AFK weekly newsletter 5

Feb 19 / AFK study plan
- Studying oral surgery may seem challenging, but it’s a trendy topic for the AFK (Assessment of fundamental knowledge) exam!

- Today, let’s tackle just 5 questions from our question bank together, diving into each answer and the concepts behind them.

-If you’re pressed for time, feel free to scroll to the end of the page to find the ✅ Takeaway & 📌 Study Tip. Together, let’s empower ourselves with knowledge!

#Prothesis
1-Which of the following impression materials is hydrophobic:
A. Polyvinyl siloxane
B. alginate
C. polyether
D. none of the above

 A. Polyvinyl siloxane (PVS)
Impression materials are classified based on their hydrophilicity (ability to interact with water) or hydrophobicity (repelling water).

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Polyvinyl Siloxane (PVS) – Hydrophobic

PVS is a silicone-based material known for its excellent dimensional stability and accuracy.
It is inherently hydrophobic, meaning it repels moisture, which can make capturing impressions in a moist environment challenging.
Some modern PVS formulations include surfactants to improve wettability, but they remain less hydrophilic than other materials.

Alginate – Hydrophilic

Alginate is an irreversible hydrocolloid and is naturally hydrophilic (absorbs water).
It is commonly used for preliminary impressions due to its ease of use and quick setting time.

Polyether – Hydrophilic

Polyether is inherently hydrophilic, making it ideal for capturing fine details in moist conditions.
It has good flow properties and excellent dimensional accuracy.
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#Orthodontics
2-Posterior cross bite with functional shift would be treated with:
A. Unilateral expansion in late mixed dentition.
B. unilateral expansion in early mixed dentition
C. bilateral expansion in the late mixed dentition
D. bilateral expansion in early mixed dentition

 D. bilateral expansion in early mixed dentition
A posterior crossbite with functional shift occurs when the patient’s mandible deviates to one side upon closure due to occlusal interferences. This is often caused by a narrow maxilla leading to dental or skeletal misalignment. Early intervention is crucial to prevent asymmetric growth and long-term occlusal problems.

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Timing (Early Mixed Dentition) Matters

The early mixed dentition phase (typically between 6-9 years old) provides an optimal window for intervention because the midpalatal suture is still open, making expansion easier and more stable.
Late mixed dentition (after age 9-10) makes expansion more difficult as sutures begin to fuse.

Bilateral vs. Unilateral Expansion

Unilateral expansion is NOT recommended because the problem is usually skeletal and symmetrical (even if the shift appears unilateral).
Bilateral expansion (using appliances like a Rapid Palatal Expander - RPE) corrects the transverse deficiency and eliminates the need for mandibular shift.

Why Not Late Mixed Dentition?

If treatment is delayed to the late mixed dentition phase, expansion becomes less effective due to suture maturation, requiring greater force or even surgical assistance in severe cases.

#Surgery
3- An envelope flap that is 6mm in comparison to 12mm will have:
A. 50% faster healing
B. 50% slower healing
C. Healing that is twice as fast
D. Healing that is twice as slow
E. The same healing time

 E. The same healing time
The healing of a surgical flap depends primarily on vascular supply and tissue viability, rather than just the size of the flap. Healing Follows a Standard Biological Process:
Inflammatory phase (0-3 days) Blood clot formation and inflammatory response.
Proliferative phase (4-14 days) – Formation of granulation tissue and re-epithelialization.
Remodeling phase (weeks to months) – Maturation and strengthening of the tissue.

These phases occur at the same rate regardless of flap size, as long as the vascular supply is maintained.

Flap Size Does Not Directly Affect Healing Time:

A well-designed envelope flap maintains its blood supply.
Even if the flap is larger (12mm), as long as it has an intact base for perfusion, the healing rate remains unchanged.
Flap thickness, not just length, has a greater impact on healing
(thicker flaps may heal faster due to better vascularity).

Factors That Can Delay Healing (but Not Flap Size Alone):

Compromised blood supply (e.g., excessive stretching, tension, or trauma).
Systemic conditions (e.g., diabetes, smoking, poor nutrition).
Infection or poor surgical technique.

#Surgery
4-A patient presents after surgery with a small swelling in the mucosa. The patient has no pain, fever or lymphadenopathy. The most appropriate management is:
A. Observation
B. Antibiotic
C. Anti-inflammatory
D. Curettage

   A. Observation
A small swelling in the mucosa after surgery, without pain, fever, or lymphadenopathy, is most likely a localized post-surgical inflammatory reaction or a minor fluid collection (such as a seroma or small hematoma). In such cases, no active intervention is immediately required beyond observation.
Why Observation is the Best Approach?

No Signs of Infection:

The absence of fever, pain, or lymphadenopathy suggests that the swelling is not infectious (e.g., an abscess).
If it were an infection, symptoms such as redness, warmth, pain, and pus formation would be expected.

Common Causes of Post-Surgical Swelling:

Seroma – A collection of clear fluid that typically resolves on its own.
Small hematoma – A mild accumulation of blood under the mucosa, which usually resorbs naturally.
Fibrosis or granulation tissue formation – Part of the healing process.
Minor post-op inflammation – Normal tissue response to surgery.

Why Not Other Options?

Antibiotics (B. Antibiotic) – Not needed since there is no evidence of infection. Unnecessary antibiotic use can contribute to resistance and side effects.
Anti-inflammatory (C. Anti-inflammatory) – Not required unless there is significant discomfort or excessive inflammation.
Curettage (D. Curettage) – Invasive and unnecessary, as there is no infection or necrotic tissue to remove.

✅ Observation – Monitor the swelling for any changes. In most cases, it resolves spontaneously within days to weeks. If the swelling persists, enlarges, or becomes painful, further evaluation may be needed.

#surgery
5-Which nerve is mostly damaged in a TMJ surgery:
A. V 
B. VII 
C.x
D.III

 B. VII (Facial Nerve)
During TMJ (temporomandibular joint) surgery, the facial nerve (cranial nerve VII) is the most commonly damaged nerve due to its anatomical course near the TMJ.
Why the Facial Nerve (VII) is Most at Risk?
Anatomical Proximity to the TMJ
The temporal and zygomatic branches of the facial nerve pass close to the preauricular region, where TMJ surgeries (such as joint replacement, arthroplasty, or disc repositioning) are performed.
The superficial location makes the nerve vulnerable to traction, compression, or direct injury.

A. Trigeminal Nerve (V)

The auriculotemporal branch of V3 (mandibular nerve) is close to the TMJ and may be stretched or injured.
However, motor function is rarely affected, and sensory loss is usually minor.
The facial nerve (VII) is more frequently involved in clinically significant complications.

C. Vagus Nerve (X)

The vagus nerve is not anatomically close to the TMJ.
It primarily runs in the neck, far from the surgical field.

D. Oculomotor Nerve (III)

The oculomotor nerve controls eye movements and is located deep within the cranial cavity, far from the TMJ.
It is not at risk in TMJ surgery.

✅ Takeaway & 📌 Study Tip

1️⃣ Impression Materials – Hydrophobicity

✅ Takeaway:
 Polyvinyl siloxane (PVS) is the most hydrophobic impression material, making it more challenging to use in moist environments. Alginate and polyether are hydrophilic, meaning they work better in the presence of saliva or blood.
📌 Study Tip:
Silicones (PVS) are hydrophobic, while hydrocolloids (alginate) and polyethers are hydrophilic. Mnemonic: “Silicone Slips (Hydrophobic), Alginate Absorbs (Hydrophilic).”

2️⃣ Posterior Crossbite with Functional Shift – Treatment

✅ Takeaway:
Bilateral expansion in early mixed dentition is the best approach for treating posterior crossbite with a functional shift. Early intervention takes advantage of the open midpalatal suture for more effective correction.
📌 Study Tip:
Early treatment = easier skeletal correction. If you delay, the suture begins to close, making correction harder and potentially requiring surgical intervention.

3️⃣  Envelope Flap Size and Healing

✅ Takeaway:
 A 6mm flap and a 12mm flap will heal at the same rate as long as vascular supply is maintained. Healing depends more on blood flow, surgical technique, and patient health rather than flap size alone.
📌 Study Tip:
Blood supply is key! Always think about the base of the flap and how it maintains circulation—this determines healing, not just the length of the incision.

4️⃣ Post-Surgical Mucosal Swelling – Management

✅ Takeaway:
Observation is the best approach for a painless, non-infected swelling after surgery. Swellings like seromas or minor hematomas usually resolve on their own.
📌 Study Tip:
If there's no pain, fever, or infection, don’t rush to antibiotics or surgery! Look for infection signs (redness, pus, fever) before deciding on active treatment.

5️⃣ Most Common Nerve Damage in TMJ Surgery

✅ Takeaway:
The facial nerve (cranial nerve VII) is most commonly injured in TMJ surgery, especially its temporal and zygomatic branches, leading to temporary or permanent facial weakness.
📌 Study Tip:
 Think about location! The facial nerve runs close to the TMJ, whereas the trigeminal, vagus, and oculomotor nerves are either sensory or too far from the surgical site to be at risk.

🔹 Read questions twice

Don't jump to options before reading questions.

🔹 Look for the keyword

It will guide you to the correct answer, which will guide you to the Ferrari later.  

🔹 Draw diagrams

Drawing nerve pathways, expansion appliances can help you retain key concepts. 🚀

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