

-posisikan segarismidline

-tekan sendok –posterior anterior

alginate

RB – instruct patient utk gerakkan lidah ke atas danke depan.

-kalau ada yg belum tertutup (vestibulum), tambahalginat.

-hold in place for atleast 2mins-cek kekerasan dgn excess di bowl

-buka seal dengan retracting cheek to allow air inside

- RA: tarik tangkai ke atas, lepaskan posterior dulu, sejajar tooth axis

- RB: tekan tangkai ke bawah, lepaskan posterior dulu.

Hasil cetakan

• Semua anatomi tercetak (muccobuccal fold, frenulum, etc)• Hopefully takde:- Bubbles yang besar- Vestibule tak tercetak sebab tak cukup tinggi- Penyimpangan midline- Decreased/increased depth

• Rinse with water to remove saliva & blood• Remove excess water..done!• Cor gips within 15-30mins..kalau lebih, moisten alginate

with damp tissue

alginate

• Plaster Gips ; study model 50-60cc:100gr

• Stone Gips; work model 30cc:100gr

• RA: ± 100 gr

• RB: ± 80 gr

• Letak powder on paper or alas if ada.

Cast model

mixing

• Isi air dlm bowl

• Tuang powder (15s)

• Tekan2 with spatula until all wet (15s)

• Aduk until homogen (60s)

• Use vibrator or ketuk2 atas meja with the upper side of bowl tertutup, until bubbles xde(1.5mins).

Cast model

loading

• Place posterior part higher

• Tgn kiri pgg handle, tgn kanan load

• Masuk dari satu arah shj!

• Ketuk2 kat meja to let it flow until cervical

• Tutup semua tapi jgn terlebih nnt susah buka

• Tunggu smpi gips hilang shine and cool down.

• Buat retensi

Cast model

removing

• Minimum 30 mins, maksimum 60 mins• Buang excess dulu• Under running water

• If gips chalky because: Impression not clean Ada air on impression Remove too early/too late Low w/p ratio

Cast model

ORAL MEDICINE-suga

Anamnesis

Chief Complaint

Location of the lesion

Time Course

Quality of pain

Factors that reliefs the pain

Factor that triggers the pain

Whether been treated before

What wants to be done

Blood Pressure Measure

• Patient is rested and relaxed.

• Check with the patient as to which arm is usually used for the cuff (preference as a result of existing medical conditions or previous procedures).

• Ensure that the arm to be used is supported at the same level as the heart.

• The elbow needs to be extended, to allow the best detection of the brachial artery in the elbow joint.

• Palpate the brachial pulse, this is where the stethoscope will be placed when listening for the Korotkoff sounds.

• Size the cuff correctly, the bladder portion must extend at least 80% around the arm.

• Apply the cuff to the upper arm, the centre of the bladder in line with the brachial artery.

• The cuff needs to be positioned to allow the stethoscope diaphragm clear access to the brachial artery (not too tight or loose).

• Should be no trapped clothing beneath the cuff: reading error, due to a pressure point.

• Find the radial pulse and keep monitoring this.

• Close the control valve (arrowed) on the sphygmomanometer.

• Gently pump the bulb until radial pulse cannot be felt.

• Continue to inflate adding 30 mmHg.

• Then, gently open the valve for a slow controlled release of air from the cuff with 2mm Hg per second.

• Listen carefully for the first beat: REAL SYSTOLIC PRESSURE.

• At some point, you will not be able to detect the beat.

• This is the: DIASTOLIC PRESSURE.

• Open the air valve fully, to rapidly deflate the cuff.

• Release the patient from the equipment.

• Record your readings, Systolic over Diastolic.

SUMMARY:

Topical Medication

Needed Items

• Pinset

• Topical Medication (gel/ointment)

• Gloves

• Cotton pellet

• Glass lab

• Gauze

• Wash your hands and wear the gloves.

• Place the gel or ointment on the glass lab.

• Use gauze to dry the mucosal tissue completely.

• Prevent using cotton roll to dry the tissue that can cause the wools stick onto the lesion.

• Use the cotton pellet to apply a small amount of the medication onto the lesion and a bit of the surrounding.

• Leave the area untouched for 5 min for a full absorption.

• If the lesions is on the palate, use folded gauze and ask the patient to bite it for 5 min.

Periodontology-githa, ashley

1. Structure of healthy gingiva

• Color: coral pink

• Size: depends on vascular supply

• Contour: marginal gingiva (collar like/scalloped)

• Shape: interdental gingiva (anterior: pyramidal shape, posterior: flattened)

• Consistency: firm, resilient

• Surface texture: stippled- on attach gingiva

• Position: gingival margin

2. Basic instruments

• Explorer

• Mouth mirror

• Pinset

• Probe

3. Examination

• Anamnesis

- Medical history

- Bad habits

• Intraoral

- Drifting of teeth

- Tooth mobility

- Attrition

- Sensivity

- Abrasion

- Pain

- Gingival bleeding(spontaneous/ non-spontaneous)

- Stillman’s Cleft (dry mouth and severe gingivitis)

4.Types of periodontal disease

• Gingival disease

- plaque induced

- non plaque induced

• acute / aggressive periodontitis

- localized/ generalized

• Chronic periodontitis

- localized/ generalized

5. Brushing method

• Vertical :disadvantage - cause gum recession

• Horizontal :disadvantage- interdental not cleaned, abrasion, recession

• Roll : for patient with healthy gingiva & brush placed above free gingiva and bristles towards apices

• Circular / Strokes: For children

• Vibratory – 450 into gingival sulcus & mainly for periodontitis patient

Choosing the right tooth brush

• Round ended

• Soft bristles

• Flat surfaces

• Small head

• Straight head