Dental MCQ
Making the bond last · Operative Dentistry · INBDE Patient Cases

Dental Adhesion & Bonding INBDE Patient Cases

By Dr. Isaac Sun, DDS

7 ADA INBDE-format patient cases on dental adhesion & bonding. 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 dental adhesion and bonding: postoperative sensitivity from an incompletely sealed bond and over-dried collapsed collagen managed conservatively, choosing between etch-and-rinse and self-etch adhesives for a sensitivity-prone patient with selective-enamel etching, the difference in bonding predictability between an enamel margin and a root-dentin margin on a Class V lesion, saliva and blood contamination of an etched surface and the rinse / re-isolate / re-etch response, the smear layer and how etch-and-rinse removes it while self-etch incorporates it, aging of the dentin bond through water hydrolysis and matrix metalloproteinase collagen breakdown with the chlorhexidine scrub, and the enamel bevel and resin tags behind a well-blended anterior composite. Topics include enamel and dentin bonding, the hybrid layer, etch-and-rinse versus self-etch systems, the smear layer, and the causes of bond failure and postoperative sensitivity.

Case Coverage Map
What each case is testing
Zing after a new white filling:
Postoperative sensitivity from an incompletely sealed bond, over-dried collapsed collagen, wet bonding, the high occlusal contact, and conservative management.
Picking an adhesive for a sensitive patient:
Etch-and-rinse versus self-etch, why self-etch sensitizes less, selective-enamel etching, the strongest enamel bond, and the shared need for isolation.
A margin that ran onto the root:
Enamel versus dentin/root bonding predictability, why dentin is harder to bond, glass ionomer / RMGI at the root margin, and protecting the weak link.
The patient closed on the cotton roll:
Saliva (glycoprotein) contamination of an etched surface, rinse / re-isolate / re-etch, the value of the rubber dam, and blood contamination.
What the bur leaves behind:
The smear layer concept, how etch-and-rinse removes it and self-etch incorporates it, the tubule-plugging and sensitivity link, and etching enamel regardless.
An older bonded filling that let go:
Aging of the dentin bond, water hydrolysis and MMP collagen breakdown, the chlorhexidine scrub, slow microleakage staining, and conservative replacement.
Blending a chipped front tooth:
The enamel bevel and resin tags, why a preserved enamel margin seals and blends, composite for anterior esthetics, and re-etching after contamination.
Patient case: Zing after a new white filling
0 of 5 answered, 0 correct
Patient
Female, 34 years old
Chief Complaint
"My new filling zings with cold and when I bite."
Background and/or Patient History
  • A deep occlusal composite was placed on a lower molar two days ago
  • Etch-and-rinse adhesive was used
  • Sharp, brief sensitivity to cold and to biting; no spontaneous or lingering pain
Allergies
NKDA
Medications
  • None
Current Findings
  • Composite restoration intact, margins appear closed
  • Sharp response to cold that resolves quickly; vital pulp, no percussion pain to suggest irreversible pulpitis
  1. Question 1
    Moderate
    The brief, sharp, non-lingering sensitivity most likely reflects:
  2. Question 2
    Hard
    If the etched dentin had been over-dried with air before bonding, the consequence would be:
  3. Question 3
    Moderate
    The principle of wet (moist) bonding in etch-and-rinse exists to:
  4. Question 4
    Moderate
    Sensitivity that is also reproduced by biting points additionally to:
  5. Question 5
    Moderate
    Reasonable initial management is to:

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Patient case: Picking an adhesive for a sensitive patient
0 of 5 answered, 0 correct
Patient
Male, 45 years old
Chief Complaint
"My fillings always end up sensitive afterward."
Background and/or Patient History
  • History of postoperative sensitivity after previous composites
  • Several small-to-moderate occlusal lesions in dentin, margins largely in dentin
  • Cooperative, easy to isolate with a rubber dam
Allergies
NKDA
Medications
  • None
Current Findings
  • Moderate dentin-bounded lesions with minimal enamel margin involvement
  • No signs of pulpal pathology
  1. Question 1
    Moderate
    Given a history of postoperative sensitivity and mostly dentin margins, a reasonable adhesive choice is:
  2. Question 2
    Hard
    Self-etch systems reduce postoperative sensitivity largely because they:
  3. Question 3
    Hard
    If strong enamel margins were also present, the operator could improve the enamel bond by:
  4. Question 4
    Moderate
    Compared with self-etch, etch-and-rinse generally provides:
  5. Question 5
    Easy
    Across both systems, the single most important shared requirement for a good bond is:

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Patient case: A margin that ran onto the root
0 of 5 answered, 0 correct
Patient
Female, 62 years old
Chief Complaint
"There's decay at the gumline I'd like fixed."
Background and/or Patient History
  • Cervical (Class V) lesion with the gingival margin extending onto root dentin/cementum below the CEJ
  • The incisal portion of the margin is in enamel
  • Gingival recession exposing root surfaces
Allergies
NKDA
Medications
  • Lisinopril
Current Findings
  • Class V lesion straddling enamel above and root dentin below
  • Margins partly in enamel, partly in dentin/cementum
  1. Question 1
    Moderate
    Which margin of this restoration will give the more predictable, durable bond?
  2. Question 2
    Moderate
    Bonding to the root dentin here is harder partly because:
  3. Question 3
    Moderate
    For the dentin/root portion of a Class V in a high-caries-risk older patient, a useful material consideration is:
  4. Question 4
    Easy
    The bond to sound etched enamel is best described as:
  5. Question 5
    Moderate
    To protect the more vulnerable gingival dentin margin against recurrent caries, the most relevant adjunct is:

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Patient case: The patient closed on the cotton roll
0 of 5 answered, 0 correct
Patient
Male, 28 years old
Chief Complaint
Routine restoration of a premolar.
Background and/or Patient History
  • Mid-procedure, isolation was lost and the etched, primed surface was contaminated by saliva
  • Cotton-roll isolation only; no rubber dam in place
  • Operator noticed the surface became glossy and wet after contamination
Allergies
NKDA
Medications
  • None
Current Findings
  • Etched preparation contaminated with saliva before adhesive was cured
  • Otherwise straightforward Class I composite
  1. Question 1
    Moderate
    Saliva contamination of an etched/primed surface before curing should be handled by:
  2. Question 2
    Hard
    The component of saliva most responsible for impairing the bond is:
  3. Question 3
    Easy
    The contamination would have been far less likely if the operator had used:
  4. Question 4
    Moderate
    Blood or crevicular fluid contamination of a bonding surface:
  5. Question 5
    Moderate
    The overarching reason adhesion is so contamination-sensitive is that the bond depends on:

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Patient case: What the bur leaves behind
0 of 5 answered, 0 correct
Patient
Female, 40 years old
Chief Complaint
Restoration of a moderate occlusal cavity.
Background and/or Patient History
  • Freshly cut dentin preparation with a dull, smeared-looking surface
  • Operator deciding between an etch-and-rinse and a self-etch protocol
  • Margins in both enamel and dentin
Allergies
NKDA
Medications
  • None
Current Findings
  • Cut dentin surface coated by a film of grinding debris with plugged tubule orifices
  • No pulpal involvement
  1. Question 1
    Easy
    The dull, smeared film on the freshly cut dentin is the:
  2. Question 2
    Moderate
    If the operator chooses etch-and-rinse, the smear layer will be:
  3. Question 3
    Moderate
    If the operator chooses self-etch, the smear layer will be:
  4. Question 4
    Hard
    A reason self-etch's handling of the smear layer can reduce postoperative sensitivity is that it:
  5. Question 5
    Moderate
    For the enamel portion of this preparation, the most reliable approach is to:

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Patient case: An older bonded filling that let go
0 of 5 answered, 0 correct
Patient
Male, 55 years old
Chief Complaint
"A filling from years ago just popped out."
Background and/or Patient History
  • A composite placed about eight years ago debonded with little force
  • Margins had shown gradual staining over recent years
  • Otherwise sound tooth structure remaining
Allergies
NKDA
Medications
  • None
Current Findings
  • Composite debonded cleanly; dentin surface visible at the old interface
  • Marginal staining suggesting slow interfacial breakdown over time
  1. Question 1
    Hard
    Slow degradation of an aged dentin bond is driven largely by:
  2. Question 2
    Hard
    The host enzymes implicated in collagen breakdown within the hybrid layer are:
  3. Question 3
    Hard
    A chairside step shown to help preserve the dentin bond by inhibiting these enzymes is:
  4. Question 4
    Moderate
    The fact that the marginal staining developed slowly over years indicates:
  5. Question 5
    Moderate
    When replacing this restoration, conserving tooth structure means the operator should:

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Patient case: Blending a chipped front tooth
0 of 5 answered, 0 correct
Patient
Female, 22 years old
Chief Complaint
"I chipped my front tooth and want it to blend in."
Background and/or Patient History
  • Incisal-edge fracture of a maxillary central incisor, entirely in enamel and superficial dentin
  • High esthetic expectations
  • Good isolation achievable
Allergies
NKDA
Medications
  • None
Current Findings
  • Class IV-type enamel-bounded defect on an anterior tooth
  • Ample sound enamel at the margins
  1. Question 1
    Moderate
    Placing an enamel bevel at the margin of this anterior composite:
  2. Question 2
    Easy
    The strong bond at this enamel margin is created when:
  3. Question 3
    Moderate
    For an esthetic anterior restoration, why is a preserved, well-bonded enamel margin so valuable?
  4. Question 4
    Easy
    Composite is the material of choice here mainly because it:
  5. Question 5
    Moderate
    If isolation were lost and saliva touched the etched enamel before bonding, the operator should:

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Dental Adhesion & Bonding core recall

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

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