Composite is a compound of two or more different constituents with properties that are superior to those of the individual constituent.
COMPOSITION: a) Resin Matrix
The matrix consists of Bis-phenol Glycidylmethacrylate (Bis-GMA) and Triethylene Glycol Dimethacrylate (TEGDMA). TEGDMA is used as a viscosity controller.
b) Fillers - silica
Addition of fillers increases the strength, hardness, abrasion resistance and decreases the polymerization shrinkage and water sorption.
c) Coupling agent
Organosilane, zirconates or titanates. They bond the filler particles to the resin matrix.
e) Opacifiers and coloring agents
Titanium dioxide and aluminum oxide are the opacifiers.
The coupling agent between filler particle and the resin is VINYL SILANE.
TYPES: CHEMICALLY ACTIVATED COMPOSITES:
# Supplied in two pastes
Basic Paste - Contains the initiator benzoyl peroxide
Accelerator Paste - Contains tertiary amine as activator (N-dimethyl-p-toluidine)
# It is manipulated by mixing the proper proportions on a mixing pad with an agate spatula as metal spatula discolors the material.
# Cavity should be slightly overfilled.
# Shrinkage occurs towards the centre of the material.
LIGHT ACTIVATED COMPOSITES
# Consists of a single paste
Initiator - Camphoroquinone
Activator - diethyl-amino-ethyl-methacrylate or diketone
- They interact when exposed to light at wavelength of 400-500 nm i.e. blue region of the visible light spectrum.
- Ultraviolet light curing is not indicated because of its limited depth of penetration through tooth structure. It also poses a potential health hazard.
- The source of light is a tungsten halogen bulb.
- The tip should be kept as close as possible to the restoration and should be cured in increments.
- Each increment should not be greater than 2 mm and the exposure time should be 40-60 seconds.
- Darker shades require longer exposure time.
- Light emitted may cause retinal damage and can be prevented by using protective eyeglasses.
- Shrinkage occurs towards the light source.
- Cavity preparation for composites is beveled except when margins are in cementum.
Type VIII and Type IX - Posterior packable GIC for atraumatic restorations
Among the first three types, the highest cumulative release of fluoride after 30 days is from glass ionomer liner.
- GIC was introduced as a potential replacement for silicate cement. It has been evolved as a hybrid from the silicate and polycarboxylate cement.
Light Polymerization:
The powder contains initiators for light curing and liquid component is modified with hydroxyethyl methacrylate (HEMA).
The polymerization starts when exposed to light and subsequently followed by acid base reactions. This is called dual cure GIC.
PROPERTIES:
GIC has low fracture toughness and wear resistance.
It is very sensitive to moisture, especially during initial setting reaction. During this period, absorption of water leads to weak cement and over drying will lead to cracks in the cement. Therefore, the surface of cement should be protected by coating with varnish or cocoa butter during setting.
It bonds chemically to the tooth structure.
- The bond of enamel is always higher than that of dentin.
- It is relatively biocompatible, the pulpal reaction is greater than ZOE but less than Zinc Phosphate Cement.
- Due to continuous fluoride release, it has some anticariogenic property.
- Powder: Liquid ratio is 3:1 by weight. Mixing should be done by agate or plastic spatula.
- 10 % polyacrylic acid should be used for conditioning the cavity surface before insertion of the cement.
- Final finishing is done 24 hours after the insertion.
MODIFICATIONS OF GIC:
a) Miracle Mix or Silver Cement
Silver-Tin alloy powder is added to GIC Powder. None of the properties were improved and it gave a gray or blackish color to the cement. It is also called as silver alloy mix.
b) Glass Cermet or Cermet
Glass and metal ( Silver-tin-titanium) powders were sintered at high temperature and made to react with liquid. It improved the fracture toughness and wear resistance and at the same time maintained the esthetics.
c) Resin modified GIC
BisGMA, TEGDMA, are added to powder and HEMA to the liquid. With exposure of light polymerization is initiated along the methacrylate groups. After that the liquid reacts with the glass particles through acid base reaction. It improved the wear resistance and decreased the sensitivity to
water attack.
d) Compomer (Polyacid modified composite resins)
It is a combination of composite and GIC. Glass particles are partially silanated (for bonding with the matrix) and are added as fillers in the composite resin. There is no water in the reaction. The properties were inferior to composites but superior to resin modified GIC.
e) Bilayered or Sandwich restoration
In this technique, GIC is used as a liner under composite restorations. It increases the retention form as GIC bonds both the tooth and composite and the fluoride content reduces secondary caries.
f) Tunneling restorations
Joining the occlusal lesion with the proximal lesion by means of a prepared tunnel under the involved marginal ridge. The marginal ridge remains intact. GIC is used as the restorative material in this technique.
g) Atraumatic restoration (ART)
Involves removal of affected tooth structure with hand instruments, followed up by restoring with GIC material (GC Fuji VIII).
h) High viscosity GIC
Used for atraumatic restorative treatment. They contain small particle sizes and a high P/L ratio, yielding greater compressive strength and excellent packability. Also used for core buildups, primary tooth fillings and intermediate restoration.
i) Calcium aluminate GIC
It is a hybrid product of calcium aluminate and GIC. The GIC components are responsible for early properties (i.e. setting time, viscosity, and strength). The calcium aluminate contributes to basic pH, biocompatibility and reduction in microleakage. Also called as hydraulic cement.
Hairy Leukoplakia is the second most common HIV-associated oral mucosal lesions after Candidiasis. It is non malignant and is not pathognomic for HIV since other immunodeficiencies such as cancer chemotherapy are also associated with hairy leukoplakia. The common site for this condition is on the lateral borders of tongue in form of vertical white folds.
Diagnosis of Hairy Leukoplakia
Features
Provisional Diagnosis
Characteristic gross appearance with or without non responsiveness to antifungal therapy
Presumptive Diagnosis
Light microscopy of histologic sections revealing hyperkeratosis, koilocytosis, acanthosis, and absence of inflammatory cell infiltrate
OR
Light microscopy of cytologic operations demonstrating nuclear beading and chromatin margination
Definitive Diagnosis
Insitu Hybridisation of histologic or cytologic specimen revealing positive staining for EBV DNA
OR
Electron microscopy of histologic or cytologic specimen showing herpes-like particles
OR
Epstein-Barr Virus was demonstrated with polymerase chain reaction technique.
Click HERE to view all our MCQ Topics. # All of the following statements about the typical features of a periapical granuloma are TRUE except :
A. It consists of proliferating granulation tissue
B. It can form only if the periapical bone is resorbed
C. It shows evidence of local antibody production
D. It results from immunologically mediated tissue damage
# Phlegmon is a :
A. Sexually transmitted disease
B. Type of cellulitis
C. Type of osteomyelitis
D. Endocrine Disease
# Most common cyst in oral region is :
A. Medial cyst
B. Radicular cyst
C. Follicular cyst
D. Nasolabial cyst
# Dental cyst:
A. Occurs from reduced enamel epithelium
B. replaces the tooth to which it is attached
C. is frequently seen with a missing tooth on the X ray
D. Cystic lining of stratified squamous epithelium
# The earliest response of pulpitis is :
A. Cyst formation
B. Calcification
C. Hyalinization
D. Formation of dental granuloma
# Garre's chronic non supurative sclerosing osteomylitis is characteried clinically by:
A. Endosteal bone formation
B. Periosteal bone formation
C. Resorption of medullary bone
D. Resorption of cortical bone
# Abscess formation is particularly characteristic of infections with which of the following microorganisms ?
A. Viruses
B. Rickettsiae
C. Streptococci
D. Staphylococci
# Organism involved in cellulitis is :
A. Streptococcus mutans
B. Streptococcus pyogenes
C. Pneumococci
D. Klebsiella
# An acute apical abscess is usually a result of :
A. Periodontal pocket
B. Occlusal interference
C. Necrotic pulp
D. Chronic gingivitis
# Which of the following periapical conditions is associated with a vital pulp ?
A. Apical cyst
B. Apical scar
C. Condensing osteitis
D. Chronic apical periodontitis
# The main causative agent of Ludwig's angina is:
A. Anaerobic Streptococci
B. Aerobic Streptococci
C. Staphylococci
D. Legionella infection
# The most common organism involved in a periapical abscess is :
A. Streptococcus pyogenes
B. Streptococcus viridans
C. B hemolytic Streptococci
D. Non hemolytic Streptococci
# The earliest radiographic sign of osteomyelitis is :
A. Solitary or multiple radiolucent areas
B. Increased granular radioopacity
C. Blurring of trabecular outlines
D. Formation of sequestrum appearing as radioopaque patches
# Osteomyelitis begins as an inflammation of :
A. Cortical bone
B. Periosteum
C. Medullary bone
D. Periosteum and inner cortex
# Focal sclerosing osteonyelitis is:
A. Due to excessive periosteal bone formation
B. An extremely painful condition
C. Due to low grade chronic infection
D. A common sequel following sequestrectomy
# A tooth with a 3 month history of pain, which was worse when hot liquid were in mouth. After extraction, the tooth was split open. The pulp chamber was completely filled with pus. A few remnants of pulp tissue were found in the apical end. The condition is :
A. Acute partial Pulpitis
B. Acute total pulpitis
C. Suppurative pulpitis
D. Strangulation of pulp
# Chronic hyperplastic pulpitis is:
A. necrotizing
B. Suppurative lesion
C. proliferation of a chronically inflammed pulp
D. also called as phoenix abscess
# Periapical cyst is usually preceded by:
A. Periapical granuloma
B. Periodontal abscess
C. Periapical abscess
D. All of the above
# Acute osteomyelitis is most frequently caused by which of the following microorganisms ?
A. Gonococcus
B. Enterococcus
C. Streptococcus
D. Staphylococcus
# An asymptomatic tooth has deep caries on occlusal surface. Radiograph shows radiopaque mass at apex of the tooth; this mass is most likely to be :
A. Cementoma
B. Condensing osteitis
C. Chronic apical periodontitis
D. Acute apical periodontitis
# A person experiences throbbing pain at night. It is due to:
A. Acute pulpal degeneration
B. Acute periodontal abscess
C. Chronic pulpitis
D. Cellulitis
# Pain due to acute irreversible pulpitis is :
A. Spontaneous
B. Sharp-shock like
C. Lasting for short time
D. Continuous
# Reversible pulpitis change to irreversible pulpitis primarily because of :
A. Vascular strangulation
B. Reduced host resistance
C. Invasion of microorganisms
D. An increase in microbial virulence
# Which is not true of Ludwig's angina?
A. Usually arises from an infected molar
B. Involves submandibular space
C. May need emergency tracheostomy
D. None of the above
# Odontogenic epithelium responsible for the formation of dental cyst is :
A. Cell rests of Serres
B. Enamel Organ
C. Reduced enamel epithelium
D. Cell rests of Malassez
# The caries of enamel surface leads to accentuation of:
A. Incremental lines of Retzius
B. Perikymata
C. Imbrication lines of Pickerill
D. Wickham's Striae
# Constant feature associated with radicular cyst is :
A. an impacted tooth
B. a missing tooth
C. a non vital tooth
D. an anomalous tooth
# Which of the following differentiates between condensing osteitis and benign cementoblastoma ?
A. Condensing osteitis is associated with vital tooth whereas cementoblastoma is associated with a non vital tooth
B. In condensing osteitis, radiopacity is attached to tooth whereas in cementoblastoma it is not
C. Cementoblastoma is associated with vital tooth whereas condensing osteitis is associated with non vital tooth
D. In cementoblastoma, radiopacity is attached to the tooth whereas in condensing osteitis it is not
# Best way to differentiate periapical cyst and periapical granuloma is:
A. Radiographically
B. Histologically
C. Clinically
D. None of the above
# A diffuse spreading inflammatory lesion is due to bacterial enzyme:
A. Coagulase
B. Hyaluronidase
C. Peroxidase
D. Bradykinin
# Chronic periostitis in children is known as:
A. Cherubism
B. Garre's osteomyelitis
C. Histiocytosis X
D. Tuberculous osteomyelitis
# Which of the following is more prone to osteomyelitis?
A. Maxilla
B. Zygoma
C. Palatine bone
D. Mandible
# The chronic osteomyelitis of jaw consists of :
A. Condensing osteitis
B. Sclerotic cemental mass
C. Chronic diffuse sclerosing osteomyelitis
D. All of the above
# The fascial spaces involved in the Ludwig's Angina are:
A. Unilateral - Submandibular and Sublingual spaces
B. Bilateral - Submandibular and Sublingual Spaces
C. Unilateral - Submandibular, Sublingual and Submental spaces
D. Bilateral - Submandibular, Sublingual and Submental Spaces
# Three stages in progression of acute odontogenic infection are :
A. Periapical osteitis, cellulitis, abscess
B. Abscess, cellulitis, periapical osteitis
C. Cellulitis, abscess, periapical osteitis
D. Periapical osteitis, abscess, cellulitis
# The tooth most commonly involved in chronic focal sclerosing osteomyelitis is:
A. Maxillary second molar
B. Maxillary third molar
C. Maxillary first molar
D. Mandibular first molar
# Cyst arising from Rests of Malassez is:
A. Dental Cyst
B. Dentigerous cyst
C. Radicular cyst
D. Keratocyst
# Low grade infection which leads to localized periosteal reaction is:
A. Garre's Osteomyelitis
B. Acute Osteomyelitis
C. Condensing Osteitis
D. Local alveolar Osteitis
# Tiny linear or arc-shaped bodies, amporphous, brittle and eosinophilic in reaction, found in association with some odontogenic cysts, are called:
A. Civatte bodies
B. Russel Bodies
C. Guarneri Bodies
D. Rushton bodies
# The cells most frequently found in a granuloma are:
A. Mast cells
B. Giant cells
C. Lymphocytes
D. Neutrophils
# Most used selective medium for Streptococcus mutans is :
A. Mac conkey agar
B. Mitius salivarius bacitracin agar
C. Nutrient agar
D. Tellurite medium
# Most demineralized zone in enamel caries is :
A. Translucent zone
B. Body of lesion
C. Dark zone
D. Surface zone
# The gelatinous deposit adherent on the tooth surface is called as:
A. Materia alba
B. Plaque
C. Calculus
D. All of the above
# Streptococcus mutans produces an adhesive polymer from sucrose, known as:
A. Levans
B. Lectins
C. Glucans
D. Polyfructans
# Liquefaction foci of Miller is a hostopathological observation in:
A. Cemental caries
B. Early enamel caries
C. Advanced enamel caries
D. Advanced dentinal caries
# Which of the following is cariostatic?
A. Selenium
B. Magnesium
C. Cadmium
D. Molybdenum
# Progression of dental caries on pit and fissures occur from:
A. Apex of the pit and fissure
B. Wide end of the pit and fissure
C. Lateral surface of the pit and fissure
D. Bottom of the pit and fissure
# Which of the following represents a soluble polysaccharide found in dental plaque and is formed from the fructose moiety of the sucrose?
A. Levan
B. Dextran
C. Amylopectin
D. Hyaluronic acid
# Plaque microflora can split carbohydrates. What does it mean?
A. Saccharolytic
B. Saprophytic
C. Virulent
D. Avirulent
# True about caries, all except:
A. Infectious and transmissible
B. Not due to microorganisms
C. Can develop in the absence of sucrose
D. Microorganisms play the most essential role
# A 30 year old patient with radiograohic appearance of endosteal bone formation, sclerosed bone is likely to be suffered from?
A. Garre's osteomyelitis
B. Chronic focal sclerosing osteomyelitis
C. Acute osteomyelitis
D. Chronic Osteomyelitis
# Internal carotid artery at the bifurcation from the common carotid is :
A. Lateral to the external carotid
B. Medial to external carotid
C. Posterior to external carotid
D. Anterior to external carotid
# Foramen transversarium transmit :
A. Internal jugular vein
B. Inferior petrosal sinus
C. Sigmoid sinus
D. Vertebral artery
# The cavernous sinus communicates directly with all except :
A. Inferior petrosal sinus
B. Pterygoid venous plexus
C. Veins in orbit
D. Sigmoid sinus and straight sinus
# Middle thyroid vein drains into :
A. External jugular vein
B. Anterior jugular vein
C. Internal jugular vein
D. Brachiocephalic vein
# Ophthalmic artery is the branch of __________ part of internal carotid artery .
A. Intra cavernous
B. Intra petrous
C. Intra cerebral
D. Extra cranial
# Artery palpable at the anterior border of masseter is :
A. Maxillary artery
B. Facial artery
C. Lingual artery
D. Superficial temporal artery
# Anterior spinal artery is a branch of :
A. Internal carotid artery
B. Basilar artery
C. Vertebral artery
D. Labyrinthine artery
# Blood supply of coronoid process of mandible is primarily from :
A. Inferior alveolar artery
B. Deep temporal artery
C. Facial artery
D. Middle meningeal artery
# Dangerous area of the face is :
A. Above the line joining tragus to the nasal fold
B. Area drained by angular facial vein
C. Spheno-ethmoidal recess
D. All of the above
# Middle meningeal artery is a direct branch of :
A. External carotid artery
B. Internal maxillary artery
C. Superficial temporal artery
D. Middle cerebral artery
# Posterior communicating artery is a branch of :
A. Middle cerebral artery
B. External carotid artery
C. Internal carotid artery
D. Ophthalmic artery
# Carotid sheath contains all except :
A. Carotid artery
B. Internal jugular vein
C. Vagus nerve
D. Phrenic nerve
# The facial vein communicates with the cavernous sinus through :
A. Retromolar vein and internal jugular vein
B. External jugular vein and internal jugular vein
C. Internal jugular vein and retromandibular vein
D. Superior ophthalmic vein and pterygoid venous plexus
# What is not true of facial artery ?
A. Main source of oxygenated blood to palatine tonsil
B. Is a branch of internal carotid artery
C. Supplies branches to both upper and lower lips
D. Conveys post ganglionic sympathetic nerve fibers to the submandibular gland
# Treatment of choice for subgaleal hematoma is:
A. Incision and evacuation
B. Needle aspiration
C. Antibiotics and then drain
D. Conservative
# Internal thoracic veins are tributaries of the :
A. Azygous
B. Subclavian
C. Internal jugular
D. Brachiocephalic
# Injury to one of the following arteries leads to extradural hematoma :
A. Middle meningeal artery
B. Facial artery
C. Temporal artery
D. Anterior cerebral artery
# Infecion spreading via lymphatics from the lower lip first enter the blood stream at the :
A. Brachiocephalic vein
B. Inferior labial vein
C. Inferior labial artery
D. Pterygoid venous plexus
# The following arteries provide a rich blood supply to the face , EXCEPT the :
A. Buccal artery
B. Mental artery
C. Posterior auricular artery
D. Infraorbital artery
# Tributaries of the cavernous sinus includes all of the following except :
A. Superior petrosal sinus
B. Inferior petrosal sinus
C. Superficial middle cerebral vein
D. Deep middle cerebral vein
# The transverse venous sinus continues as :
A. Straight sinus
B. Cavernous sinus
C. Sigmoid sinus
D. Ethmoidal sinus
# All of the following supply TMJ except :
A. External carotid artery
B. Internal maxillary artery
C. Transverse facial artery
D. Branches supplying lateral pterygoid
# Right anterior quadrant of the scalp is supplied by the following arteries except :
A. Right supra orbital artery
B. Right supra trochlear artery
C. Right superficial temporal artery
D. Right maxillary artery
# The following branches originate directly from the subclavian artery except :
A. Vertebral
B. Thyrocervical trunk
C. Internal thoracic
D. Supra scapular
# Common facial vein is formed by the union of :
A. Anterior facial and posterior facial veins
B. Anterior facial and posterior auricular veins
C. Anterior facial and maxillary veins
D. anterior facial and anterior branch of the *posterior facial vein
# The external carotid artery divides at the level of :
A. Angle of mandible
B. Neck of the mandible
C. Oblique line of thyroid cartilage
D. Lower border of cricoid cartilage
# The number of branches of the internal carotid artery in the neck is :
A. One
B. Two
C. Four
D. None
# Lymph from the teeth drains into all of the following nodes except :
A. Sub mandibular nodes
B. Deep cervical nodes
C. Retropharyngeal nodes
D. Sub mental nodes
# Facial artery does not supply the :
A. Tonsils
B. Submandibular gland
C. External auditory meatus
D. Lower part of the nasal septum
# The external jugular vein :
A. Lies deep to the Sternocleidomastoid muscle
B. It drains into internal jugular vein
C. It is formed by the union of the posterior auricular vein and posterior division of the retromandibular vein
D. It pierces pre-tracheal layer of cervical fascia before termination
# Danger area of face is called so because of connection of facial veins to cavernous sinus through :
A. Transverse facial vein
B. Superior ophthalmic vein
C. Maxillary vein
D. Ethmoidal vein
# Origin of maxillary artery :
A. Angle of mandible
B. Neck of condyle
C. Body of mandible
D. Coronoid process
# Facial artery arises at the level of :
A. Below hyoid bone
B. Above hyoid bone
C. Hyoid bone
D. Above styloid process
# The ascending palatine artery is a branch of :
A. Ascending pharyngeal artery
B. First part of the facial artery
C. Pterygopalatine part of the maxillary artery
D. Sphenopalatine artery
# Which of the following is not a branch of the external carotid artery ?
A. Ophthalmic artery
B. Pharyngeal artery
C. Maxillary artery
D. Lingual artery
# Internal jugular vein is a continuation of :
A. Common facial vein
B. External jugular vein
C. Sigmoid sinus
D. Superior petrosal sinus
# The retromandibular vein is formed by :
A. Superficial temporal and maxillary veins
B. Superficial temporal and internal jugular vein
C. Superficial temporal and supratrochlear
D. Maxillary and posterior auricular
# The main arterial supply of the face is :
A. Superficial temporal
B. Maxillary
C. Facial
D. Internal carotid artery
# Transverse facial artery is a branch of :
A. Superficial temporal
B. Maxillary
C. Facial
D. Internal carotid artery
# Largest vein of face is :
A. Facial vein
B. Retromandibular vein
C. Posterior auricular
D. Supratrochlear
# Carotid sheath contains all except :
A.Vagus nerve
B. Internal carotid artery
C. Common caroid artery
D. External carotid artery
E. Internal jugular vein
# Vertebral artery is a branch of :
A. Subclavian artery
B. Internal carotid artery
C. External carotid artery
D. Superficial temporal artery
# Which of the following is a paired venous sinus of duramater ?
A. Cavernous sinus
B. Superior petrosal
C. Transverse sinus
D. All of the above
# Hypophysis cerebri is supplied by
A. Internal carotid
B. External carotid
C. Maxillary artery
D. Facial artery
# Which of the following is not correct ?
A. Right common carotid artery is a branch of brachiocephalic artery
B. Left common carotid artery is a branch of arch of aorta
C. The common carotid artery is divided into external and internal carotid arteries at level of upper border of thyroid cartilage
D. Carotid sinus acts as a chemoreceptor
# Occipital artery is a branch of :
A. Internal carotid artery
B. Posterior branch of external carotid
C. Medial branch of external carotid
D. Anterior branch of external carotid
# TMJ is supplied by :
A. Superficial temporal
B. Maxillary
C. Internal carotid
D. Both A and B
# True about subclavian artery :
A. Principal artery of the upper limb
B. Right subclavian artery is a branch of brachiocephalic artery
C. Left subclavian artery is a branch of arch of aorta
D. Internal thoracic, vertebral and thyrocervical trunk are branches of subclavian artery
E. All of the above
# Which of the following is correct ?
A. Subclavian vein is a continuation of axillary vein
B. Internal jugular vein is a direct continuation of sigmoid sinus
C. Brachiocephalic vein is formed behind the sternoclavicular joint by the union of internal jugular vein and the subclavian vein
D. All of the above
# Soft palate is supplied by :
A. Greater palatine artery
B. Ascending palatine artery
C. Ascending pharyngeal artery
D. All of the above
# The stage of deglutition, which is voluntary in nature is :
A. Stage - I
B. Stage - II
C. Stage - III
D. Satge I and Stage II
# Auditory tube is supplied by :
A. Ascending pharyngeal
B. Middle meningeal
C. Artery of pterygoid cannal
D. All of the above
# The maxillary vein accompanies :
A. First part of the maxillary artery
B. Second part of maxillary artery
C. Third part of maxillary artery
D. None of the above
# Superior vena cava is formed by :
A. Subclavian vein
B. Internal jugular vein
C. External jugular vein
D. Thoracic vein
E. Brachiocephalic vein
# What is not true for facial artery ?
A. Main source of blood supply to palatine tonsil
B. Supplies branches to upper and lower lips
C. Conveys post ganglionic sympathetic fibers to submandibular gland
D. Is a branch of internal carotid artery
