1st day - Clinical Endo

You will receive a plaster block with 3 teeth (probably one incisor or canine, one premolar and one molar). You will have 3:15 hrs to do the opening of all teeth and full endo of one canal. The initial periapical x-ray will be given to you. You will also need to do a rubber dam exercise (10 minutes for that). For each step of your treatment you will have to show your work to an examiner and you will have a viva: 1.rubber dam exercise, 2.opening + length x-ray, 3.prep and 4.obturation. You can take as many x-rays as you wish, but keep in mind that it will take 5 minutes to process/develop each.

My experience: 

I received an upper canine, a second upper premolar and a first upper molar. The tooth with the simulated periapical lesion is the one to be instrumented, mine was the PM.

Viva:

*Rubber dam: 

1. Why did you use this clamp?

2. Why this technique?

3. What is/are the advantages of a wingless clamp?

4. What is the importance of using rubber dam for endo?

5. How can you improve your isolation?

6. Why did you choose this frame?

7. Please show us how you would take an x-ray for this patient. (they give you a film and a cup to simulate the x-ray device, you have to position the film and device).

8. What do you know about x-ray film holders? Advantages for endo? Can you use them with rubber dam and a file in the canal? How?

9. Will you ask your DA to hold the film for you? Why not?

*Opening + length x-ray

1. Which teeth did you get?

2. Why do you think this is a second premolar and not a first premolar?

3. What is the percentage of second upper premolars with 2 canals?

4. Why do you think this is a first upper molar? How many canals did you find? What is the difference between the crown of the first and second molar?

5. Are you happy with your length?

6. Why 1mm shorter to the apex?

*Prep and master gutta-percha x-ray

1. Are you happy with the position you your master gutta?

2. Which technique did you use for instrumentation?

3. What is the disadvantage of the lateral condensation in comparison to crown down?

4. If your patient has a flare up after prep, what will be your management? Will you use antibiotics?

5. Which situation would you prescribe antibiotics? Which one? If allergic to penicillin? What is the risk of using clindamycin? Does it interact with warfarin?

6. What size was your MAF? What does it mean?

7. Which irrigation solution? Which concentration?

8. What do you think about using 5% sodium hypochlorite? Which situation would you use a higher concentration?

9. Would you leave the tooth open? Why?

10. What dressings would you use?

11. What do you mean by cleaning and shaping?

12. What is the goal of shaping?

*Obturation

1. Are you happy with your endo?

2. Which obturation technique did you use?

3. Which instruments did you use?

4. How would you restore the premolar? and the molar? Amalgam?

5. How long will it take for you to be able to assess healing?

2nd day pm - Theory CD3

* Radiology

1. Cropped OPG showing posterior maxilla: what are the anatomical landmarks indicated by the arrows?

2. Bitewing: do a report. (interproximal caries: enamel and dentine-enamel).Localize with arrows and describe each anomaly.

3. Three periapicals are given of the anterior maxilla with different horizontal angulations. Radiolucent lesion on the midline. What are your differential diagnoses? What is the most likely diagnosis? Why?

4. Mistakes: 4 periapicals:  describe the mistakes and why it happened? Elongated, shortened, cone cut, scratched. 

5. What is anatomical land mark for horizontal angulation in bitewing6. What techniques would you use for location of impacted palatal canine?

*Oral Surgery

1. TMJ pain. Etiology? Treatment?

2. Patient calls 3 hours after a really difficult extraction of a lower molar complaining of inability to close the mouth completely. What happened?

3. Management of a syncope episode

4. After administration of local anesthetic patient cannot close his eye what is cause andtreatment

*Diagnosis

1. Box with kinds of pain for us to fill with the diagnosis for each type.

2. Picture showing white lesions on buccal mucosa, cheek, ventral surface of tongue and sublingual mucosa. What are your differential dxs? Which you think is the most likely and why? Management?

3. two pictures: upper and lower arch of a patient with loss of tooth structure on lingual and occlusal surfaces? Diagnosis? Etiology? Investigation? Describe what you see. 

*Infection Control

-What BBD do not have vaccination in Australia?

- Neddle stick injury, which procedures after?

Many MCQ, I do not remember.

3rd day  am - Theory paper CD1

Pedo:

Short answer

• Girl 12 yo fainted in the bathroom and knocked her front teeth on the sink, happened one hour ago. Picture of a Pin point exposure in 11. Mother brings the tooth fragment with her. What is your management? 

* Management for a 8 yo patient with high caries risk that lives in an area with no fluoridated drinking water?

*They give us an OPG and a picture of the arch. We have to do the charting for one quadrant and the tx plan for other quadrant. The OPG showed several deciduous teeth with caries (enamel, dentine and enamel), hypodontia of 35 and 45. Pay attention to all the details (soft tissues, bone, teeth erupted and impacted). Most of the candidates did not notice 35 and 45 missing. 

• Photo of Molar Hypoplasia. Sign and symptoms. Etiology. management. treatment 

MCQ:

Indications for nitrous oxide sedation

• Fearful

• Patient with gag reflex

• Asthma

• None of the above

• All of the above

Photograph showing small lesion (ulcer) on the lower lip 1cm x 1cm. The lesion was mostly likely: (trauma)

• Verruca vulgaris

• traumatic ulcer

• Fibroma

• Mucocele

Lower D was shown in photograph with distal marginal ridge loss. What treatment? Photo of tooth deep caries on 84, involving marginal ridge, abscess in buccal , what is your management?  (abscess is really discreet, pay attention!)

• pulpotomy & SSC 

• Pulpectomy and SSC

• Extraction

Photograph of an orthodontic appliance, which is it?(transpalatal appliance)

• Hawley appliance

• Quad helix

• C. Palatal crib

• transpalatal appliance

 What is this appliance used for/which treatment?

• posterior crossbite

• deep bite

• reminder appliance

Photograph showing translucent teeth which are attritted at gingival level(dentinogenesi s imperfecta). identify the condition

• amelogenesis imperfecta

• dentinogenesis imperfecta

• tetracycline staining

In which condition pulpotomy is contraindicated?

• Immunocompromised

• Valvular surgery

• Haemophilia

• a & b only

• a, b and c

Photograph of traumatic exposure of 11 one hour ago. Large exposure involving pulp. What treatment you will do?

• pulpotomy

• pulpectomy

• RCT with gutta-percha

• extraction

Which of the following are nonpharmacological methods of behaviour management. Encircle true or false

Voice control True False

Tell show do True False

Positive Reinforcement True False

Distraction True False

Hand over mouth True False

*Management of acute fluoride toxicity 

*Operative Dentistry

SAQ

1. Box with advantages and disadvantages of composite, amalgam and PFM crown.

Picture of an upper arch: patient has amalgam restorations in all premolars and molars, 22 missing with spacing, 12 missing no spacing (11 and 13 touching), ulcer on the palatal mucosa around teeth 16 and 15.

2. Patient wants to replace all the amalgams for tooth colored restorations. What will you advice your patient? What might be the risks? Any special measures for removing the amalgam restoration?

3. the same patient also wants to replace missing 22. What further examinations will you do? What will you tell your patient? What options?

*CD2 - PM

*Perio

1.Furcation on a upper molar, what is the location in relation to the CEJ?

2. Antibiotics in perio: refractory periodontitis, acute ulcerative gingivitis, perio abscess, early onset periodontitis

3. Tx for pericoronitis ,pt with hip replacement 6 weeks ago

4. Limitations of scaling of upper posterior teeth

5. What type instruments for scaling mesial of posterior teeth

*Pros

1. Write the procedures in surgery and lab for a crown fabrication on a tooth that is an abutment of a RPD.

2. Design of a RPD upper and lower class IV and Class III respectively.

Day 4

CD1 Fixed Pros - AM

Tooth 24 is missing; prepare 23 and 25 for a PFM Bridge, equigingival margins. You have 3:15 hours.

Viva (15 minutes)

*What do you understand by informed consent?

*What are the tx options for your patient? Missing 24.

*What if the patient asks: what would you select for yourself if your tooth was missing?

*How would you do the impression?

*How to you use retraction cords and why?

*What if the impression has flaws?

*How long would you expect this bridge to last? Your patient is asking you that.

*What information will you give to the lab technician?

*Would your treatment plan change if the patient is a bruxer? How?

*Orientations at insert appointment?

CD1 Amalgam - PM

You will have to perform 3 preps for amalgam fillings: mine were 36 DO, 35DO and 34DO. You will receive a picture showing the depths and locations of decay. And 1 amalgam restoration: 26 MOB (cusp capping). You can alter the prep if you think is necessary, but be ready to explain why.

Time: 3:15 minutes. You have to show your preps and your restoration, you can do in any order you prefer.

Viva (15 minutes)

They showed me the picture we were given to demonstrate the location and depth of decays for practical exercise.

Pretend this is the bitewing x-ray of your patient. She is coming for the first time in your practice, she has a 3 months baby and this is her situation today (enamel decay teeth 33D and 37M, decay at the DEJ on tooth 34D, 1/3 into dentine on 35D and really deep on 36D), she brings a x-ray 1 year old where we can only see the decay on the 36, others were sound.

*What do you think has changed in 1 year?

*How will you work with prevention with this patient?

*Any orientations regarding her baby (3 months old)?

*How would you restore tooth 36?

*Would you remove all the decay? Would you re open?

*And if you have a pulp exposure?

*How you would treat teeth 33 and 37?

*How to apply fluoride interproximally?

Day 5

Cd1 Composite - AM

Practical: preps for composite fillings on 11 and 21 with mesial/incisal fractures (tooth 21 has a discolored mesial composite) and 12D (decay on DEJ). Restoration of tooth 14 with buccal cusp fracture. (3h:15 minutes)

Viva (15minutes)

They showed me the same picture (“bitewing”) as the previous day.

*Your patient wants a white filling on tooth 36: how would you restore it?

*What if it is subgingival?

*What kind of GIC for sandwich technique?

*Would it change if it was the 11D?

*And for a Class V? Which GIC? Why?

*Which composite for posterior and anterior?

*Why do you use the etch? And primer and bond? Where?

*For how long do you etch? Explain your technique.

*What is the function of the primer? Will you use it in enamel?

*Fluoride varnish: how to use and which brand name?

CD2 Perio - PM

You will get a patient and a DA. You will have to do the full examination with charting of 1 quadrant and perform scale in 1 quadrant (usually not the one the charting was done) in 1 hour. Please treat well your patient and your assistant. If the patient needs LA, call an examiner and they will do it. After this you have 30 minutes to elaborate a full treatment plan for your patient (not only perio, but all needs). And the last part is your viva.

My experience: my patient was a female, 57yo, medical hx: previous ovarian cancer (had hysterectomy 7 years ago, no chemo or radiotherapy needed), otherwise healthy. No caries, moderate chronic periodontitis, lots of plaque and calculus, Class II with severe crowding and deep palatal vault, severe bleeding, tooth 47 missing, furcation involvement in all molars.

Viva (supposed to be for 15min, mine lasted 25min):

Since my patient did not have any medical complications, my viva was just tx planning and perio.

*They asked me to present my patient and my perio diagnosis.

*All about different situations with probing depth and CAL: - when do we have pockets but no CAL? When can we have CAL, but no pockets? Is it possible to have a pseudo pocket with gingivitis? How did you get your diagnosis?

*All about furcation involvement.

*Endo-perio lesions.

*My patient had a PBM crown on tooth 21, it was not on the quadrant that I charted, so I did not check the margins, but apparently it was deficient. They asked if I had noticed the crown and its quality. I said no. They said the patient would need the tooth extracted. How could I temporize since she has her son’s wedding this weekend? Could I foresee any complications due to her occlusion? What options for a permanent solution?

*Will you replace tooth 47? Why not?

Day 6

CD1 Pedo

Just a viva (15 min)

*First slide: bitewing x-ray mixed dentition, enamel caries on 16, enamel/dentine caries on 54 (marginal ridge breakdown) and on deciduous molars.

1. What kind of x-ray we have here?

2. Identify the teeth according to the FDI.

3. How old is the patient?

4. How will you treat tooth 16?

5. How will you treat tooth 54?

6. Which materials can you use for the pulpotomy?

7. What anesthetic would you use? Which technique?

9. Which material would you use to restore lower deciduous molars? Why? How long do you think a GIC will last?

8. If mum tells you she is having open heart surgery in two weeks, due to a congenital heart disease, how will it affect your treatment for tooth 54?

*Second slide: picture of trauma, could see uppers and just incisal of lowers, teeth 11 and 21 luxated or partially erupted? Bleeding gingival sulcus. Trauma happened minutes ago.

1. What is your management step by step? What is your diagnosis?

After I told I would take a PA x-ray to see if there was any change in tooth position or root fractures, they told me teeth were partially erupted, with no dislocation after trauma. (if you need extra information to establish a diagnosis, ask the examiners as you would ask your patient, they will give you the information if it is necessary).

2. Pain management for this situation? Dosage?

3. What would I tell the parents about possible complications?

4. When will I see her again?

*Third slide: picture of quadrant 2, showing 64 in infra-occlusion.

1. What is your diagnosis?

2. What is the usual cause?

3. What will be your management?

Day 7

Cd3 Radio and oral diagnosis

Practical is just radiology, then you have two vivas first radio then oral diagnosis.

Practical: DA will call you and explain everything; you have number 2 and occlusal films available, as well as holders for periapicals, mirror and tweezers. You will have to take two x-rays on the mannequin.

My “patient” was a female, 25yo, needed bitewing RHS and periapical of the 16.

Viva:

Radio:

1. What do you know about the Australian legislation regarding the use of lead apron? (They asked that because I forgot to use the lead apron). Which situations would you use? Is the legislation regulated by states or is it federal?

2. OPG x-ray: describe all you can see on quadrant 3. Everything normal anatomy but the anterior region of the mandible had areas of decreased radiopacity and increased radiopacity, what is it?

3. OPG showing radiolucent lesion, defined limits but not sclerosed margins, extending from the mesial of the 33 to the ramus, patient was young (root formation of second molars incomplete). Describe the lesion. What is your differential diagnosis? Why did you say traumatic cyst? Is it a true cyst? What is the tx?

Oral diagnosis

1. What are the types of ulceration we can have inside the mouth?

2. What are the differences between the types of aphtous ulceration?

3. Picture of the ventral surface of the tongue and sublingual area, various ulcerations, with different degrees, areas of hemorrhage, and lots of decay.

*Describe the lesion as if you were ringing me, I am the specialist.

*What kind of ulceration is this one?

*what questions would you ask the patient to help you reach a diagnosis?

*why do you think this patient is under radiotherapy?

*Management.

Oral Surgery

1.DA will be your patient for the anamnesis. After that examiners call you.

2. You have to present your patient. My patient was female, 25yo, on the methadone program, HIV + and Hep C +, she did not remember the name of her medications, neither details about her HIV and Hep C infections. Unemployed, single, no kids.

3.They will show an OPG and ask several anatomical landmarks and muscle attachments. Asked me about Eagle’s syndrome.

4.They will ask you to demonstrate the anesthetic technique for tooth 46. You have to select the anesthetic and needle. They will ask you about it: why this anesthetic? What did you check in the cartridge? Then you will be taken to the mannequin to show the technique for the IAN block: tell the landmarks and show technique.

*Which nerves will you anesthetize? Explain technique for IAN, lingual and buccal nerves.

*How do you know the anesthesia is working?

*What if the patient starts feeling pain during the procedure? What accessory innervation? How to overcome?

*What happens if you insert anesthetic in the vein? What will be the signs? How will you manage?

5.Then they will show you several surgical instruments, you have to say the names.

6.Then they will ask you to select the instruments for the exodontia of tooth 45 and you have to extract tooth 45 on the mannequin.

*What if you have bleeding immediately after? From the gingiva? What will be your management?

*What are the possible complications of your patient’s medical conditions (HIV and Hep C) for your treatment? How to manage these?

*Lone standing molar abutment of a partial denture needs exo. What can be the complications? What will you look for in your x-ray? You fractured the tuberosity, what will be your management? And if the tooth has a periapical cyst?