Dental MCQ
The occlusal decision (Structure / Force / Time / Stability) · Occlusion · INBDE Patient Cases

The Occlusal Decision INBDE Patient Cases

By Dr. Isaac Sun, DDS

8 ADA INBDE-format patient cases on the occlusal decision. 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 the SDF four-lens occlusal decision capstone: the decision to equilibrate (subtractive BULL/MUDL when Force is wrong but Structure is intact) vs add (composite or onlay when Structure has been lost), anterior guidance reconstruction in a worn dentition with palatal composite or ceramic at the patient-accepted provisional VDO, bite raising and VDO change through a provisional period before definitive restorations (with symptom adjustment as the safety test), stabilization splint as the long-term workhorse vs NTI / anterior bite plane for short-term deprogramming (with long-term NTI risking posterior overeruption and anterior intrusion), climbing the TMD treatment ladder in order from education + soft diet + NSAIDs through splint + PT through low-dose tricyclic to specialist referral and surgery rarely, full-mouth rehabilitation through all four SDF lenses with records + diagnostic wax-up + provisionals + adaptation + definitives + lifelong maintenance (with anterior guidance preceding posterior restorative work), a single posterior crown designed to match existing centric stops and canine guidance to preserve Structure/Force/Time/Stability, and the decision NOT to change a functional asymptomatic occlusion when all four SDF lenses hold. Topics include Structure / Force / Time / Stability, equilibration vs additive restoration, anterior guidance reconstruction, bite raising, splint therapy, the TMD treatment ladder, full-mouth rehabilitation, and the negative decision to leave the occlusion alone.

Case Coverage Map
What each case is testing
The decision to equilibrate vs add:
Grind when Force is wrong (Structure intact); build (additive composite/onlay) when Structure has been lost; BULL/MUDL preserves centric stops.
Anterior guidance reconstruction in worn dentition:
Flattened anterior guidance loses posterior disocclusion → group function with interferences; palatal composite/ceramic restores canine + incisal guidance via provisional testing.
Bite raising with provisional VDO testing:
Lost VDO from attrition → overclosure; SDF justifies raise across all four lenses; provisional period tests new VDO before definitive restorations.
Stabilization splint vs NTI decision:
Stabilization splint = long-term workhorse for chronic parafunction; NTI = short-term deprogramming; long-term NTI risks posterior overeruption + anterior intrusion.
Climbing the TMD treatment ladder:
Education + soft diet + NSAIDs → splint + PT → low-dose TCA → injection or specialist referral → surgery rarely; ladder climbed in order, not skipped.
Full-mouth rehabilitation through the four SDF lenses:
Records + diagnostic wax-up + provisionals + adaptation + definitives + lifelong maintenance; anterior guidance precedes posterior restorative; all four lenses converge.
A single posterior crown through the SDF lens:
Match existing centric stops + non-working disocclusion + canine guidance; preserve Structure, Force, Time, Stability; rethink design if anterior guidance is failing.
When NOT to change the occlusion:
Functional asymptomatic occlusion with small symmetric CR-CO slide and all four SDF lenses holding → do NOT change; document + monitor + reassure.
Patient case: The decision to equilibrate vs add
0 of 5 answered, 0 correct
Patient
Female, 45 years old
Chief Complaint
Localized non-working interference on one tooth; the surrounding dentition is intact.
Background and/or Patient History
  • Healthy dentate adult with mutually protected occlusion overall
  • One non-working interference on a maxillary first molar (lingual incline of buccal cusp)
  • No fracture, no significant wear; surrounding structure is intact
Allergies
NKDA
Medications
  • None
Current Findings
  • Local non-working interference without lost structure
  1. Question 1
    Moderate
    The SDF lens that flags the problem is:
  2. Question 2
    Moderate
    The appropriate response is:
  3. Question 3
    Moderate
    If Structure had been LOST (worn cusp, fractured incline) in the same scenario, the response would shift to:
  4. Question 4
    Moderate
    The SDF JUDGMENT for choosing between equilibration and additive restoration is:
  5. Question 5
    Easy
    The teaching point of subtractive vs additive is that:

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Patient case: Anterior guidance reconstruction in worn dentition
0 of 5 answered, 0 correct
Patient
Male, 52 years old
Chief Complaint
Flattened anterior teeth from chronic bruxism + erosion; loss of canine and incisal guidance.
Background and/or Patient History
  • Chronic bruxism + acidic-beverage history producing flattened anterior teeth
  • Lost canine guidance; group function with non-working interferences emerging on posteriors
  • Posterior wear accelerating; some restorations are chipping
Allergies
NKDA
Medications
  • None notable
Current Findings
  • Lost anterior guidance with accelerated posterior wear
  1. Question 1
    Hard
    The SDF lenses failing here include:
  2. Question 2
    Moderate
    Restoring ANTERIOR GUIDANCE typically uses:
  3. Question 3
    Moderate
    Before definitive restorations, the patient should:
  4. Question 4
    Easy
    The SDF justification for the rebuild is:
  5. Question 5
    Easy
    The teaching point of anterior guidance reconstruction is that:

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Patient case: Bite raising with provisional VDO testing
0 of 5 answered, 0 correct
Patient
Female, 60 years old
Chief Complaint
Severe attrition with overclosure; full-mouth rehabilitation planned with a planned VDO increase.
Background and/or Patient History
  • Severe attrition with overclosure and chewing inefficiency
  • Full-mouth rehab planned with VDO increase of ~4 mm
  • Provisional period planned to test the new VDO
Allergies
NKDA
Medications
  • None notable
Current Findings
  • Lost VDO from severe attrition; planned restorative increase
  1. Question 1
    Easy
    Lost VDO from attrition produces:
  2. Question 2
    Moderate
    Before definitive restorations at the new VDO, the patient should:
  3. Question 3
    Moderate
    If muscle pain develops during the provisional VDO phase, the response is:
  4. Question 4
    Moderate
    The SDF lenses justifying the VDO raise are:
  5. Question 5
    Easy
    The teaching point of bite raising is that:

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Patient case: Stabilization splint vs NTI decision
0 of 5 answered, 0 correct
Patient
Male, 38 years old
Chief Complaint
Chronic myofascial TMD with sleep bruxism; splint therapy planned.
Background and/or Patient History
  • Chronic myofascial TMD + sleep bruxism for several years
  • Discussion of stabilization splint vs anterior bite plane (NTI)
Allergies
NKDA
Medications
  • NSAID PRN
Current Findings
  • Splint therapy decision
  1. Question 1
    Moderate
    For chronic SLEEP BRUXISM and MYOFASCIAL TMD, the splint of choice is:
  2. Question 2
    Moderate
    An NTI is APPROPRIATE for:
  3. Question 3
    Hard
    The risk of LONG-TERM full-time NTI wear is:
  4. Question 4
    Moderate
    The SDF JUDGMENT for stabilization splint vs NTI is that:
  5. Question 5
    Easy
    The teaching point of splint choice is that:

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Patient case: Climbing the TMD treatment ladder
0 of 5 answered, 0 correct
Patient
Female, 42 years old
Chief Complaint
Persistent TMD pain not responding to NSAIDs and a splint after 3 months; considering next steps.
Background and/or Patient History
  • TMD myofascial pain + chronic clicking
  • Three months of stabilization splint + NSAIDs + PT without resolution
  • Considering next ladder rungs
Allergies
NKDA
Medications
  • Ibuprofen PRN
  • Splint
Current Findings
  • Refractory TMD after conservative care
  1. Question 1
    Moderate
    The TMD pain LADDER (conservative first) is:
  2. Question 2
    Hard
    Having failed the first two rungs, the next reasonable step is:
  3. Question 3
    Moderate
    If symptoms persist on the TCA + splint + PT:
  4. Question 4
    Moderate
    The SDF VIEW of climbing the ladder is that:
  5. Question 5
    Easy
    The teaching point of the TMD ladder is that:

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Patient case: Full-mouth rehabilitation through the four SDF lenses
0 of 5 answered, 0 correct
Patient
Male, 56 years old
Chief Complaint
Generalized wear + chipped restorations + non-working interferences + reduced vertical face height; full-mouth rehab planned.
Background and/or Patient History
  • Lost Structure (worn dentition), wrong Force (lost anterior guidance + non-working interferences), prolonged Time (chronic parafunction), failing Stability (mobility + fremitus + chipped restorations)
  • Full-mouth rehab planned with comprehensive records and a diagnostic wax-up
Allergies
NKDA
Medications
  • None notable
Current Findings
  • Integrated full-mouth case with all four SDF lenses failing
  1. Question 1
    Moderate
    Full-mouth REHABILITATION SEQUENCE includes:
  2. Question 2
    Hard
    ANTERIOR GUIDANCE reconstruction in this case typically:
  3. Question 3
    Moderate
    VDO change in this rehab is tested:
  4. Question 4
    Moderate
    Maintenance includes:
  5. Question 5
    Easy
    The teaching point of full-mouth rehab is that:

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Patient case: A single posterior crown through the SDF lens
0 of 5 answered, 0 correct
Patient
Female, 45 years old
Chief Complaint
Single posterior crown planned in a healthy dentate adult with intact mutually protected occlusion.
Background and/or Patient History
  • Healthy dentate adult with intact mutually protected occlusion
  • Posterior tooth needing a single crown after fractured cusp
  • Discussion of how the crown is designed to preserve Structure / Force / Time / Stability
Allergies
NKDA
Medications
  • None
Current Findings
  • Single-crown SDF lens case
  1. Question 1
    Moderate
    For a single posterior CROWN in a HEALTHY mutually protected dentition, the SDF lenses support:
  2. Question 2
    Moderate
    Chair-side verification at delivery uses:
  3. Question 3
    Moderate
    A HIGH crown that creates a premature contact in MIP would:
  4. Question 4
    Hard
    If the patient ALREADY had flattened anterior guidance, the single-crown design would change to:
  5. Question 5
    Easy
    The teaching point of the single-crown SDF lens is that:

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Patient case: When NOT to change the occlusion
0 of 5 answered, 0 correct
Patient
Male, 50 years old
Chief Complaint
Patient requests occlusal adjustment after seeing a 'high spot' on a self-photograph; otherwise asymptomatic.
Background and/or Patient History
  • Healthy dentate adult with intact mutually protected occlusion
  • Small symmetric CR-CO slide on bimanual manipulation
  • No pain, no mobility, no fracture, full chewing function
  • Patient requests adjustment after viewing self-photograph
Allergies
NKDA
Medications
  • None
Current Findings
  • Functional asymptomatic occlusion; patient-driven request without SDF indication
  1. Question 1
    Moderate
    The SDF lenses in this patient:
  2. Question 2
    Moderate
    The SDF JUDGMENT is:
  3. Question 3
    Moderate
    Grinding an asymptomatic functional occlusion risks:
  4. Question 4
    Moderate
    If, in time, Structure or Force or Stability does fail (e.g., fracture, persistent fremitus, mobility), the response shifts to:
  5. Question 5
    Easy
    The teaching point of the decision NOT to change the occlusion is that:

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The Occlusal Decision core recall

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

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