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NDECC practice questions

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Question 1Clinical Assessment and Diagnosis

A patient reports sharp, lancinating pain in the distribution of the mandibular division of the trigeminal nerve triggered by chewing. Which diagnosis is most consistent with this presentation?

  1. Acute irreversible pulpitis
  2. Atypical odontalgia
  3. Temporomandibular joint osteoarthritis
  4. Trigeminal neuralgia Correct answer.

Explanation

Trigeminal neuralgia produces brief, electric-shock-like paroxysms of pain in a trigeminal division, classically provoked by light touch, chewing, or talking. The paroxysmal, lancinating quality and trigger-evoked pattern distinguish it from continuous inflammatory or musculoskeletal pain.

Question 2Clinical Assessment and Diagnosis

Which radiographic feature most strongly suggests a periapical cyst rather than a periapical granuloma?

  1. A diffuse radiolucency with ill-defined margins
  2. A well-defined radiolucency with a sclerotic border larger than 1 cm Correct answer.
  3. External root resorption of the affected tooth
  4. Widening of the periodontal ligament space only

Explanation

Periapical cysts typically appear as well-circumscribed radiolucencies with a corticated border and tend to be larger than granulomas, often exceeding 1 cm. Granulomas more often show ill-defined margins and smaller size, though histology is required for definitive diagnosis.

Question 3Clinical Assessment and Diagnosis

A patient has a blood pressure of 168/104 mmHg recorded at the start of a dental appointment. What is the most appropriate immediate action?

  1. Proceed with elective treatment without further measurement
  2. Confirm the reading after a period of rest and defer elective treatment if it remains elevated Correct answer.
  3. Administer a sublingual antihypertensive before treatment
  4. Refer immediately to an emergency department for intravenous therapy

Explanation

A single elevated reading may reflect white-coat or anxiety effects, so the measurement should be repeated after the patient rests quietly. Persistent stage 2 hypertension warrants deferral of elective care and medical referral rather than urgent emergency intervention.

Question 4Clinical Assessment and Diagnosis

Which clinical finding is most characteristic of a pleomorphic adenoma of the parotid gland?

  1. A fluctuant swelling that resolves with antibiotic therapy
  2. A rapidly enlarging, fixed, painful mass with facial nerve palsy
  3. A slow-growing, painless, mobile mass in the tail of the parotid Correct answer.
  4. A bilateral diffuse gland enlargement with dry mouth

Explanation

Pleomorphic adenoma is the most common salivary gland tumor and usually presents as a slow-growing, painless, mobile mass, frequently in the parotid tail. Facial nerve involvement and rapid growth suggest malignancy rather than a benign mixed tumor.

Question 5Clinical Assessment and Diagnosis

A 12-year-old presents with a mixed dentition and a Class II division 1 malocclusion with an overjet of 10 mm. Which immediate concern should guide the assessment?

  1. Risk of mandibular condylar fracture
  2. Risk of traumatic injury to the maxillary incisors Correct answer.
  3. Risk of ectopic eruption of the mandibular canines
  4. Risk of ankylosis of the primary molars

Explanation

A large overjet substantially increases the risk of traumatic dental injury to the prominent maxillary incisors, particularly during sports or falls. This risk should be addressed early, often with orthodontic intervention and mouthguard counseling.

Question 6Clinical Assessment and Diagnosis

Which test is most appropriate for confirming a diagnosis of diabetes mellitus in a patient with classic symptoms of polyuria and polydipsia?

  1. Complete blood count with differential
  2. Serum calcium measurement
  3. Random salivary glucose measurement
  4. Fasting plasma glucose or glycated hemoglobin measurement Correct answer.

Explanation

Diabetes is confirmed with fasting plasma glucose, an oral glucose tolerance test, glycated hemoglobin, or a random glucose with classic symptoms. These standardized laboratory measures establish the diagnosis and guide treatment planning.

Question 7Clinical Assessment and Diagnosis

During a periodontal examination, a probe penetrates 6 mm into the gingival sulcus while the gingival margin is 2 mm coronal to the cementoenamel junction. What is the clinical attachment level?

  1. 2 mm
  2. 8 mm Correct answer.
  3. 6 mm
  4. 4 mm

Explanation

Clinical attachment level equals probing depth plus the distance from the cementoenamel junction to the gingival margin when the margin is coronal to the junction. Adding 6 mm of probing depth to 2 mm of recession-equivalent distance yields 8 mm.

Question 8Clinical Assessment and Diagnosis

Which finding on a panoramic radiograph most suggests an odontogenic keratocyst?

  1. A unilocular radiolucency at the apex of a nonvital tooth
  2. A well-defined radiolucency surrounding the crown of an impacted third molar
  3. A diffuse radiolucency crossing the midline of the anterior maxilla
  4. A multilocular radiolucency in the posterior mandible with a scalloped anterior border Correct answer.

Explanation

Odontogenic keratocysts commonly appear as multilocular radiolucencies in the posterior mandible with scalloped margins and minimal expansion relative to size. These features help distinguish them from other cystic lesions, though biopsy is required for confirmation.

Question 9Clinical Assessment and Diagnosis

A patient reports a dry mouth and bilateral parotid enlargement. Which serologic test is most useful in the diagnostic workup?

  1. Serum angiotensin-converting enzyme
  2. Antinuclear cytoplasmic antibodies
  3. Anti-Ro/SSA and anti-La/SSB antibodies Correct answer.
  4. Rheumatoid factor only

Explanation

Bilateral parotid enlargement with xerostomia suggests Sjögren syndrome, for which anti-Ro/SSA and anti-La/SSB antibodies are the most specific serologic markers. These antibodies support the diagnosis alongside clinical and histologic findings.

Question 10Clinical Assessment and Diagnosis

Which feature best distinguishes a recurrent aphthous ulcer from a traumatic ulcer?

  1. An irregular border conforming to a sharp tooth
  2. Resolution after removal of the irritant
  3. A history of recurrent episodes with a yellow pseudomembrane and erythematous halo Correct answer.
  4. A history of recent local trauma at the site

Explanation

Recurrent aphthous ulcers are characterized by repeated episodes, a yellow fibrinous center, and a distinct erythematous halo. Traumatic ulcers typically follow identifiable injury, have irregular borders, and heal after the irritant is removed.

Question 11Clinical Assessment and Diagnosis

A bitewing radiograph shows a radiolucency confined to the enamel and outer third of dentin without clinical cavitation. What is the most appropriate management?

  1. Nonoperative management with fluoride and dietary counseling Correct answer.
  2. Immediate crown placement
  3. Elective extraction of the tooth
  4. Root canal therapy

Explanation

Noncavitated caries limited to enamel or outer dentin can often be managed nonoperatively with remineralization strategies such as fluoride and dietary modification. Restorative or endodontic treatment is reserved for cavitated or deeply involved lesions.

Question 12Clinical Assessment and Diagnosis

Which clinical sign most strongly indicates that a white oral mucosal patch should be biopsied?

  1. Bilateral white striae on the buccal mucosa
  2. A white patch associated with recent aspirin placement
  3. A symmetric patch on the buccal mucosa that wipes off easily
  4. A nonhomogeneous texture with induration that cannot be wiped off Correct answer.

Explanation

Nonhomogeneous, indurated white lesions that cannot be wiped off raise concern for dysplasia or malignancy and warrant biopsy. Wipeable or clearly reactive lesions are more likely benign and may resolve after the cause is removed.

Question 13Clinical Assessment and Diagnosis

Which measurement is used to assess the severity of periodontal disease by describing the proportion of sites with attachment loss?

  1. Plaque index
  2. Bleeding on probing index
  3. Clinical attachment level distribution Correct answer.
  4. Gingival index

Explanation

Clinical attachment level distribution describes the extent and severity of attachment loss across sites and is central to periodontal staging. Bleeding, plaque, and gingival indices reflect inflammation and hygiene rather than attachment loss.

Question 14Clinical Assessment and Diagnosis

A patient with a history of infective endocarditis requires a dental extraction. Which factor most determines the need for antibiotic prophylaxis?

  1. The patient's age
  2. The presence of dental caries
  3. The type of local anesthetic used
  4. The presence of a prosthetic heart valve or previous endocarditis Correct answer.

Explanation

Antibiotic prophylaxis is recommended for patients at highest risk of infective endocarditis, such as those with prosthetic valves or a prior episode. The procedure type and patient risk category, not age or anesthetic choice, drive the decision.

Question 15Clinical Assessment and Diagnosis

Which radiographic view is best for evaluating the extent of bone loss in a patient with generalized severe periodontitis?

  1. Single panoramic radiograph
  2. Cephalometric radiograph
  3. Occlusal radiograph of the maxilla
  4. Full-mouth periapical series with bitewings Correct answer.

Explanation

A full-mouth periapical and bitewing series provides the detail needed to assess bone levels, furcation involvement, and calculus throughout the dentition. A panoramic image lacks the resolution for precise bone-level measurement.

Question 16Clinical Assessment and Diagnosis

A patient presents with unilateral facial swelling, fever, and a fluctuant mass over the mandible. Which finding most indicates the need for urgent surgical drainage?

  1. Mild localized tenderness without swelling
  2. A history of a recent dental cleaning
  3. Presence of a fluctuant abscess with systemic signs Correct answer.
  4. Radiographic evidence of a small carious lesion

Explanation

A fluctuant abscess accompanied by fever indicates a collection requiring drainage and systemic management. Fluctuance plus systemic signs distinguishes a drainable abscess from cellulitis or localized reversible conditions.

Question 17Clinical Assessment and Diagnosis

Which feature most reliably differentiates a gingival cyst of the adult from a lateral periodontal cyst?

  1. Presence of a radiopaque center
  2. Association with a nonvital tooth
  3. Size greater than 1 cm
  4. Location superficial to the alveolar bone versus within bone Correct answer.

Explanation

Gingival cysts of the adult arise in the soft tissue and appear as a bluish swelling, whereas lateral periodontal cysts are intraosseous radiolucencies. The anatomic location relative to bone is the key distinguishing feature.

Question 18Clinical Assessment and Diagnosis

Which of the following best describes the purpose of a periodontal risk assessment in treatment planning?

  1. To measure only the depth of existing pockets
  2. To determine the exact number of teeth to extract
  3. To select the color of restorative material
  4. To identify modifiable and nonmodifiable factors that influence disease progression Correct answer.

Explanation

Periodontal risk assessment integrates factors such as smoking, diabetes, and genetics to estimate the likelihood of disease progression and guide maintenance. It informs prognosis and treatment intensity rather than dictating extractions or material choices.

Question 19Clinical Assessment and Diagnosis

A patient reports pain on chewing localized to a molar with a history of deep caries. Which test result most supports a diagnosis of irreversible pulpitis?

  1. Prolonged, lingering pain after a cold stimulus is removed Correct answer.
  2. Sharp pain that resolves immediately when the stimulus is removed
  3. No response to cold testing with a normal periapical radiograph
  4. Pain only on percussion with no response to thermal testing

Explanation

Irreversible pulpitis is characterized by exaggerated or lingering pain after thermal stimulation is removed, reflecting pulpal inflammation. A brief, sharp response that resolves promptly suggests reversible pulpitis or a normal pulp.

Question 20Clinical Assessment and Diagnosis

Which finding on a panoramic radiograph suggests an impacted maxillary canine at risk of damaging an adjacent incisor root?

  1. Eruption through the alveolar ridge with no adjacent tooth contact
  2. Vertical eruption path with adequate space
  3. Horizontal impaction with the crown overlapping the lateral incisor root Correct answer.
  4. Symmetric eruption of both canines

Explanation

A horizontally impacted canine whose crown overlaps an adjacent incisor root raises concern for root resorption and requires careful assessment. Vertical or unobstructed eruption paths carry lower risk of adjacent damage.

Question 21Clinical Assessment and Diagnosis

Which clinical parameter is most useful for monitoring the effectiveness of periodontal therapy over time?

  1. Change in salivary pH
  2. Change in the number of restorations
  3. Change in tooth shade
  4. Change in probing depth and clinical attachment level Correct answer.

Explanation

Probing depth and clinical attachment level changes directly reflect periodontal tissue response to therapy. Other parameters do not measure periodontal healing or disease progression.

Question 22Clinical Assessment and Diagnosis

A patient has a white, corrugated plaque on the buccal mucosa and a history of hepatitis C. Which condition should be considered in the differential diagnosis?

  1. Pleomorphic adenoma
  2. Oral lichen planus Correct answer.
  3. Hairy tongue
  4. Recurrent aphthous stomatitis

Explanation

Oral lichen planus presents as white, reticular or corrugated striae, often bilaterally on the buccal mucosa, and is associated with hepatitis C. This pattern helps distinguish it from other white or ulcerative lesions.

Question 23Clinical Assessment and Diagnosis

Which feature most suggests a malignant rather than benign salivary gland neoplasm?

  1. A soft, mobile, painless mass
  2. Slow growth over several years
  3. A history of recurrent swelling after meals
  4. Facial nerve weakness with rapid growth and fixation Correct answer.

Explanation

Facial nerve involvement, rapid enlargement, and fixation to surrounding tissues are red flags for malignancy. Benign tumors typically grow slowly and remain mobile and painless.

Question 24Clinical Assessment and Diagnosis

Which diagnostic test is most appropriate to confirm a suspected pulp necrosis in a tooth with a large restoration?

  1. Thermal and electric pulp testing with radiographic correlation Correct answer.
  2. Transillumination of the crown
  3. Percussion testing alone
  4. Gingival probing of the sulcus

Explanation

Pulp vitality is assessed with thermal and electric pulp tests interpreted alongside radiographs, since a large restoration can alter responses. Percussion or probing evaluates periapical and periodontal status, not pulp vitality.

Question 25Clinical Assessment and Diagnosis

A patient with a suspected temporomandibular joint disorder reports clicking and limited opening. Which imaging modality is most appropriate as an initial assessment?

  1. Magnetic resonance imaging of the joint
  2. Ultrasound of the masseter muscle
  3. Panoramic radiograph Correct answer.
  4. Cone-beam computed tomography of the entire skull

Explanation

A panoramic radiograph is a reasonable initial screening image to exclude gross osseous pathology before advanced imaging. Magnetic resonance imaging is reserved for suspected disc displacement or soft tissue pathology when clinically indicated.

Question 26Clinical Assessment and Diagnosis

Which pulp sensibility test uses a cold stimulus to assess the response of a tooth?

  1. Cold test Correct answer.
  2. Percussion test
  3. Electric pulp test
  4. Heat test

Explanation

The cold test applies a cold stimulus, such as refrigerant spray on a cotton pellet, to the tooth surface to provoke a short, sharp response in a vital pulp. It is a standard sensibility test that helps distinguish reversible from irreversible pulpitis and normal vitality. The electric pulp test uses electrical current, while the heat test uses heated gutta-percha, and percussion assesses periapical inflammation rather than pulp sensibility.

Question 27Clinical Assessment and Diagnosis

A patient has a blood pressure of 150/95 mmHg recorded at two separate visits. According to current guidelines, how should this be classified?

  1. Elevated blood pressure
  2. Normal blood pressure
  3. Stage 1 hypertension Correct answer.
  4. Stage 2 hypertension

Explanation

According to the 2017 ACC/AHA guidelines, stage 1 hypertension is defined as a systolic pressure of 130–139 mmHg or a diastolic pressure of 80–89 mmHg. A reading of 150/95 mmHg exceeds these thresholds but does not reach stage 2, which requires systolic ≥140 mmHg or diastolic ≥90 mmHg. Therefore, this patient's blood pressure is classified as stage 1 hypertension.

Question 28Clinical Assessment and Diagnosis

A patient with a history of smoking presents with a non-healing ulcer on the lateral border of the tongue that has persisted for 3 weeks. Which initial diagnostic step is most appropriate?

  1. Perform an incisional biopsy of the ulcer Correct answer.
  2. Reassure the patient and schedule a 6-month review
  3. Prescribe a topical corticosteroid and review in 2 weeks
  4. Order a serum vitamin B12 level

Explanation

Any oral ulcer that persists for more than 2 weeks, especially in a high-risk patient such as a smoker, warrants biopsy to rule out malignancy. Incisional biopsy is the standard for obtaining a definitive histopathological diagnosis of a suspicious oral lesion. Topical steroids or watchful waiting could delay diagnosis of oral squamous cell carcinoma.

Question 29Clinical Assessment and Diagnosis

A patient presents with a 2-cm mobile, tender submandibular mass that fluctuates in size with meals. What is the most likely diagnosis?

  1. Mucoepidermoid carcinoma
  2. Pleomorphic adenoma
  3. Submandibular gland aplasia
  4. Sialolithiasis Correct answer.

Explanation

A submandibular mass that enlarges and becomes painful with eating is classic for sialolithiasis, where a stone obstructs salivary flow. The intermittent swelling and tenderness are due to saliva accumulation behind the obstruction. Pleomorphic adenoma and mucoepidermoid carcinoma are neoplasms that typically cause persistent, non-fluctuating enlargement, and gland aplasia would present as absence of gland tissue, not a mobile mass.

Question 30Clinical Assessment and Diagnosis

A patient with suspected medication-related osteonecrosis of the jaw (MRONJ) has exposed bone in the mandible for 10 weeks and is currently taking denosumab. Which feature best distinguishes MRONJ from osteoradionecrosis (ORN)?

  1. Pain and swelling in the affected area
  2. Presence of exposed bone for more than 8 weeks
  3. History of radiation therapy to the head and neck Correct answer.
  4. Radiographic evidence of bone sclerosis

Explanation

The key distinction between MRONJ and ORN is the patient's history: ORN occurs after therapeutic radiation to the head and neck, whereas MRONJ is associated with antiresorptive or antiangiogenic medications such as denosumab. Both conditions can present with exposed bone, pain, swelling, and sclerosis, so those features do not reliably differentiate them. Therefore, a history of radiation therapy points to ORN, while its absence in a patient on denosumab supports MRONJ.

Question 31Treatment Planning and Case Management

A patient presents with a chief complaint of a missing maxillary right central incisor. Which component of the problem list should be documented first during treatment planning?

  1. The patient's stated chief complaint and expectations Correct answer.
  2. The radiographic bone quality of the edentulous site
  3. The cost of the planned restoration
  4. The shade match of adjacent teeth

Explanation

Treatment planning begins with the patient's chief complaint and expectations, because these define the goals the plan must satisfy. Radiographic, esthetic, and financial details inform options but do not replace the patient's stated priorities.

Question 32Treatment Planning and Case Management

Which record is essential before finalizing an implant-supported prosthesis plan for a single missing posterior tooth?

  1. A mounted diagnostic cast with occlusal analysis Correct answer.
  2. A saliva pH test
  3. A complete blood count
  4. A skin patch allergy test

Explanation

Mounted casts allow assessment of occlusal scheme, interarch space, and opposing dentition, all of which determine prosthesis design. Occlusal loading and space analysis directly influence implant position and restoration type.

Question 33Treatment Planning and Case Management

A 62-year-old patient requests full-mouth rehabilitation but has uncontrolled diabetes with HbA1c of 11%. What is the most appropriate initial management step?

  1. Place implants and shorten the healing period
  2. Defer elective surgical phases until glycemic control is improved Correct answer.
  3. Reduce the number of implants to lower surgical risk
  4. Proceed with implant placement using prophylactic antibiotics

Explanation

Poorly controlled diabetes impairs wound healing and increases infection and implant failure risk, so elective surgery should be deferred until glycemic control improves. Medical optimization precedes elective reconstructive care.

Question 34Treatment Planning and Case Management

Which factor most strongly determines whether a short-span fixed partial denture or a single implant is preferred for replacing a mandibular first molar?

  1. The patient's age alone
  2. The condition of the adjacent abutment teeth and the edentulous ridge Correct answer.
  3. The patient's preference for metal over ceramic
  4. The number of years since tooth loss

Explanation

The decision hinges on the health of potential abutment teeth and the volume and quality of the edentulous ridge. Sound adjacent teeth and adequate bone favor an implant, whereas compromised abutments may favor a fixed partial denture.

Question 35Treatment Planning and Case Management

During planning for a maxillary anterior single implant, which parameter is most critical for achieving a natural emergence profile?

  1. The implant platform depth relative to the facial gingival margin and adjacent papillae Correct answer.
  2. The shade of the healing abutment
  3. The implant diameter relative to the opposing molar
  4. The torque value at placement

Explanation

Emergence profile and papilla support depend on three-dimensional implant position, especially the depth and facial position of the platform relative to the gingival margin. Correct positioning preserves interimplant bone and soft tissue architecture.

Question 36Treatment Planning and Case Management

A patient with a severe gag reflex requires a maxillary complete denture. Which modification to the treatment sequence is most appropriate?

  1. Delay all treatment until the reflex resolves
  2. Increase the number of try-in appointments
  3. Eliminate the final impression and use a stock tray only
  4. Use a smaller custom tray and consider a shortened border extension where tolerable Correct answer.

Explanation

Managing an exaggerated gag reflex involves minimizing tray size and border extension while maintaining the seal and support needed for retention. Custom trays and gradual acclimatization allow an acceptable impression.

Question 37Treatment Planning and Case Management

Which occlusal scheme is generally recommended for an implant-supported single molar to reduce overload risk?

  1. Flatter cusps with light centric contacts and no excursive interference Correct answer.
  2. A mutually protected occlusion with full anterior guidance
  3. Steep cusps with heavy working-side contacts
  4. Balanced bilateral contacts in all excursions

Explanation

Implants lack a periodontal ligament and thus reduced proprioceptive feedback, so lighter centric contacts and reduced cuspal steepness minimize overload. Avoiding excursive interferences protects the implant restoration.

Question 38Treatment Planning and Case Management

A patient has a vertical maxillary excess with lip incompetence and anterior gingival display of 6 mm. Which treatment approach addresses the underlying skeletal problem?

  1. Anterior crowns to lengthen the teeth
  2. Composite veneers on the maxillary incisors
  3. Le Fort I impaction with orthodontic coordination Correct answer.
  4. Gingivectomy alone

Explanation

Excessive gingival display from vertical maxillary excess is a skeletal problem best corrected by Le Fort I impaction, often combined with orthodontics. Dental-only procedures cannot reduce the vertical dimension of the maxilla.

Question 39Treatment Planning and Case Management

Which diagnostic tool best evaluates the temporomandibular joint and airway before a large restorative reconstruction?

  1. Cone-beam computed tomography Correct answer.
  2. Panoramic radiograph alone
  3. Bitewing radiographs
  4. Periapical radiographs of the posterior teeth

Explanation

Cone-beam computed tomography provides three-dimensional assessment of the condyles, joint spaces, and airway, which panoramic and intraoral films cannot show adequately. This information guides vertical dimension and occlusal decisions.

Question 40Treatment Planning and Case Management

A patient with a history of infective endocarditis requires a dental extraction. Which planning consideration is most important?

  1. Using a single suture technique
  2. Choosing a flap design that minimizes bleeding
  3. Scheduling the extraction in the morning
  4. Consulting the physician and following current antibiotic prophylaxis guidelines Correct answer.

Explanation

Patients with a history of infective endocarditis are at elevated risk for recurrent infection, so physician consultation and adherence to current prophylaxis guidelines are essential. Antibiotic regimen, not surgical convenience, drives planning.

Question 41Treatment Planning and Case Management

What is the primary purpose of a diagnostic wax-up in treatment planning?

  1. To record the patient's centric relation bite
  2. To serve as the definitive restoration
  3. To visualize and communicate the planned tooth form and position before treatment Correct answer.
  4. To determine the final shade of the restorations

Explanation

A diagnostic wax-up is a three-dimensional visualization of the planned outcome, allowing the clinician and patient to evaluate form, position, and function before irreversible treatment. It also guides provisional fabrication and preparation design.

Question 42Treatment Planning and Case Management

A patient with a Kennedy Class I mandibular arch requests removable partial denture therapy. Which design principle best protects the abutment teeth?

  1. Minimal denture base extension
  2. Removal of all remaining posterior teeth
  3. Rigid bilateral distal extension bases
  4. Stress-releasing clasping and broad denture base coverage Correct answer.

Explanation

Distal extension bases flex under load, so stress-releasing attachments and maximal tissue coverage distribute forces and protect abutments. Broad coverage also improves stability and support.

Question 43Treatment Planning and Case Management

Which clinical finding most strongly contraindicates a single-visit endodontic and post-core restoration in a molar with a large pulp chamber?

  1. A shallow periodontal pocket on the buccal
  2. Presence of a cast restoration on the opposing tooth
  3. A single canal anatomy
  4. Insufficient remaining coronal tooth structure for a ferrule Correct answer.

Explanation

Adequate ferrule is essential to resist fracture and retain the restoration, so insufficient coronal structure is a major contraindication. Without ferrule, the tooth is at high risk of catastrophic failure.

Question 44Treatment Planning and Case Management

A patient reports a history of bisphosphonate use for osteoporosis. Which planning consideration is most relevant before an extraction?

  1. The risk of medication-related osteonecrosis of the jaw Correct answer.
  2. The choice of impression material
  3. The need to change the suture material
  4. The drug's effect on local anesthesia

Explanation

Bisphosphonate therapy is associated with medication-related osteonecrosis of the jaw, especially after invasive procedures, so risk assessment and possible drug holiday consultation are needed. This drives the decision to extract or pursue alternatives.

Question 45Treatment Planning and Case Management

Which step should follow completion of the problem list and treatment options in the planning process?

  1. Sequencing of treatment phases with defined interim goals Correct answer.
  2. Dismissal of the patient
  3. Immediate commencement of surgery
  4. Final impression for the definitive prosthesis

Explanation

After identifying problems and options, the clinician sequences care into phases with interim goals, ensuring that each step supports the next. Sequencing precedes definitive restorative steps.

Question 46Treatment Planning and Case Management

A patient requires both periodontal therapy and implant placement. Which sequencing principle applies?

  1. Implant placement should be avoided entirely
  2. Implant placement should precede periodontal control
  3. Periodontal disease should be controlled before implant placement Correct answer.
  4. Both should occur simultaneously without staging

Explanation

Active periodontal disease compromises implant survival, so periodontal control precedes implant placement. Staging ensures a stable, disease-free foundation for osseointegration.

Question 47Treatment Planning and Case Management

Which factor is most important when deciding between a screw-retained and cement-retained implant restoration for a posterior site?

  1. The shade of the opposing tooth
  2. The patient's preference for the color of the abutment
  3. Retrievability and the ability to manage residual cement Correct answer.
  4. The number of years since the implant was placed

Explanation

Screw retention offers retrievability and avoids residual cement, which is a recognized cause of peri-implant disease. Cement retention may be chosen when angulation precludes a screw channel, but retrievability and cement control are central.

Question 48Treatment Planning and Case Management

A patient presents with a failing maxillary first molar with furcation involvement and mobility. Which option is most conservative while addressing the prognosis?

  1. Extraction with socket preservation and delayed implant planning Correct answer.
  2. Periodontal surgery alone
  3. Root canal therapy and crown without addressing furcation
  4. Immediate extraction and implant placement

Explanation

When a tooth has a poor prognosis, extraction with socket preservation preserves ridge volume for future implant placement, which is more conservative than immediate implant placement in an infected site. Delayed planning allows healing and assessment.

Question 49Treatment Planning and Case Management

Which patient-reported outcome is most relevant when comparing treatment options for a missing anterior tooth?

  1. The material cost of the impression
  2. The number of appointments required
  3. The clinician's preferred technique
  4. The perceived esthetic result and impact on quality of life Correct answer.

Explanation

Patient-reported outcomes such as esthetic satisfaction and oral health-related quality of life are central when comparing options for visible sites. These outcomes should be weighed alongside clinical feasibility.

Question 50Treatment Planning and Case Management

A patient has a deep overbite and limited interocclusal space in the posterior region. Which planning adjustment is most appropriate before implant restoration?

  1. Place a taller crown to compensate
  2. Increase the occlusal vertical dimension or reduce the restoration height Correct answer.
  3. Ignore the space and proceed
  4. Reduce the implant diameter to fit

Explanation

Limited interocclusal space can lead to thin, fracture-prone restorations, so the plan should address vertical dimension or restoration height. Adjusting the occlusal scheme restores adequate space for durable material thickness.