Dental MCQ
Choosing the material · Operative Dentistry · INBDE Patient Cases

Direct Restorative Materials INBDE Patient Cases

By Dr. Isaac Sun, DDS

7 ADA INBDE-format patient cases on direct restorative materials. 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 direct restorative materials: amalgam for a high-load, hard-to-isolate posterior tooth (with the high-copper advantage, mechanical retention, and delayed expansion), composite polymerization shrinkage and postoperative sensitivity managed by incremental placement and occlusal adjustment, glass ionomer or RMGI for a high-caries-risk cervical root lesion with its chemical bond and fluoride release, composite for an anterior esthetic restoration, counseling a patient about mercury in set amalgam and when replacement is genuinely indicated, the material-selection decision weighing load, esthetics, isolation, and caries risk, and glass ionomer or RMGI in atraumatic restorative treatment for a young child. Topics include amalgam, composite resin, and glass ionomer and RMGI properties, indications, and handling, and matching the material to the situation.

Case Coverage Map
What each case is testing
A big back-tooth filling in a hard-to-dry mouth:
Amalgam for high load and poor isolation, high-copper benefit, mechanical retention, delayed expansion, and the cuspal-coverage shift.
Sensitivity after a new white filling:
Composite polymerization shrinkage and postoperative sensitivity, incremental placement, high occlusion, and isolation.
A root cavity in a high-risk mouth:
Glass ionomer / RMGI for a high-caries-risk cervical root lesion, chemical bonding, fluoride release, and moisture sensitivity.
A chipped front tooth to match:
Composite for anterior esthetics, shade matching, the enamel bevel, and the importance of isolation for bonding.
"Is the mercury in my filling dangerous?":
Mercury bound in set amalgam, not removing sound restorations, delayed-expansion handling, and genuine reasons to replace.
Choosing among amalgam, composite, and glass ionomer:
The selection factors (load, esthetics, isolation, caries risk) and how shifting each changes the material choice (the SDF synthesis).
A forgiving material for a young child:
Glass ionomer / RMGI and ART for a less cooperative high-risk child, fluoride release, and pairing restoration with prevention.
Patient case: A big back-tooth filling in a hard-to-dry mouth
0 of 5 answered, 0 correct
Patient
Male, 50 years old
Chief Complaint
"I need a filling on a back molar that's hard to keep dry."
Background and/or Patient History
  • A large posterior lesion on a heavily loaded molar
  • A subgingival margin and brisk salivary flow make isolation difficult
  • Bruxism with heavy occlusal forces
  • Esthetics not a concern for this tooth
Allergies
NKDA
Medications
  • None
Current Findings
  • Large cavitated lesion on a load-bearing molar; difficult to isolate
  • Adequate structure for a direct restoration
  1. Question 1
    Moderate
    Given high load and difficult isolation, a strong, moisture-tolerant material choice is:
  2. Question 2
    Hard
    The modern high-copper amalgam is preferred because it:
  3. Question 3
    Moderate
    Because amalgam does not bond, the preparation must provide:
  4. Question 4
    Hard
    To avoid delayed expansion with a zinc-containing amalgam, the operator must:
  5. Question 5
    Moderate
    If, after removing caries, the cusps are left thin and undermined, the plan should shift toward:

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Patient case: Sensitivity after a new white filling
0 of 5 answered, 0 correct
Patient
Female, 34 years old
Chief Complaint
"My new tooth-colored filling is sensitive when I bite and to cold."
Background and/or Patient History
  • A posterior composite placed recently
  • Sensitivity to biting and cold since placement
  • The restoration may have been placed in a single bulk increment
  • No deep caries near the pulp reported
Allergies
NKDA
Medications
  • None
Current Findings
  • Composite restoration with possible marginal gap and a high occlusal contact
  • Postoperative sensitivity
  1. Question 1
    Moderate
    A common materials-related cause of postoperative sensitivity under a composite is:
  2. Question 2
    Moderate
    A technique that reduces this shrinkage stress is:
  3. Question 3
    Moderate
    Another contributor to her biting sensitivity may be:
  4. Question 4
    Moderate
    Saliva contamination of the bonded surface during placement would:
  5. Question 5
    Moderate
    The materials lesson is that composite's main weakness, compared with its esthetics and bonding, is:

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Patient case: A root cavity in a high-risk mouth
0 of 5 answered, 0 correct
Patient
Male, 70 years old
Chief Complaint
"I have a soft cavity on the root of a tooth near the gum."
Background and/or Patient History
  • A cervical (Class V) root surface lesion
  • High caries risk with dry mouth from medications
  • Gingival margin makes isolation tricky
  • Several other root surfaces at risk
Allergies
NKDA
Medications
  • Multiple xerostomic medications
Current Findings
  • Active root (Class V) caries near the gingival margin
  • Generally high caries risk
  1. Question 1
    Moderate
    A material especially suited to this high-risk cervical root lesion is:
  2. Question 2
    Moderate
    The key advantage of glass ionomer here is that it:
  3. Question 3
    Moderate
    A handling caution with conventional glass ionomer is that it is:
  4. Question 4
    Moderate
    Why does his dry mouth make fluoride release particularly valuable?
  5. Question 5
    Moderate
    If higher strength or better esthetics were needed at this site, a reasonable step up would be:

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Patient case: A chipped front tooth to match
0 of 5 answered, 0 correct
Patient
Female, 24 years old
Chief Complaint
"I chipped my front tooth and want it to look natural."
Background and/or Patient History
  • A small fracture of a maxillary incisor edge
  • High esthetic expectations
  • Good isolation achievable on the anterior tooth
  • Low caries risk
Allergies
NKDA
Medications
  • None
Current Findings
  • Small incisal/proximal defect on an anterior tooth
  • Esthetics is the priority
  1. Question 1
    Easy
    The direct material of choice for this anterior esthetic restoration is:
  2. Question 2
    Moderate
    Composite achieves esthetics partly because its filler and matrix can be:
  3. Question 3
    Moderate
    Beveling the enamel margin of this anterior composite would:
  4. Question 4
    Moderate
    Good isolation on this anterior tooth is favorable because composite bonding requires:
  5. Question 5
    Moderate
    This case fits composite because the priorities are:

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Patient case: "Is the mercury in my filling dangerous?"
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Patient
Female, 45 years old
Chief Complaint
"I read that amalgam fillings have mercury. Are mine dangerous?"
Background and/or Patient History
  • Several existing amalgam restorations functioning well
  • Read online concerns about mercury
  • Asking whether to have them removed
  • No symptoms attributable to the restorations
Allergies
NKDA
Medications
  • None
Current Findings
  • Intact, functional amalgam restorations
  • No clinical signs of failure
  1. Question 1
    Moderate
    Regarding mercury in her set, functioning amalgams, the accurate counseling is that:
  2. Question 2
    Moderate
    Routinely removing intact, well-functioning amalgams to eliminate mercury is:
  3. Question 3
    Hard
    When amalgam IS placed, an important handling step to prevent delayed expansion is to:
  4. Question 4
    Moderate
    A genuine clinical reason to replace an amalgam would be:
  5. Question 5
    Moderate
    If a patient does want an existing amalgam replaced for esthetics, a reasonable tooth-colored option is:

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Patient case: Choosing among amalgam, composite, and glass ionomer
0 of 5 answered, 0 correct
Patient
Male, 41 years old
Chief Complaint
"What kind of filling is best for this tooth?"
Background and/or Patient History
  • A moderate posterior lesion, moderate occlusal load
  • Moderate caries risk and reasonable isolation
  • Some esthetic concern as the tooth shows when smiling
  • Wants an informed recommendation
Allergies
NKDA
Medications
  • None
Current Findings
  • Restorable lesion with options across materials
  • No single overriding constraint
  1. Question 1
    Moderate
    The factors that should drive the material choice are:
  2. Question 2
    Moderate
    Given a visible tooth with moderate load and good isolation, a strong candidate is:
  3. Question 3
    Moderate
    If isolation turned out to be impossible (constant moisture), the choice would shift toward:
  4. Question 4
    Moderate
    If the patient were high caries risk with a root-surface component, the choice would lean toward:
  5. Question 5
    Moderate
    The overarching principle for material selection is:

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Patient case: A forgiving material for a young child
0 of 5 answered, 0 correct
Patient
Male, 5 years old, accompanied by parent
Chief Complaint
Parent: "He has a cavity in a baby molar and is hard to keep still."
Background and/or Patient History
  • A cavitated lesion in a primary molar
  • Limited cooperation and difficult moisture control
  • Moderate to high caries risk
  • Parent wants a durable but practical option
Allergies
NKDA
Medications
  • None
Current Findings
  • Cavitated primary molar lesion; isolation challenging
  • Higher caries risk overall
  1. Question 1
    Moderate
    A practical material for a cavitated primary tooth lesion with difficult isolation and caries risk is:
  2. Question 2
    Moderate
    Its fluoride release is valuable here because the child is:
  3. Question 3
    Moderate
    RMGI is chosen over conventional glass ionomer when one wants:
  4. Question 4
    Hard
    In atraumatic restorative treatment (ART), glass ionomer is favored because it:
  5. Question 5
    Moderate
    Alongside the restoration, the high-risk child should receive:

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Keep studying
Direct Restorative Materials core recall

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

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