SAQs For Dentistry - Pastest
SAQs for DentistryThird EditionKathleen F M Fan PhD, MBBS, BDS,FDSRCS (Eng), FRCS (Ed), FRCS (OMFS)Consultant Oral and Maxillofacial Surgeon,Honorary Senior LecturerKing’s College Hospital, LondonJudith Jones BDS, MSc, FDSRCS (Eng),PhD, FDS (OS), FHEAReader / Honorary Consultant, Department of Oral andMaxillofacial Surgery, Queen Mary University of London,Barts and the London School of Medicine and Dentistry,Institute of Dentistry
ContentsList of ContributorsviIntroductionvii1Child Dental Health and Orthodontics2Restorative Dentistry493Oral Surgery1594Oral Medicine2135Oral Pathology2536Oral Radiography/Radiology2837Human Disease and Therapeutics3198General Dentistry383Index1439
3Oral Surgery
ORAL SURGERY3.1Local anaesthetics(a) You plan to extract a lower left first permanent molar tooth on a fitand healthy 34-year-old patient using 25% lidocaine with adrenaline1:80 000. You plan to carry out an inferior dental/alveolar block,but what other nerves will you need to anaesthetise for theextraction to be carried out, and which injections will you give toachieve this?(b) Once you have given your injections how will you test each nerve tosee whether it is anaesthetised?(c) What are the techniques for giving an inferior dental/alveolar block?Please give an advantage and disadvantage for each of thetechniques.(d) The patient is still feeling discomfort when you try to elevate thetooth. What alternative techniques or anaesthetic agents could youtry?161
162ORAL SURGERYAnswer 3.1(a) An inferior dental (alveolar) block (IDB) of the nerves will anaesthetise thepulp of the tooth to be extracted. Which technique is used (see section c)for an IDB will determine whether you need to use other injectiontechniques, eg with certain high IDBs the long buccal nerve is blocked atthe same time as the inferior dental/alveolar nerve. Hence, if not alreadyanaesthetised, the long buccal nerve will need to be anaesthetised,because this supplies the buccal tissues adjacent to the tooth.You will also need to anaesthetise the lingual nerve because this suppliesthe lingual tissues adjacent to the tooth, and can be given at the sametime as the IDB.(b) To test that the various injection techniques have been successful, you willneed to probe in different areas. Probing in the buccal gingival sulcus ofthe lower first permanent molar to be extracted will test whether the longbuccal nerve has been anaesthetised. Probing in the lingual gingivalsulcus of the lower first permanent molar to be extracted will testwhether the lingual nerve has been anaesthetised. Hence it is necessaryto probe at another site to determine whether your IDB has beensuccessful. As the buccal mucosa anterior to the mental foramen will beanaesthetised in a successful IDB, this area can be probed to determinewhether the inferior dental/alveolar nerve has been successfullyanaesthetised. However, care must be taken not to do this too close tothe midine, because there is crossover supply from fibres on thecontralateral side and a false-negative result may occur.(c) IDB techniques are shown below.
ORAL SURGERYTechnique of IDBAdvantagesDisadvantagesDirect technique, alsoknown as Halstead’stechniqueSimpleIf needle inserted in wrongposition, may encounterinternal oblique ridge andprevent advancement tolingulaIndirect techniqueGets round the problem ofhitting the internal obliqueridge on insertion of theneedleMore movement of needlewithin tissuesAnterior ramus techniqueCan be done in patientswith limited mouthopeningNeedle movement in thetissuesGow—Gates techniqueBlocks the long buccalnerve at same time, aswell as accessory nervesupplies such as themylohyoid and auriculartemporal nervesTakes longer to workbecause the nerve trunk islarger at this pointPossibility of intravascularinjection into maxillary ormiddle meningeal arteriesor veinsAkinosi techniqueCan be done in patientswith limited mouthopeningBlocks long buccal nerveat same time, as well asaccessory nerve suppliessuch as the mylohyoid andauricular temporal nervesTakes longer to workbecause the nerve trunk islarger at this pointPossibility of intravascularinjection into maxillary ormiddle meningeal arteriesor veins(d) Other techniques that could be used:x Intraligamentous injectionxIntraosseous injectionOther agents: lidocaine is the gold standard dental local anaesthetic, butin refractory cases it is possible to use articaine as an alternative/adjunctive anaesthetic agent. As a 4% solution, it is stronger thanlidocaine and often helps anaesthesia to be achieved in difficult cases.163
164ORAL SURGERY3.2(a) You are seeing a patient who needs to have a tooth surgicallyremoved in your practice. One of the principles of flap design isthat vital structures should be avoided. Name two vital structuresthat you should avoid when carrying out surgical tooth removal inthe maxilla and the mandible.(b) What are the other principles to which you should adhere whendesigning a mucoperiosteal flap for surgical tooth extraction?(c) You wish to remove a lower left, second premolar tooth; a diagramof the tooth to be removed is shown. Please draw on it where youwould place your incisions and explain your reasons for siting themthere.
ORAL SURGERY(d) After the procedure you wish to suture the wound. What functionsdo sutures perform?(e) Name two different sutures that could be used to suture anintraoral wound and an advantage of each.165
166ORAL SURGERYAnswer 3.2(a)xxMaxilla: greater palatine artery; nasopalatine nerves and arteriesMandible: lingual nerve and mental nerve(b) Mucoperisoteal flaps that are raised when surgically removing a toothneed to:x Provide adequate access to the surgical sitexxxxxRetain a good blood supply to the mucoperiosteal flap, so the basemust be broader than the apex, unless the flap includes a decentsized artery within the flapAvoid vital structures such as local nerves and blood vesselsHave their margins placed on sound bone and not over the areawhere you are removing boneBe able to be extended if necessaryBe able to be closed appropriately at the end of the operation(c) There is no single universally accepted flap design. However, so long asthe principles of flap design are adhered to, then the design will beappropriate.When designing a flap in this area two- or three-sided flaps areappropriate and, depending on preference, some operators will place therelieving incision in a two-sided flap mesially, whereas others will place itdistally. It is important to include the whole interdental papilla in the flapto make suturing at the end easier. The relieving incisions must be flaredto ensure a larger base than apex for a good blood supply. In the figureare two designs: one a three-sided flap and the other a two-sided flapwith a mesial relieving incision.
ORAL SURGERY(d) Sutures primarily approximate and hold the wound margins in theappropriate place to enable them to heal. The smaller the space betweenthe two wound margins, the quicker the wound will heal. Sutures will helpin holding the mucoperiosteal flap over bone, which will reduce the risk ofit becoming non-vital. Sutures also help haemostasis.(e)xNon-resorbable:ŏŏđ braided: black silk — soft and easy to knotŏŏđ monofilament: Prolene — hygienicxResorbable:ŏŏđ braided: polyglactin (Vicryl) or Polysorb, which is a glycolide/lactide co-polymer — soft, easy to knot, resorbs so patient doesnot need to have sutures removedŏŏđ monofilament: poliglecaprone 25 (Monocryl) — hygienic,resorbable but slow resorption167
168ORAL SURGERY3.3(a) A fit and healthy patient presents to your surgery complaining ofrecurrent episodes of pain and swelling of the gum in the region ofan impacted, lower right wisdom tooth. What is the most likelydiagnosis?(b) A radiograph of the tooth involved is shown here. How would youdescribe the position of the tooth?
ORAL SURGERY(c) What is the relationship of the inferior dental canal to the tooth, asjudged by this radiographic view? What are the likely implicationsof this appearance and how would you proceed?(d) Coronectomy: what is the rationale behind a coronectomy and whatare the complications of carrying it out?169
170ORAL SURGERYAnswer 3.3(a) Recurrent pericoronitis(b) Mesioangularly impacted and partially erupted(c) The inferior dental canal crosses the root of the tooth and there is aradiolucent band across the root in this area. There is also loss of thesuperior cortical outline of the inferior dental canal as it crosses the tooth.This is likely to represent an intimate relationship between the inferiordental nerve and the roots of the tooth, which means that, if the toothwere to be removed, the patient would be at higher risk of damage to theinferior dental canal.In an ideal world a cone-beam CT (CBCT) scan would be the next stepbecause this would provide a three-dimensional view of the area andprovide a definitive answer as to the true relationship between the rootand the nerve. If there is an intimate association or if no CBCT scan isavailable, then to minimise damage to the nerve the treatment optionsare:x To leave the tooth in situ and treat each episode of pericoronitis asand when it occursx To remove the tooth in its entirety but accept that it has a higherthan average risk of causing damage to the inferior dental nervex To carry out a coronectomy(d) A coronectomy is a procedure in which the crown of the tooth is removedand the vital roots are retained. The rationale is that not touching theroots will limit damage to the inferior dental nerve, and removing thecrown will allow the mucosa to be sutured across to the lingual side,closing the wound primarily and thereby preventing any further episodesof pericoronitis.The possible complications are infection from or migration of the retainedroot. In some instances the root becomes mobile when the crown issectioned and removed, and a mobile root cannot be left in situ so it isnecessary to surgically remove the whole tooth.
ORAL SURGERY3.4(a) Which patients should be referred to a specialist for urgentassessment according to the 2005 National Institute for Health andCare Excellence (NICE) guidelines on urgent referrals for suspectedoral cancer?(b) As a general dental practitioner, to whom would you refer a patientfor management if you suspected that they had a squamous cellcarcinoma of the oral cavity?(c) What treatment modalities are commonly used for treatingsquamous cell carcinoma of the oral cavity?(d) What do you understand by the term palliative care?171
172ORAL SURGERYAnswer 3.4(a) Any patient with: x Unexplained red and white patches (including suspected lichenplanus) of the oral mucosa that are painful or bleeding or swollen.Note: a non-urgent referral should be made in the absence of these,ie not painful, bleeding or swollen. x Unexplained ulceration of the oral mucosa persisting for more than 3weeksAny adult patient withx Unexplained tooth mobility persisting for more than 3 weeksx An unexplained lump in the neck which has recently appeared or alump which has not been diagnosed before that has changed over aperiod of 3—6 weeks(b) An oral and maxillofacial surgery consultant who manages oncologypatients within a cancer centre would be the best person to manage thepatient as the surgeon is part of a multidisciplinary team that can offerthe patient holistic care.Oral medicine and oral surgery consultants will see patients referred forsuspected squamous cell carcinomas (SCCs), and may arrange forbiopsies to be performed but as they are not able to offer the patientdefinitive surgical treatment. Therefore, it would be ideal for the patient tobe referred to the person who would be able to diagnose and managethat lesion from the start.(c) x Surgery x Chemotherapy x Radiotherapyx Combination of any of the above(d) According to the World Health Organization (2003), ‘palliative care is anapproach that improves the quality of life of patients and their familiesfacing the problems associated with life-threatening illness, through theprevention and the relief of suffering by means of early identification andimpeccable assessment and treatment of pain and other symptoms,physical, psychosocial and spiritual’.
ORAL SURGERY3.5(a) What are bisphosphonates?(b) You are a general dental practitioner who has a patient who isabout to commence treatment with bisphosphonates. How wouldyou manage them?(c) You have a patient who has been on oral bisphosphonates for 5years and requires a dental extraction. Describe how you wouldmanage this patient.173
174ORAL SURGERYAnswer 3.5(a) Bisphosphonate are pyrophosphate analogues that inhibit resorption ofbone. Their proposed mechanism of action includes: x Reduction of bone turnover x Inhibition of osteoclast activity(b) Patients about to commence treatment with bisphosphonates should havebeen informed of the risk and benefits of the chosen drug by theprescribing physician including the risk of medication-relatedosteonecrosis of the jaw (MRONJ), which was previously known asbisphosphonate-related osteonecrosis of the jaw (BRONJ). The patientideally should have a dental assessment prior to commencement of thedrugs. This is especially important if the patient is to be given high-doseiv bisphosphonates. x Patients should be informed of the importance of maintaining a highstandard of dental health following treatment with bisphosphonatedrugs, and the consequences of not doing so. x Dental hard and soft tissues must be examined for any disease. Anyactive infection must be treated before commencement of thetreatment.x Any prosthesis must be carefully examined, as mucosal injury andbreakdown is the second most commonly identified risk factor forMRONJ.x Teeth which are in an acceptable condition but unlikely to beretained in the long term need careful consideration as futureexodontia is a risk factor for MRONJ.x Any teeth of dubious prognosis must also be removed.x Patients should be advised on oral hygiene and preventive measuresto minimise risk of dental disease.x Patients must be educated about the signs and symptoms of MRONJand to seek advice if they have concerns.x Patients must be made dentally fit before commencement of thedrug treatment.
ORAL SURGERY(c) Current evidence would suggest that those at serious risk of MRONJ arelikely to have been on iv bisphosphonates for more than 12 months or atleast 36 months of oral bisphosphonates. Prevention is the best optionand it is generally recommended that high-risk procedures, eg extractions,should be avoided and instead root canal treatment should be considered,even when it is not possible to restore the crown of the tooth to afunctional form.There are some variations in the guidelines for exodontia from differentcountries, eg oral as oppose to parental (iv) bisphosphonates, and thusit is worthwhile checking your up-to-date local guidelines, in particular,Scottish Dental Clinical Effectiveness Programme(www.scottish.dental.org.uk).The common steps usually followed are:1 Preoperatively:ŏŏđ Rinse with chlorhexidine mouthwashŏŏđ Prophylactic antibiotics (although this is not universally adoptedby all clinicians, hence the need to consult with local guidelines)2 Conservative surgical technique (atraumatic)3 Primary closure of soft tissue where possible, without strippingperiosteum4 Postoperatively:ŏŏđ Chlorhexidine mouthwash for 2 weeks or until mucosa has healedŏŏđ Antibiotics for 5 days (again this is not universally adopted — seeabove)5 Keep the patient under review until the socket has healedDo not attempt further extractions in other sextants of the mouth untilthe first socket has healed.175
176ORAL SURGERY3.6(a) In order to diagnose MRONJ, certain criteria must be met. What arethey?(b) Apart from bisphosphonate drugs, what other types of drugs areassociated with MRONJ? Give an example of each type, and list theconditions for which they are prescribed.(c) In which conditions might a patient be prescribed bisphosphonatemedication?(d) What are the common routes of administration of bisphosphonatemedication?(e) Which patients are most at risk of getting MRONJ?(f) Name some local risk factors.
ORAL SURGERYAnswer 3.6(a) x The patient must be taking or have taken anti-resorptive or antiangiogenic medication.x The patient must have exposed bone or bone that can be probedthrough an intraoral or extraoral fistula in the maxillofacial regionthat has persisted for more than 8 weeks.x There must be a history of radiotherapy to the jawsx There must be no obvious metastatic disease to the jaws (seeRuggiero SL, Dodson TB, Fantasia J, et al. American Association ofOral and Maxillofacial Surgeons. Journal of Oral & MaxillofacialSurgery 2014; 72:1938—56)(b) Bisphosphonates, along with other anti-resorptive medications such asdenosumab are associated with MRONJ. The other group of drugs thatare implicated is the anti-angiogenesis drugs such as bevacizumab andsunitinib.(c) Anti-resorptive drugs are taken for: x Osteoporosis: both prevention and treatment x Prevention of skeletal fractures in susceptible individuals x Osteogenesis imperfecta x Paget’s diseasex Metastatic bone disease (usually in connection with breast orprostate carcinoma)x Bisphosphonates are also used in the management of patients withmultiple myeloma, although other anti-resorptives such asdenosumab are notx Anti-angiogenesis drugs are taken for renal cell carcinoma andgastric tumours(d) Oral and iv.(e) Patients who have been on high-dose potent medication by an iv route,usually for the management of malignancies.177
178ORAL SURGERY(f) x Mandibular extractions x Periodontitis, presence of oral abscesses or infection x All dentoalveolar surgeryx Poor oral hygienex Denture-related traumax Thin mucosal coverage, eg lingual tori
ORAL SURGERY3.7A fit and healthy 25-year-old patient attends your dental practicewith a 2-day history of a painful, loose left mandibular firstpermanent molar after he was hit in the face with the cricket ball.(a) What key questions you would ask the patient?(b) What radiological investigations if any would you carry out afterexamination?(c) Following your examination and investigations, you are concernedthat the mobile tooth is a result of a fractured mandible. How wouldyou proceed?(d) If there was a mandibular fracture which radiological view(s) woulddemonstrate it?(e) What treatment is likely to be required in this case?179
180ORAL SURGERYAnswer 3.7(a) You would take the history and examination as usual to ascertain thecurrent complaint, the history of the complaint, the patient’s medical,dental and social history. However, in this type of injury, in particular, youwould also want to know: x The circumstances surrounding the incident x Any loss of consciousness or any other injuries x If there is any altered sensation in the distribution of the inferioralveolar/dental nerve x If his occlusion is derangedx The state of the tooth before the incident, eg pain and mobility(b) A panoramic radiograph to obtain an overview of the dentition andmandible. If there is insufficient detail of the region of the lower leftmandibular first molar tooth then a periapical radiograph may bewarranted to determine whether there is a fracture in the tooth or todetermine the periodontal status of the tooth.(c) Immediately refer the patient to the nearest oral and maxillofacial surgerydepartment for further assessment and management.(d) x A dental panoramic radiograph and another view at another angle,usually a posterior-anterior view of the mandible (PA mandible).x An alternative would be oblique lateral views of the mandible and PAmandible, but the oblique lateral views are often inferior to apanoramic radiograph.x Cone-beam computed tomography (CT) or standard CT would alsoprovide good information regarding the fracture but is not indicatedin simple fractures due to the higher radiation dose relative to adental panoramic radiograph and PA mandible.(e) It is likely that the fracture is displaced as the patient feels movement inthe lower left first molar. Hence he requires surgical treatment in the formof open reduction and internal fixation of the fractured mandible. For abody of mandible fracture this is often accessed via an intraoral approach.
ORAL SURGERY3.8(a) A fit and healthy 10-year-old child fell while playing on his microscooter and is brought into your surgery with evidence of injury tohis maxillary anterior teeth. Your worry is that the child may havesustained an alveolar or dento-alveolar fracture. What are thedifferences between these two terms?(b) What features would lead you to suspect that the child hadsustained a dento-alveolar fracture?(c) What investigations would you carry out and what findings wouldyou expect?(d) Assuming the child is co-operative and there are no other injuries,how would you manage the dento-alveolar fracture?(e) What post-treatment instructions would you give the patient andhis parents?181
182ORAL SURGERYAnswer 3.8(a) A fracture of the alveolar process may or may not involve the alveolarsocket. A dento-alveolar fracture would involve fracture of the alveolarprocess and the socket.(b) (c) x Teeth related to the fractured dento-alveolar segment are typicallyall mobile and move as a unit.x An occlusal change will often be present due to the displacement ofthe entire segment.x The teeth of the affected segment are often tender to percussion.x Vitality testing of all the involved teeth — this is usually negative.x Radiographs — usually two views are recommended for identificationof fractures. Ideally, these should be at right angles to one anotherfor better identification of fracture lines but in practice the views areusually taken with the X-ray tube head in two different positions. Inthe anterior region the options would be periapical views and anupper standard occlusal. A panoramic or a cone-beam CT may alsobe useful. Radiographic findings suggestive of a dento-alveolarfracture may present as: đ A radiolucent line between the fragments. However, thevertical line of the fracture may be difficult to see as it mayrun along the periodontal ligament space. The horizontal linemay be located apical at the apex or coronal to the apex.đ An alteration in the outline shape of the root and discontinuityof the periodontal ligamentđ An associated fracture(s) of the roots of the teeth.(d) After gaining consent you would:1 Administer local analgesia2 Reposition the displaced segment with digital pressure applied bothlabially and palatally or with forceps if necessary3 Stabilise the fractured segment for 4 weeks with flexible splinting,such as:ŏŏđ An acid etch splint with composite with or without a wire
ORAL SURGERYŏŏđ Orthodontic brackets on the teeth and splinting with a flexiblesectional archwireŏŏđ Preformed trauma arch bars(e) x Soft diet for 1 week x Explain the need for longer-term follow-up, as there is the risk of: x Explain that good oral hygiene is essential for healing of the tissueand that chlorhexidine mouthwash may be beneficialŏđ Pulp necrosisŏđ Ankylosisŏđ Resorption associated with infectionŏđ Bone lossŏđ Loss of toothCurrent suggested guidelines for follow-up x Splint removal and clinical and radiographic control after 4 weeks x Clinical and radiographic control after 6—8 weeks, 4 months, 6months, 1 year and yearly for 5 yearsFor further information, please see www.dentaltraumaguide.org3.9(a) What does the term pericoronitis mean? Which teeth are mostcommonly affected by it?(b) What are the signs and symptoms of pericoronitis?(c) How do you treat acute pericoronitis?183
184ORAL SURGERYAnswer 3.9(a) Pericoronitis means infection of the tissue surrounding the crown of atooth. The lower third molars are most commonly affected.(b) Depends on the severity of the infection: x Mild — swelling of soft tissue around the crown of the tooth, badtaste, pain x Moderate — lymphadenopathy, trismus, extraoral swellingx Severe — fever, malaise, spreading infection and abscess formation(c) Treatment depends on the severity of the infection. Management of mildinfection includes: x Oral hygiene instructions such as cleaning around the tooth andoperculum with chlorhexidine or hot salty water xDebridement of the area around the tooth and under the operculumx Relief of trauma from opposing tooth — grind cusps or extraction ofthe toothx Analgesicsx Antibiotics (metronidazole)Severe infection may need hospitalisation, intravenous antibiotics, removalof the lower third molar and/or incision and drainage.
ORAL SURGERY3.10(a) What does the acronym NICE stand for?(b) NICE guidelines gives specific indications for removal of wisdomteeth. List five such indications.(c) What features on a radiograph would suggest that a wisdom toothis associated with the inferior dental nerve?(d) What specific information must be given to a patient prior toremoval of an impacted lower wisdom tooth, which you would notgive if you were removing an upper wisdom tooth?185
186ORAL SURGERYAnswer 3.10(a) National Institute for Health and Care Excellence(b) Surgical removal of impacted third molars should be limited to patientswith evidence of pathology such as (any five of the following): x Caries x Non-treatable pulpal and/or periapical pathology x Abscess and osteomyelitis x Cellulitisx Internal and external resorption of the tooth or adjacent toothx Fracture of toothx Tooth/teeth impeding surgery or reconstructive jaw surgeryx Tooth is within the field of tumour resection(c) Loss, deviation or narrowing of the ‘tramlines’ of the inferior dental canal,and a radiolucent band across the root of the tooth.(d) Information specific to lower wisdom teeth: numbness/tingling or alteredsensation of the lower lip, chin and tongue which may be temporary orpermanent. This information needs to be given to the patient because ofthe possibility of damage to the inferior dental nerve or the lingual nerveduring the procedure.
8 General Dentistry 383 Index 439. 3 Oral Surgery. ORAL SURGERY 161 3.1 Local anaesthetics (a) You plan to extract a lower left first permanent molar tooth on a fit and healthy 34-year-old patient using 25% lidocaine with adrenaline 1:80 000. You plan to carry out an inferior dental/alveolar block,
Bruksanvisning för bilstereo . Bruksanvisning for bilstereo . Instrukcja obsługi samochodowego odtwarzacza stereo . Operating Instructions for Car Stereo . 610-104 . SV . Bruksanvisning i original
10 tips och tricks för att lyckas med ert sap-projekt 20 SAPSANYTT 2/2015 De flesta projektledare känner säkert till Cobb’s paradox. Martin Cobb verkade som CIO för sekretariatet för Treasury Board of Canada 1995 då han ställde frågan
service i Norge och Finland drivs inom ramen för ett enskilt företag (NRK. 1 och Yleisradio), fin ns det i Sverige tre: Ett för tv (Sveriges Television , SVT ), ett för radio (Sveriges Radio , SR ) och ett för utbildnings program (Sveriges Utbildningsradio, UR, vilket till följd av sin begränsade storlek inte återfinns bland de 25 största
Hotell För hotell anges de tre klasserna A/B, C och D. Det betyder att den "normala" standarden C är acceptabel men att motiven för en högre standard är starka. Ljudklass C motsvarar de tidigare normkraven för hotell, ljudklass A/B motsvarar kraven för moderna hotell med hög standard och ljudklass D kan användas vid
LÄS NOGGRANT FÖLJANDE VILLKOR FÖR APPLE DEVELOPER PROGRAM LICENCE . Apple Developer Program License Agreement Syfte Du vill använda Apple-mjukvara (enligt definitionen nedan) för att utveckla en eller flera Applikationer (enligt definitionen nedan) för Apple-märkta produkter. . Applikationer som utvecklas för iOS-produkter, Apple .
Paediatric operative dentistry-KENNEDY Pediatric dentistry –Pinkham Dentistry for child and adolescent - McDonald Art and science of operative dentistry-Studervants Rubber dam in clinical practice - Reid, Callis, Patterson Pediatric dentistry , 2010;32-1, Jan-Feb DCNA , 1995; 39-4, Oct Fundamental of pediatric dentistry - Mathewson Internet
9780702046001 Coulthard Master Dentistry: Volume 1: Oral and Maxillofacial Surgery, Radiology, Pathology and Oral Medicine, 3e 2013 GBP 32.99 9780702045974 Heasman Master Dentistry: Volume 2: Restorative Dentistry, Paediatric Dentistry and Orthodontics, 3e 2013 GBP 32.99 9780702055386 Ricketts Advanced Operative Dentistry: A Practical Approach .
asset management must be considered as one of the first revolutions in financial technology. However, it quickly became the industrial secret of many successful hedge funds such as Re-naissance, D.E.Shaw, Two Sigmas, CFM, e.t.c. The 2008 crisis has changed the investment point of view of investors and the regulators. They required more and more efforts from the hedge fund industry and asset .
