Dental MCQ
Beyond the standard canal · Endodontics · INBDE Patient Cases

Surgery, Retreatment & Trauma INBDE Patient Cases

By Dr. Isaac Sun, DDS

8 ADA INBDE-format patient cases on surgery, retreatment & trauma. Each case is a shared patient box (chief complaint, history, medications, allergies, exam) followed by linked multiple-choice questions with full distractor explanations. Practice the way the real exam is structured.

8 patient cases40 linked questionsADA INBDE formatFull distractor explanations

Eight ADA INBDE-format patient cases on surgical endodontics, retreatment, and dental trauma: an avulsed permanent tooth replanted with milk storage and a flexible splint, choosing nonsurgical retreatment over surgery for a re-accessible failing canal, apicoectomy with an MTA root-end filling when a post makes orthograde re-entry too risky, regenerative endodontics or apexification for an immature necrotic tooth, vital pulp therapy for a crown fracture with pulp exposure in a young tooth, a horizontal root fracture repositioned and splinted with a better apical-third prognosis, distinguishing internal from external resorption, and an intrusive luxation with its ankylosis and replacement-resorption risk. Topics include nonsurgical retreatment, apical surgery, traumatic dental injuries and avulsion, regenerative endodontics, and internal and external resorption.

Case Coverage Map
What each case is testing
A tooth knocked out at a soccer game:
Avulsion management, replant fast, milk storage and PDL cell viability, flexible splinting, and why a mature tooth still needs root canal therapy.
A failing root canal: through the crown or surgery?:
Nonsurgical retreatment as first choice when re-accessible, gutta-percha removability, the causes corrected, and when a post forces surgery.
A lesion that won't heal under a post and crown:
Apicoectomy when orthograde re-entry is too risky, root-end resection with MTA, biopsy, and the oral-surgery scope boundary for extraction.
A young tooth with a wide-open root tip:
Immature necrotic tooth, regenerative endodontics for continued root development, apexification as the alternative, and why saving it matters.
A chipped front tooth with the nerve showing:
Crown fracture with pulp exposure, vital pulp therapy (pulp cap/pulpotomy) to keep the immature root developing, and the necrotic-tooth alternative.
A loose front tooth after a fall:
Horizontal root fracture, reposition and splint, the better apical-third prognosis, monitoring vitality, and the worse cervical-third outlook.
A pink spot on a tooth and a puzzle on the x-ray:
Internal resorption (pink tooth, treated by root canal therapy) versus external resorption (root surface, post-trauma), and why classification guides care.
A tooth driven up into the gum:
Intrusive luxation as the worst-prognosis luxation, likely necrosis needing root canal therapy, and ankylosis/replacement resorption from PDL death.
Patient case: A tooth knocked out at a soccer game
0 of 5 answered, 0 correct
Patient
Male, 14 years old
Chief Complaint
An upper front permanent tooth was knocked completely out 20 minutes ago.
Background and/or Patient History
  • Permanent maxillary central incisor avulsed during sports
  • The tooth was picked up and placed in milk by a coach
  • Closed apex (mature tooth); patient otherwise healthy
Allergies
NKDA
Medications
  • None
Current Findings
  • Empty socket; the avulsed tooth is intact and was stored in milk
  • Short extra-oral time
  1. Question 1
    Moderate
    The most important immediate action for this avulsed permanent tooth is to:
  2. Question 2
    Moderate
    Storing the tooth in milk was appropriate because milk:
  3. Question 3
    Hard
    The viability of the periodontal ligament cells matters because it determines whether the tooth:
  4. Question 4
    Moderate
    After replantation, the tooth should be stabilized with:
  5. Question 5
    Hard
    For this mature (closed-apex) tooth, root canal therapy is generally:

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Patient case: A failing root canal: through the crown or surgery?
0 of 5 answered, 0 correct
Patient
Female, 48 years old
Chief Complaint
Persistent lesion on a previously root-treated tooth.
Background and/or Patient History
  • Root canal done years ago; a periapical lesion persists
  • The existing obturation appears short and the coronal restoration is intact and accessible
  • No post is present and the canal can be re-entered
Allergies
NKDA
Medications
  • None
Current Findings
  • Persistent apical radiolucency; canal re-accessible through the crown
  • No obstruction preventing orthograde re-entry
  1. Question 1
    Moderate
    Because the canal can be re-accessed, the preferred first option is:
  2. Question 2
    Moderate
    Retreatment here is feasible largely because:
  3. Question 3
    Moderate
    Retreatment would specifically aim to correct:
  4. Question 4
    Moderate
    If a well-fitting post had been cemented and the canal could not be safely re-entered, the better option would be:
  5. Question 5
    Moderate
    If apical surgery were performed, the apex would be sealed with:

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Patient case: A lesion that won't heal under a post and crown
0 of 5 answered, 0 correct
Patient
Male, 55 years old
Chief Complaint
Ongoing tenderness over the root of a crowned, post-restored tooth.
Background and/or Patient History
  • Root canal, a cemented post, and a crown were placed years ago
  • A periapical lesion persists with tenderness to palpation over the apex
  • Removing the post to retreat would risk fracturing the root
Allergies
NKDA
Medications
  • None
Current Findings
  • Persistent apical radiolucency; well-fitting post and crown
  • Orthograde re-entry judged too risky
  1. Question 1
    Moderate
    Given a well-fitting post and the risk of orthograde re-entry, the appropriate option is:
  2. Question 2
    Moderate
    Apicoectomy treats the lesion by:
  3. Question 3
    Moderate
    A biocompatible root-end material that seals well in the moist surgical field is:
  4. Question 4
    Moderate
    If tissue removed at surgery needs a definitive diagnosis, apical surgery also allows:
  5. Question 5
    Easy
    Extraction of this tooth, were it chosen instead, would be a procedure belonging to:

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Patient case: A young tooth with a wide-open root tip
0 of 5 answered, 0 correct
Patient
Female, 9 years old
Chief Complaint
A discolored front tooth after a fall last year.
Background and/or Patient History
  • Permanent central incisor traumatized previously; now non-responsive to pulp testing
  • The root is still immature with an open apex and thin walls
  • Small apical lesion present
Allergies
NKDA
Medications
  • None
Current Findings
  • Necrotic pulp; open apex and thin dentinal walls on radiograph
  • Periapical radiolucency
  1. Question 1
    Moderate
    An immature necrotic tooth differs from a mature one mainly in that it has:
  2. Question 2
    Moderate
    A treatment aimed at continued root development for this tooth is:
  3. Question 3
    Moderate
    If continued root development is not pursued, the alternative is:
  4. Question 4
    Moderate
    Why is preserving and developing this tooth worthwhile in a 9-year-old?
  5. Question 5
    Moderate
    The pulp non-response in this previously traumatized tooth, combined with a lesion, indicates:

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Patient case: A chipped front tooth with the nerve showing
0 of 5 answered, 0 correct
Patient
Male, 11 years old
Chief Complaint
Chipped a front tooth in a fall an hour ago, with a small bleeding spot.
Background and/or Patient History
  • Permanent central incisor with a crown fracture exposing a small point of pulp
  • Immature tooth, recently injured, with a pinpoint pulp exposure that is bleeding slightly
  • Otherwise healthy
Allergies
NKDA
Medications
  • None
Current Findings
  • Small pulp exposure at the fracture site; vital, bleeding pulp
  • Open apex (immature tooth)
  1. Question 1
    Moderate
    For a small pulp exposure in a young, immature tooth, the preferred approach is:
  2. Question 2
    Moderate
    Preserving pulp vitality in this immature tooth is especially important because it allows:
  3. Question 3
    Moderate
    A pulpotomy specifically involves:
  4. Question 4
    Moderate
    Time since the injury matters because a recent, small exposure of a vital pulp:
  5. Question 5
    Hard
    If this exposure had instead been large, old, and the pulp necrotic in this immature tooth, management would shift toward:

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Patient case: A loose front tooth after a fall
0 of 5 answered, 0 correct
Patient
Female, 27 years old
Chief Complaint
A front tooth feels loose and slightly displaced after a fall.
Background and/or Patient History
  • Maxillary central incisor mobile after trauma
  • Radiograph shows a horizontal fracture line across the root in the apical third
  • The coronal segment is slightly displaced
Allergies
NKDA
Medications
  • None
Current Findings
  • Horizontal root fracture in the apical third; mobile coronal segment
  • Pulp currently responsive
  1. Question 1
    Moderate
    Initial management of a horizontal root fracture with a displaced coronal segment is to:
  2. Question 2
    Hard
    The apical-third location of this fracture suggests:
  3. Question 3
    Moderate
    Because the pulp is currently responsive, root canal therapy is:
  4. Question 4
    Moderate
    A cervical-third horizontal root fracture, by contrast, would:
  5. Question 5
    Moderate
    Follow-up of this tooth should specifically watch for:

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Patient case: A pink spot on a tooth and a puzzle on the x-ray
0 of 5 answered, 0 correct
Patient
Male, 38 years old
Chief Complaint
Asymptomatic pinkish area noticed on a tooth at a checkup.
Background and/or Patient History
  • History of trauma to the area years ago
  • A faint pink discoloration is seen in the crown of one tooth
  • Radiograph shows a resorptive defect that needs to be classified
Allergies
NKDA
Medications
  • None
Current Findings
  • Pink discoloration of the crown; resorptive radiolucency centered on the canal
  • Tooth currently responsive to testing
  1. Question 1
    Hard
    A pink discoloration of the crown (the pink tooth) classically suggests:
  2. Question 2
    Moderate
    Internal resorption is arrested by:
  3. Question 3
    Moderate
    External resorption differs in that it:
  4. Question 4
    Moderate
    Distinguishing internal from external resorption relies heavily on:
  5. Question 5
    Moderate
    Correctly classifying the resorption matters because it:

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Patient case: A tooth driven up into the gum
0 of 5 answered, 0 correct
Patient
Male, 16 years old
Chief Complaint
A front tooth was pushed up into the gum during a collision.
Background and/or Patient History
  • Maxillary incisor appears shorter, driven into the socket (intruded)
  • Mature tooth with a closed apex
  • Significant force during a sports collision
Allergies
NKDA
Medications
  • None
Current Findings
  • Intrusive luxation (tooth displaced apically into bone)
  • Periodontal ligament and pulp likely severely injured
  1. Question 1
    Moderate
    Among luxation injuries, intrusive luxation generally has:
  2. Question 2
    Moderate
    A mature intruded tooth often goes on to need:
  3. Question 3
    Hard
    A major long-term complication to watch for after severe luxation or intrusion is:
  4. Question 4
    Moderate
    Ankylosis (replacement resorption) occurs because:
  5. Question 5
    Moderate
    This case reinforces that across trauma, the structure whose survival drives the periodontal prognosis is the:

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Surgery, Retreatment & Trauma core recall

Refresh the anatomy facts these cases depend on: nerve numbers, foramina, functions, and lesion findings.

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