Dental MCQ
How teeth meet · Occlusion · INBDE Patient Cases

Occlusal Schemes INBDE Patient Cases

By Dr. Isaac Sun, DDS

7 ADA INBDE-format patient cases on occlusal schemes. 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 occlusal schemes: mutually protected occlusion in a healthy dentate adult with canine guidance and posterior centric stops, group function in a worn dentition with compromised canines that distributes lateral guidance across multiple working-side posterior teeth, balanced occlusion in a complete denture patient with bilateral simultaneous contact (and the lingualized variant), tripod contacts on a new posterior crown with the mandibular buccal supporting cusp seating in the maxillary central fossa, supporting (maxillary palatal + mandibular buccal) vs non-supporting (maxillary buccal + mandibular lingual) cusps and their restorative implications, Hanau's quint (condylar guidance + anterior guidance + plane of occlusion + curve of Spee + cusp height) translated into articulator setup with facebow + CR + protrusive/lateral records, and identifying and adjusting a non-working interference using the BULL rule (Buccal Upper Lingual Lower) for non-working and the MUDL rule (Mesial Upper Distal Lower) for working interferences while preserving centric stops. Topics include mutually protected occlusion, group function, balanced occlusion, lingualized occlusion, tripod contacts, supporting vs non-supporting cusps, marginal ridges, Hanau's quint, non-working interferences, and selective grinding rules.

Case Coverage Map
What each case is testing
Mutually protected occlusion in a healthy dentate adult:
Canine guidance + posterior centric stops in MIP; anterior disocclusion in protrusion; non-working contacts are interferences; canine's long root + single cusp + proprioception.
Group function in a worn dentition with compromised canines:
Lateral guidance distributed across multiple working-side posterior teeth when canines cannot guide alone; careful equilibration; restore canine guidance when feasible.
Balanced occlusion in a complete denture patient:
Bilateral simultaneous contact in centric and eccentric for denture stability; lingualized variant; inappropriate in dentate adults.
Tripod contacts on a new posterior crown:
Three contacts around the supporting cusp tip; mandibular buccal supporting cusp in maxillary central fossa; shimstock held bilaterally at adjacent teeth.
Supporting vs non-supporting cusps:
Maxillary palatal + mandibular buccal = supporting (centric load); maxillary buccal + mandibular lingual = non-supporting (guide lateral movement); restore both roles.
Hanau's quint applied to articulator setup:
Condylar guidance (joint-fixed) + anterior guidance + plane of occlusion + curve of Spee + cusp height; facebow + CR + protrusive/lateral records set the inputs.
Identifying and adjusting a non-working interference:
Articulating paper marks during lateral excursion; BULL rule for non-working (Buccal Upper Lingual Lower); MUDL for working (Mesial Upper Distal Lower); preserve centric stops.
Patient case: Mutually protected occlusion in a healthy dentate adult
0 of 5 answered, 0 correct
Patient
Female, 35 years old
Chief Complaint
Routine occlusal examination; full healthy dentition with strong canines.
Background and/or Patient History
  • Full healthy dentition with intact canines
  • Class I molar and canine; no significant wear
  • Discussion of occlusal scheme
Allergies
NKDA
Medications
  • None
Current Findings
  • Mutually protected occlusion (canine guidance with posterior centric stops)
  1. Question 1
    Easy
    In this patient's mutually protected occlusion, the working canine in lateral movement should:
  2. Question 2
    Moderate
    The CANINE is favored as the guide because of its:
  3. Question 3
    Moderate
    In PROTRUSIVE movement, the protective role is:
  4. Question 4
    Moderate
    Non-working contacts in this patient should be:
  5. Question 5
    Easy
    The teaching point of mutually protected occlusion is that:

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Patient case: Group function in a worn dentition with compromised canines
0 of 5 answered, 0 correct
Patient
Male, 68 years old
Chief Complaint
Severely worn canines and posterior teeth; canine guidance no longer possible.
Background and/or Patient History
  • Severe attrition with worn canines
  • Canine guidance lost; posterior teeth share lateral contact
  • Discussion of group function as the appropriate scheme
Allergies
NKDA
Medications
  • None
Current Findings
  • Group function from worn canines
  1. Question 1
    Moderate
    When the CANINE cannot guide alone (worn, missing, periodontally compromised, or out of guide), the appropriate scheme is:
  2. Question 2
    Moderate
    Group function distributes lateral force:
  3. Question 3
    Moderate
    Restorative modern best practice when feasible is to:
  4. Question 4
    Moderate
    Group function in this patient still requires:
  5. Question 5
    Easy
    The teaching point of group function is that:

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Patient case: Balanced occlusion in a complete denture patient
0 of 5 answered, 0 correct
Patient
Female, 75 years old
Chief Complaint
New complete maxillary and mandibular dentures; discussion of occlusal scheme.
Background and/or Patient History
  • Edentulous maxilla and mandible
  • New complete dentures being fabricated
  • Discussion of balanced occlusion (or lingualized variant)
Allergies
NKDA
Medications
  • None notable
Current Findings
  • Complete denture patient needing balanced occlusion
  1. Question 1
    Moderate
    BALANCED OCCLUSION in complete dentures involves:
  2. Question 2
    Moderate
    Without balancing contacts, a complete denture would:
  3. Question 3
    Hard
    LINGUALIZED OCCLUSION (a simpler variant) places:
  4. Question 4
    Moderate
    Balanced occlusion is INAPPROPRIATE in dentate adults because:
  5. Question 5
    Easy
    The teaching point is that the occlusal scheme:

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Patient case: Tripod contacts on a new posterior crown
0 of 5 answered, 0 correct
Patient
Male, 50 years old
Chief Complaint
Single posterior crown placement; chair-side occlusal verification.
Background and/or Patient History
  • Single mandibular first molar crown placed
  • Articulating paper and shimstock used for occlusal verification
  • Goal: equal-pressure simultaneous contact matching the surrounding teeth
Allergies
NKDA
Medications
  • None
Current Findings
  • Verifying centric stops on a new posterior crown
  1. Question 1
    Moderate
    An ideal posterior centric stop pattern is:
  2. Question 2
    Moderate
    The SUPPORTING CUSP of the mandibular first molar that contacts the maxillary first molar is the:
  3. Question 3
    Moderate
    A HIGH crown that creates a premature contact in MIP would produce:
  4. Question 4
    Hard
    SHIMSTOCK at the crowned tooth in MIP should:
  5. Question 5
    Easy
    The teaching point is that single restorations:

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Patient case: Supporting vs non-supporting cusps
0 of 5 answered, 0 correct
Patient
Mixed (educational case)
Chief Complaint
Conceptual case on supporting (functional) vs non-supporting (guide) cusps.
Background and/or Patient History
  • Discussion of cusp roles in centric and eccentric movements
  • Restorative implications for crown design
Allergies
NKDA
Medications
  • None
Current Findings
  • Conceptual case
  1. Question 1
    Moderate
    SUPPORTING (stamp / functional) cusps are the:
  2. Question 2
    Moderate
    NON-SUPPORTING (guide / shearing) cusps are the:
  3. Question 3
    Moderate
    SUPPORTING cusps contact the opposing:
  4. Question 4
    Moderate
    When restoring a posterior CROWN, the SUPPORTING cusp should be designed to:
  5. Question 5
    Easy
    The teaching point of supporting vs non-supporting cusps is that:

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Patient case: Hanau's quint applied to articulator setup
0 of 5 answered, 0 correct
Patient
Female, 60 years old
Chief Complaint
Full-arch fixed restoration planned; articulator setup with facebow + CR + protrusive/lateral records.
Background and/or Patient History
  • Full-arch fixed restoration planned
  • Semi-adjustable articulator setup
  • Discussion of Hanau's quint inputs
Allergies
NKDA
Medications
  • None
Current Findings
  • Pre-prosthetic articulator setup
  1. Question 1
    Moderate
    HANAU'S QUINT summarizes:
  2. Question 2
    Moderate
    Among Hanau's quint, the JOINT-DETERMINED factor is:
  3. Question 3
    Moderate
    The DENTIST CONTROLS:
  4. Question 4
    Hard
    Articulator setup with Hanau's quint records:
  5. Question 5
    Easy
    The teaching point of Hanau's quint is that:

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Patient case: Identifying and adjusting a non-working interference
0 of 5 answered, 0 correct
Patient
Male, 45 years old
Chief Complaint
Cracked lingual cusp of an upper second molar; on examination a non-working interference is found.
Background and/or Patient History
  • Cracked maxillary second molar lingual cusp
  • On articulating paper, a contact appears on the non-working side during right lateral excursion
  • Plan: identify and adjust the interference
Allergies
NKDA
Medications
  • None
Current Findings
  • Non-working interference contributing to cusp fracture
  1. Question 1
    Moderate
    Identification of non-working interferences uses:
  2. Question 2
    Hard
    The BULL RULE adjusts:
  3. Question 3
    Hard
    The MUDL RULE (working-side interferences) adjusts:
  4. Question 4
    Moderate
    When equilibrating, the dentist should PRESERVE:
  5. Question 5
    Easy
    The teaching point of non-working interferences is that:

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Keep studying
Occlusal Schemes core recall

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

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