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When force damages structure · Occlusion · INBDE Patient Cases

Parafunction, TMD & Occlusal Trauma INBDE Patient Cases

By Dr. Isaac Sun, DDS

7 ADA INBDE-format patient cases on parafunction, tmd & occlusal 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.

7 patient cases35 linked questionsADA INBDE formatFull distractor explanations

Seven ADA INBDE-format patient cases on parafunction, TMD, and occlusal trauma: sleep bruxism managed with a full-arch hard-acrylic stabilization splint plus medication review and sleep evaluation (with SSRI/SNRI contribution recognized), wear pattern differential distinguishing attrition (matched facets bruxism) from toothbrush abrasion (cervical V-notches) vs erosion (GERD/bulimia palatal of upper anteriors; soft drinks occlusal cupping) vs abfraction (cervical wedge controversial), TMD myofascial vs intra-articular distinction with Wilkes staging of internal derangement and conservative first-line care, primary occlusal trauma from a high crown on healthy periodontium (reversible by selective grinding) vs secondary occlusal trauma on a reduced periodontium (treat the underlying periodontitis + reduce force; trauma does not cause periodontitis by itself), stabilization splint as the workhorse for sleep bruxism and chronic myofascial TMD vs NTI / anterior bite plane for short-term deprogramming with risks of posterior overeruption and anterior intrusion if worn long-term, and fremitus + Miller-classified mobility on a single tooth with selective grinding and re-evaluation. Topics include bruxism, wear patterns, occlusal trauma, TMD diagnosis, Wilkes staging, splint therapy, fremitus, and mobility.

Case Coverage Map
What each case is testing
Sleep bruxism managed with a stabilization splint:
Sympathetic-driven RMMA; SSRI/SNRI contribution; stabilization splint full-arch hard acrylic; medication review + sleep evaluation.
Wear pattern differential (attrition vs abrasion vs erosion vs abfraction):
Attrition matched facets bruxism; toothbrush abrasion cervical notches; erosion GERD palatal vs soft-drink occlusal cupping; abfraction cervical wedge controversial.
TMD myofascial vs intra-articular distinction:
Myofascial diffuse muscle tenderness; disc displacement with reduction clicking preserved opening; Wilkes Stage II reciprocal + intermittent lock; conservative first.
Primary occlusal trauma from a high crown:
Healthy perio + excessive force; widened PDL; reversible by selective grinding to restore equal-pressure simultaneous contact.
Secondary occlusal trauma in a periodontitis patient:
Reduced perio + normal force; treat underlying periodontitis + reduce force; splint distributes load; trauma does NOT cause periodontitis by itself.
Stabilization splint vs anterior bite plane (NTI):
Stabilization splint as workhorse; NTI / anterior bite plane short-term selected use; long-term NTI risks posterior overeruption + anterior intrusion.
Fremitus and mobility on a single tooth:
Fremitus = excessive force; Miller mobility classes; selective grinding + re-evaluation for parafunction or developing periodontal pathology.
Patient case: Sleep bruxism managed with a stabilization splint
0 of 5 answered, 0 correct
Patient
Female, 38 years old
Chief Complaint
Partner reports nocturnal grinding; morning jaw fatigue and bilateral masseter tenderness.
Background and/or Patient History
  • Partner-reported nocturnal grinding
  • Morning jaw fatigue + bilateral masseter tenderness
  • Examination: matching wear facets on posterior teeth and masseter hypertrophy
Allergies
NKDA
Medications
  • Sertraline (SSRI)
Current Findings
  • Sleep bruxism; SSRI may contribute
  1. Question 1
    Easy
    SLEEP BRUXISM is best described as:
  2. Question 2
    Moderate
    Recognized CONTRIBUTORS to bruxism in this patient include:
  3. Question 3
    Moderate
    First-line management is:
  4. Question 4
    Moderate
    A STABILIZATION SPLINT in this patient should be:
  5. Question 5
    Easy
    The teaching point is that bruxism:

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Patient case: Wear pattern differential (attrition vs abrasion vs erosion vs abfraction)
0 of 5 answered, 0 correct
Patient
Male, 40 years old
Chief Complaint
Generalized wear; differential needed to plan treatment.
Background and/or Patient History
  • Generalized wear with mixed patterns
  • History of GERD + soft drink consumption + bruxism history + horizontal-scrubbing brushing technique
  • Wear pattern differential discussion
Allergies
NKDA
Medications
  • Omeprazole
Current Findings
  • Mixed wear patterns from multiple etiologies
  1. Question 1
    Moderate
    FLAT, SHINY, MATCHED wear facets on opposing teeth suggest:
  2. Question 2
    Hard
    PALATAL EROSION of the maxillary anterior teeth in this patient is best explained by:
  3. Question 3
    Moderate
    OCCLUSAL CUPPING and buccal-surface smoothness in this patient is best explained by:
  4. Question 4
    Moderate
    CERVICAL V-SHAPED NOTCHES at the CEJ in this patient are best explained by:
  5. Question 5
    Easy
    The teaching point of wear patterns is that:

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Patient case: TMD myofascial vs intra-articular distinction
0 of 5 answered, 0 correct
Patient
Female, 32 years old
Chief Complaint
Bilateral preauricular pain and clicking; distinguishing myofascial from intra-articular TMD.
Background and/or Patient History
  • Bilateral preauricular pain and right TMJ clicking on opening
  • Examination: masseter and temporalis tenderness; right TMJ click
  • Maximum opening 46 mm; no closed lock
Allergies
NKDA
Medications
  • NSAID PRN
Current Findings
  • Mixed myofascial + intra-articular TMD
  1. Question 1
    Moderate
    MYOFASCIAL TMD typically presents with:
  2. Question 2
    Moderate
    TMJ CLICKING on opening with preserved opening suggests:
  3. Question 3
    Hard
    WILKES STAGE II describes:
  4. Question 4
    Moderate
    First-line management for this MIXED myofascial + intra-articular TMD is:
  5. Question 5
    Easy
    The teaching point is that TMD:

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Patient case: Primary occlusal trauma from a high crown
0 of 5 answered, 0 correct
Patient
Male, 45 years old
Chief Complaint
Mobility and fremitus on a recently crowned tooth; tooth tender on percussion.
Background and/or Patient History
  • Recent posterior crown placed
  • Mobility and fremitus on the crowned tooth
  • Healthy surrounding periodontium; radiograph shows widened PDL
Allergies
NKDA
Medications
  • NSAID PRN
Current Findings
  • Primary occlusal trauma from a high crown
  1. Question 1
    Moderate
    Healthy periodontium + excessive occlusal force on a tooth describes:
  2. Question 2
    Moderate
    Radiographic finding is:
  3. Question 3
    Moderate
    Management is:
  4. Question 4
    Moderate
    FREMITUS on the involved tooth indicates:
  5. Question 5
    Easy
    The teaching point is that primary occlusal trauma:

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Patient case: Secondary occlusal trauma in a periodontitis patient
0 of 5 answered, 0 correct
Patient
Female, 60 years old
Chief Complaint
Mobile teeth in a patient with chronic periodontitis; normal occlusal forces.
Background and/or Patient History
  • Chronic periodontitis with attachment loss
  • Mobile teeth despite normal occlusal force
  • Radiograph shows bone loss + widened PDL
Allergies
NKDA
Medications
  • None
Current Findings
  • Secondary occlusal trauma
  1. Question 1
    Moderate
    Reduced (periodontitis-attached) periodontium + normal occlusal force describes:
  2. Question 2
    Moderate
    Treatment focuses on:
  3. Question 3
    Hard
    Occlusal trauma alone:
  4. Question 4
    Moderate
    A splint in this patient would:
  5. Question 5
    Easy
    The teaching point is that secondary occlusal trauma:

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Patient case: Stabilization splint vs anterior bite plane (NTI)
0 of 5 answered, 0 correct
Patient
Male, 35 years old
Chief Complaint
Acute myofascial pain; discussion of stabilization splint vs short-term anterior bite plane (NTI).
Background and/or Patient History
  • Acute myofascial TMD with masseter tenderness
  • Discussion of stabilization splint vs anterior bite plane (NTI)
Allergies
NKDA
Medications
  • NSAID PRN
Current Findings
  • Splint therapy decision
  1. Question 1
    Moderate
    A STABILIZATION SPLINT is:
  2. Question 2
    Hard
    An NTI / anterior bite plane is appropriate for:
  3. Question 3
    Moderate
    Most patients with sleep bruxism or chronic myofascial TMD are best managed with:
  4. Question 4
    Moderate
    Splint adjustment at delivery should produce:
  5. Question 5
    Easy
    The teaching point of splint therapy is that:

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Patient case: Fremitus and mobility on a single tooth
0 of 5 answered, 0 correct
Patient
Female, 50 years old
Chief Complaint
Mobility and fremitus on an upper incisor without periodontal infection.
Background and/or Patient History
  • Upper lateral incisor with Miller Class I mobility
  • Fremitus on closing
  • No infection; suspected high contact from another restoration
Allergies
NKDA
Medications
  • None
Current Findings
  • Primary occlusal trauma on a single tooth
  1. Question 1
    Moderate
    FREMITUS on this tooth indicates:
  2. Question 2
    Moderate
    MILLER MOBILITY Class I is:
  3. Question 3
    Moderate
    First-line management of this primary occlusal trauma is:
  4. Question 4
    Moderate
    If mobility persists after force reduction in a healthy periodontium, consider:
  5. Question 5
    Easy
    The teaching point is that fremitus + mobility on a single tooth:

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Keep studying
Parafunction, TMD & Occlusal Trauma core recall

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

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