Chapter 1: Introduction to Tooth Conservation

Scenario 1: Early Occlusal Caries

Case: A 32-year-old female presents with tooth 16 sensitivity to cold for 10 days—sharp pain resolving in 3 seconds, mild chewing discomfort. Examination shows moderate occlusal caries, no periapical tenderness. Cold test: 3-second response. Radiograph: caries in mid-dentin, no pulpal involvement.

1. What is the diagnosis?

2. What is the primary treatment objective?

3. What ensures restoration retention?

4. Which material is most suitable for this restoration?

Scenario 2: Post-Restorative Sensitivity

Case: A 28-year-old male returns 2 days post-Class I amalgam restoration on tooth 36. He reports cold sensitivity (5 seconds), no spontaneous pain. Restoration is intact, no high points. Initial caries was mid-dentin, removed to firm dentin.

6. What is the cause of sensitivity?

Scenario 3: Deep Caries Evaluation

Case: A 50-year-old female reports tooth 27 pain for 3 weeks—dull ache on chewing, sharp with sweets, lingering 15 seconds. Deep occlusal caries visible. Cold test: 15-second pain. Radiograph: caries approximating pulp, no periapical changes.

11. What is the diagnosis?

Scenario 4: Material Selection

Case: A 40-year-old male needs a Class II restoration on tooth 35 (MO caries, mid-dentin). No pulpal symptoms, good oral hygiene. He prefers durability over aesthetics.

16. What material is most appropriate?

17. What ensures retention in this case?

18. What ensures resistance form?

19. What instrument confirms caries removal?

20. What if patient reports aesthetics concern post-treatment?

Scenario 5: Anterior Aesthetic Restoration

Case: A 25-year-old female presents with tooth 11 caries (mesial, mid-dentin) visible when smiling. No pulpal symptoms. She prioritizes aesthetics.

21. What material is most suitable?

22. What ensures retention?

23. What ensures aesthetic outcome?

24. What if patient reports post-op sensitivity?

25. What instrument aids preparation?

Scenario 6: Traumatic Fracture

Case: A 30-year-old male reports tooth 21 chipped after biting a hard object. Sharp pain to cold (4 seconds), no spontaneous pain. Examination: enamel-dentin fracture, no pulpal exposure. Radiograph: no periapical pathology.

26. What is the diagnosis?

28. What ensures retention?

29. What if pulp is exposed?

30. What patient instruction is key?

Scenario 7: Restoration Failure

Case: A 45-year-old female reports tooth 46 pain 6 months post-amalgam restoration. Pain on chewing, no cold sensitivity. Examination: fractured amalgam, caries at margin. Radiograph: no pulpal involvement.

31. What is the cause of failure?

32. What is the next step?

33. What improves resistance form?

34. What caused secondary caries?

35. What prevents recurrence?

Scenario 8: High Caries Risk Patient

Case: A 60-year-old male with poor oral hygiene presents with tooth 45 caries (occlusal, mid-dentin). No pulpal symptoms. Radiograph: no pulpal involvement.

36. What material is most suitable?

39. What patient instruction is critical?

40. What if caries recurs?

Scenario 9: Pulpal Exposure During Prep

Case: A 35-year-old male with tooth 14 caries (deep occlusal) undergoes excavation. Pulp is exposed (pinpoint) during prep. Cold test pre-op: 5-second pain. Radiograph: caries near pulp, no periapical changes.

41. What is the immediate step?

42. What material is used for capping?

43. What if pain persists post-capping?

44. What confirms success of capping?

45. What restoration follows capping?

Scenario 10: Outline Form Error

Case: A 38-year-old female undergoes Class I restoration on tooth 17. Post-op, radiograph shows caries remaining at DEJ. No pulpal symptoms pre-op (5-second cold pain). Restoration intact.

46. What caused the error?

47. What is the next step?

48. What ensures proper outline form?

49. What instrument aids correction?

50. What if pulpal symptoms develop later?