Restorative Dentistry and Operative Dentistry
This domain tests caries management, cavity design, adhesive dentistry and material selection. The modern exam emphasises minimal intervention and evidence-based conservation rather than extension for prevention.
Caries and minimal intervention
- Assess caries risk, use ICDAS or radiographs, and consider remineralisation for early lesions. Sealing and fluoride can arrest non-cavitated lesions.
- Excavate infected dentine but preserve affected dentine near the pulp. Rubber dam isolation improves moisture control and safety.
Materials and technique
- Amalgam is durable and moisture tolerant but not adhesive and is being phased down. Composite requires enamel etching, dentine bonding and light curing.
- Glass ionomer releases fluoride and bonds chemically; resin-modified glass ionomer is useful in primary teeth and non-load-bearing areas.
- Cavity margins should be clean and supported. Avoid unsupported enamel. Finish and polish to reduce plaque and sensitivity.
Worked example
A deep proximal lesion approaches the pulp but the tooth is vital and asymptomatic. Reasoning: complete excavation risks exposure. Stepwise excavation or indirect pulp capping with a calcium silicate or calcium hydroxide liner, a good seal and review is safer than immediate pulp exposure.
Traps that cost marks
Do not remove all discoloured dentine if it risks exposure; use clinical judgement. Do not etch dentine for as long as enamel. Do not place composite without isolation. Postoperative sensitivity may reflect poor bonding or incomplete sealing. Amalgam is not contraindicated in every patient, but aesthetics and policy matter.