OPERATIVE ODTP

Question 1

A female aged 60, suffering from DM …( I remember there was a table on C/O, HPC, PDH, etc)

Fig.1 (assume coming from the same patient)

a. Comment on aesthetics/give necessary diagnosis of the anterior teeth (3?)

Answer 1

• Gap between upper central incisors
• Yellowish teeth
• Restoration not the same colour as the tooth on 21
• Stained margins of the restoration
• Diagnosis
  
  • Fractured tooth

Question 2

a. Comment on the aesthetics of the restoration

Answer 2

 Colour: not match, margins are discoloured, not resemble the tooth fat shape,

Question 3

b. Treatment options for peg-shaped lateral incisors (6)

Answer 3

 CMC, ceramic crown, shiny gold crown, direct restoration, no treatment, replace with huge implant

Question 4

c. What factors would affect your decision?

Answer 4

 Amount of tooth substance left

 The cost of treatment

 Aesthetic consideration

Question 5

Patient has toothache. A picture is shown (CMC exposed metal). X-ray is also given

a. What is the restoration?

Answer 5

 Ceramo-Metallic Crown restoration

Question 6

Patient has toothache. A picture is shown (CMC exposed metal). X-ray is also given

b. How to assess the restoration

Answer 6

 Use a probe to probe at the margins of the crown to see if the margins are still acceptable  Check the aesthetics of the crown, see if there is any staining
 Check for allergy
 Check if there is any fracture of the crown
 Check if there are any secondary caries
 Check if there is any wear of crown and opposing dentition
 Check if there is any cracks in the crown

Question 7

Patient has toothache. A picture is shown (CMC exposed metal). X-ray is also given

c. Describe the radiograph. (defective root canal filling?)

Answer 7

 Defective root canal filling

Question 8

Patient has toothache. A picture is shown (CMC exposed metal). X-ray is also given

d. Differential diagnosis

Answer 8

 Irreversible pulpitis
 Necrotic pulp with apical periodontitis

Question 9

Patient has toothache. A picture is shown (CMC exposed metal). X-ray is also given

e. Is the tooth in picture is the same one as the one in x-ray? Explain (Need you to identify the root morphology and crown morphology)

Answer 9

 Lets look at the root morphology and crown morphology and also the location

Question 10

a. What would you ask the px about the fractured upper left premolar? (4 or 5)

Answer 10

 How did the tooth fracture?
 When did the tooth fracture?
 Any pain or sensitivity or discomfort?
 Has there been any previous restoration done on that tooth?

 Do you still have the fractured tooth fragment?

Question 11

b. Describe clinical photo in related to fractured upper left premolar.(4 or 5)

Answer 11

Can’t answer

Question 12

c. Why tooth will fracture? (3)

Answer 12

see page 143, long answer

Question 13

d. What will be the condition (or consequence??) if this left untreated?

Answer 13

 Pain and discomfort during mastication

 Possibility of pulpitis
 Reduced masticatory function
 Tooth sensitivity

Question 14

e. List the treatment plan (in phase) in detail. Assume that the premolar can be retained. (5)

Answer 14

• Initial Phase
  
  • Emergency Root Canal Treatment on premolar and provisional crown
• Systemic Phase
  
  • Does the patient smoke, have diabetes?
• Preventive Phase
  
  • Oral Hygiene Instructions
  • Root surface debridement
  • Supragingival scaling
  • Dietary analysis
• Corrective Phase
  
  • Post and core and CMC crown
• Maintenance Phase
  
  • I have no idea

Question 15

5. Operative - Patient complains for pain/sensitivity initiated by hot and cold food and biting, pain goes off quickly. Found to have deep DO composite placed last week. (Formative, 2013)
   a. What is the pulp condition(1)

Answer 15

 Vital, reversible pulpitis

Question 16

5. Operative - Patient complains for pain/sensitivity initiated by hot and cold food and biting, pain goes off quickly. Found to have deep DO composite placed last week.
   b. What would you do to confirm your diagnosis (6)

Answer 16

 Pulp test (thermal, EPT), percussion, radiograph, air blow, check occlusion, detect crack line by several test (bite test, transillumination, etc), check other tooth to exclude referred pain

Question 17

50 year old man. Clinical photo (anterior teeth apart front view), PAN, Study Cast.
C/O: reduced height of anterior tooth.
HPC: Sharp pain on cold drink. Not spontaneous.
I/O Photographs: showing generalized attrition and erosion of upper and lower arch. (mainly anterior) PAN

Describe the radiographic findings. (5) b. Describe the clinical findings. (5)

What is the diagnosis of the patient?

Answer 17

Tooth hypersensitivity

Question 18

50 year old man. Clinical photo (anterior teeth apart front view), PAN, Study Cast.
C/O: reduced height of anterior tooth.
HPC: Sharp pain on cold drink. Not spontaneous.
I/O Photographs: showing generalized attrition and erosion of upper and lower arch. (mainly anterior) PAN

c. List 5 questions you will ask the patient to support your diagnosis. (5)

Answer 18

 Diet (acidic beverage)
 Brushing method, forces and tools
 Parafunctional habit like bruxism or clenching / stress / muscle or joint pain

 Eating disorder like anorexia nervosa
 Pain is generalized or specifically to certain tooth or teeth

Question 19

50 year old man. Clinical photo (anterior teeth apart front view), PAN, Study Cast.
C/O: reduced height of anterior tooth.
HPC: Sharp pain on cold drink. Not spontaneous.
I/O Photographs: showing generalized attrition and erosion of upper and lower arch. (mainly anterior) PAN

d. Why the patient feel pain on cold drink? (2)

Answer 19

 Hydrodynamic theory

 Plasma-like biological fluid inside the dentinal tubules. Cold stimulus cause outward fluid movement and deform the odontoblastic process, which stimulate the A-delta fibers to initiaite short durated sharp pain