Dental MCQ
Static jaw position · Occlusion · INBDE Patient Cases

Centric Relation & Vertical Dimension INBDE Patient Cases

By Dr. Isaac Sun, DDS

7 ADA INBDE-format patient cases on centric relation & vertical dimension. 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.

7 patient cases35 linked questionsADA INBDE formatFull distractor explanations

Seven ADA INBDE-format patient cases on centric relation and vertical dimension: identifying the CR-CO slide as the short anterior-superior movement from joint-determined CR into tooth-determined MIP (small symmetric normal vs large non-symmetric requiring adjustment), bimanual manipulation (Dawson technique) for CR registration with operator-guided condyle positioning and patient muscle relaxation, the Lucia jig anterior deprogrammer removing muscle memory of MIP to reveal the CR prematurity, lost VDO from severe attrition producing overclosure with perioral wrinkles and angular cheilitis and the provisional-VDO testing period before definitive full-mouth rehabilitation, over-restored single crown raising VDO and losing freeway space with muscle fatigue and lip-seal difficulty managed by selective grinding to equal-pressure simultaneous contact, facebow plus CR record plus protrusive and lateral interocclusal records together translating the patient's CR and mandibular movement onto a semi-adjustable articulator, and freeway space (VDR minus VDO, typically 2-4 mm) as the buffer between physiologic rest and tooth contact preserved in any restorative plan. Topics include centric relation, centric occlusion / MIP, the CR-CO slide, vertical dimension of occlusion and at rest, freeway space, bimanual manipulation, leaf gauge, and the anterior deprogrammer.

Case Coverage Map
What each case is testing
Identifying the CR-CO slide:
Short anterior-superior movement CR → MIP; small symmetric normal; large non-symmetric may warrant adjustment; Lucia jig deprogramming reveals the prematurity.
Bimanual manipulation for a CR record:
Dawson technique: operator fingers on chin + thumbs near lower border; patient relaxes and closes lightly; PVS/wax record at first tooth contact.
Anterior deprogrammer (Lucia jig) for CR registration:
Acrylic platform on upper centrals disengages posteriors and removes MIP memory; reveals CR prematurity; CR record mounts casts on a semi-adjustable articulator.
Lost VDO from worn dentition + full-mouth rehab:
Severe attrition → decreased VDO + perioral wrinkles + angular cheilitis + chewing inefficiency; provisional period tests new VDO before definitive restorations.
Over-restored crown raising VDO and causing pain:
High crown loses freeway space → muscle fatigue + pain + parafunction + lip-seal difficulty; selective grinding restores equal-pressure simultaneous contact.
Facebow and CR for articulator mounting:
Facebow transfers maxillary cast to hinge axis; CR record mounts mandibular cast to maxillary at CR; protrusive/lateral records set condylar inclination + Bennett.
Freeway space and rest position:
VDR - VDO = freeway space (~2-4 mm); lost when VDO is over-restored; excessive when VDO is reduced from wear/tooth loss (overclosure).
Patient case: Identifying the CR-CO slide
0 of 5 answered, 0 correct
Patient
Female, 50 years old
Chief Complaint
Routine prosthodontic workup with question of CR vs MIP.
Background and/or Patient History
  • Pre-prosthetic planning for full-mouth rehabilitation
  • Bimanual manipulation reveals first contact in CR, then a short anterior-superior slide into MIP
  • Discussion of the CR-CO slide
Allergies
NKDA
Medications
  • None
Current Findings
  • CR-CO slide identified on bimanual manipulation
  1. Question 1
    Easy
    The short anterior-superior movement from CR to MIP is:
  2. Question 2
    Moderate
    A small SYMMETRIC slide (<1-2 mm) is:
  3. Question 3
    Moderate
    A LARGE NON-SYMMETRIC slide may warrant:
  4. Question 4
    Hard
    After deprogramming with a Lucia jig, the FIRST tooth contact on closing in CR often reveals:
  5. Question 5
    Easy
    The teaching point is that the CR-CO slide:

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Patient case: Bimanual manipulation for a CR record
0 of 5 answered, 0 correct
Patient
Male, 60 years old
Chief Complaint
Full-arch fixed restoration planned; CR record needed for articulator mounting.
Background and/or Patient History
  • Full-arch fixed restorative case planned
  • Bimanual manipulation chosen for CR registration
  • Discussion of technique
Allergies
NKDA
Medications
  • None
Current Findings
  • Pre-prosthetic CR record case
  1. Question 1
    Moderate
    The bimanual manipulation (Dawson) technique places the operator's:
  2. Question 2
    Moderate
    The PATIENT'S role is to:
  3. Question 3
    Moderate
    Why is patient COOPERATION essential?
  4. Question 4
    Moderate
    The CR record is captured with:
  5. Question 5
    Easy
    The teaching point is that bimanual CR records:

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Patient case: Anterior deprogrammer (Lucia jig) for CR registration
0 of 5 answered, 0 correct
Patient
Female, 55 years old
Chief Complaint
Strong muscle memory of MIP; pre-prosthetic CR registration challenging by bimanual manipulation alone.
Background and/or Patient History
  • Strong muscle memory of MIP preventing reliable bimanual CR
  • Plan: anterior deprogrammer (Lucia jig) before CR record
  • Discussion of deprogramming
Allergies
NKDA
Medications
  • None
Current Findings
  • Anterior deprogrammer chosen for CR registration
  1. Question 1
    Moderate
    A Lucia jig (anterior deprogrammer) is:
  2. Question 2
    Hard
    It works by:
  3. Question 3
    Moderate
    After deprogramming, the FIRST tooth contact on closing often reveals:
  4. Question 4
    Moderate
    Once CR is registered, the record:
  5. Question 5
    Easy
    The teaching point of anterior deprogrammers is that:

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Patient case: Lost VDO from worn dentition + full-mouth rehab
0 of 5 answered, 0 correct
Patient
Male, 65 years old
Chief Complaint
Severe attrition with shortened crowns, perioral wrinkling, angular cheilitis, and chewing inefficiency.
Background and/or Patient History
  • Severe attrition from chronic bruxism over decades
  • Shortened clinical crowns, overclosed appearance, perioral wrinkles, angular cheilitis
  • Full-mouth rehabilitation planned
Allergies
NKDA
Medications
  • None
Current Findings
  • Lost vertical dimension from generalized wear
  1. Question 1
    Moderate
    Severe attrition has DECREASED VDO, which produces:
  2. Question 2
    Moderate
    Angular cheilitis in this patient is favored by:
  3. Question 3
    Moderate
    Before definitive restorations, the patient should:
  4. Question 4
    Moderate
    If muscle pain develops during the provisional phase:
  5. Question 5
    Easy
    The teaching point is that VDO change in full-mouth rehabilitation:

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Patient case: Over-restored crown raising VDO and causing pain
0 of 5 answered, 0 correct
Patient
Female, 42 years old
Chief Complaint
Persistent muscle pain and jaw fatigue after a single posterior crown was placed.
Background and/or Patient History
  • New single posterior crown placed two weeks ago
  • Persistent muscle pain, jaw fatigue, difficulty achieving lip seal
  • On examination, the crown appears to be in supra-occlusion (high)
Allergies
NKDA
Medications
  • NSAID PRN
Current Findings
  • Suspected high crown raising VDO and causing muscle symptoms
  1. Question 1
    Moderate
    A high (supra-occluded) single crown that raises VDO produces:
  2. Question 2
    Moderate
    Initial chair-side detection of a high crown uses:
  3. Question 3
    Moderate
    Adjustment of a high crown is typically performed:
  4. Question 4
    Moderate
    After adjustment, the patient's expected course is:
  5. Question 5
    Easy
    The teaching point is that single restorations must:

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Patient case: Facebow and CR for articulator mounting
0 of 5 answered, 0 correct
Patient
Male, 58 years old
Chief Complaint
Pre-prosthetic workup; facebow and CR record planned before mounting the casts.
Background and/or Patient History
  • Full-mouth rehabilitation planned
  • Facebow transfer planned for the maxillary cast
  • CR record planned for the mandibular cast
Allergies
NKDA
Medications
  • None
Current Findings
  • Routine pre-prosthetic articulator mounting case
  1. Question 1
    Moderate
    The FACEBOW transfers:
  2. Question 2
    Moderate
    The CR RECORD mounts the:
  3. Question 3
    Hard
    PROTRUSIVE and lateral interocclusal records are used to:
  4. Question 4
    Moderate
    Semi-adjustable ARTICULATORS are the workhorse of fixed and removable prosthodontics because:
  5. Question 5
    Easy
    The teaching point of articulator mounting is that:

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Patient case: Freeway space and rest position
0 of 5 answered, 0 correct
Patient
Mixed (educational case)
Chief Complaint
Conceptual case on the freeway space and physiologic rest position.
Background and/or Patient History
  • Discussion of VDR, VDO, and freeway space
  • How freeway space sets a buffer between rest and occlusion
Allergies
NKDA
Medications
  • None
Current Findings
  • Conceptual case
  1. Question 1
    Easy
    FREEWAY SPACE is:
  2. Question 2
    Moderate
    VDR (physiologic rest) is determined by:
  3. Question 3
    Hard
    Freeway space is LOST when:
  4. Question 4
    Moderate
    Freeway space is EXCESSIVE when:
  5. Question 5
    Easy
    The teaching point of freeway space is that:

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Keep studying
Centric Relation & Vertical Dimension core recall

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

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