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Oral Surgery
HAEMORRHAGE
M91 1
You receive a call from a patient from whom you have extracted a lower first molar 2
hours earlier who states that he is still bleeding. Briefly discuss the following :
A) What instructions would you give the patient over the phone?
B) What would determine whether you would see the patient in the office?
C) List the steps you would take to control the bleeding if you did see the patient in your
office.
D) What modifications in treatment might you make if the haemorrhage has occurred a
week following the extraction?
E) Under what circumstances would you order laboratory tests, which tests would you
order and why?
S92 2
A patient whom you have removed a wisdom tooth returned to your clinic because of
bleeding. Elaborate on your management of this patient.
S97
Discuss the causes of post-operative bleeding that may occur following a minor oral
surgical procedure and give an outline of your management.
M99Q2
An apparently healthy man aged 35 has had his lower third molars removed in your
clinic. Postoperative bleeding appears excessive on the left side. Describe the steps you
would take in your clinic to deal with this situation.
M02Q1
A 50 year-old patient complains of a labial sulcus swelling associated with a 15mm x
15mmpe periapical radiolucency of a non-vital upper right central incisor.
He has a prosthetic heart valve and is on wafarin.
Describe how you would manage this patient.
COMPLICATIONS OF EXODONTIA
M06Q3
After an extraction of the maxillary first molar, a patient developed tenderness around the
infra-orbital region at the same side, with discharge at the socket wound. Discuss the
possibilities for these presentations with investigation and treatment options.
M05Q1
A male patient of 30 years old required te extraction of a mandibular first molar. The
procedure was difficult but the tooth was completely removed. He returned to your
practice three hours later in pain with significant bleeding which he had been unable to
control. Describe your management in this situation.
S90 1
Discuss the management of a patient presenting with a pain following extraction of an
upper first permanent molar.
S92 1
During the extraction of an upper molar tooth, a root fractures and it is thought that it
may have been displaced into the maxillary antrum, Describe the subsequent
management of the patient.
M92 1
Discuss the diagnosis, management and progress of a patient with an infected facial
haematoma following the surgical removal of an impacted tooth.
M94 1
A 17 year-old patient returns to your office 4 days following the removal of 4 impacted
3rd molars.
She has swelling associated with the mandibular left 3 rd molar extraction site. Describe
the clinical findings in this patient that would differentiate swelling secondary to surgical
1
Oral Surgery
trauma from that of an infection. Assuming this patient has findings consistent with an
infection, describe the potential
morbidity of an infection in this anatomical region, and your treatment plan for the
management of this patient.
M95 4
An elderly man complained of fluid discharging from the left nostril on drinking. This
happened soon after an extraction of his maxillary molar about a month ago. Discuss the
management of this patient.
M96 1
An X-ray taken prior to the removal of a lone standing maxillary second molar discloses
the presence of a pneumatized sinus. What are your concerns? The mesial buccal root
fractures during the extraction of the tooth. While attempting to remove the fractured root
tip disappears. Where
might the root tip have gone? How would you proceed
with management?
S96
Discuss the management of a fractured apical one third of the palatal root of a max. first
molar in an adult patient during extraction under L.A.
S97
Discuss the complications that may arise following tooth extraction. How would you
manage these complications?
J01Q2
During extraction of a maxillary first molar the palatal root fractures. Describe how you
would manage the situation.
J01Q1
A 30 year old man presents with a localized submandibular swelling. Describe how you
would investigate this in order to establish a diagnosis.
M03 Q2
A 22 year old patient with 2 weeks status post aortic valve replacement presents with a
tooth requiring extraction. Discuss your concerns and what measures you would adopt to
minimize the risk to the patient.
( SEE ALSO UNDER Medical Conditions)
IMPACTIONS
M08Q4
Discuss the current concepts and their rationales in the surgical excision of an impacted
third molar.
M05Q3
Discuss the management of a healthy adult with pericoronal abscess associated with an
impacted mandibular third molar and an over erupted maxillary third molar on the same
side. On the other side of the mandible, an asymptomatic and deeply impacted third molar
is present.
S96
Discuss the management of a patient presenting with pain and swelling following and
impacted lower third molar surgery.
M97
Discuss the factors you would consider, when planning the treatment of an impacted
lower third molar, to determine :
(a) The need for post-operative antibiotics
(b) The risk of inferior dental nerve damage
(c) The method of wound closure
M98
Discuss the risks and benefits in the removal of an asymptomatic and impacted lower
third molar in a healthy 17-year old male
(a) a 47-year old male with controlled hypertension
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Oral Surgery
S98Q4
A 30-year-old male patient presented with an asymptomatic impacted lower right wisdom
tooth. How would you manage the case.
M00Q3
Discuss the management of an impacted mandibular third molar, associated with
pericoronal infection and a carious second molar.
M02Q4
A 45 year-old woman presents with an acute pericoronitis involving a partially erupted
and impacted lower right wisdom tooth as well as an overerupted upper right wisdom
tooth.
She also has an asymptomatic, deep horizontally impacted left lower wisdom tooth.
Discuss your management of the patient.
MEDICAL CONDITIONS
M90 2
Describe the management of a patient requiring a dental extraction and who is on longterm steroid therapy.
S90 3
Discuss the changes which might occur on the dorsal surface of the tongue in systemic
diseases.
M95 3
Discuss the management of a diabetic patient who presents with pain and swelling arising
from a stone that is related to the submandibular salivary gland.
M96 3
A 47 yr old patient presents in your clinic for the extraction of a lower molar tooth. The
patient states that she is a diabetic. What is diabetes mellitus? What questions would you
ask her in order to determine the severity of her diabetes? What emergency might you
expect during the extraction if the patient failed to eat prior to the appointment but took
their insulin?
S96
Discuss the Mx of dental patients with : 1) Diabetes mellitus 2) Anti-coagulant therapy.
M97
How would you manage a patient who has a heart-valve replacement and requiring a
dental extraction? He is currently on Warfarin therapy.
M98
Discuss the precautions and preparations that are necessary for extraction of teeth in
patients with a history of :
(a) prosthetic heart valve replacements
(b) long term steroid therapy
M00Q2
Discuss the problems of dental treatment in patient who have a history of:
(a) steroid therapy
(b) anticoagulant therapy
J01Q3
Discuss the management of a fully dentate diabetic male who is involved in a road traffic
accident, with upper lip injuries and dento-alveolar fracture involving the upper incisors.
M03 Q2
A 22 year old patient with 2 weeks status post aortic valve replacement presents with a
tooth requiring extraction. Discuss your concerns and what measures you would adopt to
minimize the risk to the patient.
( SEE ALSO UNDER Complications of Exodontia)
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Oral Surgery
BENIGN & MALIGNANT GROWTHS
M07Q4
A 20-year-old lady comes to see you for a slow growing mass of her mandible which is
hard to palpation and originates from within the left molar – ramus of the mandible.
Discuss the possible differential diagnoses together with a brief write-up on the treatment
of the conditions mentioned. What are the pros and cons of different options for medical
imaging that can be employed to evacuate this mass?
M06Q1
A 65-year old man has a hard mobile lump (about 2cm diameter) in the right
submandibular triangle since three weeks. What questions do you ask? How do you
examine the patient?
M05Q4
A 35 year old male complained of a gradual expansion of his left retromolar region over
the past year. He has full complement of erupted teeth except the clinically missing lower
left wisdom tooth. Discuss how you would manage this patient.
M05Q2
Discuss the etiology, clinical presentation, diagnosis and treatment of a 60 year old
diabetic woman complaining of a white patch on lateral border of her tongue
M91 4
Write short notes on radiolucent lesions of the mandible.
M92 3
Discuss the management of a patient with a large maxillary cyst encroaching the sinus.
M92 4
Write short notes on radiolucent lesions of the mandibular ramus region.
M94 2
Discuss the differential diagnosis and management of a persistent white patch on the right
cheek of an elderly man.
M94 3
A 49 year old Chinese man complains of difficulty in wearing his upper dentures due to a
painless enlarging mucosal growth in the anterior maxillary region. Discuss your
management of this patient in the light of suspected malignancy.
M95 2
A 60 yr old patient has a growth in the buccal sulcus. What signs and symptoms would
lead you to suspect that it is cancer? How would you manage a case of squamous cell
carcinoma affecting the same area.
M96 4
How do you recognize an oral malignant lesion? What factors predispose a patient to oral
cancer?
M97
What conditions of the oral mucosa are associated with malignant potential? Discuss how
you would manage a patient with one such lesion.
S97
Discuss the role of the dental surgeon and the dental contributions in the management of
oral cancer.
J01Q4
A man aged 60 complained of an ulcer on the left boarder of his tongue. Discuss
how you would manage this patient.
M04Q1
A patient with Hodgkin’s lymphoma who is undergoing active treatment by the
oncologists , develops a left submandibular space abcess of odontogenic origin. Discuss
the important considerations in the oral surgical management of this patient.
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Oral Surgery
TRAUMATIC INJURIES
O07Q2
M06Q2
A fully dentate diabetic elderly man who was involved in a road traffic accident sustained
lips and chin injuries together with a dento-alveolar fracture involving all the lower
incisors. Discuss how you would manage this patient.
A 15-year old boy was hit on the chin the evening before. The patient has pain in front of
the right ear and difficulties in opening his month. He has also partial numbness of the
left lower lip.
Discuss examination and management
M03 Q1
A 7 year old boy arrives in your office following complete avulsion of two permanent
maxillary central incisors in a fall from scooter. The accident happened 2 hours ago. The
teeth were preserved by a passing doctor in milk and are intact. Examination of the
patient does not reveal the presence of fractures of the dento-alveolar or maxillary
complexes. Discuss your management and the prognosis.
M95 1
A seven yr old patient presents in your office following a fall from his bicycle. As a result
of the accident, he avulsed his two maxillary central incisor teeth. Assume the teeth have
not been fractured and the alveolar bone is intact. Discuss your comprehensive
management of this patient
if:
(a) The patient presents within 15 minutes of the accident
(b) The patient presents four hours following the accident
S88 2
Discuss the clinical presentation and management of a depressed fracture of a zygomatic
complex.
S86 1
Describe briefly the use of each of the following in the management of maxillo-facial
trauma:
(a) Radiographs
(b) Antibiotics
(c) Arch bars
M85 4
Write short notes on arch bar wiring.
M83 3
A patient with a fracture of the maxilla following a RTA has just been admitted to
hospital. Describe the assessment and initial management.
M82 4
You are practicing alone in woodlands with no nearby hospital. A mother brings in her 15
yr old daughter to your clinic saying that she has been hurt in a car accident. The young
girl is in shock and has several anterior teeth fractured. Discuss your management of the
case with no special
reference to the medico-legal implications.
S82 1
Discuss the management of a displaced alveolar fracture bearing the 4 maxillary
permanent incisors in a young adult with a good dentition.
OROFACIAL INFECTIONS AND TREATMENT
O07Q4
Discuss the treatment plans and its rationales for the management of a badly carious
upper central incisor with an abscess.
S91 3
Discuss the management of a periapical abscess related to an upper central incisor.
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Oral Surgery
M92 2
Discuss the important causes of oro-facial pain and give a critical
appraisal on the management of
one of them.
M92 3
Discuss the management of a patient with a large maxillary cyst
encroaching the sinus.
M97
Discuss the management of a large and tender radiolucent lesion associated with an upper
incisor, which was incisally fractured about 2 years ago, after a fall.
S97
A 14 year-old girl complained of a swelling in the upper right molar region on the right
side. Discuss the differential diagnosis with particular reference to odontogenic lesions.
Describe the management of one of them.
M98
A 14 year old boy presented with a swelling in the retromolar region. Radiographs
showed a large radiolucency, associated with the wisdom tooth. Discuss your differential
diagnosis and how you would manage each of the conditions mentioned.
S98Q1
A patient was diagnosed with a cystic lesion in the molar-ramus region of the mandible.
Discuss the pre-operative workup and subsequent management of the patient.
M99Q4
A 60 year old dentate man presented with a white lesion of two month’s duration on the
left lateral border of his tongue. What is your differential diagnosis? How would you
manage him?
M00Q1
Describe the spread of dental infection and the principles of treatment.
M02Q2
Describe and discuss the etiology, clinical presentations, diagnosis and treatment of oral
candidiasis.
M03 Q4
A 60 years old man complained of “sourness” in the right lateral border of his tongue.
He admitted to being a heavy smoker. How would you investigate his complaint to arrive
at a diagnosis and treatment plan?
( SEE ALSO UNDER Miscellaneous)
M04Q2
A 70 year-old rather anxious woman living in a nursing was referred to your denal center
on a wheelchair for complaints of pain and difficulty in eating over the past couple of
weeks. Intra-orally she presented with multiple septic teeth some of which have
accompanying sinuses. You also noted that one of her foot was amputated. How do you
go about managing this patient? What are your thoughts with regards to issue of
anaesthesia for this patient?
M04Q3
A 12 year-old patient developed a painful facial swelling , associated with large
radiolucent lesion in the angle of the mandible. The mandibular second molar on the
complain side was clinically not seen.
Discuss the differential diagnosis and the management of this case.
DISEASES OF THE TMJ
S86 2
An 18 yr old female Chinese undergrad complains of pain in the right TMJ area. Discuss
how you would manage the patient.
M88 4
Discuss the causes of restricted mouth opening and their investigations.
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Oral Surgery
S88 3
Discuss the disorders of the TMJ that may limit mouth opening.
S89 1
Discuss briefly the causes of the limitation of mouth opening.
M90 1
Discuss the investigations and management of a patient with a fracture of
the mandible involving the angle and associated with an extruded third molar.
M90 4c
Write short notes on the surgical aspects of jaw disproportion.
S90 2
A soldier fell during a training exercise and sustained a deep laceration on his chin,
deranged occlusion and pain at the left preauricular region. How would you go about
your examination and diagnosis. Give reasons for each investigation you indicate.
FRACTURES
M08Q1
Discuss the typical symptoms and clinical signs for the following facial fractures:
(a) mandibular condyle fracture
(b)mandibular angle fracture
(c) zygomatico-orbital fracture
(d)le fort I fracture
M07Q1
Describe the management of different fractures of the jaw bones, taking into account
location and types of fractures, clinical symptoms, indication for surgical treatments,
methods and materials for the fracture repair, adding a brief mention on the possible
complications in cases of surgical and non-surgical treatments.
S83 3
Discuss the diagnosis and management of a bilateral fracture of the mandibular condyles.
M85 3
Discuss the management of a 50 yr old man with a unilateral fracture of the body and
condyle of the mandible.
A85 2
A 30 yr old man was involved in an RTA in which he suffered a temporary loss of
consciousness, broken upper denture, fractured mandible with a deep cheek laceration.
Discuss your management.
S87 3
A young male adult is brought in with a history of having injured his chin in a fall. He
also complained of limitation of mouth opening and inability to occlude properly. Briefly
discuss the investigations to establish the diagnosis and the management of his injuries.
M88 3
Describe possible methods of treatment for a dentate patient with a displaced fracture of
the body of the mandible.
M\91 4
Write short notes on surgical correction of mandibular prognathism.
S91 3
A 20 yr old motorcyclist was admitted following a road traffic accident in which he
suffered soft tissue lacerations on the left side of the face, fractured mandible at the angle
and had some loose teeth. Discuss how you would manage this patient.
M92 4a
Write short notes on : Signs and symptoms on unilateral fracture of the mandibular
condyle.
7
Oral Surgery
CLEFT PALATE & CLEFT LIP
M98
M02Q3
Discuss the dental contributions in the long term management of a cleft lip and palate
patient.
Discuss the dental contributions in the long-term management of a cleft lip and palate
patient.
MISCELLANEOUS
M08Q2
Which symptoms and clinical signs are suggestive of oral squamous cell carcinoma?
What are the advantages and disadvantages of the different imaging methods used for
diagnosis?
M08Q3
Write an essay on the diagnosis, differential diagnosis and treatment of mandibular
odontogenic kerotcyst.
M07Q2
Discuss the involvement of the maxillary sinus in dental procedures and diseases.
M07Q3
Discuss the management of a 30-year-old man with a prognathic mandible.
O07Q1
An eighteen year old girl presented to you in the Oral and Maxillofacial clinic with a
class III malocclusion together with maxillary hypoplasia. Discuss the pre-surgical
planning and management of this patient.
O07Q3
A 21-year-old female patient came for a wisdom tooth operation and halfway during the
operation, she felt dizzy and collapsed. Please explain the pathophysiology of the
possible causes in detail and what will be the management of the patient.
M06Q4
Discuss the use of steroids in dental practice. What are the implications of a patient on
long-term steroid seeking dental treatment?
M04Q4
An adult patient required removal of a fully erupted right lower second molar. After
given an Inferior Dental Nerve ( IDN) block, he complained of palsy of his right face.
Discuss how the palsy could have come about and how you would manage the patient
from then on. List other causes of facial palsy that are not related to IDN block.
M03 Q4
A 60 years old man complained of “sourness” in the right lateral border of his tongue.
He admitted to being a heavy smoker. How would you investigate his complaint to arrive
at a diagnosis and treatment plan?
( SEE ALSO UNDER Orofacial Infections and Treatment)
M03 Q3
Discuss the clinical importance of the maxillary sinus in relation to oral surgical
procedures.
M00Q4
A 40-year-old man presented with a swelling of several months duration in the posterior
part of his left palate. Discuss your management of this patient in particular the various
biopsy procedures available.
M99Q3
Discuss the relations and involvement of the maxillary sinus in oro-maxillary conditions
and surgical procedures.
M99Q1
In what ways may oral surgery improve the mouth of an edentulous patient to facilitate
the wearing of complete upper and lower dentures?
8
Oral Surgery
S98Q3
A 60 year old woman complained of pain over her upper left quadrant of her jaws.
Discuss your differential diagnosis and briefly elaborate on how you would manage each
of these conditions.
S98Q2
What are the complications that may arise in the maxillary antrum from dental
procedures and diseases? Describe their management.
S96
Discuss the use of antibiotics in dental practice.
M96 2
An edentulous woman complains of poor retention of her lower denture. Describe the
local factors contributing to her complaint. Elaborate on the various oral surgical
procedures that could help her overcome her problem.
M94 4
Discuss the important considerations in the planning and treatment of a patient requiring
a mandibular push-back osteotomy.
M92 2
Discuss the important causes of oro-facial pain and give critical appraisal on the
management of one of them.
S91 4
Write short notes on :
(a) Xerostomia
(b) Oral candidiasis
M91 4b
Write short notes on oral implants.
M91 2
A 55 yr old lady complained of dry mouth. How would you investigate and manage this
patient?
J90 4
Write short notes on
(a) primordial cyst
(b) Pre- prosthetic surgery
(c)
Write short notes on the surgical aspects of the following:
(a) Supernumerary teeth
(b) Unerupted, palatally impacted upper canines
M90 4
M90 3
Discuss the factors the general practitioner should take into consideration before deciding
whether to carry out a minor oral surgical procedure himself at his practice or
alternatively, to refer the patient to a hospital department.
9
Preventive Dentistry
DENTAL PUBLIC HEALTH
M08Q4
Using nano technology, the terrorists have successfully created a special biocompatible
agent which can become a toxic agent or initiate an atomic explosion after photochemical activation through radio waves emited from a remote site. This agent can easily
bind to fluoride. If you are appointed chief dental officer to tackle this potential
community and clinical problems list your steps of approach to this issue and strategies in
each step.
O07Q3
Emily is a 3-year-old hyperactive girl, brought in by her mother to your clinic, with early
carious lesions on all the molars. Her mother complained that Emily takes only 1-2
candies a day, compared to their neighbour’s kids who take 4-5 candies per day, yet
without tooth decay. She would like to know if Emily really has “weak teeth”.
(i) How would you address her mother’s complaint and the question raised?
(ii) Describe the steps you would take to assess Emily’s caries risk.
(iii) List your treatment plan for her in preventing further tooth decay.
O07Q4
S-city has 100% water fluoridation and low DMFT among the school children. However,
the recent survey revealed the dmfs of 1.3, 3.0, 4.4 among the 3-year-olds, 4-year-olds
and 5-year-olds, respectively. As Chief Dental Officer, what steps would you take to
reduce the caries rate among the pre-schoolers in S-city.
M06Q3
(a) List the timing and rationle for caries risk assessment.
(b) Give reason(s) why patients with high DMFT counts may have low caries risk, and
vice versa.
M05Q3
On April 15, 2005, there was a message, titled “Toothpaste Cancer Alert” on the web and
TV programs on several countries:
Researchers have discovered that “chemical-T” in toothpaste may cause depression, liver
problems and, in some cases, cancer. Placebo Pharmacy confirmed today that it was
removing products containing “chemical-T” from all its stores. There are dozens of
products on supermarket shelves containing the chemical, including Colgate, Aquafresh,
Dentyl and Sensodyne.
(a) List the steps and criteria you (as a general practitioner) would take to
validate the evidence before advising your patients further.
(b) If all the evidence currently available is not sufficient to draw a conclusion,
list the best steps and actions you would take in conducting a research to
find out the truth.
M04B3
Five years after the SARS outbreak in 2003, one special group of bio-terrorists has
successfully engineered an innovative mirco-organism (IM-666) . IM-666 have survived
all chemical and thermal challenges known to mankind, and have a great affinity to
human saliva. Their reproductive cycle shortens exponentially after the direct contact
with highly mineralized tissues. Without direct contact with hydroxyapatite (HA) , the
IM-666 would die in two weeks even in human saliva. In 3-4 weeks after the infection,
many people in particular those with DFS/dfs greater than 4, died with high fever
unknown origin. The potential link between saliva , tooth/HA , pulpal infection, and
systemic infection has been suspected. Post mortem of victims revealed rampant caries
and penetrating tooth decays and multiple bony defects in various part of the body .
Patients of all ages can be infected except for edentulous patients. More dentists and
dental assistants have been died in this outbreak than any other health care workers. (*the
following questions can be answered from the perspectives of primary, secondary and
tertiary prevention).
10
Preventive Dentistry
(i)
(ii)
(a)
(b)
(c)
(d)
As a private practitioner, how would you manage and educate your patient Mr A
(male , aged 36) , who has rampant caries , multiple residual roots and crown
fractures and with three family members infected and passed away recently?
As a private practitioner, how would you manage and educate your patient Mrs
B (female , aged 28) with the following conditions :
two enamel caries (on the occlusal surface of tooth #46 and #36);
no other decayed , filled or missing tooth, or systemic discomfort/fever;
she has a daughter aged 2.5 with all the primary teeth erupted and no decay present
no family members have been infected with IM-666.
M04B4
A company representative comes to your clinic to present the result of an
epidemiological survey evaluating the effectiveness of a new type of toothpaste. The
study, carried out during 1998-2002 among two thousand children in Asia, has shown
28% and 60% reduction of DMF in children aged 7 and 8 , respectively. As a private
practitioner, please state and explain the reason(s) why you will or will not introduce this
new product to your patient.
M02B3
Please list and describe the potential impacts of insurance companies on oral health care
in Singapore (e.g. from the angle of dentists, the public, the administrators of companies
and/or government, in terms of financing, utilization… ).
J01B4
Metrostate is a large emerging-economy country with a population of 80 million but
served by 500 dentists. There is only one dental school with an annual student intake of
50. DMF for 12-year old children is 7.5 with no public health programme readily
available. Most of the public dental clinics are located in 2 large cities. Most of the
people are poor and live in the rural areas. The country recently elected a new
government who has pledged to improve the level of oral health care.
You have been appointed as the Dental Consultant to advise the new Government on how
to achieve better oral health status for the country over the next 5 years in the most costeffective manner.
Outline your plans and explain the rationale of key areas in your recommendations.
M00B3
Discuss how the use of systemic fluorides has significantly reduced the incidence of
dental caries, using the local experience as much as possible.
M00B4
Indostate is a third world country with a large population of 100 million but served by
only 100 dentists. The majority of people are poor and live in rural areas where access to
dental service is poor. DMF of 12 year old is 6.5 and the general health is low. There are
only 3 dental schools producing about 90 dentists annually. The government of this
country has decided to allocate a significant part of its budge to improving health
(including dental health).
If you were tasked as consultant to the government to plan a 10-year programme for the
achievement of good oral health, outline your plan giving particular emphasis on dental
personnel, utilization of services and dental health education.
M99B3
Sanstate Country is a large third-world country with a population of 50 million and
served by only 100 dentists. There are two dental school providing 80 dentists a year.
There are three big cities, with population more than 2 million for each city. 70% of the
dentists are practising in these big cities. The economy is booming but the priority for
oral health is low. DMF for 12-year old is 5.4 and the population pyramid is inverted,
reflecting a large population of senior citizen. As a consultant to the Government of this
country,
11
Preventive Dentistry
i)
ii)
What may be the factors affecting the distribution of dentist in this country?
How would you recommend the planning of dental manpower needs for the next
5 years.
S98B3
Discuss the factors that affect the distribution of dental practitioners in the country.
M98B3
The 1994 oral health survey of 2706 Singapore school children aged 12-18 revealed the
following findings on the periodontal conditions utilising the CPITN (Community
Periodontal Index of Treatment Needs) criteria:
CPITN score 0
30.0
Prevalence (% of individuals affected)
CPITN score 1
CPITN score 2
CPITN score 3
16.5
53.0
0.5
CPITN score 4
0
a) Explain the implications of these findings.
b) You have been asked by the Ministry of Health to organise a programme to improve the periodontal
conditions of school children in this age range.
Discuss how you would plan the programme from the pilot phase to the
implementation and evaluation phase. ( You are free to make reasonable
assumptions, requests and recommendations based upon the current local
structure in dental services, dental utilisation patterns, dental manpower and
financial constraints).
O97B3
Bamban Primary School has an enrollment of 900 students. The School is located in a
rural district in a third world country where there is no water fluoridation and the dental
disease level is comparatively high. Dental service for young children is poor and hence
there is low priority for dental health care.
You are the dental officer responsible for planning a dental health programme to improve
the oral health of the school children. Within the limited resources of one mobile dental
unit, one dental nurse, one dental assistance, one health educator and one attendant,
discuss how would you present your plans.
M97A3
“Sinpolis is a third-world country with a population of 40 million, served by less than a
hundred dentists, mostly practicing in the capital city. The DMF for 12-yr old is 5.2 in
1996 and the water supply is not fluoridated. Dental service is generally poor and health
education low in priority. There is only one dental school in the country producing about
30 dentists a year. There is evidence of rapid influence from the industrialized countries
as Sinpolis is geographically well located with rapid economic growth potential.”
Discuss how you would plan a Dental Health program to improve the oral health of the
population within the next decade.
M96B4
Discuss the factors which influence the distribution of dental manpower and apply these
principles to the local context.
O96B3
Discuss the use of topical fluorides in the prevention and control of dental caries.
O96B4
Classify dental auxillaries. Discuss the role of dental auxillaries in dental care.
M95B3
Define the Dental Epidemiology. Discuss the role of epidemiology in the control and
prevention of oral diseases.
M94B4
How would you define the term "Epidemiology"? What are the different uses of
epidemiology? Discuss the different types and applications of epidemiology.
M93B4
Write short notes on:
(a) Operating Auxiliaries
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Preventive Dentistry
(b) Factors affecting distribution of dental power
M92B4
Discuss the factors influencing demand for dental care in the urban society.
S91B4
Discuss the training and utilization of dental nurses in the world.
S91B3
Describe the factors affecting the distribution of dental practitioners in the country.
M91B3
Discuss the utilization of operating dental auxiliaries in the delivery of Dental Care in
Singapore.
S90C5
Discuss the use of operating dental auxiliaries in Singapore.
S89C6/
M90C6
Discuss the factors influencing utilization of dental services in an urban
population.
PREVENTIVE DENTISTRY
M08Q4
An old GP made the following comments:
1. A 54 year old lady walked in with no decay in the mouth. The dentist did a normal
SAP and sent the patient off, saying ‘there is no need for CRA since she has zero DMFT’
2. A 38 year old research scientist came in with DMFT = 20. The dentist filled all the
cavities and sent him off, saying ‘there is no need for CRA since he surely a high risk
patient with such a high DMFT’
3. A 25 year old man, with a stressful sales job, came in with several deep pockets around
his molars. The dentist said ‘there is no need for CRA since the etiological factors and
microorganisms for perio diseases are so different from those for caries’
M07Q3
“Circulation” published by the American Heart Association (AHA) online on April 19
2007 has new guidelines on “Prevention of Infective Endocardities (IE)”. The major
changes in the updated recommendations are based on the following conclusions: (1)
Bacteremia resulting from daily activities is much more likely to cause IE than bactermia
associated with a dental procedure. (2) Only an extremely small number of cases of
infective endocardities might be prevented by antibiotic prophylaxis for dental
procedures even if such prophylactic therapy were 100% effective.
A. Would you agree with these conclusions? List the reasons why you are convinced or
not.
B. List the steps you, as a general practitioner, would take to critically appraise the
literature and clinical data before you apply them in your practice.
M07Q4
Caries risk assessment has developed from a single-factor, or multiple-factore evaluation
to a computer-based expert system, such as Cariogram©.
A. List the unique features of Cariogram© and elaborate how these specific features can
be used to enhance your quality of patient care.
B. List your diagnosis and preventive treatment plan for a 3-year-old girl with no cavity
but 28% “chance of avoiding caries”, estimated using Cariogram© with salivary tests.
M06Q4
Scenario: A patient walks into your clinic with the latest download copy from
http://www.fluoridealert.org/health/cancer/osteosarcoma.html . He highlighted following
paragraph and questions the safety of fluoridated water in Singapore.
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Preventive Dentistry
“Most notably, a recent national case control study conducted by scientists at Harvard
University found a significant relationship between fluoride exposure and osteosarcoma
among boys, particularly if exposed to fluoridated water between the ages of 5 and 10
(the mid-childhood growth spurt)”.
(a) What would be your immediate response to the question and the educational message
for this patient?
(b) Discuss your general approach in appraising the validity of published data from
epidemiological studies or clinical trials.
M03B3
What are the trends in dental caries prevalence worldwide? Discuss the factors that have
contributed to the trend of caries prevalence in Singapore.
M03B4
Dellastate is a large country with a population of 50 million people and served by only
100 dentists, many practicing dentistry without formal training. Most of the people live in
scattered communities where transportation is poor. DMF of 12-year olds is estimated at
5 and general oral health awareness is extremely low. Fluoridation of water is nonexistent. The country has only one dental school producing 30 dentists annually. The
dental health profession has to compete intensely for government funding to raise the
level of oral health in the country where there are few private practitioners.
M02B4
Water fluoridation has been implemented in Singapore since 1956. The 0.2 ppm natural
fluoride was increased to 0.7 ppm and then dropped to 0.6 ppm in 1992. The DMFT in
12-year old was 3 after 10-year water fluoridation, with caries reduction ranging from 3050%. This figure kept dropping to 2.5 in 1980 and 1.0 in 1994. If you are chairing the
committee evaluating the timing and adequacy of terminating water fluoridation, please
(1) List the steps and the important information you need to obtain before you can make a
proper decision.
(2) Create one set of reasonable data for yourself, and, based on your data or information,
draw a concrete suggestion for MOH to consider whether and/or when water fluoridation
need to be terminated in Singapore.
J01B3
"Dental Caries is under control in Singapore". Do you agree ? Discuss this statement in
the context of Preventive measures that have been implemented locally.
M99B4
A young adult patient presents with multiple caries and generalised gingivitis due to oral
health neglect and poor oral hygiene. From a preventive viewpoint, discuss your
approach to the management of this patient for his first appointment.
S98B4
What factors are important in considering the use of topical fluorides in caries
prevention? Discuss the precautions necessary in the use of topical fluorides.
M98B3
What are the WHO/FDI oral health goals for the year 2000? How have these goals
affected trends in dental caries globally? Discuss specifically how the use of fluorides
have influenced dental health worldwide and in the local context.
N97B4
Discuss the role of diet in relation to the aetiology of dental caries, emphasizing the
preventive actions you will recommend to your patients
M97B4
Discuss the factors that contribute to the aetiology of dental caries. Based on the
etiological factors, how would you initiate measures that will control dental caries rate?
M96B3
"Prevention is better than Cure"
Discuss the statement in the context of preventive measures which you can take as a
private practitioner.
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Preventive Dentistry
M95B4
Discuss the factors which affect the efficacy of fluorides in the prevention of dental
caries.
M94B3
Discuss the evidence for the benefit of fluoridation. How might the recent reduction in
dental caries affect this?
M93B4
Discuss the role of fluoride in the prevention of dental caries.
M92B3
Discuss the effect of fluoride on the control of dental caries.
M91B4
Discuss the following preventive measures:
a) Use of fluoride in caries prevention
b) Clinical preventive procedures.
M90C5
Discuss the use of fluorides as a preventive measure against dental caries.
M89C5
Discuss the relationship of bacterial plaque and caries.
PERIODONTOLOGY
M08Q1
An erupted tooth creates a break in the oral mucosa. What do you understand by the
statement there is a persistent wound at this site? Discuss the mechanisms involved to
keep the tooth-mucosa interface intact.
M08Q2
You are a GP working at a private clinic.
Mr Tan is a heavy smoker and claims to be a controlled type II diabetic patient.
At the post-instrumentation evaluation, your patient presents with poor oral hygiene,
generalized gingival inflammation, pus exudates from #16 and remaining pocket depths
for 4-6mm on the upper right quadrant. The rest of the probing depths are less than 4mm.
Light gingival calculus is found clinically. Describe the clinical management of this
patient at this appointment and give your rationale for treatment.
M07Q1
With increasing emphasis on the link between periodontal disease and systemic health,
discuss briefly how medical conditions may act as risk factors in the progression of
periodontal disease. What are the implications in the management of these patients
presenting with periodontal disease?
M07Q2
Discuss with evidence the significance of maintenance care in the long term control of
periodontitis. Describe what you would do during the maintenance visits and the rationale
for the procedures undertaken.
O07Q1
What is the role of scaling and root planning (non-surgical) in the management of chronic
periodontitis?
Discuss the problems and factors that would influence the treatment outcome following
this modality of therapy.
O07Q2
Describe the structural components of the Periodontal ligament in health.
Describe the role of periodontal ligament in the following circumstances:
(i) When traumatic forces are applied on the tooth
(ii) In periodontal regeneration
M06Q1
What is a biofilm? Discuss with supporting evidence, how will understanding the concept
of oral biofilm affect periodontal therapy?
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Preventive Dentistry
M06q2
Ms Tan, a 29 year old bank executive, complained of increasing mobility of #11 and #12
and that the space between #11 and #12 seems to have “opened up” over the last two
months.
Intra-orally, you observe a spacing of about 1.5mm between #11 and #12. #11 and #21
also showed 1mm recession buccally, with probing depths of about 5mm. The rest of the
mouth presented with about 2-3mm probing depths, with 0.5mm recession at #16, #26.
Radiographs showed about 40% bone loss at #11, #21, #12 and #22. There were also
some evidence of bone loss (early interdental cratering) at #16, #17, #26, #27 and about
10% horizontal bone loss at #36 and #46.
Discuss how you would approach her complaint. List the possible differential diagnoses.
What would be the most probable diagnosis and how would you manage Ms Tan’s
problem?
M05Q2
“…the cell type which repopulates the root surface after periodontal surgery, determines
the nature of the attachment formed”. (Melcher, 1976).
Discuss the regenerative potential of the periodontium and the biological concepts of
current regenerative periodontal therapy.
M05A1
Mrs Mary Tan, a 36 year old bank executive, complained of ‘red and bleeding gums; and
difficulty in flossing after my crowns are cemented’. She was unhappy about ‘the red
gums making my smile unsightly’
The dental history revealed that her general practitioner cemented the crowns on #12,
#11, #21 and #22, about six months ago. On examination, probing depths around all teeth
were about 2-3 mm. but there was moderate gingival inflammation with bleeding on
probing at the labial and interdental region of #12, #11, #21 and #22
Complaints like Mrs Tan’s are not uncommon. Discuss with supporting evidence, how
aesthetic predictability can be achieved in fixed prosthodontics.
M04A1
A 25 year-old healthy female teacher presents in your clinic with Aggressive
Periodontitis. Probing depths ranges from 5-7 mm with minimal recession and Degree I
mobility. The lower molars shows Class I & II furcation involvement. Radiographs show
loss of about 30-50% bone support around the molars and incisors. She has an intact
dentition. Oral hygiene is fair.
Discuss in sequence how you would manage this patient and the rational in the treatment
plan on the basis of some of the available scientific evidence.
M04A2
What are the common systematic risk factors associated with destructive periodontal
disease that you are likely to encounter in clinical practice. Explain how ONE of the risk
factors your have identified may contribute to periodontal destruction.
M03A1
In periodontal health, the dentoepithelial junction seals the underlying periodontium from
the oral mucosa. Discuss the effects of plaque-induced inflammation on the physiology
of this region of the gingival.
M03A2
A 42-year old man, with a history of smoking, presented with generalized 5-7mm
probing depths, 2mm recession at the buccal of the upper canine-premolar region. Class
II furcal involvements of #36 and #26 and general irregular bone loss of 30%-40%. He
was diagnosed as suffering from Moderately Severe Generalised Chronic Periodontitis.
What would the differences be if you were to apply conventional decision-making versus
the evidence-based approach in drawing up your treatment?
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Preventive Dentistry
M02A1
A 35-year old healthy female who is 5 months pregnant complains of bleeding gums and
gum swelling for the past month. She also requests for replacement of her upper anterior
porcelain crowns on 11, 21 which were done about 3 years ago due to trauma. On
examination, she presents with inadequate oral hygiene, generalized bleeding on probing
and probing depths of 3-5 mm. gingival inflammation was most severe around 11, 21
with loss of attachment in the form of increased probing depths of 5mm. the crown
margins are about 1.5mm subgingival, the contours are over bulbous.
(i) Explain the possible factors which contribute to the patient’s periodontal status.
(ii) Discuss in sequence how you would manage the case.
M02A2
Discuss conventional methods of diagnosing periodontitis in your patients in clinical
practice. What additional diagnostic tools would you consider as useful in assisting you
to assess the periodontal status of patients presenting with Aggressive Periodontitis and
why?
J01A2
Mrs Tan complained of sensitivity and foul smell at #46 whenever she flossed. Intra-oral
examination revealed that #46 presented with recurrent caries at the distal margin of a
porcelain-fused to metal crown. The existing crown is 2 mm subgingival at the mesial
and distal margins. Buccally, there was a 2mm recession and the crown had an increased
cervical bulge. All probing depths were about 2-3 mm, with generalized mild gingival
inflammation. There was more severe gingival inflammation around #46. Periapical
radiograph of #46 showed a normal periapex with slight angular bone loss at the distal
margin.
Explain the clinical findings presented. Discuss the periodontal considerations you would
take to increase the success of your prosthodontic treatment? What are some of the
limitations or problems you might encounter when re-treating #46?
J01A1
"Microbial plaque is the initiator of periodontal disease, but whether it affects an
individual, what form the disease takes and how the disease progresses are variable".
Discuss the factors that could modify the outcome of plaque-induced periodontitis.
M00A1
Loss of periodontal attachment is a pathognomonic feature of periodontitis. Discuss the
pathogenic mechanisms involved in periodontal tissue breakdown.
M00A2
A patient gives you a history of having completed “gum treatment”, including “gum
surgery” two years ago. However, since his last post-operative visit 2 years ago, he has
not seen any dentist. On examination, you find that his oral hygiene is not satisfactory
and he presents with generalized probing depths of 5-7 mm, especially at the posterior
teeth. What are the possible reasons for your recent findings? Briefly discuss the factors
that determine the success of periodontal therapy.
M99A1
A 35-year old healthy female complains of spacing of the upper anterior teeth which
became progressively worse over the past year. On clinical examination, the anterior
teeth exhibit Class II mobility with spacing of about 1-2 mm; 16 and 26 are missing.
There are generalised probing depths of 5-7 mm with recession 1-2 mm around most
teeth. Radiographs reveal loss of about 50% supporting bone. All teeth are vital and the
patient is caries free. Oral hygiene is inadequate.
Briefly explain the possible reasons for the spacing and mobility of the upper anterior teeth.
Discuss your proposed treatment plan in the management of the patient’s oral health problems and
the rationale of each phase of the treatment.
17
Preventive Dentistry
How would you ensure the patient’s periodontal condition is well controlled on the long-term
basis?
M99A2
Discuss the various clinical assessment criteria you would use in diagnosing periodontal
disease in your patient. Briefly explain how some of the new technologies available could
improve the effectiveness and utility of your current diagnostic procedures.
S98A1
What are the risk factors associated with Chronic Inflammatory Periodontal disease?
Discuss the role of one local and one systemic risk factor in the progression of CIPD.
S98A2
A 35-year old female patient complains of bleeding gums around the upper anterior
crowns on 11 and 21 for the past two years. The porcelain bonded to metal crowns were
constructed two and a half years ago. On examination, the patient presents with in
adequate plaque control particularly around 11 and 21, probing depths around the crowns
are 4-6 mm while other sites are less than 5 mm. The marginal gingivae around 11 and 21
are markedly inflamed with spontaneous bleeding. The crown margins are at least 1-2
mm subgingival and the crown contours are bulbous. There is loss of about one quarter of
bony support from the periapical radiographs. There are no periapical and pulpal
involvement of the teeth.
Discuss:
(i)
The detrimental effects of the above mentioned crowns on periodontal health.
(a) Management of the case and the rationale of the sequence in your treatment
plan.
The gingival sulcus is constantly challenged by the presence of subgingival plaque. What
features of the dento-gingival complex allows it to maintain the periodontium in a healthy
state?
(i)
M98A1
M98A2
A 45-yr old male complains of recurrent episodes of gum swelling. The clinical
examination revealed the following findings:
i)
Generalised probing depths 5-8mm with no recession and Class I furcation
involvement around the upper molars.
ii)
Inadequate oral hygiene especially around the lingual and interproximal region
iii)
Tooth mobility degree I - II
iv)
Caries free dentition with no missing teeth and no endodontic involvement
v)
Periodontal abscess on 11
vi)
Patient is a non-insulin dependent diabetic and smokes about 20 cigarettes a day
Briefly discuss the likely risk factors associated with the patient's periodontal status.
Outline your treatment plan for this patient and explain the rationale for the treatment
options.
N97A1
What is trauma from occlusion? Briefly discuss the role of trauma from occlusion on the
periodontium.
M97A1
What is the rationale for mechanical plague control. Discuss the role of “pathogenic
microbiota” in relation to chronic inflammatory periodontal disease.
M97A2
A 27-yr old lady presents with a complain of spacing between her upper central incisors.
She has had orthodontic treatment for this same problem 3 years ago. She feels that these
two teeth are getting “loose” lately. Discuss your differential diagnosis and management
of her complaint.
N97A2
A 32-yr old man comes into the clinic complaining of a swelling at the lower left anterior
region. On examination, you observe a buccal swelling at 32. What are the possible
differential diagnosis for his complaint. What investigations would you carry out to help
you diagnose his problem?
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Preventive Dentistry
M96A2
Describe the clinical features of Periodontal abscess and briefly outline the possible
aetiological factors.
A 35-yr old male presents with multiple periodontal abscesses of 2-3 days duration.
Discuss the management of the case.
M96A1
Discuss the current status of Non-Surgical Mechanical Periodontal therapy in the
management of Chronic Inflammatory Periodontal Disease.
O96A1
Discuss the current status of perio-surgery in:
a) management of C.I.P.D.
b) Restorative dentistry
O96A2
Your patient is a 45-yr old male presenting with gen. adult periodontis. Loss of
aattachment ranging from 4-6 mm manifested in the form of increased probing depths are
found: lower molars presenting with class I furcation involvement. Mobility is in the
range of I – II. He has an intact dentition with no clinically detectable caries. Oral
hygiene is poor. Patient gives a history of D.M. diagnosed 2 years ago. Patient has been a
smoker for past 20 years, smoking 15-20 cigarettes per day. He is currently on dietary
control for his diabetic condition. He also gives a history of occasional periodontal
abscesses.
Briefly discuss the potential risk factors which may be associated with the patient’s
periodontal condition.
Discuss the Mx of the case.
M95A2
What are the objectives of periodontal therapy? Briefly discuss the efficacy of nonsurgical periodontal therapy.
M95A1
Discuss the role of dental plaque in the aetiology of chronic inflammatory periodontal
diseases.
M94A2
Discuss the current status of topical anti-plaque agents in the control of Chronic
Inflammatory Periodontal Disease.
M93A1
Describe the clinical features of Juvenile Periodontitis. Name a micro-organism which
has been strongly implicated with this condition and briefly discuss its pathogenic
potential. Discuss how you would manage a patient with juvenile periodontitis in clinical
practice.
M93A2
Describe the clinical features and management of various forms of chronic inflammatory
periodontal diseases.
M93A1
Define the term "probing depth". Discuss the role of periodontal probing as a diagnostic
aid.
M92A2
Describe the anatomy of the region between the gingival sulcus and the marginal alveolar
bone. What are the clinical importance of the structures in this region?
M92A1
Describe the possible causes of gingival recession. What advice and preliminary
treatment would you give to a new patient complaining of gingival recession?
S91A2
Discuss the role of maintenance therapy in the treatment of periodontal diseases.
S91A1
Discuss the diagnosis aetiology and emergency treatment of an acute periodontal abscess.
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Preventive Dentistry
M91A2
What are the objectives of periodontal treatment? Briefly discuss the efficacy of surgical
versus non-surgical therapy.
M91A1
Discuss the post-surgical healing potential:
a) the gingival
b) the bone
c) the periodontal ligament
S90B4
Briefly discuss the importance of maintenance therapy in the treatment of periodontal
disease.
S90B3
In partially dentate patients, how will prosthodontic replacement of teeth affect the
periodontium?
M90B4
Write short notes on: a) probing depth
M90B3
Define chemotherapy in relation to periodontal treatment. Briefly discuss the efficacy of
chemotherapy in the control dental plaque.
b) alveolar depth.
PEDODONTICS
M08Q1
Discuss the causes of both localized and generalized acquired developmental defects of
enamel. In general, what would be your treatment aims when managing a child with
chronological enamel hypoplasia?
M08Q2
A 10 year old boy presents with a developing class II discision I malocclusion and an
increased over jet. His mother complains that he Is lazy and does not brush his teeth. He
also snacks frequently. He had a history of multiple fillings in his deciduous teeth. On
examination., oral hygiene is fair with mild to moderate gingivitis. The pits and fissures
of all the 1st permanent molars are stained. Discuss your management of this patient with
emphasis on preventive care.
M07Q1
Discuss the possible causes and management of discoloration of teeth in a 9-year-old
patient.
M07Q2
How would you manage a healthy 2-year-old child who suffered intrusion of both upper
central incisors when he fell at home an hour ago? Discuss the possible sequelae of such
an injury on the developing permanent successor teeth.
O07Q1
Discuss how you would assess the need to fissure seal the first permanent molars in a 7year-old patient.
O07Q2
Discuss the management of root fracture in primary as well as immature permanent
incisor teeth.
M06Q1
Discuss the types of luxation injuries that can affect the permanent dentition and outline
your management for each of these injuries affecting the upper right central incisor of a 9
year old boy.
M06Q2
5 year old David arrives at your dental clinic for his dental visit with his mother. He is a
healthy and co-operative child. His mother wants “fillings” for David’s front teeth which,
20
Preventive Dentistry
according to her, have broken down. Examination revealed carious lesions on the labial
and proximal surfaces of the upper incisors and on the occlusal surfaces of the upper and
lower primary molars. All other teeth were sound and he had no complains of pain.
Based on the clinical findings presented, discuss the cause of David’s dental problems.
Outline your treatment plan and behaviour management strategy for this patient.
M05Q1
Discuss the circumstances in which severe periodontal disease is likely to occur in
childhood.
M05Q2
Trauma to primary teeth may result in damage to underlying permanent teeth. Discuss the
possible sequelae of such injuries on the developing permanent succeedaneous teeth and
outline how you would manage the problems that may arise.
M04A1
Discuss the causes of delayed eruption of permanent teeth.
Describe how you would manage the case of Paul who is almost 9 years old and presents
with non-eruption of #21.
M04A2
What would be your guidelines for recommending the use of fluoride to
your child patients in Singapore? Discuss the rationale for your recommendations.
M03A1
Discuss the value of fissure sealants in a program of preventive dentistry for children.
Describe the types of dental materials currently employed for this purpose.
M03A2
Justin, a healthy 12-year old, presented with fever, pain and right facial swelling of 2 days
duration. On examination, he was found to be caries free. A buccal swelling was present
in relation to #45. The tooth was tender to percussion and had a fractured dens evaginatus.
A dens evagintus was also seen on #35 which was asymptomatic.
Explain the cause of Justin’s complaints. Describe how you would manage #45 & #35 in
the immediate and long term.
M02A1
Discuss the possible causes and management of bleeding gums in a 3 year-old child.
M02A2
A healthy 9 year-old boy was involved in a bicycle accident 30 minutes ago and sustained
some injuries to his teeth. There is an oblique coronal fracture of the upper right central
incisor with exposure of the pulp. The crowns of the other teeth are intact but
haemorrhage is seen from the gingival margin around the upper left central incisor. He
has no other injury. Discuss your immediate and long-term management of this patient.
J01A2
A 6-year-old presents with lingual swelling associated with a painful first primary molar.
Discuss how you would manage the case. What are the treatment options? List the centraindications to the pulp treatment of a primary molar.
J01A1
Discuss some of the common dental conditions that can be associated with disabled
children.
M00A1
A mother brings her anxious 3 year-old child to your dental clinic with a complaint of
pain on the upper left quadrant. On examination, the child presents with:
(ii)
Poor oral hygiene,
(iii)
Class I molar relationship
(iv)
caries on all the upper and lower molars
21
Preventive Dentistry
(v)
a large cavity on 65 which you suspect may be the cause of the complaint
Discuss your management of this case and outline a comprehensive treatment plan.
M00A2
Describe the dentition and the stage of development of all teeth of a child aged 6 years.
What are the clinical preventive measures you would adopt for children of this age?
M99A1
Discuss the possible causes of discolouration of children’s teeth. How would you manage
each of the conditions mentioned?
M99A2
Inherited abnormality of tooth number and form may be associated with problems in the
developing dentition. Discuss the ways in which these problems may manifest and the
possible methods of treatment for each of the conditions mentioned.
S98A1
A 4-year old patient presents with buccal swelling associated with a second primary
molar. What are the treatment options? List the contra-indications to pulp treatment of a
primary molar.
S98A2
Describe the common oral habits found in children. How would you manage each of the
conditions mentioned?
M98A1
What do you understand by the term "rampant caries"? Discuss the clinical
manifestations and the management of rampant caries in a 4-yr old .
M98A2
Briefly discuss the problems associated with management of trauma to immature
permanent incisor teeth.
A 9-yr old boy injured his upper right central incisor while roller-blading an hour ago.
Clinical examination revealed a coronal fracture with pulp exposure. There were no other
injuries. Describe your management of this patient.
N97A1
Discuss the factors that will help you determine whether to restore or extract a carious
deciduous molar in your child patient.
N97A2
What are the possible causes of delayed eruption of permanent teeth? How would you
manage a normal 9-yr old child whose upper left central incisor has failed to erupt?
M97A1
Define the terms “apexogenesis” and “apexification”. Discuss in detail the management
of a non-vital Leong’s premolar with an open apex.
M97A2
A mother brings her 3-yr old son to see you for his first dental checkup and to seek
advice on how to maintain good oral health. Briefly list the advice you would give them.
Discuss the application of the preventive measures for preschoolers in your clinic.
M96A1
What are the types of traumatic injuries that may occur to the primary anterior teeth.
Discuss the management of each of the conditions mentioned.
M96A2
A 3-yr old boy in your practice is found to be developing numerous cavities in all his
molar teeth. There is no history of dental pain but the child is apprehensive.
a) Describe briefly factors that may influence the child’s behaviour in the dental chair.
b) What treatment would you provide?
O96A1
Discuss the anomalies of tooth form and structure you may encounter in your child
patient.
O96A2
Describe the common oral habits found in children. Briefly discuss how you would
manage each of the conditions mentioned.
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Preventive Dentistry
M95A2
Describe the common oral and dental problems that may occur in pre-school children.
Outline the treatment for each of the conditions mentioned.
M95A1
A two and a half-year-old boy attends your clinic after falling and striking his mouth on
the edge of a table. Visual examination fails to reveal the presence of the upper central
incisors but there is bleeding and laceration of tissues. Discuss the management of this
patient.
M94A2
Briefly discuss the necessity of conservation of the primary dentition. What are the
clinically available preventive measures for the child patient?
M94A1
A healthy 6 years old girl who has never been to the dentist before is brought to you by
her mother. She has noticed a hole in one of her daughter's primary molars, but the girl is
in no pain. Discuss your treatment plan for this girl.
M93A2
Discuss the factors to be considered, and the behavioral management you would adapt, to
ensure the success of the first dental visit of a 4-year old child.
M93A1
Discuss the possible the causes of discolouration of children's teeth. How would you
manage each of the conditions mentioned?
M92A2
A child aged 8.5 had sustained a fractured upper central incisor with pulp exposure.
Discuss how you would manage and treat the case.
M92A1
Discuss the applications of clinically available preventive measures for the child patient.
S91A2
Describe the ways in which inherited abnormality of tooth number and form are
manifested in children. Outline the dental management of each of the condition
mentioned.
S91A1
Discuss the aetiology and management of rampant caries in pre-school children.
M91A2
Describe the methods you would employ in the treatment of traumatized maxillary
permanent incisors with open apices.
M91A1
An anxious mother brings her 4-year old child to your dental office with a complaint of
pain on the lower right quadrant for the last two days. On examination the child presents
with:
a) poor oral hygiene
b) Class 1 molar relationship
c) Caries on
d) A large cavity on E which you suspect may be the cause of the complaint.
Discuss briefly the management of the above child patient and describe a plan for
treatment.
S90A2
When is pulpotomy of a primary tooth indicated? How do you access its success or
failure?
S90A1
A child aged 9 has a missing upper right central incisor. List all the possible causes.
M90A2
What part does oral hygiene play in determining the pattern of dental disease in
childhood? Describe ways by which an improvement in oral hygiene can be brought
about during childhood.
M90A1
Describe the ways in which children's teeth may become discoloured and suggest
possible methods of treatment.
23
Preventive Dentistry
ORTHODONTICS
M08Q3
Two late teenage male patients (circa 17years of age) presented at different times to your
clinic with a similar concern of protruding upper front teeth (“my front teeth stick out and
I look like bugs bunny”). After a cursory clinical examination of class II division I
malocclusion, you recommended a provisional treatment plan of mandibular advancement
jaw surgery (in combi with ortho) for one patient, while the other patient was informed
that ortho treatment with fixed appliances alone could correct the protrusive upper front
teeth.
(i) What further diagnostic steps would you take to arrive at the definitive treatment plan
for each of the two patients
(ii) Explain why these diagnostic steps are needed
(iii) Explain why one patient would require mandibular jaw advancement surgery (in
combi with ortho) while fixed ortho appliances alone would correct the protrusive upp
front teeth of the other patient.
M08Q4
“27 months, its like being pregnant three times” The third time mother, a corporate high
flying executive jumped with joy that her fixed ortho treatment for a severe class II
division I mmalocclusion is finally over. She exclaimed in delight and with relish. Now I
can re-conquer the world’. Just then you informed her that she needs to wear retainers. In
a sudden, her mood darkened considerably and snapped ‘say what?’ You replied ‘yes
madam, retainers., you will have retainers for the next 18months’. You could hear the pin
drop then. She asks
(i) Why do I need retainers?
(ii) Do I need to wear retainers for 18 months only?
(ii) Can they be seen and will they affect my lifestyle?
(iv) What options for retainers do I have?
You are to answer her questions clearly, logically and concisely WITHOUT using dental
jargon.
A 14-year-old male presents with a severe class III malocclusion. The overjet was
reversed at 3mm and he has an anterior open bite of 2mm. Accompanying him was his
40-year-old mother who has a protrusive lower jaw.
Explain the relevance and role of appropriate history taking, clinical examination and the
taking of essential diagnostic records in arriving at a complete orthodontic diagnosis and
the need for treatment for this young male patient.
M07Q3
M07Q4
Tooth movement during active orthodontic treatment and retention of teeth after treatment
were two contrasting but sequential phases of managing malocclusions. Explain why
teeth would move on application of a force, and why teeth would not remain in a stable
position when the force application ceases. What retention appliance would you
recommend a patient who previously had rotated incisors?
O07Q3
What morphological differences and similarities exist between a class II division I
malocclusion and a class III malocclusion? Explain how dento-alveolar compensation
might have taken place for a class III malocclusion.
O07Q4
A child of 11 years of age presents with an anterior open bite malocclusion. Explain the
possible aetiology of the malocclusion.
M06Q3
Discuss the factors that influence orthodontic treatment uptake and relevance of treatment
need assessment.
M06Q4
An 18 year old female patient comes to see you with a set of orthodontic study models
and complains of her crooked lower incisors. She had a previous history of
24
Preventive Dentistry
comprehensive orthodontic treatment that was completed at 15 years of age. She has a
convex profile with retrusive mandible, increased lower face height and a gummy smile
with incompetent lips at rest. She indicated that she had enlarged adenoids and mouth
breathing habit during her childhood years.
She now presents with the following dentition:
8765321
1235678
8765321
1235678
The lower third molars are partially impacted while the upper third molars are fully
erupted. A comparison with her post-treatment orthodontic study model shows that the
lower incisors had developed 4mm of dental crowding since the time of treatment
completion. The overbite has also reduced from 3mm at post-treatment to 1mm at present.
The existing maxillary and mandibular dental arches display 2mm of transverse arch
constriction when compared with the post treatment models. The overjet has increased
from 2mm to 4mm.
(a) What type of growth pattern does the patient display?
(b) What is the presenting orthodontic problem related to the patient’s complain?
(c) Discuss the contributing factors associated with the development of this clinical problem
and the recent evidence-based literature on the effectiveness of various methods used to
maintain the occlusion upon completion of orthodontic treatment.
M05Q3
A !6 year old boy complained of a mobile upper left permanent lateral incisor during a
dental checkup. He presents with the following intra oral findings:
a.
teeth present:
a7654C21 12C4567
7654321
134567
b. minimum overjet with deep traumatic overbite.
c. The two maxillary central incisors and four mandibular incisors are retroclined.
d. the two maxillary lateral incisors are proclined with a hyper-mobile maxillary left
lateral incisor.
e. Class II buccal segment relationships with bilateral scissor bite.
a.
b.
M04B3
M04B2
M03B3
Discuss the aetiological factors and dentofacial features that are commonly
associated with the development of the above malocclusion.
Discuss the diagnostic steps necessary to establish the cause of the mobile
maxillary left lateral incisor and the prognostic indicators associated with the
clinical problem.
A 9 year-old girl comes with a complaint of “ my lower teeth arer biting in front of the
upper teeth”. On examination , patient is in mixed dentition and has a Class III
malocclusion.
 List the features of a Class III malocclusions.
 Discuss the management of a Class III malocclusion and comment on the timing
of any appliance therapy
Discuss the importance of the aetionlgy of malocclusion and dentofacial deformity in
orthodontics. Please give the relevant examples to illustrate your answer.
(a) Define “Anchorage” and explain why it is important in orthodontic treatment.
25
Preventive Dentistry
(b) An 8-year old child in the early mixed dentition stage presents at your clinic with a
bilateral posterior crossbite and a single upper left central incisor locked against the
corresponding lower central incisor in crossbite. No other features of malocclusion are
noted.
Using your knowledge of anchorage, elaborate on the design of a removable appliance
that would facilitate the correction of the observed malocclusion.
M03B4
What do you understand by Dentoalveolar Compensation? How is this compensation
relevant to the management of malocclusion.
M02B3
In what ways are complex malocclusions different from mild malocclusions?
M02B4
Elaborate on the orthodontic problems that may arise from premature loss of deciduous
teeth, and discuss the considerations for the management of these problems.
J01B4
Discuss the importance of study models and lateral cephalogram in planning orthodontic
treatment.
J01B3
An 8-year old child presents with an anterior open bite. Explain to the child's parent the
possible causes of anterior open bites in the early mixed dentition stage, and how may
such a malocclusion be prevented?
M00B3
A 15 year-old boy come to you with a complaint of unerupted upper right canine (13).
The precedent primary canine had already been extracted some time ago. The presence of
the #13 could be detected clinically by a slight bulge on the buccal aspect and this was
confirmed by a periapical radiograph. What do you think are the possible causes of the
delayed eruption of the canine (13)? How would you manage this patient?
M00B4
“Leeway space” is considered an important especially from an orthodontic point of view.
What do you know of the “Leeway space” and why is it so important in an orthodontic
treatment planning?
M99B3
“Cephalometric analysis is a necessity for the correct assessment of orthodontic patients”.
Discuss this statement.
M99B4
Discuss the factors that may affect the retention and stability of the dentition following
orthodontic treatment. How may stability be enhanced?
S98B3
Describe how standardized lateral cephalometric radiographs can be used in diagnosis,
treatment planning and monitoring growth during orthodontic treatment.
S98B4
Discuss the limitations and complications of orthodontic treatment.
M98B3
Define the term "anchorage" as it applies to orthodontic treatment. What types of
anchorage are available to utilise during orthodontic treatment?
M98B4
Describe the skeletal, dental and soft tissue features of a Class 2 division I malocclusion.
What treatment options are available, and comment on the timing of any appliance
therapy.
M97B3
Discuss the factors that limit the use of removable orthodontic appliance.
26
Preventive Dentistry
M97B4
A 12-yr old boy presents with a positive incisal overjet of 8mm and a deep traumatic
overbite. List the possible etiologies of the presenting malocclusion and discuss the aims
of treatment of this malocclusion.
O97B3
A 9-yr old boy presented with apparent lower lip trap and protruding upper incisors.
Discuss the aetiology of the presenting problem.
O97B4
A successful outcome in any orthodontic treatment lies in the important five steps, i.e. the
establishment of a proper diagnosis and the development of an appropriate treatment
plan. Elaborate on the role and importance of the diagnostic records you would take to
help you achieve those five steps.
M96B3
A 12-yr old child is receiving a course of orthodontic treatment to correct a class II
division I malocclusion. What are the objectives of a treatment plan which involves
extraction of upper premolars and lower premolars. Discuss the stages involved in the
treatment and retention process.
M96B4
What dental and soft tissue damage may occur during a course of orthodontic treatment.
How can this be prevented?
O96B4
Why is the tracing of a standardized lat. cephalometric radiograph useful in orthodontic
diagnosis? How are these used to study cranio-facial growth?
O96B4
Discuss the characteristics of orthodontic treatment which differ from the other aspects of
dental care.
M95B4
a) What are the differences between normal occlusion and a malocclusion?
a) Describe the criteria you would use to determine the suitability of a malocclusion for
removable appliance treatment.
M95B3
Relate the histological changes that occur in the periodontium when a maxillary central
incisor is subjected to rotational orthodontic forces. In addition discuss the possible ways
of minimizing rotational relapse.
M94B4
Write short notes on:
a) The "Ugly Duckling" stage of development of the permanent dentition.
b) Digit sucking
M94B3
Describe the features of a class III malocclusion, and outline the principles of treatment.
M93B4
Discuss the various methods of derotating an upper central incisor. What precautions will
you take to prevent relapse of the corrected rotated incisor?
M93B3
Discuss the use of extra-oral traction in orthodontics.
M92B4
Write short notes on:
a) Serial extractions
b) Minimizing rotational relapse
M92B3
Discuss the role of cephalometric radiography in orthodontics.
S91B4
Write short notes on: (choose 2 out of 3)
a) Cephalometrics
b) Post-treatment retention of derotated teeth
c) Spring aligner
27
Preventive Dentistry
S91B3
Discuss the use of headgears in orthodontics.
M91B4
A patient of 9 has a 3mm median diastema between 11 and 21. Discuss the possible
aetiology and describe your investigations and treatment of the patient.
S90B1
Write short notes on 2 of the following:
a) Serial extractions
b) Maxillary median diastema
c) "Ugly Duckling" stage of development of the permanent dentition.
M90B1
A 13-yr old male with class III dental malocclusion (2mm ob, -2mm oj) presented for
orthodontic treatment. All the permanent teeth with the exception of the 3 molars were
erupted. Discuss the various methods of treating the above mentioned malocclusion with
removable appliances.
28
Restorative Dentistry
TOOTH COLOURED RESTORATIONS AND ACID ETCH TECHNIQUE
M08Q1
Shade matching is subjective and consistency is difficult to achieve. However, regardless
of which system of shade selection is used, there should be general adherence to certain
principles. Discuss these principles.
M07A1
Discuss the impact of composite resins and its bonding systems in achieving the role of
an ideal material in the oral environment.
O07A1
What are the factors to be considered in restoring an abrasion cavity? What are the
restorative materials that may be used? Discuss the advantages and disadvantages of each
material.
M06A2
One of the clinical problems of composite resin is microleakage. Discuss the properties of
the material that contribute to this phenomenon. How can the clinician manage this
problem in his clinical practice?
M04A1
How has the introduction of composites , glass ionomers and their hybrid variants
affected the approach to restoring posterior teeth? What are the problems associated with
the use of these materials and discuss the recent developments to overcome them?
M95 A2
A patient presents with a spacing between the maxillary central incisors. Discuss the
management of this patient who intends to have this gap closed.
M94 A1C
Write short notes on the finishing of restorations of polyalkenoate
( glass ionomer cements).
M94 A2
A patient presents with a stained proximal anterior tooth coloured restoration which could
possibly be a composite resin or GIC. Comment on the possible causes of the stain and
the management of the restoration.
S92
What types of dental materials could be used to restore an abrasion cavity. Briefly discuss
the advantages and disadvantages of the materials chosen in each instance.
S91
Discuss treatment options for discoloured teeth.
M91
Mclean’s sandwich technique advocates the use of two tooth coloured filling materials in
restoring abrasion cavities. Describe briefly the chemical compositions of the materials
used in this technique and explain how the properties of these materials can contribute to
produce an ideal preparation.
M90
Describe the various uses of glass ionomer cement in Cons Dentistry and discuss their
properties in relation to each use that you mention.
S90
Describe the development of anterior restorations. How have composite resins improved
over the years?
M97
Glass ionomer cements adhere to the tooth structure. Explain this mechanism of
adhesion. How is the property of GIC made use of in clinical dentistry?
M98
Two patients in your practice require class V restorations on the facial surfaces of their
maxillary left canines and at the cementum/enamel junction. Patient “A” is a 27 year old
female television news reporter with shallow caries on that surface and no other carious
lesions or restorations in the mouth. Patient “B” is a 39-year old fishing boat captain
29
Restorative Dentistry
whose carious lesions appear deeper. He (patient “B”) has 7 other class V carious lesions
and recurrent caries around 3 of his class II amalgams. The restorative products available
to you include :1) a microfilled composite resin; 2) a compomer (polyacid-modified
composite resin); 3) a resin-modified glass ionomer; and 4)dental amalgam. Assume that
you have the appropriate dentin/enamel adhesive system of your choice. Which
restorative material would you recommend to restore the tooth of patient “A” and which
would you choose for patient “B”? What are your specific reasons for choosing those
materials, rather than the others?
M99A1
“All restorations leak”
Discuss this phenomena in relation to composite resins, including the management of this
problem in the clinical situation.
M00A2
Glass Ionomer Cements have undergone some modifications since it was introduced
about four decades ago. Discuss the indications and uses of this material. Include in your
answer the development of the material which has made all this possible.
M02A1
A patient presented at your clinic complaining of transient pain in her lower right
posterior teeth. On investigation, the cause of pain could be attributed to recurrent caries
at the cervical margins of multiple posterior composite restorations in the quadrant.
During history taking, it was noted that the restorations were placed only 10 months ago.
Discuss the possible causes of restoration failure and how they could be minimized.
M03 A2
Discuss the factors leading to microleakage in a composite resin restoration. Elaborate on
the measures a dentist should take to overcome this problem.
AMALGAM RESTORATIONS / PINS
J01A1
A 22-year old female presents with multiple interproximal caries. She is extremely
concerned about the health effects of amalgam and does not want any amalgam
restorations. Discuss the management of this patient.
S97
A patient presents with numerous occlusal and occluso-proximal dental amalgam
restorations. She requests to have all of them converted to posterior composite resins for
aesthetic reasons. Discuss your management of this patient.
M97
A patient presents with a request to have the posterior amalgam restorations replaced with
composite resins. Discuss the factors you would consider before deciding to replace the
restorations. What are the limitations of posterior composite restorations and how would
you overcome them?
S96
A patient with dental decay in the proximal surface of the maxillary first premolar.
a) What are the various modes of retention for restoration of this tooth with dental
amalgam?
b) Discuss the factors you would consider in your choice of a dental amalgam or direct
posterior composite resin for this tooth.
M96 A1
Retention is defined as the quality inherent in the restoration acting to resist the forces of
dislodgement. Discuss how this is achieved for dental amalgam and direct tooth coloured
restorations.
M94 1a
Write short notes on the use of dental pins.
M94 1b
Write short notes on common causes of failure of amalgam restorations.
30
Restorative Dentistry
M93
List the common causes of failure of restorations of dental amalgam. Discuss the factors
which influence the clinical performance of such restorations.
M92
Compare and contrast pin vs slot retention for amalgam restorations.
S91
Give a brief account of the types of pins which can be used for the retention of amalgam
restorations. Discuss how you would use pins for an amalgam restoration of a partially
broken down vital molar tooth.
M00 A1
Mrs Tan walks into your surgery requesting to change her numerous amalgam
restorations into tooth coloured materials. Discuss the management of Mrs Tan’s
problems.
CAVITY PREPARATION
S98A1
What diagnostic aids would you employ to assist in the detection of caries? Discuss how
they are used and their limitations.
S97
a) How would you detect dental caries in a clinical situation?
b) Discuss the management of initial carious lesions in your patient.
M91
A fully dentate patient presents with a carious lesion on the mesial surface of the
maxillary first premolar. What types of cavity preparation and dental materials could be
used for its restoration?
Describe briefly the advantages and disadvantages of the materials listed in this situation.
BASES AND LUTING AGENTS
M08Q1
Discuss the suitability of GIC for the following clinical applications:
(a) Preventive
(b) Luting
(c) Lining
(d) Restorative
M06Q2
Review the materials available for final cementation of indirect restorations, indicating
the advantages and disadvantages of each type.
J01A2
Mr Tan presents with a deep carious maxillary premolar involving the buccal surface, m
the process of excavating caries, the pulp is exposed. How would you manage the
situation? Explain the rationale for your course of action.
J01Q2
List the various types of luting agents available for permanent cementation of fixed
restorations. Discuss their advantages, disadvantages and indications.
S94
Discuss the types of liners and bases suitable for use in a very deep cavity with no visible
pulpal exposure.
STERILIZATION
M92
Compare and contrast the following: Sterilization vs disinfection.
31
Restorative Dentistry
S90
Write an essay on the “prevention of cross infection in Cons Dentistry”.
MISCELLANEOUS
M08Q4
70 year old Mr Tan is using a loose and unsatisfactory set of upper/lower removable
partial dentures. The dentures are about 10 years old. He has 2 teeth left in the mouth. The
#24 and #34 are both relatively firm and have no carious or periapical lesions although
there is some loss of attachment. Mr tan is not interested in implants, besides he finds
them too expensive. Discuss the different treatment options you can offer Mr Tan and
which one in your opinion would yield the most satisfactory results.
M07B1
A patient complains of pain upon biting from one of the teeth in the mandiublar right
posterior region. A periapical radiograph taken is attached:
(a) Describe clinical diagnostic procedures
(b) Describe the periapical radiograph
(c) provide diagnosis and the etiological cause.
M07Q2
A 22-year-old patient presents with rampant decay and multiple defective resorations.
Discuss and explain the rationales of your management of the patient.
M07Q4
Discuss the altered cast techniques, indications and contraindications.
O07Q1
A 24-year-old patient complained that her removable partial denture replacing a maxillary
left lateral incisor is uncomfortable. What are the treatment options that are available for
the patient to improve her comfort? Discuss the advantages and disadvantages of each
treatment option.
O07Q2
Discuss the problems associated with providing a full coverage restoration for a tooth
clinical crown. Discuss and assess the treatment options available to ensure long-term
clinical success.
O07A2
Discuss the management of a patient with multiple frank carious lesions and a smaller
number of initial lesions.
M06A1
A new patient, Mrs Lim, requests for treatment for her maxillary and mandibular
discolored teeth. Discuss the management of this patient and discuss the options available
for her condition.
M05A1p2
Discuss the factors which may determine the frequency at which you will review a patient
after a course of restorative treatment.
M05A2
Its been said that the success of a restoration is highly dependent on the proper material
and case selection. Elaborate on this statement with reference to the restoration of a class
II.
M04A2
Discuss the ways in which intracoronal restorations fail in clinical
service. Are there any clinical indications to repair rather than replace failing intracoronal
direct restorations?
M03 A1
A 35-year olds female presents with a history that she has not seen a dentist for the last
six years. Her neglect started after her university degree as she was very busy with work
32
Restorative Dentistry
and family. She denies a history of medical problems. Her chief complaint: “My upper
teeth are sensitive to sweets and hot and cold”. She admits that she sips sweetened
lemon tea while working at her desk the whole day.
On oral examination, patient has no restorative. Her six maxillary anterior teeth show
visible carious lesions at the gingival area. (Figure 1) Enamel appears to be
demineralised at the line angel area and the underlying dentine is stained. Radiographic
examination revealed obvious carious lesions involving the facial surface with no
proximal involvement.
(i)
(ii)
Develop a restorative list for this patient: include both short and long term
problems.
Discuss your comprehensive plan of treatment, paying particular attention
to behaviour management and your choice of restorative materials.
M02B1
Under the restorative treatment plan, you were supposed to perform a caries-free
procedure followed with a restoration on a grossly carious upper right first molar which
used to be ‘sensitive at times’.
a) Describe the pre-treatment procedures and treatment plan.
b) Assuming there is a vital carious pulp exposure during the caries-free procedure,
describe the immediate treatment procedures and outline the subsequent treatment plan.
M02A2
A routine bitewing radiograph of a fully dentate young adult shows that a carious lesion
affecting the mesial surface of the maxillary second premolar has progressed to involve
dentine. Describe your management of this tooth
M02Q2
A 28-year old female comes to you with a request to whiten her upper anterior teeth.
Upon examination, she is generally healthy. Her teeth match the C4 Vita shade. There is
a brown band of discolouration at the cervical third area of all the anterior teeth. The
incisal edges of the 4 incisors were fractured 15 years ago due to trauma. Tooth coloured
restorations are present at the incisal edges as well as the mesial and distal surfaces of the
incisors. The margins of the restorations are discoloured. These restorations were placed
more than 8 years ago. The canines are intact.
All the teeth are vital. There is only mild chronic marginal gingivitis noted. Replacing the
tooth coloured restorations will not satisfy her request.
a) What re the types of restorations you may select to restore her teeth? Which type/types
would be most suitable for her? Give reasons to support your choice.
b) After your clinical examination, what is your sequential treatment plan to fulfill her
request? Explain the rationale for your plan.
J01Q3
What is the "Combination Syndrome"? Discuss the problems associated with the
restoration of patients who are edentulous in the maxilla but not in the mandibular.
J01Q1
In some clinical situations, crown lengthening procedures to increase the clinical
crown length are indicated prior to restorative procedures.
a)What are the various situations where crown lengthening procedures will be
indicated?
b)Discuss the factors you need to consider when you are indicating a surgical crown
lengthening procedure prior to restoring a tooth with a fixed prosthesis.
M99A2
A patient presents with extensive loss of tooth structure of #16 (maxillary first molar)
compromising the retention of the permanent restoration. Discuss the management of this
tooth.
33
Restorative Dentistry
M99B2
A few treatment options are available for managing deep caries of a permanent tooth. List
and state the indications for the choice of procedure. What are the presenting signs and
symptoms if treatment should fail?
S98A2
A patient presents with a discoloured anterior tooth. How would you arrive at a
diagnosis? What are the treatment options?
S98B1
a. What are the differences between dentinal pain and pulpal pain?
b. A patient, age 19, experienced tenderness of the mandibular right second premolar
seven days ago. Presently, there is severe throbbing pain and swelling near and around
the tooth. The tooth is elongated and has Cl III mobility. The patient appears pale,
irritable and weakened from pain and loss of sleep. His temperature is 39 degree Celsius
and his fever is accompanied by chills. Describe how you would manage this case.
M98
How would you manage a patient who has a discoloured tooth versus one who has a
generalized discolouration?
M96 A2
A patient presents with extensive carious lesions for most of the posterior teeth and initial
lesion ( R1 on radiographs) for the upper anterior teeth. Discuss how you would manage
this patient in your clinical practice.
M95 B1
Outline the basic requirements for the examination of a new patient seeking treatment in
your dental practice. How does the examination and diagnosis contribute to the overall
management of the patient?
M92
Discuss the factors which would influence your choice of making and impression of a
single tooth preparation.
M92
Your adult patient shows an etched and stained lesion on the mesial surface of the lower
first molar.
What are the criteria you would use in your decision to restore or not to restore the
surface. If the decision would be to restore the tooth, discuss your criteria for selection of
the materials to use for the restoration.
S92
Describe the technique of restoring an approximal initial carious lesion in a premolar
tooth. What factors will you take into consideration in your approach to treatment
planning for such a lesion?
M95
Discuss the methods by which the vitality of a tooth can be established. Include in your
discussion how you would test the vitality of a tooth.
S96
In your delivery of dental care involving complex work (eg. Bridges and veneers),
discuss the differences in management for a patient who has rampant caries vs another
patient whose teeth are
relatively free from dental decay.
ENDODONTICS
M08Q2
Describe your RCT treatment procedures to tooth #46.
M07B2
Describe the principles of root canal treatment of non-vital teeth.
34
Restorative Dentistry
O07B2
A 30-year-old Chinese female patient presents for the management of a recurring sinus
discharge on the “gum” over the left mandibular left molar.
(a) Describe diagnostic procedures including radiographic interpretation.
(b) Provide a diagnosis for the tooth concerned.
(c) Outline your treatment plan with supporting rationale.
After you present the treatment plan, the patient asked to explain the following:
(a) What are the probably causes of failure?
(b) How would you perform the treatment better?
M06B1
An apprehensive 21 year old male patient has a maxillary right lateral incisor
endodontically treated about 3 years ago which now presents with a discharging sinus. A
periapical radiograph shows a leaky temporary restorative margin and a short root canal
filling of about 3mm.
(a) Describe your management approach.
(b) Elaborate and account for the clinical findings including signs
and symptoms.
M06B2
A 53 year old female has been experiencing increasing sensitivity to sweets as well as
cold good and beverages associated with the lower right first molar (#46) which has an
MOD amalgam restoration placed more than 20 years ago. Recently, the sharp pain
sensation has progressed to a dull ache and is now intolerable.
(a) What are the pulpal nerves involved?
(b) Describe their profile and characteristics with a brief account on the presenting
symptoms.
M05Q3
A healthy 23 year old male patient with an upper right central incisor that has dark grey
discolouration. He noticed the tooth turning grey gradually over the past 1 year but it is
not painful. On examination, you noticed that the tooth has a large tooth-coloured
restoration on the mesial aspect with recurrent caries. Periapical film shows a raiolucent
lesion about 5 mm in diameter at the root apex.
a) What is the most likely endodontic treatment for this tooth?
b) Discuss the cause of tooth discolouration in this case.
c) Describe a suitable method for managing the tooth discolouration in this patient.
M04B1
A patient presented with a tooth previously root canal treated which is now associated
with an enlarging periapical lesion.
(a) What are the different causes of endodontic failures?
(b) What measures could you take to minimize endodontic failures?
M04B2
Discuss the common procedural errors that can occur during cleaning and shaping of a
slightly curved mesio-buccal canal of a lower first molar. How may these procedural
errors be prevented?
M03B1
A mandibular left first molar requires a root canal treatment. On the periapaical
radiograph taken from a straight view, the root canal system within the mesial root
appears ‘obliterated’ at the mid-root level and this root does not look curved .
(i)
Describe the common presentation of root/canal morphology of this tooth.
(ii)
Describe one variation of root/canal morphology of this tooth.
(iii)
Describe your approcach to this endodontic case during the diagnostic
procedures.
M03B2
You have been fortunate to run a busy practice. One day, with your appointments fully
booked, there are unfortunately two new endodontic emergencies presenting one after
another. One complains of severe lingering pain to cold/hot drinks and slight tenderness
35
Restorative Dentistry
upon biting associated with the carious maxillary right first molar. The other presents
with a sinus discharge associated with a maxillary central incisor.
(a) Provide endodontic diagnoses of the two cases.
(b) Describe with the relevant rationale, the type of the endodontic emergencies you
would provide for these two patients.
M02B2
A maxillary first molar is indicated for root canal treatment. The pre-operative
radiograph shows that the mesio-buccal root canal has marked curvature in its apical
third. What difficulties may this create during treatment and how may these difficulties
be prevented or overcome?
M02Q1
When restoring endodontically treated teeth, discuss the clinical significance of the
following:
a) Adequate apical seal
b) Ferrule
c) Post dimensions in relation to material properties of the selected post
J01B2
A 43 year-old male presented with severe sensitivity upon taking cold beverages and also
with pain upon biting on the lower right first molar (#46). Patient had a history of
previous bacterial endocarditis.
a)Describe diagnostic procedures and the most probable endodontic diagnosis.
b)Describe treatment plan and the endodontic management.
J01B1
Describe the procedural accidents that could occur during the chemo-mechanical
instrumentation of the root canal system. Discuss how they could be prevented.
M95 B1
Discuss the role of bacteria in the pathogenesis of pulpal and periapical pathosses. How
do they affect the overall success of endodontic treatment?
M94 B1
What are the aims of root canal treatment? Describe the complications which may arise
during this treatment, indicating how such complications may be avoided.
M94 B2
What procedures are available for the treatment of the exposed dental pulp? Discuss the
factors that influence your choice of treatment.
M93 1
Discuss the common causes, diagnosis and management of a perforation through the side
of the root of a permanent anterior tooth.
M93 2
Discuss the role of cleaning and shaping root canals prior to onturation. How do you
avoid cross contamination during this procedure?
S92 1
What contributes an endodontic emergency?
An 18 yr old female patient was seen 2 days ago for cleaning and shaping of her upper
left central incisor. Today, she complained of throbbing pain and tenderness to touch on
the same tooth. Describe how you would manage such a situation.
S92 2
What are the factors you would need to take into consideration prior to making an access
cavity for root canal treatment. Identify the possible errors that can occur.
M92 1
Identify 2 core materials most commonly used to obturate root canals and list their
constituents. Describe and discuss the lateral condensation technique.
36
Restorative Dentistry
M92 2A
Describe the functions of the dental pulp.
M92 2B
What are the indications and contraindications for pulp capping? Describe the clinical
technique.
S91 1
Discuss the measures and precautions you would adopt to ensure success in root canal
treatment.
S91 2
WSN on : a) Waling bleach technique
b) Diagnosing an acute apical abscess
M91 1
Discuss the importance of radiographs in endodontics.
M91 2
WSN on : a) Step back technique
b) Electric pulp testing as a diagnostic test
M90 2
A 20 yr old woman complains of a discoloured upper left central incisor. No symptoms
are present and no other teeth are affected. Discuss possible causes of her problems in
your investigations and possible lines of treatment.
S90 2
What are the objectives in establishing the working length of a root canal? How may
working length be determined?
M96 2
The restoration of the endodontically treated root requires special attention both in
diagnosis and in clinical technique.
(a) When does an anterior tooth require a post core restoration?
(b) Describe how retention and resistance forms are achieved in post cores.
(c) Describe two techniques for the retention of core material in the restoration of a
posterior endodontically treated tooth.
M96 B2
Write short notes on
(a) Use of Gutta Percha as a root filling material
(b) Bleaching a non-vital tooth
S96
Discuss the measures and precautions you would adopt to ensure success in root canal
treatment.
S96
Write notes on :
a) causes of pulpal pathosis
b) how tooth and root canal anatomy can affect RCT
M97
A 10 year old boy hurries into your office carrying a cup of milk containing his upper
front tooth. Discuss the management of this case.
M97
Discuss the advantages and disadvantages of the use of the use of electronic apex locator.
Would the use of the electronic apex locator make radiographs unnecessary for
endodontic treatment. Give your
reasons.
S 97 B1
Explain the rationale for obturating root canals that have been cleaned and shaped.
Describe one method of achieving this and how you would evaluate the results.
S 97 B2
Identify and distinguish between :
(a) reversible pulpitis and irreversible pulpitis
(b) acute apical abscess and phoenix abscess
37
Restorative Dentistry
M98 B1
Discuss the importance of radiographs in endodontic diagnosis and treatment.
M98 B2
Procedural accidents can occur during the cleaning and shaping of the root canal system.
Discuss the causes and management of these accidents.
S98B2
What bacterial can be isolated from the necrotic tissue of root canals? Discuss the effect
and significance of these bacterial on the pathogenesis of pulpal and periapical pathoses.
M99B1
A twenty-one year old, healthy female presents with a non-vital upper right central
incisor which has a well-fitting porcelain jacket crown recently cemented.
Radiographically a very large, well circumscribed lesion is present at the apex and a
patent canal is noted.
i)
If this patient presents with the tooth in an asymptomatic condition,
i)
what would be the periapical diagnosis?
ii)
What would you do for her?
ii)
If the same patient presents with a soft, fluctuant mass labial to the tooth which
is also acutely sensitive to percussion,
a) what would be the periapical diagnosis?
b) What would your treatment plan be then?
M00B1
A 33-year old male presented with a sinus discharge traceable to the periapical lesion of
#21, estimating 9mm in diameter. Root canal treatment was commenced and the apical
preparation was done to a master apical file size #35. The root canal was then closed up,
awaiting obturation the next visit. However, two weeks later, the sinus discharge
remained persistent.
a) give an endodontic diagnosis for the tooth #21
b) explain the pathogenesis for the persistent sinus discharge despite root canal
instrumentation.
c) Describe subsequent treatment procedures or plans and provide rationales.
M00B2
Describe the aims of root canal preparation. How may these be best achieved?
FIXED PROSTHODONTICS
M08Q2
How do resin-bonded bridges fail? For any two of these failure types, discuss the possible
causes and explain how you would manage the failure.
M07Q1
The maxillary central incisor single crown has been described as a challenging restoration
Discuss this statement and describe the steps you might take to ensure clinical success.
M07Q2
Discuss the rationale of placement of crown margins, both supragingival and subgingival.
Include the advantages and disadvantages of each location.
M05Q3
What are the principles that govern tooth preparation of full overage crowns?
M05Q1
Discuss the rationale for placement of crown margins, both supragingival and
subgingival. Include the advantages and disadvantages of both location.
M90
Discuss the principle of post-preparation in a successfully endodontically treated tooth.
List the methods by which post and core may be constructed.
WSN on :
(a) pontic design
(b) shade selection
38
Restorative Dentistry
S90 3
How would you classify post-core systems in the restoration of an endodontically treated
tooth? What are the factors you should take into consideration when designing a postcrown?
M91 3A
B
Discuss the importance of provisionalisation in fixed prosthodontics.
One of the major reasons for the failure in post-endo treated tooth is improper restoration.
What factors would you consider in the treatment of planning of an endo treated terminal
molar abutment opposing natural dentition?
S91 3
What factors would influence your decision to restore an upper central incisor with a
crown. In what ways does a tooth preparation for a porcelain bonded to metal crown
differ from an all ceramic crown?
M 92 3
Discuss the design of a pontic for a 3 unit porcelain-bonded to metal F.P.D extending
from the maxillary right canine to the central incisor replacing the lateral incisor. Explain
the metal and porcelain design of the pontic, as well as the location and site of the
connectors (solder joints) and the edentulous ridge relationship.
S92 3
Design a fixed prosthesis to replace both the upper central incisors. Discuss the factors
that will increase the possibility of success of your restoration.
M93 1
Discuss the importance of provisional restorations in crown and bridge prosthodontics.
Describe a technique you would use to fabricate a provisional restoration for a full veneer
crown.
M93 2
What is a bridge? A patient attends your surgery and requests fixed bridgework to replace
a missing maxillary left central incisor. Assuming that there are no contraindications to
provide bridgework, discuss with reasons the various forms of bridgework you might use
in such a case.
M94 1
Discuss the advantages and disadvantages of resin-bonded bridges.
M94 3
A 3-unit fixed partial denture with metal ceramic crowns on #14 and #16 as retainers and
#15 as pontic has been fabricated. It was found to have marginal discrepancies and was
unstable when placed on the abutment teeth. What are the possible causes to these
problems? How would you verify and rectify the mistakes?
M96 1
Discuss the tooth preparation features that are necessary to ensure mechanical, biologic
and aesthetic success in a metal ceramic crown.
M96 1
A pontic is defined as an artificial tooth in a fixed partial denture.
(a) Discuss the biological and physical requirements of a pontic.
(b) Describe the different types of pontic designs and discuss their indications and
rationale for utilization in various clinical situations.
S96 1
a) What are the different types of margin design in extracoronal restorations?
b) Discuss the indications, advantages and disadvantages of these margin designs.
S96 2
At the issue visit, the 3-unit fixed partial denture that you had planned to fit rocks and
exhibits marginal discrepancy. The patient also reports that the provisional that you had
fabricated had loosened one week ago. What are the possible causes of this problem and
discuss the precautions you would take to prevent them.
39
Restorative Dentistry
M97
A patient presents with the maxillary right central and lateral incisors missing. The
adjacent teeth are in otherwise excellent functional and esthetic condition, free of existing
restorations and the edentulous ridge relatively unresorbed.
(a) Discuss the various fixed prosthetic options of treatment that may be considered in
order to restore the missing teeth with the advantages and disadvantages of each
option.
(b) If a bridge is required, what would you recommend and describe the preparation
design for abutment teeth.
S97
Discuss the differences between porcelain-fused-to-metal crowns and all-ceramic crowns
under the following categories :
(a) Indications/Contraindications
(b) Advantages/Disadvantages
(c) Tooth preparation design
(d) Physical and mechanical properties
S97
Discuss the factors which will influence the success of an anterior fixed partial denture
restoration.
M98
Porcelain-fused-to-metal crowns have several margin designs that can accommodate the
metal understructure and the porcelain veneer. Describe these margin designs in detail;
list their advantages and disadvantages; and explain the factors that lead to appropriate
margin design selection in various locations in the mouth.
M98
A patient had an extraction of the lower left first molar 3 months ago due to caries. He
requests to replace the missing tooth now. He is healthy and all other teeth are present
with stable occlusion. What other clinical data do you want to obtain from this patient?
Why are these information important to your treatment planning?
S98
In your delivery of dental care involving complex work (eg. Bridges, veneers), discuss
the differences in management for a patient who has rampant caries versus another
patient whose teeth are relatively free from decay.
S98 1
Discuss the problems associated with providing a full coverage restoration for a tooth
with a short clinical crown. Describe how you would overcome these problems.
S98 2
A fifty-five year old male patient complained that he started to have more frequent
episodes of bleeding gum, especially around the fixed partial denture which was placed
one month ago.
Clinical examination revealed that there was generalised redness and oedema along the
gingival margin of all the teeth. A fixed partial denture was at #21-23 where #22 was the
pontic. The gingival papillae between #11, 21, 22, 23 and 24 showed more severe signs
of inflammation.
State the possible causes of his problems and outline your treatment plan to inprove his
condition.
M99 1
What are the advantages and disadvantages of all ceramic crown and metal ceramic
crown restorations? Discuss the important factors that will influence the success of an all
ceramic crown restoration.
M99 2
The restoration of endodontically treated teeth requires special attention both in diagnosis
and in clinical technique.
A. Do all anterior and posterior endodontically treated teeth require a post-crown restoration?
Explain your answer for each type of teeth.
B. Describe the optimum retention and resistance form desirable for post-cores.
40
Restorative Dentistry
C. Describe 1 technique for the retention of core material in the restoration of a posterior
endodontically treated tooth.
M00 1
Discuss in detail, the factors that influence crown margin placement location in full
veneer crowns. Are there any (further) special considerations for a) anterior teeth; b)
teeth with short clinical crowns; c) fixed partial denture abutments; and d) periodontally
involved teeth ?
M00 2
A patient requires a fixed prosthesis to replace their missing maxillary central incisor.
Discuss the factors which will determine the treatment provided.
Dislodgement of a fixed partial denture (FPD) can occur anytime after final cementation.
Discuss the possible causes of this failure and explain your management, in particular, the
steps you would take to prevent recurrence.
M03 Q1
M03 Q2
M04Q1
M04Q2
In some clinical situation, a crown lengthening procedure to increase clinical crown
height maybe indicated prior to restorative treatment.
a) What are the objectives for indicating a crown lengthening procedure for restorative
purposes?
iii)
Discuss the factors you need to consider when indicating a surgical crown
lengthening procedure prior to restoring a tooth with a fixed prosthesis.
Discuss the role of provisionals in the treatment of partial edentulism with fixed partial
dentures.
In the restoration of anterior teeth, metal ceramic crowns and all ceramic crowns are
viable options.
a)
Discuss the indications and contraindications of these crown systems.
b)
Compare and contrast the tooth preparation designs for these two systems.
c)
Give a brief account of the all ceramic crown systems that you are aware of.
OCCLUSION
M08Q2
“I am unable to eat on the right lower posterior teeth in the molar region” On
examination, you note that the mandibular first and second molars are pristine, without
any restorations. Explain your management of this patient.
M05Q2
Discuss various methods available to evaluate the vertical dimension of occlusion (VDO)
for the patient who has lost VDO.
M91 4
a) Occlusal analysis may be performed “chairside” or on an articulator. Compare and
contrast the advantages and disadvantages of these methods.
b) Why is it necessary to screen all prospective “restorative” patients for
Temporomandibular Disorders. Describe the type of questions you would ask and the
screening examination protocol you would recommend.
S91 4
M92 4
a) The concept of Centric Relation (CR) has evolved over the years. What is the current
definition of CR according to the 5th Ed of the Glossary of Prosthodontic Terms?
1.
“CR is still clinically relevant in Restorative Dentistry”. Discuss the above statement.
2.
List the clinical situation whereby CR-Border techniques might be contraindicated.
a) What do you understand by the term “condylar envelope”?
41
Restorative Dentistry
b) The CR obtained by you and verified to be corrected by one clinical instructor at the
MMR stage is found to be “incorrect” by another instructor at the denture issue stage.
Classify all factors that may be directly and indirectly responsible for this phenomenon
and discuss the steps you would take to avoid such a situation.
S92 4
1.
a)
Describe the Bimanual jaw manipulation technique for taking CR as
advocated by Dawson.
If the patient complains of discomfort in the left preauricular region when the jaw relation is being
forcefully induced/verified. How would you account for it?
O96 3
Discuss the importance of obtaining the correct centric relation and the occlusal vertical
dimension registrations for your complete denture patient. How does an eldery patient
present with problems in these two areas of concern?
M03 Q3
What do you understand by the term centric jaw relationship (CR) in complete dentures?
Discuss the effects of an incorrect jaw relationship on your complete denture patient.
How can you reduce this error during the clinical recording stage and at the laboratory
stages?
(SEE ALSO UNDER COMPLETE DENTURE)
REMOVABLE PARTIAL DENTURE
M08Q3
Discuss the importance of obtaining good impressions for complete denture construction.
What techniques are available? How would you manage the making of an impression of a
patient who presents to you with an upper maxillary flabby edentulous ridge?
O07Q3
Name and describe the different types of major connectors used in removable partial
dentures. What are the advantages and disadvantages of each?
M90 A2
The RPD can sometimes be damaging to the remaining oral structures. Discuss the
factors that would contribute to this problem.
S90 A2
What are direct retainers? How do they help in the retention of RPD? Include in your
discussion the following:
A. type of retainers, the advantages and disadvantages
B. their contributions to a successful denture.
M91 1
Describe how you minimize stresses to distal extension abutment teeth when designing
and fabricating RPDs.
S91 2
Discuss the role of major and minor connectors in PD. Illustrate with examples of the
designs you would use and the reasons for doing so in lower free-end saddle case.
M92 2
A patient with a totally edentulous maxilla and a bilateral free-end partially edentulous
mandible presents for prosthetic treatment. The residual tissues and mandibular teeth are
healthy. (Design chart is provided)
Full Denture
42
Restorative Dentistry
5 4 3 2 1/ 1 2 3 4 5
Briefly describe how you could provide for the patient the following:
b) a stable assembly and well-supported removable mandibular partial denture.
c) A retainer assembly conducive to the health of the mandibular abutment teeth
d) The correct choice of major connector in relation to its design, function and location
e) And the appropriate refitting of the posterior free-end saddles following long-term
residual ridge resorption of the mandible.
M93 4
Describe the RPI system of PD design for Kennedy Class 1 PD. Compare this to the
circumferential clasp design
M94 4
Briefly describe how you design a Kennedy Class 1 RPD that helps preserve the health of
residual teeth, periodontium and the alveolar bone over the saddle areas of the mandible.
The teeth remaining are from #31,32,33,34,41,42,43,44.
M95 2
Discuss the factors that determine whether and edentulous space from 12 to 22 should be
restored with a fixed partial denture or a removable partial denture. There is no other
edentulous space in the patient’s dentition.
M95 4
A partially edentulous patient presents for prosthetic treatment. The dentition and
periodontium are healthy. The teeth present are as follows:
7 - - 4 3 2 1/ 1 2 3 4 5 - 7 6 5 4 3 2 1/ 1 2 3 4 5 6 7
On the design sheet, illustrate your design of a maxillary removable cobalt chromium
partial denture for the patient. Incorporate also an occlusal rest, proximal plate and 1-bar
(RP1) assembly on the left maxillary second premolar (/5).
Briefly explain the function of
b) the RP1 system
c) the major connector
M95 3
The clinical success of a Kennedy Class 1 removable partial denture can only be achieved
when the clinical an laboratory procedures are accomplished with respect for the
physiologic limits of the biological supporting structure.
a.
b.
Discuss the problems which you would expect to encounter in such situations.
Describe the techniques you would use to overcome these problems.
O96 4
Discuss the effect of partial dentures on the health of the remaining oral structures. How
might certain deleterious effects of partial dentures be minimized by design features.
Explain.
M97 3
"Removable partial dentures cause dental caries and periodontal disease." Discuss the
steps you would take to design and construct the denture to ensure that a removable
partial denture does not have a deleterious effect on oral health.
O97 4
A middle-aged patient presents with a fully dentate maxilla and a partially edentulous
mandible. The mandibular arch is represented by:
__ __ __ 4 3 2 1
1 2 3 __ 5 6 7
43
Restorative Dentistry
a.
b.
c.
M98 3
Oral hygiene is fair. The teeth are without caries. Only the teeth #31, 41, 42 have
advanced periodontitis with guarded prognosis. For this patient,
Briefly describe your prosthetic treatment plan, taking into account the status of #31, 41, 42.
Map out a design for a mandibular removable partial denture, based on your treatment plan.
Explain the role of each selected component of your design.
Discuss pre-prosthetic management in RPD work using the following categories as a
guide.
a) Soft tissue management
b) Hard tissue management
c) Enamel modification
S98 4
Discuss the role of major and minor connectors in removable partial dentures. Compare
and contrast the U-shaped palatal plate and the palatal ring connector. What are the
indications for each?
M99 4
Explain the role of the following factors relating to a removable partial denture:
fulcrum line, proximal plate, direct retainer, indirect retainer, major connector.
M00 4
A middle-aged woman presents for prosthetic treatment She is totally edentulous in the
maxillae and partially edentulous in the mandible as follows:
Maxillary Complete Dentures
-
-
-
4
3
2
1
1 2
3
4
5
6
7
All teeth present are periodontally sound.
(i)
design a lower partial denture for the patient
(ii)
briefly explain how the occlusion and extra-coronal clasping system you have
designed for the right mandibular posterior quadrant will help preserve the
health of abutment teeth and tissue of the 765 edentulous space.
J01Q4
A partially edentulous man presents at your clinic for treatment. His
dentition is as charted below:
He is currently wearing an acrylic resin partial denture that requires
replacement. His current denture has an anterior flange but no rests
and retainers.
(a) Discuss the steps you would take to design a cobalt chromium partial
denture for this patient and illustrate your final design on the denture design sheet.
(b) What are the advantages of your new cobalt chromium partial denture over the
existing acrylic resin one that he is using?
44
Restorative Dentistry
M02A4
Write brief notes on the following:
a) A stable and well-supported removable partial denture
b) Retainer designs conducive to the health of the abutment teeth
c) The correct choice of major connectors, in relation to design, function and location.
M03 Q4
List the components of a cobalt chromium removable partial denture. Briefly describe
how each component contributes towards effective function of the partial denture.
M06Q3
A 45 year old female patient with the following missing teeth wants to have her maxillary
removable partial denture (RPD) replaced with a new RPD. How does the cobalt
chromium RPD compare with the all acrylic resin RPD in this situation? Which one
would you advise her to have and why?
8
8 7 6 5 4
3
2 1
2 1
12
12
5 6
8
3 4 5 6 7 8
45
Restorative Dentistry
COMPLETE DENTURES
M07Q3
Why is it important to ensure that the upper and lower anterior denture teeth are placed
correctly when designing a complete upper and lower denture for your 65-year-old fully
edentulous female patient who presents with a maxillary upper anterior ridge which is
resorbed and fibrous.
Describe your answer in relation to aesthetics, retention and stability when making a new
set of complete upper and lower denture for your edentulous patient.
O07Q4
What do you understand by the term centric jaw relation (CR) in complete dentures?
What are the possible errors that can occur and how do you minimize this when recording
this jaw relationship position for your patient?
Are there possible consequences of issuing a complete set of upper and lower dentures
for your patient with an inaccurate CR jaw relation position?
M06Q4
Discuss the physical and physiological factors that are responsible for retention of the
complete maxillary denture. Explain their influences on your prosthetic clinical
technique.
M05Q4
Occlusal planes are important measurements when making complete dentures.
(iv)
Discuss the importance of getting a correct lower mandibular occlusal plane
for your completely edentulous patient.
(v)
How would you obtain this position and discuss its importance in relation
to retention and stability of the lower complete denture bearing in mind
anterior and posterior teeth position.
M80
Discuss the importance of properly recording the compressible, non-compressible and
M90
“Aesthetic and functional considerations often conflict in restorative dentistry” Discuss
this statement in relation to the successful construction of the complete dentures. In your
answer consider the importance of VD and tooth placement to the success of your
treatment
S90
Discuss the management of the complete denture patient with poor mandibular ridge.
M91
Describe how you would handle a complete denture patient with ill fitting dentures,
denture stomatitis and angular cheilitis prior to the fabrication of new dentures.
S91
Discuss the influence occlusal and polished surfaces have in relation to retention and
stability of a complete upper and lower denture.
M92
Discuss the importance of the correct support of the lips which complete dentures should
provide in relation to aesthetics and function. What methods are available to help you
determine the position, size and shape of the teeth for this support?
S92
A 56 years old female patient complains that her ten-year-old dentures are loose. What
are the steps you would take to investigate this problem? What are the factors that are
involved in the maintenance of retention and stability of complete dentures?
M93
Discuss the importance of obtaining the correct CR record for your complete denture
patient. What would be the effect if the VD of occlusion is increased or decreased for
your patients?
M94 2
Denture-wearing can adversely affect the health of related oral structures. Discuss this
statement.
46
Restorative Dentistry
M95 3
During the maxillo-mandibular recording stage of complete denture construction how
would you ensure that the VD you record is accurate. What are the effects if the occlusal
VD you record is accurate. What are the effects if the occlusal VD you have given to the
patient is increased?
M96 4
Discuss the factors that are involved in the maintenance of support, retention and stability
of complete denture in a patient with moderately advanced residual ridge resorption.
M97 4
An eldery 65-yr old female patient requests replacement of complete dentures, which
have been in use for 18 years. What oral and denture changes might have occurred over
this period of time? Discuss your management and treatment of such a patient.
O97 3
Discuss the influence of teeth position and polished surfaces of complete dentures in
relation to retention and stability. Explain how would you maximise these features when
constructing a denture for a patient with fully edentulous mandibular flat ridge.
M98 4
A 60-yr old female patient wearing complete maxillary and mandibular dentures that
were made recently comes to you complaining that her upper denture is loose. The
looseness is exaggerated when she tries to bite on food using her anterior teeth and on
wide opening of her mouth. She has to use her tongue to aid retention of her maxillary
denture. Her maxillary ridge is moderately flabby in the anterior region.
a) What are the possible causes for the loss of retention of her maxillary denture?
b) Discuss how you would investigate and manage the patient for her complaints.
S98 3
What do you understand by the term “balanced articulation” in complete dentures? How
do you achieve it and why is it important to have this feature in your complete dentures?
M99 3
It has often been said that successful complete dentures depend on three important
denture surfaces. These are the (a) occlusal, (b) polished and (c) fitting surfaces of the
denture.
i)
discuss how you would design a complete denture using these surfaces to
maximise retention and resistance.
ii)
What possible techniques would you employ to enhance these design features
when making a complete lower denture for a patient presenting with active lip
musculature together with a flat and resorbed mandibular ridge.
M00 3
What are the anatomical features, which may be present in an elderly edentulous mouth
that may cause pain and discomfort when wearing complete dentures. Discuss how would
you overcome these problems for the patient.
M02Q3
Describe methods that are available to determine the position, size and shape of the
anterior teeth in complete dentures in relation to function and aesthetics. How would you
ensure that the set up positions prescribed by you for the anterior teeth would help
maintain good retention and stability of your complete dentures?
M03 Q3
What do you understand by the term centric jaw relationship (CR) in complete dentures?
Discuss the effects of an incorrect jaw relationship on your complete denture patient.
How can you reduce this error during the clinical recording stage and at the laboratory
stages?
(SEE ALSO UNDER OCCLUSION)
The posterior palatal area of the maxillary completely edentulous ride is an important
zone for complete denture prosthodontics.
M04Q3
47
Restorative Dentistry
a)
What are some of its important anatomical structures and landmarks?
How would you determine this are in relation to complete dentures?
b) Discuss the significance of this area in relation to the retention and comfort of the
maxillary complete denture for your patient.
M04Q4
Patients wearing upper maxillary complete dentures opposing 6 remaining lower anterior
teeth often develop a flabby maxillary anterior ridge and other complications.
a) Discuss how a flabby maxillary anterior ridge may have developed under such
circumstances.
b)
What aspects can you incorporate into the design of your new F/P to prevent
such flabby ridge complications from arising or minimize further
deterioration of the denture supporting tissues in an existing anterior
flabby ridge situation ?
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