Case J: Thoroughgood Epps

Order these steps to surgical placement of the restorative treatment noted in the patient's mandibular anterior region. Match each letter with its proper sequence number. Begin with the first step. A. A surgical guide stent is constructed. B. An abutment is placed on top of the implant and sutured so that the abutment protrudes through the periosteum. C. A prosthetic restorative appliance is fabricated and oral self-care instructions are provided. D. A hole is drilled into the bone and an implant anchor is placed into the hole. The tissue is sutured over the anchor. E. A healing cap is positioned on top of the abutment.

1. A 2. D 3. B 4. E 5. C

For each number noted on the panoramic radiograph, select the most likely interpretation. (Answers may be used only once.) Tooth Interpretation ____1. Thin radiolucent structure outlined by faint paired radiopaque lines ____2. Thin radiopaque line ____3. Faint radiopaque structure ____4. Radiopaque horizontal band ____5. Radiopaque landmark ____6. Rounded radiopaque structure ____7. Faint radiopaque structure A. Condyle B. Hard palate C. Hyoid bone D. Mandibular canal E. Nasal conchae F. Oblique ridge G. Wall of the maxillary sinus

1. D 2. G 3. E 4. B 5. F 6. A 7. C

Which of the following term applies to the maxillary left second molar? A. Abutment B. Pontic C. Retainer D. Cantilever E. Rest

A. Abutment

What classification is the restoration on the mandibular left first molar? A. Class I B. Class II C. Class III D. Class IV E. Class V

A. Class I

Instruments made of each of the following types of materials may be used to scale subgingival deposits in the mandibular anterior region of this patient EXCEPT one. Which one is the EXCEPTION? A. Metal B. Plastic C. Gold tipped D. Nylon E. Graphite

A. Metal

Which of the following is observed in the pulp chamber of the mandibular right first molar? A. Secondary dentin B. Enamel pearl C. Condensing osteitis D. Hypercementosis E. Dens invaginatus

A. Secondary dentin

If necessary, each of the following may be used to remove stains from the implant superstructure EXCEPT one. Which one is the EXCEPTION? A. Ultrasonic scaling with a slim-diameter tip B. Light, sweeping motion with the air polisher C. Rotary rubber cup with tin oxide D. Sonic scaling with a specially designed plastic tip sleeve E. Nonabrasive paste applied with dental tape

A. Ultrasonic scaling with a slim-diameter tip

Which of the following would be contraindicated for this patient? A. Mouth rinses containing alcohol B. Acidulated phosphate fluoride C. Tartar control dentifrice D. Disclosing solution E. Periapical radiographs

B. Acidulated phosphate fluoride

Which of the following may have contributed to the lack of tissue response in the interproximal region of the mandibular left second premolar and first molar at the six-week reevaluation appointment? A. Inappropriate time interval for tissue response B. Bacterial seeding from dental caries C. History of repeated radiation exposure D. Undetected systemic conditions E. Inappropriate use of toothpicks

B. Bacterial seeding from dental caries

Which of the following describes the implant? A. Blade B. Cylinder C. Staple D. Plate E. Screw

B. Cylinder

Each of the following is a poor design characteristic of the restorative treatment of the mandibular anterior region EXCEPT one. Which one is the EXCEPTION? A. Acrylic that contacts the gingival surface B. Left pontic not attached to adjacent natural tooth C. Widely shaped pontics D. Overcontoured crowns E. Narrowed embrasures

B. Left pontic not attached to adjacent natural tooth

Why does the left side of the mandibular anterior restorative treatment appear not to be attached to the adjacent natural tooth? A. The implant has failed. B. This is a cantilever pontic. C. The tooth root has resorbed. D. There is a clasp missing from the bridge. E. This portion of the restoration is temporary.

B. This is a cantilever pontic.

Which of the following hand-activated instruments would be the best choice to effectively and efficiently debride all natural teeth? A. Area-specific curets B. Universal curets C. Extended-shank curets D. Sickle scalers E. Periodontal files

B. Universal curets

Which of the following will benefit this patient the most? A. Pit and fissure sealants B. Professional fluoride varnish C. Direct, local application of chlorhexidine D. Oral irrigation with essential oils E. Administration of potassium oxalate

C. Direct, local application of chlorhexidine

Which of the following is the most reliable indicator of this patient's implant success? A. Gingival color B. Papillary shape C. Lack of mobility D. Pocket depths E. Amount of bleeding on probing

C. Lack of mobility

Which of the following explains the bilateral increased radiolucencies in the regions of the submandibular fossae? A. Pathologic bone resorption or unexplained bone loss B. Superimposition of several structures imaged in the same place C. Negative shadows representing areas of decreased density D. Radiographic error that resulted in black artifacts E. Accidental exposure of the film to white light

C. Negative shadows representing areas of decreased density

How often should radiographs be taken of the mandibular anterior region? A. Every 3 months B. Every 6 months C. Once a year D. Once every 24 to 36 months E. Depends on the signs and symptoms at the time of assessment

C. Once a year

Which of the following is the most appropriate dental hygiene care plan for this patient? A. One 1-hour appointment for oral prophylaxis, followed by a maintenance appointment in three to four months B. One 90-minute appointment for full-mouth disinfection and one 1-hour appointment 24 hours later to evaluate tissue response and perform a second full-mouth disinfection if inflammation persists, followed by a reevaluation appointment in four to six weeks C. One 1-hour appointment for full-mouth debridement and one 45-minute appointment 7 to 10 days later to evaluate tissue response and to instrument if inflammation persists, followed by a reevaluation appointment in four to six weeks D. One 90-minute appointment for half-mouth periodontal debridement and one 90-minute appointment 7 to 10 days later for half-mouth periodontal debridement of the other side, followed by a reevaluation appointment in four to six weeks E. Four 1-hour appointments scheduled 7 to 10 days apart for periodontal debridement by quadrant, followed by a reevaluation appointment in four to six weeks

C. One 1-hour appointment for full-mouth debridement and one 45-minute appointment 7 to 10 days later to evaluate tissue response and to instrument if inflammation persists, followed by a reevaluation appointment in four to six weeks

With what type of implant does this patient present? A. Endodontic B. Subperiosteal C. Transosteal D. Endosteal E. Post and core

D. Endosteal

Which one of these oral hygiene aids might be contraindicated for this patient? A. Wooden wedges B. Holder for toothpick C. End-tuft brush D. Interproximal brush E. Tufted floss

D. Interproximal brush

Who is responsible for maintaining this patient's oral health? A. The dentist B. The dental hygienist C. The dentist and dental hygienist D. The patient E. The patient, dentist, and dental hygienist

D. The patient

This patient's medications put him at risk for developing which of the following? A. Glossitis B. Angular cheilitis C. Gingival hyperplasia D. Xerostomia E. Black hairy tongue

D. Xerostomia

What is the appropriate length of time between periodontal maintenance appointments for this patient's recall? A. One-month intervals B. Six-week intervals C. Three-month intervals D. Six-month intervals E. Dictated by patient needs

E. Dictated by patient needs

Each of the following played a role in determining that this patient was a good candidate for dental implants EXCEPT one. Which one is the EXCEPTION? A. Medical condition B. Attitude and emotional health C. Tobacco use D. Periodontal condition E. Genetic testing

E. Genetic testing

Each of the following is recommended for managing this patient's treatment EXCEPT one. Which one is the EXCEPTION? A. Use a semisupine position. B. Use physical supports such as a neck pillow. C. Allow for frequent position changes. D. Schedule short appointments. E. Schedule morning appointments.

E. Schedule morning appointments.