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NEET MDS Synopsis

Wax elimination
Dental Materials

Wax elimination (burnout):

Wax elimination or burnout consists of heating the investment in a thermostatically controlled furnace until all traces of the wax are vaporized in order to obtain an empty mold ready to receive the molten alloy during procedure.

• The ring is placed in the furnace with the sprue hole facing down to allow for the escape of the molten wax out freely by the effect of gravity .
• The temperature reached by the investment determines thethermal expansion. The burnout temperature is slowly increased in order to eliminate the wax and water without cracking the investment.
•For gypsum bonded investment, the mold is heated to650 -6870 c )to cast precious and semiprecious
precious alloys.
• Whereas for phosphate-bonded investment, the mold is heated up to 8340 c to cast nonprecious alloys at high fusing temperature.
The ring should be maintained long enough at the maximum temperature (“heat soak”) to minimize a sudden drop in temperature upon removal from the oven. Such a drop could result in an incomplete casting because of excessively rapid solidification of thealloy as it enters the mold.
• When transferring the casting ring to casting, a quick visual check of the sprue in shaded light is helpful to see whether it is properly heated. It should be a cherry-red color .

WAX BURNOUT AND HEATING THE RING

After the investment has set hard, the crucible former and the metal sprue former is removed carefully, and any loose particles at the opening of the sprue hole are removed with small brush.
The purpose of the wax burnout is to make room for the liquid metal. The ring is placed in the oven at 250C with the sprue end down, thus allowing the melted wax to flow, out for 30min or even up to 60min may be a good procedure to ensure complete elimination of the wax and the carbon.

Heating the ring: The object is to create a mold of such dimension, condition and temperature so that it is best suited to receive the metal.

Hygroscopic Low-Heat Technique. 

After the wax elimination the temperature of the same furnace can be set to a higher temperature for heating or else, the ring can be transferred to another furnace, which has already set to the higher temperature. In any case accurate temperature control is essential and therefore these furnaces have pyrometer and thermocouple arrangement. The ring is placed in the furnace with the sprue hole down and heated to 500C and kept at this temperature for 1 hour. In this low heat technique the thermal expansion obtained is less but together with the previously obtained hygroscopic expansion the total expansion amounts to 2.2 percent, which is slightly higher than what is required for gold alloys.

So this technique obtains its compensation expansion from three sources:
(1)   The 37º C water bath expands the wax pattern
(2)   The warm water entering the investment mold from the top adds some hygroscopic expansion
(3)   The thermal expansion at 500' C provides the needed thermal expansion.

High-Heat Thermal Expansion Technique. 

After the wax elimination, the ring should be placed in the furnace which is at room temperature and then the temperature is gradually raised, until it comes to 700C in 1 hour. Then the ring is heat soaked at this temperature for ½ hour. This slow rise in temperature is necessary to prevent 
This approach depends almost entirely on high-heat burnout to obtain the required expansion, while at the same time eliminating the wax pattern.  Additional expansion results from the slight heating of gypsum investments on setting, thus expanding the wax pattern, and the water entering the investment from the wet liner, which adds a small amount of hygroscopic expansion to the normal setting expansion.

Muscles of the Pharynx
Anatomy

Muscles of the Pharynx


This consists of three constrictor muscles and three muscles that descend from the styloid process, the cartilaginous part of the auditory tube and the soft palate.


External Muscles of the Pharynx 


The paired superior, middle, and inferior constrictor muscles form the external circular part of the muscular layer of the wall.
These muscles overlap each other and are arranged so that the superior one is innermost and the inferior one is outermost.



These muscles contract involuntarily in a way that results in contraction taking place sequentially from the superior to inferior end of the pharynx.
This action propels food into the oesophagus.



All three constrictors of the pharynx are supplied by the pharyngeal plexus of nerves, which lies on the lateral wall of the pharynx, mainly on the middle constrictor of the pharynx.
This plexus is formed by pharyngeal branches of the glossopharyngeal (CN IX) and vagus (CN X) nerves.


The Superior Constrictor Muscle


Origin: pterygoid hamulus, pterygomandibular raphe, posterior end of the mylohyoid line of the mandible, and side of tongue.
Insertion: median raphe of pharynx and pharyngeal tubercle.
Innervation: though the pharyngeal plexus of nerves.



The pterygomandibular raphe is the fibrous line of junction between the buccinator and superior constrictor muscles.


The Middle Constrictor Muscle


Origin: stylohyoid ligament and greater and lesser horns of hyoid bone.
Insertion: median raphe of pharynx.
Innervation: through the pharyngeal plexus of nerves.


The Inferior Constrictor Muscle


Origin: oblique line of thyroid cartilage and side of cricoid cartilage.
Insertion: median raphe of pharynx.
Innervation: through the pharyngeal plexus of nerves.



The fibres arising from the cricoid cartilage are believed to act as a sphincter, preventing air from entering the oesophagus. 


Gaps in the Pharyngeal Musculature


The overlapping arrangement of the three constrictor muscles leaves 4 deficiencies or gaps in the pharyngeal musculature.
Various structures enter and leave the pharynx through these gaps.



Superior to the superior constrictor muscle, the levator veli palatini muscle, the auditory tube, and the ascending palatine artery pass through a gap between the superior constrictor muscle and the skull.
Superior to the superior border of the superior constrictor, the pharyngobasilar fascia blends with the buccopharyngeal fascia to form, with the mucous membrane, the thin wall of the pharyngeal recess.



Between the superior and middle constrictor muscles, the gateway to the mouth, though which pass the stylopharyngeus muscle, the glossopharyngeal nerve (CN IX), and the stylohyoid ligament.



Between the middle and inferior constrictor muscles, the internal laryngeal nerve and the superior laryngeal artery and vein pass to the larynx.



Inferior to the inferior constrictor muscles, the recurrent laryngeal nerve and inferior laryngeal artery pass superiorly into the larynx.

Growth and spread of tumours
General Pathology

Growth and spread of tumours

Growth in excess of normal is a feature of all tumours but extension to tissue away from the site of origin is a feature of malignant tumours.

Modes of spread of malignant tumours

- local, invasion. This is a feature of all malignant tumors and  takes place along tissue spaces and facial planes
    o    Lymphatic spread. Most often seen in carcinomas. This can be in the form of 
    o    Lymphatic permeation:  Where the cells extend along the lymphatics as a  solid core 
    o    Lymphatic embolisation: Where a group of tumour cells break off and get carried to the draining mode

-Vascular spread :  This is a common and early mode of spread for sarcomas but certain carcinomas like renal cell carcinoma and chorio carcinoma have a predilection to early vascular spread.

Vascular spread is most often due .to invasion of venous channels and can be by permeation or embolisation.

Lungs, liver, bones and brain are the common sites for vascular metastasis but
different tumours have different organ preference for metastasis, e.g. : Bronchogenic carcinoma often spreads to liver and adrenals.

-Body cavities and natural passages
    o    Gastrointestinal carcinomas spread to ovaries (Krukenberg’s tomour)
 

Other coxibs
Pharmacology

Valdecoxib

used in the treatment of osteoarthritis, acute pain conditions, and dysmenorrhoea

Etoricoxib new  COX-2 selective inhibitor

Kinins
Pharmacology

Kinins
Peptide that are mediated in the inflammation.
Action of kinin:
On CVS: vasodilatation in the kidneys, heart, intestine, skin, and liver. It is 10 times active than histamine as vasodilator.

On exocrine and endocrine glands: kinin modulate the tone of pancreas and salivery glands and help regulate GIT motility, also affect the transport of water and electrolytes, glucose and amino acids through epithelial cell transport.


Classification of Dental Fractures
Pedodontics

Treatment modifications to consider if there are concerns regarding vasoconstrictors
Pharmacology

Treatment modifications to consider if there are concerns regarding vasoconstrictors

- Monitor blood pressure and heart rate preoperatively

- Minimize administration of epinephrine or levonordefrin

- Monitor blood pressure and heart rate 5 min after injection

- May re-administer epinephrine or levonordefrin if blood pressure and heart rate are stable

- Continue to monitor as required

- Consider limiting epinephrine to 0.04 mg, levonordefrin to 0.2 mg

- Avoid epinephrine 1:50,000

- Never use epinephrine-impregnated retraction cord

Antral Puncture and Intranasal Antrostomy
Oral and Maxillofacial Surgery

Antral Puncture and Intranasal Antrostomy
Antral puncture, also known as intranasal antrostomy, is a
surgical procedure performed to access the maxillary sinus for diagnostic or
therapeutic purposes. This procedure is commonly indicated in cases of chronic
sinusitis, sinus infections, or to facilitate drainage of the maxillary sinus.
Understanding the anatomical considerations and techniques for antral puncture
is essential for successful outcomes.
Anatomical Considerations


Maxillary Sinus Location:

The maxillary sinus is one of the paranasal sinuses located within
the maxilla (upper jaw) and is situated laterally to the nasal cavity.
The floor of the maxillary sinus is approximately 1.25 cm below
the floor of the nasal cavity, making it accessible through the nasal
passages.



Meatuses of the Nasal Cavity:

The nasal cavity contains several meatuses, which are passageways
that allow for drainage of the sinuses:
Middle Meatus: Located between the middle and
inferior nasal conchae, it is the drainage pathway for the frontal,
maxillary, and anterior ethmoid sinuses.
Inferior Meatus: Located below the inferior
nasal concha, it primarily drains the nasolacrimal duct.





Technique for Antral Puncture


Indications:

Antral puncture is indicated for:
Chronic maxillary sinusitis.
Accumulation of pus or fluid in the maxillary sinus.
Diagnostic aspiration for culture and sensitivity testing.





Puncture Site:

In Children: The puncture should be made through
the middle meatus. This approach is preferred due to
the anatomical differences in children, where the maxillary sinus is
relatively smaller and more accessible through this route.
In Adults: The puncture is typically performed
through the inferior meatus. This site allows for
better drainage and is often used for therapeutic interventions.



Procedure:

The patient is positioned comfortably, usually in a sitting or
semi-reclined position.
Local anesthesia is administered to minimize discomfort.
A needle (often a 16-gauge or larger) is inserted through the chosen
meatus into the maxillary sinus.
Aspiration is performed to confirm entry into the sinus, and any
fluid or pus can be drained.
If necessary, saline may be irrigated into the sinus to help clear
debris or infection.



Post-Procedure Care:

Patients may be monitored for any complications, such as bleeding or
infection.
Antibiotics may be prescribed if an infection is present or
suspected.
Follow-up appointments may be necessary to assess healing and sinus
function.



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