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Exodontia: Extractions & Impactions INBDE Patient Cases

By Dr. Isaac Sun, DDS

7 ADA INBDE-format patient cases on exodontia: extractions & impactions. 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 exodontia: rotational movement for a single conical-rooted maxillary incisor, surgical extraction with a flap and sectioning for a broken-down divergent-rooted molar, a mesioangular impacted mandibular third molar with pericoronitis and inferior alveolar nerve assessment, an impacted maxillary canine surgically exposed for orthodontic alignment, the retrieve-versus-leave decision for a fractured root tip near the maxillary sinus, socket healing and clot protection, and the osteoradionecrosis risk of extracting in a previously irradiated jaw. Topics include extraction indications, forceps and elevators, the mechanical principles of luxation, simple versus surgical extraction, and third molars and impactions.

Case Coverage Map
What each case is testing
A front tooth that can be rotated out:
Rotational movement for a single conical root, what extraction force does, luxating with an elevator first, and the simple closed technique.
A badly broken-down molar that won't come with forceps:
Surgical extraction with a flap, sectioning a multirooted tooth, broad-based flap design, and the closed-versus-surgical decision.
A wisdom tooth angled into its neighbor:
Mesioangular impaction, pericoronitis as an indication, assessing the inferior alveolar nerve, modified technique for close roots, and surgical removal.
An impacted upper canine in a teenager:
The canine as the second most common impaction, surgical exposure for orthodontic alignment, and the contrast with removing third molars.
A root tip that snapped off:
Retrieve-versus-leave for a small deep fragment, the sinus-displacement risk, when to retrieve, and documentation/monitoring.
Aftercare to protect the socket:
The socket healing sequence, the clot as scaffold, what to avoid, the dry-socket link, and primary versus secondary intention.
An extraction in a previously irradiated jaw:
Osteoradionecrosis risk, the relative contraindication, completing extractions before radiation, and atraumatic technique with adjuncts.
Patient case: A front tooth that can be rotated out
0 of 5 answered, 0 correct
Patient
Female, 44 years old
Chief Complaint
A nonrestorable maxillary central incisor to be extracted.
Background and/or Patient History
  • Maxillary central incisor, nonrestorable, with a single conical root
  • Simple (closed) extraction planned
  • Adequate access; no impaction
Allergies
NKDA
Medications
  • None
Current Findings
  • Single straight conical root on the radiograph
  • Erupted, accessible tooth suitable for closed extraction
  1. Question 1
    Moderate
    Which extraction movement is appropriate for this single conical-rooted tooth?
  2. Question 2
    Moderate
    Rotation is acceptable here specifically because the root is:
  3. Question 3
    Moderate
    The two things the extraction force accomplishes are:
  4. Question 4
    Moderate
    An elevator may be used first to:
  5. Question 5
    Easy
    This case is a simple (closed) extraction because the tooth is:

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Patient case: A badly broken-down molar that won't come with forceps
0 of 5 answered, 0 correct
Patient
Male, 55 years old
Chief Complaint
A grossly broken-down lower molar for extraction.
Background and/or Patient History
  • Mandibular molar with little coronal structure and divergent roots
  • Forceps cannot get a purchase on the crown
  • Simple extraction is not feasible
Allergies
NKDA
Medications
  • None
Current Findings
  • Badly broken-down multirooted tooth with divergent roots
  • Surgical approach anticipated
  1. Question 1
    Moderate
    This badly broken-down, divergent-rooted molar is best removed by:
  2. Question 2
    Moderate
    Sectioning this multirooted tooth is done to:
  3. Question 3
    Hard
    The flap raised should be designed with:
  4. Question 4
    Moderate
    An elevator and the periosteal elevator have which roles here?
  5. Question 5
    Easy
    The decision to go surgical here illustrates that the approach is chosen by:

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Patient case: A wisdom tooth angled into its neighbor
0 of 5 answered, 0 correct
Patient
Female, 25 years old
Chief Complaint
Recurrent pericoronitis around an impacted lower wisdom tooth.
Background and/or Patient History
  • Impacted mandibular third molar tipped mesially against the second molar
  • Recurrent pericoronitis episodes
  • Roots appear close to the inferior alveolar canal on the panoramic film
Allergies
NKDA
Medications
  • None
Current Findings
  • Mesioangular impacted third molar with recurrent pericoronitis
  • Possible proximity to the inferior alveolar nerve
  1. Question 1
    Moderate
    This third molar, tipped mesially against the second molar, is classified as:
  2. Question 2
    Moderate
    Recurrent pericoronitis is:
  3. Question 3
    Moderate
    Before removing this tooth, the most important structure to assess is the:
  4. Question 4
    Hard
    If the panoramic film suggests intimate root-to-canal proximity, a reasonable step is to:
  5. Question 5
    Moderate
    Removing this impacted tooth will require a:

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Patient case: An impacted upper canine in a teenager
0 of 5 answered, 0 correct
Patient
Female, 14 years old
Chief Complaint
An upper canine has not erupted; found impacted on imaging.
Background and/or Patient History
  • Impacted maxillary canine, palatally positioned
  • Otherwise healthy adolescent in orthodontic care
  • The arch space is being maintained for the canine
Allergies
NKDA
Medications
  • None
Current Findings
  • Impacted maxillary canine (the second most common impaction)
  • Strategic tooth worth bringing into the arch
  1. Question 1
    Moderate
    After the third molar, the maxillary canine is:
  2. Question 2
    Moderate
    An impacted maxillary canine in this adolescent is usually managed by:
  3. Question 3
    Moderate
    The oral surgeon's role in this orthodontic plan is to:
  4. Question 4
    Moderate
    This contrasts with third molars, which are generally:
  5. Question 5
    Easy
    The principle illustrated is that the plan for an impacted tooth depends on:

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Patient case: A root tip that snapped off
0 of 5 answered, 0 correct
Patient
Male, 60 years old
Chief Complaint
A root tip fractured during an upper molar extraction.
Background and/or Patient History
  • Small apical root fragment of a maxillary molar fractured during delivery
  • The fragment lies deep, near the maxillary sinus
  • No active infection on the fragment
Allergies
NKDA
Medications
  • None
Current Findings
  • Small, deep root fragment near the sinus floor
  • Decision between retrieval and monitored retention
  1. Question 1
    Hard
    For a small, deep, non-infected root fragment near the maxillary sinus, a reasonable option is to:
  2. Question 2
    Moderate
    When SHOULD a fractured root tip generally be retrieved?
  3. Question 3
    Moderate
    A risk of forcing retrieval of this deep upper fragment is:
  4. Question 4
    Moderate
    If the fragment is left, the appropriate follow-up is to:
  5. Question 5
    Easy
    This decision illustrates weighing:

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Patient case: Aftercare to protect the socket
0 of 5 answered, 0 correct
Patient
Female, 30 years old
Chief Complaint
Post-extraction instructions after a routine extraction.
Background and/or Patient History
  • Routine extraction completed; clot formed
  • Patient asks how the socket heals and what to avoid
  • Healthy, non-smoker
Allergies
NKDA
Medications
  • None
Current Findings
  • Healthy socket with a good clot
  • Reviewing healing and aftercare
  1. Question 1
    Moderate
    The extraction socket heals in the sequence:
  2. Question 2
    Moderate
    The blood clot is important because it:
  3. Question 3
    Moderate
    To protect the clot, the patient should avoid:
  4. Question 4
    Moderate
    Loss or breakdown of the clot can lead to:
  5. Question 5
    Hard
    The surgical flap (if one was raised) heals by ___ while the open socket heals by ___:

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Patient case: An extraction in a previously irradiated jaw
0 of 5 answered, 0 correct
Patient
Male, 66 years old
Chief Complaint
Needs an extraction; had head and neck radiation therapy for cancer.
Background and/or Patient History
  • Prior high-dose radiation to the mandible for head and neck cancer
  • A tooth in the irradiated field requires extraction
  • Concern about bone healing
Allergies
NKDA
Medications
  • None
Current Findings
  • Extraction site within a previously irradiated jaw
  • Elevated osteoradionecrosis risk
  1. Question 1
    Moderate
    The principal concern with extracting a tooth in a previously irradiated jaw is:
  2. Question 2
    Moderate
    This makes the irradiated jaw a:
  3. Question 3
    Hard
    Ideally, dental extractions relative to planned radiation therapy are best completed:
  4. Question 4
    Hard
    If extraction in the irradiated field is unavoidable, management may include:
  5. Question 5
    Easy
    This case reinforces that extraction decisions follow:

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Keep studying
Exodontia: Extractions & Impactions core recall

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

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