Department Of Operative

1) All Class Ill lesions should be filled with composite resin, because they are esthetically important.

A) Both the statement and the reason are correct and related
B) Both the statement and the reason are correct but not related
C) The statement is correct, but the reason is not
D) The statement is not correct, but the reason is correct
E) Neither the statement nor the reason is correct

2)Class V amalgam restorations rarely require retentive grooves, but if they are used, they are placed
at the incisoaxial and gingivoaxial line angles.

A) Both statements are true

B) Both statements are false
C) The first statement is true, the second is false
D) The first statement is false, the second is true

3) Delayed expansion of amalgam restorations is associated with which two factors?

A) The failure to use a cavity varnish

B) High residual mercury
C) The contamination of the amalgam by moisture during trituration and condensation
D) the failure to use a cavity varnish

4) Proper condensation and carving makes an amalgam restoration stronger because it removes the
mercury-rich matrix.

A. both the statement and the reason are correct and related
B. both the statement and the reason are correct but not related
C. the statement is correct, but the reason is not
D. the statement is not correct, but the reason is correct
E. neither the statement nor the reason is correct

5) When preparing a Class II amalgam restoration, all surface angles should be approximately 90
degrees.

However, the internal angles should be rounded.

A) Both statements are true

B) Both statements are false
C) The first statement is true, the second is false
A) ·D) The first statement is false, the second is true

6) Beveling the enamel of the gingival cavosurface margin of the proximal box of a Class II amalgam
preparation on a permanent tooth:

A) Should result in a long bevel

B) Is contraindicated because of the low edge strength of amalgam

pg. 1 Department Of Operative

By Dr.yaser Elkareimi
 C) Should remove unsupported enamel that may fracture
D) Is unnecessary since the tooth structure in this area is strong

7) Which of the following is/are true statement/s regarding the polishing of amalgam? Select all that
apply.

A) It reduces marginal discrepancy

B) It should be done about 10 minutes after placement
C) Occlusion should not be checked prior to polishing
D) it prevents tarnishing of the restoration
E) it improves the appearance of the restoration
F) It should be done with a dry polishing powder

8) All of the following are true concerning a Class V amalgam preparation EXCEPT. Which one is the
exception?

A) The outline form is determined primarily by the location of the free gingival margin
B) The mesial, distal, gingival, and incisal walls of the cavity preparation diverge outward
C) The retention form is provided by the gingival retention groove along the gingivoaxial line angle
and an incisal retention groove along the incisoaxial line angle
D) A cervical clamp is usually necessary to retract gingival tissues

9) Which of the following statement/s is/are true regarding glass inomer cements? Select all that
apply

A) Release fluoride
B) Good chemical adhesion
C) Good thermal insulator
D) Thermal expansion similar to tooth
E) High solubility after initial setting

10) ZOE cements make good temporary sedative restorations because their pH is very basic.

A) Both the statement and the reason are correct and related
B) Both the statement and the reason are correct but not related
C) The statement is correct, but the reason is not
D) The statement is not correct, but the reason is correct
E) Neither the statement nor the reason is correct

11) Which of the following statement/s is/are true regarding glass ionomer restorations? Select all
that apply.

A) Glass ionomer is often the ideal material of choice for restoring root surface caries in patients
with high caries activity
B) The best surface finish for a glass ionomer restoration is that obtained against a surface matrix
C) Glass ionomers are somewhat esthetic and polish much better than composites
D) Glass ionomer adheres to mineralized tooth tissue

pg. 2 Department Of Operative

By Dr.yaser Elkareimi
12) Which of the following materials could be used to cement a bridge and fill a cervical lesion?

A) Glass lonomer
B) Zinc oxide-eugenol
C) Zinc polycarboxylate
D) Zinc phosphate

13) When using a zinc phosphate cement you place the varnish first. This is because zinc phosphate
cements are not biocompatible.

A) both the statement and the reason are correct and related
B) both the statement and the reason are correct but not related
C) the statement is correct, but the reason is not
D) the statement is not correct, but the reason is correct
E) neither the statement nor the reason is correct

14) Suspension liners, for example calcium hydroxide, harden intraorally by the:

A) Chemical reaction of acids and bases

B) Chemical reaction involving polymerization
C) Chemical reaction involving chelation
D) Physical reaction of drying
E) Physical reaction of a sol-gel transformation

15) Chronic caries is characterized by which of the following. select all that apply.

A) Pain is common
B) Slowly progressing or arrested
C) Entrance to the lesion is small
D) Lesion is deep and narrow
E) Common in adults

16) Acute caries is characterized by all the following EXCEPT, which one is the exception?

A) Rapidly progressing
B) The lesion is shallow (small lesion)
C) Pain may be a feature
D) Often multiple, soft-to-the-touch lesions

17) ____ is degraded by Streptococcus mutans into ______ and ______ thereby causing caries
initiation and progression.

A) Sucrose, glucans, lactic acid

B) Glucose, glucans, lactic acid
C) Sucrose, glucose, acetic acid
D) Glucose, sucrose, acetic acid
E)

18) All of the following statements are true concerning posterior composite restorations EXCEPT,
which one is the exception.

pg. 3 Department Of Operative

By Dr.yaser Elkareimi
 A) Posterior composite restorations are frequently indicated in the treatment of occlusal lesions
that allow conservative preparations
B) Posterior composite restorations are contraindicated in a patient with heavy occlusion (bruxism)
C) Posterior composites are contraindicated in patients with high caries risk
D) Posterior composite restorations may be indicated for the restoration of Class II cavities in
premolar teeth where the appearance is very important, the cavity margins are in the enamel,
and the occlusal contacts are on the enamel
E) Posterior composites are contraindicated for cusp replacements unless a dry operating field is
maintained

19) Which property of filled resins is primarily to blame for the failure of Class II composite
restorations?

A) Low flexural strength

B) Low compressive strength
C) Low wear resistance
D) Low tensile strength

20) Which composite type is 70% to 77% percent filled by volume and has an average particle size
ranging from 1 to 3 Mm.

A) Flowables
B) Hybrids
C) Microhybrids
D) Packables

21) Composite filler particles function to do which of the following? Select all that apply.

A) reduce the coefficient of thermal expansion

B) increase the tensile strength and compressive strength
C) reduce the polymerization shrinkage
D) increase the hardness
E) improve wear resistance

22) When restoring a darker shade of composite, keep in mind the following:

A) UV light is better than visible light

B) You must keep the light 2 mm away or more
C) You should cure for longer than normal
D) Darker shades have less chemical bonding

23) Which restorative material has the lowest thermal conductivity and diffusivity?

A) Amalgam
B) Gold
C) Unfilled resin
D) Filled resin

pg. 4 Department Of Operative

By Dr.yaser Elkareimi
24) Enamel etching is typically completed with:

A) 37% phosphoric acid

B) 13% phosphoric acid
C) 37% hydrochloric acid
D) 13% hydrochloric acid

25) Which one of the following is the most important event for dentin bonding?

A) Smear layer removal

B) Smear plug removal
C) Peritubular dentin decalcification
D) Intertubular dentin decalcification

26) The modified pen grasp is the most common instrument grasp in dentistry; this is because it
allows for the greatest intricacy and delicacy of touch.

A) both the statement and the reason are correct and related
B) both the statement and the reason are correct but not related
C) the statement is correct, but the reason is not
D) the statement is not correct, but the reason is correct
E) neither the statement nor the reason is correct

27) Chisels are used primarily to cut enamel.

Hatchets are primarily used to cut dentin.

A) Both statements are true

B) Both statements are false
C) The first statement is true, the second is false
D) The first statement is false, the second is true

28) When restoring a Class II or Class Ill lesion, it is important to create properly shaped embrasures
for all of the following reasons EXCEPT, which one is the exception.

A) Create a spillway for food during mastication

B) Make the teeth self-cleansing
C) Protect the gingival tissue, while also allowing stimulation of it
D) Provide arch stability

29) A tooth was restored 3 months ago by a new associate of yours. The patient is complaining of
mobility and thermal sensitivity. You take a periapical radiograph. You could see all of the following in
that radiograph to confirm your suspicions, EXCEPT, which one is the exception?

A) Hypercementosis
B) Root resorption
C) Periodontal pockets
D) Alteration of the lamina dura
E) Widening of the periodontal ligament space

pg. 5 Department Of Operative

By Dr.yaser Elkareimi
30) Which of the following would NOT necessarily indicate the need for root canal treatment or
extraction of a carious tooth?

A) Lingering pain over 15 seconds

B) Negative electric pulp test
C) Frank apical radiolucency
D) Percussion sensitivity

31) The ideal amount of time from placing an indirect pulp cap until reopening the tooth to remove
the remaining decay is:

A) 7-10days
B) 2- 3 weeks
C) 1 month
D) 3-4 months
E) Never, unless the tooth becomes symptomatic there is no need for further treatment.

32) A patient walks into your office for an emergency visit. He asks the receptionist for a cold glass of
water and seems to be tilting his head sideways as to hold the water on one side of his mouth.
Immediately, you suspect which reason for his visit?

A) Pulp necrosis
B) Reversible pulpitis
C) Symptomatic irreversible pulpitis
D) Asymptomatic apical periodontitis

33) A cold test reveals a lingering pain. You ask the patient to raise her hand until the pain subsides.
The patient raises her hand for about 8 seconds. What does this data suggest?

A) Pulp necrosis
B) Symptomatic irreversible pulpitis
C) Reversible pulpitis
D) Symptomatic apical periodontitis

34) What was previously an MOD amalgam in #35 now shows that the entire lingual portion of the
tooth has fractured off. You believe that the tooth is restorable with a pin-retained amalgam
restoration/core. How many pins will you likely use and why?

A) One, because you are missing the lingual cusp only

B) Two, because you are missing both the mesio- and disto-lingualline angles
C) Three, because you are missing the mesial, distal, and lingual walls
D) None of the above

35) When preparing a pin channel, you perforate into the vital pulp chamber. What best describes
your next step.

A) Explain to the patient the need for root canal treatment

B) Allow bleeding to stop, dry with paper point, place calcium hydroxide

pg. 6 Department Of Operative

By Dr.yaser Elkareimi
 C) Allow bleeding to stop, dry with paper point, place pin to depth of 1 mm as to not enter the pulp
chamber
D) Allow bleeding to stop, dry with paper point, place pin elsewhere, and restore with amalgam

36) The rubber dam can still be used effectively even if teeth are crowded and overlapped because the
hole punch pattern does not always have to be followed.

A) both the statement and the reason are correct and related
B) both the statement and the reason are correct but not related
C) the statement is correct, but the reason is not
D) the statement is not correct, but the reason is correct
E) neither the statement nor the reason is correct

37) Fluoride reduces the rate of enamel solubility.

This increases the hardness of enamel.

A) Both statements are true

B) Both statements are false
C) The first statement is true, the second is false
D) The first statement is false, the second is true

38) An enamel bonding agent that bonds enamel to composite is termed a ‘Cohesive joint’; this is
because there are three materials involved.

A) both the statement and the reason are correct and related
B) both the statement and the reason are correct but not related
C) the statement is correct, but the reason is not
D) the statement is not correct, but the reason is correct
E) neither the statement nor the reason is correct

39) A patient return to your office only 24 hours after you cemented her new gold crown on tooth #19
(#36). She claims to feel a sharp electrical sensation in both her upper and lower jaw on the left side.
When you explain to her what might be happening, you call it:

A) Electromagnetic pulse
B) Alternating current corrosion
C) Electrolyte explosion
D) Galvanic shock

40) None active carious lesion is distinguished by all EXCEPT, which one is the exception?

A) Covered by a layer of plaque

B) Soft and leathery in Consistency
C) Brown to black discoloration
D) Sever pain during caries removal

41) In class II cavity preparation the axio-pulpal line angle is rounded to:

A) Prevent the fracture of enamel

pg. 7 Department Of Operative

By Dr.yaser Elkareimi
 B) Prevent the fracture of amalgam
C) Prevent the fracture of gingival sheath
D) prevent the fracture of dentine

42) The restorative material that shows chemical bonding to the tooth surface is:

A) Composite resins
B) Glass ionomer cement
C) Unfilled resin
D) Zinc phosphate

43) In the restoration of deep cavity with composite resins, the following precautions have to be
taken to protect the pulp:

A) Calcium Hydroxide base

B) Cavity varnish
C) Zinc oxide eugenol palliative base
D) No need for base as they are non-irritant to the pulp

44) For a class V cavity for amalgam restoration:

A) Mesial and distal walls are parallel, occlusal and gingival walls converging
B) Mesial and distal walls diverging, occlusal and gingival walls converging
C) Mesial and distal walls diverging, occlusal and gingival walls diverging
D) Mesial and distal walls, occlusal and gingival walls parallel

45) Which of the following materials can be confused with caries

A) Amalgam
B) Gutta percha
C) Composites
D) ZoE

46) All of the following types of corrosion occur in high copper amalgam EXCEPT, which one is the
exception?

A) Galvanic
B) Penetrating
C) Chemical
D) Electrochemical

47) The contamination of the amalgam by moisture during trituration and condensation is
unquestionably the principal cause of failures.

A. True
B. False

48) Amalgam restorations should be finished and polished for: select all that apply.

A. To improve the appearance of the restoration.

B. To reduce marginal discrepancies

pg. 8 Department Of Operative

By Dr.yaser Elkareimi
 C. To reduce marginal breakdown
D. To prevent tarnishing

49) Incipient carious lesions are contained entirely within enamel and have not spread to the
underlying dentin, the treatment in such case could be:

A. Promote remineralization
B. Place a restoration
C. Leave it, as it is arrested caries
D. A and B

50) The following could be performed to increase the strength of the amalgam, EXCEPT, which one is
the exception?

A. Higher condensation pressure

B. Larger particle
C. Longer trituration time
D. Fewer voids

51) Secondary caries is decay appearing at the margins of a restoration and under it.

A. True
B. False

52) The etiologic factors for xerostomia include:

A. Radiation therapy to head and neck

B. Autoimmune disorders
C. Endocrine disorders
D. All of the above

53) The cavo-surface angle of amalgam cavity preparation should be :

A. Beveled
B. Rounded
C. Right angle
D. None

54) The placement of pin should be:

A. Parallel to each other

B. Parallel to the nearest external surface
C. Perpendicular to the external tooth surface
D. Never beneath the cusp to be restored

55) Self etching primer:

A. Simultaneously etch and prime dentin and enamel

B. Etches enamel
C. Only bond to dentin
D. Only removes smear layer

pg. 9 Department Of Operative

By Dr.yaser Elkareimi
56) The rate of carious destruction of dentin tend to be slower in adults than in children because:

A. Increase in intratubular organic content

B. Change in PH of saliva with age
C. Generalized dentinal sclerosis with aging
D. All of the above

57) When placing a matrix band for a class II amalgam restoration the gingivo-occlusal width of the
matrix band should be trimmed:

A. Below the marginal ridge height

B. Equal to the height of marginal ridge
C. At least 1 mm greater than expected height of marginal ridge
D. Not trimmed at all

58) The gingival margin is:

A. Always beveled
B. Not routinely beveled
C. Beveled at 45 degree
D. Only acid etched

59) Addition of fillers in resins:

A. Increases polymerization shrinkage

B. Decreases polymerization shrinkage
C. Has no effect on shrinkage but increases strength
D. Decreases wear resistance

60) The most superior finished surface for composite resin can be achieved by:

A. White stone
B. Aluminium oxide
C. Carbide finishing bur
D. Diamond finishing bur

61) Composite resins are not usually recommended for restoration of class II cavity because of
excessive:

A. Occlusal wear
B. Marginal fracture
C. Lack of color stability
D. Isthmus fracture

62) All of the following are true about dentinal tubules EXCEPT, which one is the exception?

A. Inner dentin layer contain more dentinal tubules than outer dentin layer
B. The diameter of dentinal tubules ranges from 5 to 7 Mm
C. The diameter of dentinal tubule is more at the pulpal layer than outer layer
D. The bonding is more on the inner area of dentin than outer surface

pg. 10 Department Of Operative

By Dr.yaser Elkareimi
63) What is not true about root caries?

A. Secondary to gingival recession

B. Most rapidly spread
C. Caused by actinomycosis viscosus
D. Can not be arrested and remineralised after treatment

64) Extension for prevention is directly related to:

A. Removal of unsupported enamel on proximal surface of class III cavity

B. Depth of the axial wall of class III cavity preparation
C. Elimination of all carious dentin beyond average depth of pulpal wall
D. The outline form of cavity preparation

65) Incipient caries was covered accidently by pits and fissure sealant, which is correct about its
progression?

A. Progress at a faster rate

B. Progress at slower rate
C. Will not progress at all
D. Progression cannot be predicted

66) With age and irritation, which form of dentine is laid down?

A. Secondary dentin
B. Reparative dentin
C. Sclerotic dentin
D. None of the above

67) Cavity varnish is indicated under amalgam restoration because:

A. Prevents galvanic current from reaching the pulp

B. Improves the marginal seal
C. Is an effective thermal insulator
D. All of the above

68) Varnish can be used under all type of cavity restorations EXCEPT, which one is the exception?

A. Resins
B. Amalgam
C. Gold
D. Ceramic

69) Polishing of an amalgam restoration is done by: select all that apply.

A. Before 24 hours
B. amalgloss
C. After a few days
D. With pumice powder

70) An amalgam restoration has to be burnished after:

pg. 11 Department Of Operative

By Dr.yaser Elkareimi
 A. 24 hours
B. 10 to 15 minutes
C. 2 to 3 minutes
D. 1 hour

71) Clinically the earliest evidence of caries is:

A. Brown area on tooth surface

B. Roughness on the surface of the tooth
C. Chalky white area on the tooth
D. Sensitivity to sweets

72) A bacteria not associated with caries process is:

A. Streptococcus mutans
B. Staphylococcus aureus
C. Lactobacillus acidophilus
D. Actinomyces

73) A glazing agent is applied to the surface of a composite resin restoration in order to: select all that
apply.

A. Increase the surface hardness

B. Improve the marginal seal
C. Decreases the surface roughness
D. Improve aesthetic

74) The presence of zinc in amalgam alloy:

A. Minimizes the formation of oxides

B. Causes delay expansion of the restoration
C. Both A and B
D. None of the above

pg. 12 Department Of Operative

By Dr.yaser Elkareimi
Q1) E

Neither the statement nor the reason is correct

*** Think closely, distolingual Class III lesions are relatively nonesthetic and Nattiona! Board questions
consider the best material to be amalgam or direct gold.

Composite resin is not recommended for Class III lesions on the distal-lingual aspect of canines (use either
amalgam or direct gold). Composite material will not maintain the mesiodistal dimension of the tooth.
Note: This may not be entirely true today due to the fact that there are much better wear-resistant resins
than in the past. However, for National Board questions composite is not recommended for this situation.

A lingual approach is made when preparing a Class III dental amalgam preparation for the distal surface
of a canine because a lingual approach preserves the esthetic value of the facial surface.

Q2) D

The first statement is false, the second is true

*** Class V amalgam restorations commonly require and utilize retention grooves.

The retention form for a Class V amalgam preparation is provided by the gingival retention groove placed
along the gingivoaxial line angle and the incisal retention groove placed along the incisoaxialline angle.

The outline form for the classical Class V amalgam preparation is a deformed trapezoid (sometimes called
"kidney-shaped"). The outline form is determined by the location and size of the carious area.

The nonparallel mesial and distal walls ofthe preparation are straight and parallel to the transitional line
angles. The direction of these walls is determined by the direction of the enamel walls (as is the decay
pattern).

The occlusal and gingival walls of the preparation should be gently curved arcs as determined by the
contour of the free margin of the gingival tissue.

Note: These arcs should be as parallel to each other as possible.

pg. 13 Department Of Operative

By Dr.yaser Elkareimi
Q3) C. The contamination of the amalgam by moisture during trituration and condensation

D. the failure to use a cavity varnish

Q4) A

both the statement and the reason are correct and related

The most important consideration in the strength of the amalgam is the mercury content. If the mercury
content exceeds 55%, a dramatic loss in strength results. Amalgam restorations that contain mercury
levels of about 55% exhibit a high incidence of marginal breakdown, fracture, and corrosion, and the
surface finish of the restoration is not good.

Factors that influence the final mercury content of a restoration: • Original mercury-alloy ratio: specific
to each product but generally less than 1: 1 so that amalgam contains 43% to 50% mercury • Amount of
trituration • Condensation pressure and time involved in carrying out condensation

pg. 14 Department Of Operative

By Dr.yaser Elkareimi
Very important: Removing the mercury-rich matrix by proper condensation and carving produces a
stronger and more corrosion-resistant amalgam because it minimizes the formation of the matrix phases
of amalgam, which are the least desirable parts of the set material.

Q5) A

Both statements are true

General properties of Class II amalgam preparations:

• All walls should meet the surface of the tooth at a 90° angle (butt joint)

• Occlusal dovetail: provides resistance to proximal displacement

• Pulpal floor should be flat same as Class L

• The buccal and lingual walls of the proximal section should converge occlusally- the extension of these
walls is determined primarily by the position of the adjacent teeth in relation to the tooth being restored.
• The buccal, lingual, and gingival walls should be extended into the embrasures enough to allow easy
cleaning-areas of lessened caries susceptibility.

• The axiopulpal line angle is beveled to reduce concentration of stresses - resistance form.

• Retention grooves are placed in the axiobuccal and axiolingual line angles and extend-ed to the height
of the axial wall - resistance to dislodgement

• Lingually, it is often necessary to create a reverse curve in the outline. A reverse curve is a curve put into
the buccal or lingual wall so the wall meets the external surface of the tooth at a 90° angle.

Note: Class II amalgam preps have independent retention and resistance form for both the proximal box
and occlusal portion of the preparation.

Q6) C

Should remove unsupported enamel that may fracture

***The gingival cavosurface margin is beveled only if it is in the enamel. Beveling is not necessary if the
gingival margin is within cementum.

The gingival cavosurface margin should be beveled to remove any unsupported enamel. The bevel is
usually placed with a gingival margin trimmer. This gingival margin must be below any existing contact
with the adjacent tooth in order to allow proper finishing of the gingival margin.

pg. 15 Department Of Operative

By Dr.yaser Elkareimi
Q7)

A. It reduces marginal discrepancy

D. it prevents tarnishing of the restoration
E. it improves the appearance of the restoration

Q8) A

The outline form is determined primarily by the location of the free gingival margin

the outline form is determined primarily by the location and size of the carious lesion.

Q9)

A. Release fluoride
B. Good chemical adhesion
C. Good thermal insulator
E. High solubility after initial setting

glass ionomer cements have low solubility, lower than zinc phosphates (which are lower than zinc
polycarboxylates).

pg. 16 Department Of Operative

By Dr.yaser Elkareimi
Glass ionomer cements are hybrids of silicate and polycarboxylate cements designed to combine the
fluoride releasing properties of silicate particles with the chemically adhesive and more biocompatible
characteristics of the polyacrylic acid matrix compared to the extremely acidic matrix of silicate cement.

Advantageous physical properties of glass ionomer cements:

• Release of fluoride: anticarcinogenic

• Chemical adhesion to the prepared tooth and certain metals. Micromechanical bond to composite
resins. Important: Chelation of calcium ions on tooth structure by ionized polyacrylic acid side-groups is
the principal mechanism of chemical adhesion to tooth structure.

• Biocompatibility is high, thus with enough dentin remaining (0.5-1 mm,) no pulpal protective agent
(calcium hydroxide) is required

• Good thermal insulators: equal to that of natural dentin

• Thermal expansion is similar to that of tooth structure

• After initial setting, they have low solubility in the mouth

Q10) C

The statement is correct, but the reason is not

ZOE cements make good temporary sedative restorations because their pH is about 7 (neutral).

ZOE cement is a soft, sedative-type cement. It is used as a sedative or temporary filling material, as an
insulative base, and in interim caries treatment. The powder is zinc oxide and the liquid is eugenol.
Eugenol has a palliative effect on the dental pulp, and this is one of the main advantages of using this
type of cement.

Note: The combination of surface treatment and polymer reinforcement results in a material that has
good strength and toughness which markedly improves abrasion resistance. Reinforced ZOE is fine for
basing large and complex cavities. This material is able to withstand the pressure of amalgam
condensation and it has minimal effect on the pulp

Q11)

A. Glass ionomer is often the ideal material of choice for restoring root surface caries in
patients with high caries activity
B. The best surface finish for a glass ionomer restoration is that obtained against a surface
matrix
D. Glass ionomer adheres to mineralized tooth tissue

It is true that glass ionomers are somewhat esthetic, however, they do not polish as well as composites.

pg. 17 Department Of Operative

By Dr.yaser Elkareimi
Both self-cured and light-cured versions of glass ionomers are available. Light-cured glass ionomers are
preferred because of both the extended working time and their improved physical properties. Because of
their limited strength and wear resistance, glass ionomers are indicated generally for the restoration of
low stress areas where caries activity potential is of significant concern.

Compared to composites, glass ionomers:

• Have a lower compressive strength, tensile strength, and hardness

• Are generally very technique-sensitive because of their high solubility when first mixed

Note: With the newer hybrid or light-cured resin-modified glass ionomers, the above properties have
been improved.

Glass ionomers are generally considered the nearly ideal base/liner material because of the following
properties:

• Adhesive bond to tooth structure

• Snap set in the light-cured form (for e.x.ample, Vitrebond)

• Anticariogenic: due to fluoride release

• Bond to composite: makes for excellent liners for Class V root caries restorations.

*** Sometimes called the "sandwich technique." This technique achieves all the benefits of the glass
ionomer cements plus the high polishability, surface hardness, and strong bond to enamel of the
composite resin.

pg. 18 Department Of Operative

By Dr.yaser Elkareimi
Q12) A

Glass lonomer

Q13) A

both the statement and the reason are correct and related

It should be emphasized that the use of a base in conjunction with amalgam or gold foil does not alleviate
the need for a varnish as an aid in sealing the cavity margins against leakage. However, the type of base
governs the respective order of application of the varnish and the base. If a zinc phosphate cement base
is to be used, then the cavity varnish should be applied to the cavity walls prior to placement of the base.
On the other hand, if a biocompatible agent (e.g., a calcium hydroxide, zinc oxide-eugenol, or
polycarboxylate cement base) is employed, then these should be placed against the dc.ntin, and the

pg. 19 Department Of Operative

By Dr.yaser Elkareimi
varnish should not be applied until the base material has hardened. Important: If varnish is added before
a biocompatible base, it may prohibit positive qualities such as eugenol's soothing effect or
polycarboxylate's chelation and adhesion.

14) D

Physical reaction of drying

15) B

Slowly progressing or arrested

Q16) B

The lesion is shallow (small lesion)

Q17) A

Sucrose, glucans, lactic acid

*** Sucrose is degraded by Streptococcus mutans into glucans and lactic acid, thereby causing caries
initiation and progression.

Pit and fissure caries has the highest prevalence of all dental caries. Smooth surface areas, especially the
proximal enamel surfaces immediately gingival to the contact area are the second most susceptible areas

pg. 20 Department Of Operative

By Dr.yaser Elkareimi
to caries. Streptococci and lactobacilli species are common in this area. The facial and lingual root surfaces
may have plaque-containing filamentous actinomyces species that can cause root surface caries.
Remember: Lactobacilli species do not produce the dextran-like, extracellular long-chain polysaccharides
(fructans and glucans) as do Streptococci species but produces a different extra-polysaccharide called
Iexan. The way that the lactobacillus species cause dental caries in the pit and fissure areas is that it gets
packed into those pit and fissure areas, thereby exerting its effec

Q18) E

Posterior composites are contraindicated for cusp replacements unless a dry operating field is
maintained

Although the ADA does not endorse composite resins as a substitute for amalgam in posterior teeth,
composite restorations can be excellent if strict guidelines are followed for tooth selection and if the
restorations are done properly. But remember, composite resin restorations are inferior to amalgam in
te1ms of compressive strength and abrasion resistance (occlusal wear). In addition, current composite
resins have no capability to provide an anticariogenic effect as do freshly placed glass ionomer or resin
modified glass ionomers, for example.

Q19) C

Low wear resistance

Ideally, composite resins should be used only to restore minimal cavities in posterior teeth. Its use should
be restricted to those instances which it will not be subjected to excessive occlusal forces and when teeth
are in occlusion, there is cusp-to-cusp contact and not cusp to restoration. For Class III preparations using
resins, the rule of extension for prevention into embrasures is disregarded for Class Ill esthetic
restorations. This compromise is for esthetic reasons, as well as the unnecessary removal of tooth
structure, which will often involve the incisal edge. If possible, the outline form should place the gingival
margin incisally from the crest of the gingiva. When placing the composite resin in a Class III preparation,
the wooden wedge is placed to provide some separation of the teeth (for contact), to stabilize the mylar
strip, and to avoid creation of excess gingival flash. Important: Restoring the contact area must be done
properly and diligently.

Q20) B

Hybrids

pg. 21 Department Of Operative

By Dr.yaser Elkareimi
Q21) E

Improve wear resistance

Q22) C

You should cure for longer than normal

Important points to remember when using a visible light-curing unit:

• Hold the light as close to the resin as possible-within 2 mm to be effective.

pg. 22 Department Of Operative

By Dr.yaser Elkareimi
• Place a shield between the light tip and the operator's eyes. Patients who have had recent cataract
removal should have protection also. Note: Studies have shown that the visible light used in
polymerization of photo-activated materials can cause retinal damage-always usc a shield and eyeglasses
for protection.

• For deep restorations, you have to cure the composite in increments - if you don't, the deeper areas will
not be cured. Important: No more than 1.5 mm to 2 mm increments should be light cured at one time.

• Make sure the bulb in the light is still powerful enough - they have commercially available products to
test the bulb.

• With darker resin shades, cure a little longer.

Q23) C

Unfilled resin

Q24) A

37% phosphoric acid

Q25) D

Intertubular dentin decalcification

Dentin bonding systems (DBS) consist of 3 components:

• Etchant: Typical acid conditioners include phosphoric acid, EDTA, maleic acid, and citric acid.

• Primer: is designed to penetrate through the remnant smear layer and into the intertubular dentin to
fill the spaces left by dissolved hydroxyapatite crystals. This allows the primer to form an
interpenetrating network around dentin collagen. Note: The bonding primer is based on hydrophilic
monomers, such as hydroxyethyl methacrylate (HEMA).

• Bonding agent: unfilled resin adhesive is applied. The resin is then cured (light-, self-, or dual-cured).
This layer can now bond to composite or amalgam.

pg. 23 Department Of Operative

By Dr.yaser Elkareimi
Q26) A

both the statement and the reason are correct and related

Q27) C

The first statement is true, the second is false

pg. 24 Department Of Operative

By Dr.yaser Elkareimi
*** Hatchets are also primarily used to cut enamel Chisels may be grouped as: I. Straight, slightly
curved, or bin-angle: primarily used for planing or cleaving enamel. Characterized by a blade that
terminates in a cutting edge formed by a one-sided bevel. 2. Enamel hatchets: arc chisel-bladed
instruments with the cutting edge in the plane of the handle. They come paired left and right. 3. Gingival
margin trimmers: are similar in design to the enamel hatchet except it has a curved blade and an angled
cutting edge. They are primarily used for beveling gingival margins. Among other uses for these
instruments is the rounding or beveling of the axiopulpal line angle of Class II preparations (very
important).

Q28) D

Provide arch stability

Q29) C

pg. 25 Department Of Operative

By Dr.yaser Elkareimi
Periodontal pockets

***You should have suspected that the restoration was high, based mainly on the mobility factor. Occlusal
trauma can still cause periodontal pocketing; however, that cannot be seen on a radiograph.

Some common clinical signs of trauma from occlusion include:

• Increased tooth mobility is the most common clinical sign

• Thermal sensitivity (cold): presumably, this sensitivity is due to venous hyperemia of the tooth

• Attrition of the enamel

• Recession of the facial gingival tissue

Q30) D

Percussion sensitivity

Q31) D

3-4 months

Q32) C

Symptomatic irreversible pulpitis

Symptomatic irreversible pulpitis is a clinical diagnosis based on subjective and objective findings
indicating that the inflamed pulp is incapable of healing. Additional descriptors include lingering thermal
pain, spontaneous pain, and referred pain. In the early stages, it may appear as just a sensitive tooth. As
the condition continues, the pain may be described as a gnawing or dull throbbing. The treatment
accepted by most clinicians is pulp removal (root canal therapy}. Note: The tooth is usually percussion-
positive.

pg. 26 Department Of Operative

By Dr.yaser Elkareimi
Q33) C. Reversible pulpitis

Q34) B

pg. 27 Department Of Operative

By Dr.yaser Elkareimi
Two, because you are missing both the mesio- and disto-lingualline angles

pg. 28 Department Of Operative

By Dr.yaser Elkareimi
Q35) B

Allow bleeding to stop, dry with paper point, place calcium hydroxide

Q36) A

both the statement and the reason are correct and related

In this case, you can punch the holes closer or in a similar pattern to the teeth, allowing for the elimination
of wrinkles and avoid having papillae protruding through.

Five functions of rubber dam isolation:

• Retracts soft tissue, such as lips, cheeks, and tongue

• Provides for clean, dry field

• Protects the patient by eliminating the possibility of swallowing debris or instruments. Protects the
dentist somewhat by isolating him/her from possible infectious conditions in the patient's mouth.

• Provides for maximum physical properties of materials. For example: The rubber dam provides a dry
field, which is essential for placement of amalgam restorations as well as cements. Remember, the

pg. 29 Department Of Operative

By Dr.yaser Elkareimi
cements that are placed under dry conditions have maximum strength. Also, a dry field prevents delayed
expansion of amalgam.

• Saves time - rubber dam saves time because the operator can work more efficiently in a clean, dry field
where visibility is not impaired.

Q37) C

The first statement is true, the second is false

*** Fluoride does not make the enamel harder but reduces its rate of solubility.

Fluorides exert their anticaries effect by three different mechanisms:

I. The presence of fluoride ions greatly enhances the precipitation into tooth structure of fluorapatite from
calcium and phosphate ions present in saliva. This insoluble precipitate replaces the soluble salts
containing manganese and carbonate, which were lost due to bacterial-mediated demineralization. This
exchange process results in the enamel becoming more acid resistant.

2. Incipient, noncavitatcd, carious lesions are remineralized by the same process.

3. Fluoride has antimicrobial activity. In low concentrations, fluoride ion inhibits the enzymatic production
of glucosyltransferase. Glucosyltransferase prevents glucose from forming extracellular polysaccharides,
and this reduces bacterial adhesion and slows ecological succession. Intracellular polysaccharide
formation is also inhibited, preventing storage of carbohydrates by limiting microbial metabolism
between the host's meals. Thus, the duration of caries attack is limited to periods during and immediately
after eating.

Q38) E

neither the statement nor the reason is correct

*** An enamel bonding agent that bonds enamel to composite is termed an "adhesive joint"; this is
because there are two unlike materials being bonded together.

Adhesion is a process of solid and/or liquid interaction of one material (adhesive or adherent) with
another (adherend) at a single interface. Most instances of dental adhesion are also called dental bonding.
A pit and fissure sealant bonded to etched enamel is a case of dental adhesion.

An adhesive joint is the result of interactions of a layer of intermediate material (adhesive or adherent)
with two surfaces (adherends) producing two adhesive interfaces. Examples include orthodontic bracket
bonding resin, enamel bonding system for a composite resin, and a bonded porcelain veneer.

pg. 30 Department Of Operative

By Dr.yaser Elkareimi
Q39) D

Galvanic shock

Galvanic shock is the brief but sharp electrical sensation one can receive when two dissimilar metals
come into contact in the mouth.

An example of this phenomenon: An amalgam restoration is placed on the occlusal surface of a lower
tooth directly opposing a gold inlay in an upper tooth. Because both restorations are wet with saliva, an
electric couple exists, with a difference in potential between the dissimilar restorations. When the two
fillings are brought into contact, the potential is short-circuited through the two alloys. The result is
sharp pain. Such postoperative pain usually occurs immediately after insertion of a new restoration and,
generally, it gradually subsides and disappears in a few days.

Q40) D

Sever pain during caries removal

Q41) B

Prevent the fracture of amalgam

Resistance form is that form the cavity walls take to resist the forces of mastication. Resistance form
prevents fracture of the restoration and the tooth. Examples: Severely undermined cusps should be
reduced so as to prevent fracture. The axio-pulpal line angle in Class II amalgam preparation is rounded
or beveled so as to reduce concentration of stresses and thus prevent fracture of the brittle amalgam.
Also, proper angulation of cavity walls (converging) and pulpal and gingival walls that are perpendicular
to occlusal forces (flat walls at right angles to the long axis of the tooth) help achieve resistance form.

Q42) B

Glass ionomer cement

Its Advantages: chemical bond to enamel and dentin, anticariogenic effect (releases fluoride), coefficient
of thermal expansion similar to that of tooth structure, high compressive strength, low solubility.
Disadvantages low initial pH which may lead to post cementation sensitivity, sensitivity to both moisture
contamination and desiccation. Note: Its mechanical properties are superior to zinc phosphate and
polycarboxylate cements.

pg. 31 Department Of Operative

By Dr.yaser Elkareimi
Q43) A

Calcium Hydroxide base

When the cavity floor is near the pulp, GIC’s can also be quit irritant here a calcium hydroxide base is used
more because it has stimulant effect on pulp which enhances reparative dentin formation

Q44) C

Mesial and distal walls diverging, occlusal and gingival walls diverging

Because the distal mesial gingival and incisal walls of the tooth preparation are perpendicular to the
external tooth surface

They usual diverge facially

The depth of the cavity should be kept uniform

Pulpal wall of class V cavities is closest to the pulp chamber compared to the other cavity classes

Q45) C

Composites

Q46) B

Penetrating

Corrosion: is a chemical or electrochemical process through which the metal is attacked by natural agents
such as air and water, resulting in partial or complete dissolution, deterioration or weakening any sold
substances

Q47) A

True

If moisture is incorporated into an alloy that contains zinc, the water reacts with the zinc to produce
hydrogen gas. The resulting pressure from the liberated gas produces severe expansion of the amalgam.
This results in the following clinical manifestations:

• The amalgam protrudes from the cavity preparation

• Postoperative pain

• Excessive corrosion

pg. 32 Department Of Operative

By Dr.yaser Elkareimi
Q48)

A. To improve the appearance of the restoration.

B. To reduce marginal discrepancies
C. To reduce marginal breakdown
D. To prevent tarnishing

The final finish of the amalgam restoration should not be done until after the amalgam is fully set. It should
be delayed for at least 24 hours after condensation and preferably longer (24-48 hours). By waiting, you
can be ensured that the reactions between the alloy and mercury will have been completed and a more
corrosion-resistant surface will be created.

Amalgam restorations should be finished and polished for three major reasons:

 to reduce marginal discrepancies and to create a more hygienic restoration

 to reduce marginal breakdown, which will reduce the chance of recurrent decay
 to prevent tarnishing and to improve the appearance of the restoration.

Q49) D

A and B

Incipient carious lesions are contained entirely within enamel and have not spread to the underlying
dentin. The two options for treatment are:

1. Promote remineralization: with fluoride varnish and self-administered fluoride, followed by regular
monitoring. Note: Incipient carious lesions usually do not progress rapidly.

2. Place a restoration: be as conservative as possible.

Q50) B

Larger particle

Strength of the amalgam:

Amalgam is brittle but possesses good compressive strength. The most important consideration in the
strength of the amalgam is the mercury content. Mercury content above 55% will cause a marked
decrease in strength (should be within 45-53% by weight).

• Higher condensation pressure increases strength

• The smaller the particle, the more strength

• The longer the trituration time, the more strength

pg. 33 Department Of Operative

By Dr.yaser Elkareimi
• The fewer voids, the more strength

Q51) A

True

I. Residual caries is caries that remain in a completed cavity preparation whether by dentist intention or
by accident.

2. Secondary (recurrent) caries is decay appearing at the margins of a restoration and under it.

Q52) A

All of the above

pg. 34 Department Of Operative

By Dr.yaser Elkareimi
Q53) C

Right angle

Q54) B

Parallel to the nearest external surface

Q55) A

Simultaneously etch and prime dentin and enamel

Q56) C

Generalized dentinal sclerosis with aging

Q57) C

At least 1 mm greater than expected height of marginal ridge

Q58) B

Not routinely beveled

The gingival margin is not routinely beveled since very little or no enamel is present and access is difficult
for finishing procedures. Further, if preparation extends gingivally into the root no bevel is placed on
cementum.

Q59) B

Decreases polymerization shrinkage

Because of the high monomer and high concentration of inorganic fillers in composite resins, the
polymerization shrinkage is reduced to ¼ the value for unfilled resin, while the coefficient of thermal
expansion is decreased by approximately 60%.

pg. 35 Department Of Operative

By Dr.yaser Elkareimi
Q60) B

Aluminium oxide

Finishing of composite resin restoration involves the following steps:

Initial contouring and finishing with 12 fluted carbide bur

Smoothening with fine white finishing stones and rubber points used at low speed with air coolant.

Levitated aluminum as a final polishing agent.

Q61) A

Occlusal wear

Class II restoration necessarily involve building up of marginal ridge area. Since this area is subjected to
high occlusal stress and since composite has a low wear resistance, hence the are not usually
recommended for restorations in such cavities.

Q62) B

The diameter of dentinal tubules ranges from 5 to 7 Mm

Q63) D

Cannot be arrested and remineralised after treatment

Q64) D

The outline form of cavity preparation

Q65) C

Will not progress at all

Q66) C

Sclerotic dentin

It results from aging and mild irritation and causes a change in the composition of the primary dentin

pg. 36 Department Of Operative

By Dr.yaser Elkareimi
The peritubular dentin become wider, gradually filling the tubules with calcified material, progressing
pulpally from the DEJ

Sclerosis resulting from aging in physiologic dentin sclerosis and that from mild irritation is reactive dentin
sclerosis

Q67) B

Improves the marginal seal

Q68) A

Resins

Q69)

C. After a few days

D. With pumice powder

Q70) C

2 to 3 minutes

Burnishing involves mechanically moving and compressing the carved amalgam surfaces, producing a
smooth shiny surface. It is desirable to burnish the fast setting, high copper amalgams which would have
achieved sufficient strength in about 2-3 minutes after carving to support firm but not heavy rubbing
pressure. Burnishing of slow setting copper system is not indicated as it may damage the margin of the
restoration

Q71) C

Chalky white area on the tooth

Q72) B

Staphylococcus aureus

Q73)

B. Improve the marginal seal

pg. 37 Department Of Operative

By Dr.yaser Elkareimi
C. Decreases the surface roughness

Q74) C

Both A and B

pg. 38 Department Of Operative

By Dr.yaser Elkareimi