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The orthodontic plan · Orthodontics · INBDE Patient Cases

Treatment Planning INBDE Patient Cases

By Dr. Isaac Sun, DDS

7 ADA INBDE-format patient cases on treatment planning. 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 orthodontic treatment planning: Class I crowding with extraction-vs-non-extraction decisions driven by incisor position and profile, growing Class II Division 1 with the functional-vs-camouflage decision (and BSSO mandibular advancement in non-growing severe cases), non-growing severe skeletal Class III with Le Fort I maxillary advancement plus BSSO mandibular setback and presurgical decompensation, premature primary tooth loss managed with band-and-loop or lower lingual arch or Nance appliance, mixed-dentition anterior crossbite distinguished from skeletal Class III (interceptive simple mechanics vs facemask plus expansion), maximum-anchorage extraction case with TADs and Newton's third law, and ortho-restorative uprighting of a tipped molar before implant placement with coordinated interdisciplinary sequencing. Topics include interceptive vs comprehensive treatment, space management, anchorage groups A/B/C, orthognathic surgery overview, and the four-anchor framework of diagnosis, growth, space, and anchorage.

Case Coverage Map
What each case is testing
Class I crowding: extraction vs non-extraction:
Crowding amount + incisor position + profile + anchorage drive premolar extraction vs IPR vs expansion; profile risk with over-retraction.
Growing Class II Div 1: functional vs camouflage decision:
Growing = functional appliance + headgear; non-growing = camouflage with upper premolar extractions or BSSO advancement; FMA decides headgear type.
Non-growing severe skeletal Class III:
Le Fort I maxillary advancement + BSSO mandibular setback + genioplasty as needed, with presurgical orthodontic decompensation; retention post-surgery.
Premature loss of a primary molar:
Band-and-loop (unilateral), lower lingual arch (bilateral lower), Nance (bilateral upper); preserves arch length and prevents successor impaction.
Anterior crossbite in mixed dentition (interceptive):
Localized dental crossbite → simple interceptive mechanics; skeletal Class III → facemask + palatal expansion; positive overjet/overbite as retention.
Anchorage planning in an extraction case:
Maximum (Group A) anchorage reinforcement with TADs/headgear/TPA; Newton's third law makes the reciprocal effect unavoidable.
Ortho-restorative: uprighting a tipped molar before implant:
Uprighting orthodontics precedes implant; implants cannot be moved orthodontically once osseointegrated; coordinated interdisciplinary sequence.
Patient case: Class I crowding: extraction vs non-extraction
0 of 5 answered, 0 correct
Patient
Female, 13 years old
Chief Complaint
Class I crowding ~9 mm with proclined incisors and a convex profile.
Background and/or Patient History
  • Full permanent dentition with Class I molar and canine
  • 9 mm of crowding (significant)
  • Proclined upper and lower incisors with a convex profile
Allergies
NKDA
Medications
  • None
Current Findings
  • Significant Class I crowding with proclined incisors
  • Extraction decision
  1. Question 1
    Moderate
    With about 9 mm of crowding and proclined incisors, a reasonable plan is:
  2. Question 2
    Hard
    If the incisors were UPRIGHT (not proclined) and the profile straight, the same 9 mm of crowding might instead be approached with:
  3. Question 3
    Moderate
    After first premolar extractions in this case, the anchorage plan should be:
  4. Question 4
    Moderate
    A risk of premolar extraction with maximum incisor retraction is:
  5. Question 5
    Easy
    The teaching point of Class I crowding decisions is that:

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Patient case: Growing Class II Div 1: functional vs camouflage decision
0 of 5 answered, 0 correct
Patient
Male, 12 years old
Chief Complaint
Skeletal Class II Div 1 with mandibular retrognathia.
Background and/or Patient History
  • Class II Div 1 molar and canine bilaterally
  • ANB 6° (skeletal Class II) with FMA 26° (average vertical)
  • Pubertal growth spurt approaching per CVM
Allergies
NKDA
Medications
  • None
Current Findings
  • Growing skeletal Class II Div 1
  • Functional appliance candidate
  1. Question 1
    Easy
    First-line option for this growing patient is:
  2. Question 2
    Moderate
    If growth modification is unsuccessful or treatment starts after the spurt, the next option in a young adult might be:
  3. Question 3
    Moderate
    In a non-growing patient with severe skeletal Class II, the next option above camouflage is:
  4. Question 4
    Moderate
    Headgear selection in this average-FMA case would be:
  5. Question 5
    Easy
    The teaching point is that the same Class II Div 1 diagnosis:

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Patient case: Non-growing severe skeletal Class III
0 of 5 answered, 0 correct
Patient
Male, 22 years old
Chief Complaint
Severe skeletal Class III with anterior crossbite and a concave profile.
Background and/or Patient History
  • Severe skeletal Class III (ANB -4°) with maxillary deficiency and mandibular excess
  • Anterior and bilateral posterior crossbite
  • Skeletally mature; growth complete
Allergies
NKDA
Medications
  • None
Current Findings
  • Non-growing severe skeletal Class III
  • Orthognathic surgery candidate
  1. Question 1
    Easy
    Definitive treatment in this non-growing severe Class III is:
  2. Question 2
    Moderate
    The maxillary advancement procedure is:
  3. Question 3
    Moderate
    The mandibular setback procedure is:
  4. Question 4
    Hard
    Before surgery, orthodontic DECOMPENSATION:
  5. Question 5
    Moderate
    Posttreatment retention in a surgical Class III case:

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Patient case: Premature loss of a primary molar
0 of 5 answered, 0 correct
Patient
Male, 7 years old
Chief Complaint
Non-restorable lower right primary second molar (E) requires extraction.
Background and/or Patient History
  • Mixed dentition; non-restorable lower right E
  • Permanent second premolar present radiographically but not yet erupted
  • Discussion of space management
Allergies
NKDA
Medications
  • None
Current Findings
  • Planned premature loss of a primary molar
  • Space-maintenance opportunity
  1. Question 1
    Moderate
    Without space maintenance after losing a lower E, the most likely consequence is:
  2. Question 2
    Moderate
    Appropriate space maintenance for the unilateral lower E loss is:
  3. Question 3
    Hard
    Bilateral lower primary molar loss before eruption of the lower incisors is best handled with:
  4. Question 4
    Moderate
    Bilateral upper primary molar loss is often managed with a:
  5. Question 5
    Easy
    The teaching point is that premature primary tooth loss:

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Patient case: Anterior crossbite in mixed dentition (interceptive)
0 of 5 answered, 0 correct
Patient
Female, 8 years old
Chief Complaint
Upper lateral incisor erupting into lingual crossbite with the lower incisor.
Background and/or Patient History
  • Mixed dentition with newly erupting upper lateral incisor in crossbite
  • Otherwise Class I; no skeletal Class III pattern
  • Growing patient
Allergies
NKDA
Medications
  • None
Current Findings
  • Localized dental anterior crossbite suitable for interceptive treatment
  1. Question 1
    Moderate
    Localized dental anterior crossbite in a mixed-dentition patient is best managed with:
  2. Question 2
    Moderate
    Untreated localized anterior crossbite can lead to:
  3. Question 3
    Moderate
    If the patient has a SKELETAL Class III pattern rather than a localized dental crossbite, the management changes to:
  4. Question 4
    Moderate
    After correction, retention of an anterior crossbite case includes:
  5. Question 5
    Easy
    The teaching point of mixed-dentition anterior crossbite is that:

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Patient case: Anchorage planning in an extraction case
0 of 5 answered, 0 correct
Patient
Female, 16 years old
Chief Complaint
Bimaxillary protrusion; four first premolar extractions planned with maximum anchorage retraction of anteriors.
Background and/or Patient History
  • Bimaxillary protrusion with proclined incisors
  • Four first premolar extractions planned
  • Maximum anchorage planned to retract anteriors fully
Allergies
NKDA
Medications
  • None
Current Findings
  • Maximum anchorage planning case
  1. Question 1
    Moderate
    Maximum (Group A) anchorage requires:
  2. Question 2
    Moderate
    TADs (mini-implants) are favored in maximum anchorage cases because they:
  3. Question 3
    Moderate
    Newton's third law in extraction-case anchorage planning means:
  4. Question 4
    Moderate
    If anchorage planning is INADEQUATE, the most likely outcome is:
  5. Question 5
    Easy
    The teaching point is that anchorage:

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Patient case: Ortho-restorative: uprighting a tipped molar before implant
0 of 5 answered, 0 correct
Patient
Male, 45 years old
Chief Complaint
Long-standing missing lower first molar; the second molar has tipped mesially into the space.
Background and/or Patient History
  • Lower first molar missing for years
  • Lower second molar tipped mesially into the space
  • Implant planned for the lower first molar position
Allergies
NKDA
Medications
  • None
Current Findings
  • Tipped second molar reducing implant space
  • Ortho-restorative uprighting candidate
  1. Question 1
    Moderate
    Before an implant in the lower first molar position can succeed, the tipped second molar should be:
  2. Question 2
    Moderate
    An osseointegrated implant CANNOT be:
  3. Question 3
    Moderate
    This case is best managed by:
  4. Question 4
    Moderate
    While uprighting the second molar, anchorage may be reinforced with:
  5. Question 5
    Easy
    The teaching point of ortho-restorative care is that:

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