Restorative Dentistry and Endodontics
What the exam tests
This domain tests operative and endodontic decision-making: caries removal, pulp protection, access and shaping, irrigation, obturation, restoration of the endodontically treated tooth and management of complications. The exam favors minimal intervention delivered with controlled technique.
Core rules and concepts
- Caries removal: in deep lesions, selective removal to firm dentine reduces pulp exposure; do not leave soft infected dentine at the enamel–dentine junction. Re-enter and seal rather than aggressively excavate.
- Pulp exposure: mature teeth with irreversible pulpitis need root canal treatment; immature teeth may be managed by revascularization or calcium-silicate pulpotomy. Direct pulp capping uses a calcium silicate cement in a clean, non-hemorrhaging field.
- Endodontic technique: rubber dam is mandatory. Establish working length with an apex locator and confirm radiographically; maintain patency and a glide path. Irrigate with sodium hypochlorite, then EDTA to remove the smear layer; avoid extrusion. Obturate with warm vertical compaction or a matched single-cone system.
- Visit pattern: single-visit treatment is acceptable when canals can be cleaned and dried; use calcium hydroxide dressing when exudate or time constraints prevent completion.
- Restoration: provide cuspal coverage for weakened teeth and a ferrule of 1.5–2 mm. Use a post only when coronal structure is insufficient; avoid posts in molars unless required.
- Retreatment: remove old filling material, locate missed canals such as MB2, and repair perforations with a calcium silicate cement.
Worked example
A 42-year-old has deep caries on 36 with provoked pain that settles quickly and no spontaneous pain. Reasoning: this suggests reversible pulpitis, so perform selective caries removal, protect the pulp with a calcium silicate liner and seal with a well-adapted restoration; review in six to eight weeks before deciding on root canal treatment.
Traps
Sodium hypochlorite extrusion; separating an instrument by forcing a path; over-instrumenting curved canals; ignoring a cracked cusp; working without a rubber dam; placing a post where a ferrule would suffice.