KINGDOM OF SAUDI ARABIA ‫المملكة العربية السعودية‬

Ministry of Higher Education ‫وزارة التعليـــم العالــي‬

TAIBAH UNIVERSITY ‫جـامعـة طـيبـــة‬
College of Dentistry ‫كلية طب االسنان‬
Education Affairs Office ‫الشؤون التعليمية‬

Dental Education Department

Comprehensive clinical Dentistry – DDE620
Comprehensive clinical Dentistry – DDE520 old

Final OSVE Exam

Date: 12.9.1441H 5.5.2019 A.D.
Time: 09:00 pm – 09:00 am

DDE520 old
Student's Name: AbdulMajeed Mohammed AlHumaidi
University Number: 3310190
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#12,
22

Bitewings

#28

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Periodontal charting

Maxilla

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Periodontal charting

Mandible

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A 29 years old female patient presented to the clinic complaining from
pain in the upper left side (pointing to tooth #28). Also, she has pain
related to the upper anterior teeth when drinking cold water or exposed
to cold air. Her vital signs were normal, Known with stage I
hypertension, ischemic heart disease, asthmatic and diabetes mellitus
type2. She is on the following medications, Metformin, Nitroglycerin and
Ventolin inhaler on demand usually 10 times /day .
According to the provided photos, radiographs and charting, please
answer the following questions.

Periodontics:
1- Assuming scaling and root planning was planned for this patient
when the revaluation of this this case would be. (half point)

The reevaluation for this case to be after 4 weeks due to the patient
medical history.

2- Assuming scaling and root planning was planned for # 47 mention

the name and number of the subgingival instrument needed to scale
the mesial, middle and distal area of the tooth. (1 and a half point)

For middle area gracey curette 9/10.

For mesial area gracey curette 11/12.
For distal area gracey curette 13/14.

3- On a cellular level, in regard to healing after scaling and root

planning, mention the exact time needed for each soft tissue layer
to heal. ( 2 points)

Connective tissue complete healing is after 7 weeks.

Epithelium complete healing is after 4-5 weeks.

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4- Assuming the tooth # 47 had periodontal abscess. Mention the
indications to give this patient antibiotics. (mention at least 4) ( 2
points)

A. Acute onset infection.

B. Diffuse swelling.
C. Compromised host defense.
D. Involvement of facial spaces.
E. Osteomyelitis.

5- If the patient was diabetic. Mention the effect of uncontrolled

diabetes on neutrophils functions. (3 points)

Neutrophils has a reduction in its functional activity in uncontrolled diabetic

patient.

6- Assuming tooth # 47 had deep pockets ( 6 mm) and did not improve
after phase I therapy, what is your options for periodontal treatment
to stabilize the area in phase II. Mention 2 options (1 point) .
(1 point, Half of each choice)

Osseous surgery (Osteoplasty – osteoectomy)

Periodontal flab surgery.

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Oral and maxillofacial surgery:

1- Define pain and illustrate orofacial pain pathway?

An unpleasant sensation that can range from mild, localized discomfort to

agony. Pain has both physical and emotional components.
posterior superior alveolar nerve, maxillary nerve, trigeminal ganglion,
nucleus caudalis
Trigeminal thalamus tract, thalamus, cerebral cortex

2- Mention nerves and area anaesthetized when to extracting #46?

Inferior alveolar nerve block.

Lingual nerve.
Long buccal nerve.

3- What are the instruments you may need regarding either closed or
surgical extraction of badly broken non-restorable #17.

Straight elevator.
Bayonate forceps.
Upper right molar forceps.
Periosteal elevator.

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4- During extraction of # 17 one of its roots suddenly disappeared apically;
describe the provisional diagnosis? How you could confirm your
diagnosis? your management?

The root was displayed in the maxillary sinus (oro-antral communication).

Nose blowing and CBCT.
Enlarging the socket and trying to retrieve the root or Caldwell luc approach.

5- If your patient is 60Kg and you are going to use Lidocaine 2% with
1:100,000 Epinephrine ; what is the maximum recommended dose
regarding local anesthetic agent and vasoconstrictor?

7*60=420.
(2%*10)*1.8= 20*1.8=36 mg.
420/36=11.6 carpules are allowed.

6- What are the medical complications you may encounter during

managing patient with above mentioned medical history? How you
could manage the complications?

Hypoglycemia: Lay the patient flat, give oral glucose 20-40 g,

give 1 mg glucagon IM.
Hyperglycemia: placed supine with their legs slightly elevated, IV infusion
of 5% dextrose and water or of normal saline.
Asthma: Do not lay the patient flat, give oxygen and adrenaline.

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7- Panoramic radiograph showed that the patient needs multiple
extraction; what is your sequence for dental extraction?

#17
#46
#36
Maxillary molars then mandibular molars

8- Since the patient is medically compromised, could you prescribe

postoperative medication for her? If you will do , mention in detail.

Amoxicillin 500 mg TDS.

Paracetamol 1000 mg QDS.

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Endodontics:

1. After reviewing patient medical history. Can rubber dam be used in

this patient if she needs root canal treatment? If yes, what is the
modification you will do in the rubber dam? If no, what are other
options for isolation? (2 marks)

Yes, make sure that rubber dam sheet does not block the nose for airway
and reduce the procedure time.

2. For tooth #28, clinical testing showed the following: severe sharp pain
with cold test that lasts for 30 seconds, positive response to EPT,
normal response to percussion, sensitive response to palpation,
probing depth (3-2-3, 3-2-3) and grade I mobility. What is the diagnosis
of tooth #28? What it is the best treatment option? And how many root
canals you expect to see? (3 marks)

Symptomatic irreversible pulpitis with normal apical tissue.

Root canal treatment.
Three canals.

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3. If the treatment plan was to use tooth #28 as abutment for Removable
partial denture, and clinical signs and symptoms showed direct pulp
capping is enough to address the patient’s complain. What are the
treatment options for tooth #28? (2 mark)

Surveyed crown

4. For teeth #12, #22. Diagnostic tests showed the following:

#12: sharp pain to cold, normal response to EPT, percussion and
palpation
#22: no response to cold, no response to EPT, normal response to
percussion and palpation.
What is the diagnosis and treatment options for teeth #12, #22? (2
marks)

#12 reversable pulpitis with normal apical tissue.

Caries excavation and final composite restoration.

#22 necrotic pulp with normal apical tissue.

Root canal treatment followed by post and core and crown.

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5. What is the difficulty you may face while treating upper lateral
incisors? (1 mark)

Palatogingival groove.

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Operative:
1. Using the International Caries Detection and Assessment System
(ICDAS), what are the teeth with detected carious lesions in the upper
right quadrant and what are their severity classification codes? (3
marks)

Tooth#11 Codes 2
Tooth#12 Codes 5
Tooth#13 Codes 4
Tooth#14 Codes 2
Tooth#15 Codes 2
Tooth#16 Codes 2

2. Name two caries risk assessment systems. What would be the likely
overall caries risk category of this patient? List 4 reasons why? (3
marks)

1- Cariogram,caries management by risk assessment(CAMBRA)

2- American Dental Association (ADA)
High caries risk
Because of
1- 3 or more caries lesion
2- plaque present
3- missing teeth due to caries
4- use medications cause reduction in salivary flow (Ventolin inhlaler)

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3. Based on your caries risk assessment, what would be the suitable
management of this patient? 2 marks (0.25 marks for each point)

Behavioral modification
Oral hygiene instructions
Diet
Topical fluoride application
Recall every 3 months
Prescription fluoride toothpaste is prescribed (5000 parts per million [ppm])
and the patient is instructed to brush with it three times per day and to use
according to given instructions (do not rinse after use, only expectorate
excess).

4. How would you differentiate between active and inactive carious

lesions in this patient? (2 marks)

The difference between active and inactive caries :

Active :
1- the lesion has rough and Matt surface
2- Soft Dentin and rough enamel
3- Lesion is in a plaque stagnation area
4- bleeding on probing
5- plaque over the lesion is thick
Inactive:
1-Not thick or sticky
2-Surface Appearance Shiny; color: brown-black
3-Smooth, hard enamel/ hard dentin
4- Lesion is not in a plaque stagnation area
5- no inflammation no bleeding on probing

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Fixed Prosthodontics:

1- What is the classification of this patient according to the

Prosthodontic Diagnostic Index (PDI)? (1 mark)

Class III

2- The treatment plan of this case included fixed partial dentures # 35-
37 and 45-47. When a protrusive record is being used to program
the articulator, what is the most appropriate type of semi-adjustable
articulators to use in such a case “arcon or non-arcon” and why?
(1.5 mark)

Arcon like condyles attached to mandible

Face bow transfere,occlusal plane, and relation of opposing cast can be
preserved when the articulator is opened and closed.

3- According to the panoramic radiograph, tooth # 37 is mesially tilted.

Provide 4 treatment options to overcome this problem? (2 marks)

A- Orthodontic uprighting.
B- Telescopic crown.
C- Recontouring and scaling + placing grooves to increase retention.
D- Non-rigid connector

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4- In this case, the maxillary missing teeth will be restored with RPD
while the mandibular missing teeth will be restored with FPD. What
are the 3 clinical steps should be done to transfer the patient
occlusion on a semi-adjustable articulator? (1.5 mark)

Face bow ,dawson technique, triple tray technique, enamel island method.

5- What is the best Pontic design should be used to replace missing

tooth # 36? What are the instructions to the lab technician to
compensate for the space discrepancy (span length less than
original) due to the mesial drift of # 37? (2 marks)

Sanitary pontic.
Make the pontic smaller than original size.

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6- During the preparation of #12 for all ceramic crown, as a result of
multiple carious lesions, the dentist needs a circumferential area
(ring) of axial sound dentin superior to the preparation finish line
around the placed fiber post. What is the scientific term of this ring
and its effect on crown to root ratio? (1 marks)

Ferrule effect, prevent root fracture.

Increased the clinical crown length.

7- During the final cementation visit of the final prostheses, the

occlusal contact with opposing dentition must be checked. What
are the best 2 occlusal contact indicators to use? and why? (1 mark)

Myler shim stock to identify presence or absence of occlusal, articulating

paper, articulating foil.
Because its less thickness.

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Removable Prosthodontics:

In this presented case, the missing teeth of the maxilla (# 17, 26, 27) will
be replaced with metallic RPD. A surveyed crown will cover the #28.
Please answer the following questions accordingly:
1- What is the classification of this partially edentulous maxilla
according to Kennedy and support? (1 mark)

Class II mod I

2- Draw the maxillary RPD design and label its components. (2.5
marks) 1.5 marks for design and 1 for labels.

Clasps: Ring clasp #16 and #25

RPI on #16
Rest: Mesial rest seat #16 and #28
Distal rest seat #25
Cingulum rest #23
Surveyed crown: #28

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3- What are the features that should be included in the surveyed
crown placed on tooth #28 ? (1.5 mark) ½ mark each point

Preplanned guide surfaces, rest seats, retentive areas, and axial contour.

4- List 4 different methods to establish the occlusal relationship for

the partially edentulous patients in general. What is the method
that indicated for this presented case? (2.5 marks)

Direct Apposition of Casts indicated for this case.

Occlusal Relations Using Occlusion Rims on Record Bases.
Jaw Relation Records Made Entirely on Occlusion Rims.
Establishing Occlusion by the Recording of Occlusal Pathways.

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5- Form biomechanical point of view, how can we decrease the torque
on the tooth #16 that happened during rotational tissue ward
movement of the denture base? (1.5 marks)

Maximizing tissue coverage over the supporting structures will decease

force.

6- During Alginate Primary impression making the patient exhibit a

severe gag reflex. Mention 4 tips or tricks that could be used to
overcome this problem? (1 mark) ¼ mark each point

Using warm water to fasten the set.

Making the patent face toward the front.
Reduce the water amount.
Instruct the patient to breath repeatedly from the nose.
Hypnotic relaxation.

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